
==== Front
Sci Rep
Sci Rep
Scientific Reports
2045-2322
Nature Publishing Group UK London

70942
10.1038/s41598-024-70942-1
Article
The impact of increased computer screen time during the COVID-19 pandemic on the occurrence of upper part of musculoskeletal diseases among health personnel
Lucka Ewa ewachlebus@ump.edu.pl

Wareńczak-Pawlicka Agnieszka
Lucki Mateusz
Lisiński Przemysław
grid.22254.33 0000 0001 2205 0971 Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland
31 8 2024
31 8 2024
2024
14 202571 3 2024
22 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Health personnel who played a key role in the fight against the pandemic stayed during it burdened with increased working time using a computer. We analyzed the impact of increased computer working time during the COVID-19 pandemic on the occurrence of the upper part of musculoskeletal diseases among health personnel. The study group consisted of 418 health personnel, divided according to the time they worked at the computer during the pandemic: up to 2 h a day, from 3 to 5 h a day, and more than 6 h a day. The ICF profile analyzed symptoms of dysfunction of structures of the upper part of the musculoskeletal system (head and cervical spine, shoulder girdle, elbow joint, wrist joint). Employees working more than 6 h daily had a higher risk of developing restrictions in tone of isolated muscles and muscle groups p < 0.001), range of motion of the shoulder girdle (p < 0.001), increased tension of paraspinal muscles (p < 0.001), weakened shoulder girdle muscle strength (p < 0.001), elbow joint pain (p = 0.016), wrist joint pain (p < 0.001), coordination disorders (p = 0.004), difficulties in arm and hand use (p < 0.001), lifting and carrying objects (p = 0.008) and paraesthesia (p < 0.001) compared to those working less than 2 h daily. Additionally, working for 3–5 h and above 6 h compared to health personnel working up to 2 h was associated with a greater risk of headaches and cervical spine pain (p < 0.001), shoulder girdle pain (p < 0.001), limited mobility in the wrist joint (p = 0.003), and tremors (p < 0.001), that working below 2 h. Prolonged computer working time among health personnel during the COVID-19 pandemic is significantly associated with an increased risk of dysfunction and pain in structures of the upper part of the musculoskeletal system. Effective preventive measures are necessary to improve the functioning of the musculoskeletal system during extended periods of computer use.

Keywords

Health personnel
COVID-19 pandemic
Screen time
Musculoskeletal diseases
International Classification of Functioning, Disability and Health
Subject terms

Health occupations
Signs and symptoms
issue-copyright-statement© Springer Nature Limited 2024
==== Body
pmcIntroduction

The COVID-19 pandemic has brought about changes not only in the way we function socially1, but also in our workplaces2–4. Health personnel who played a key role in the fight against the pandemic stayed during it burdened with increased screen time using a computer5. This trend resulted from the need to conduct remote consultations, and provide telemedicine services and administrative tasks related to managing the pandemic. However, long-term work at a computer may result in various health problems6, mainly affecting the upper part of the musculoskeletal system7. Previous research has shown that chronic computer work is associated with an increased frequency of ailments in the cervical spine, shoulder girdle and wrist joint due to improper workstation ergonomics and extended working hours8,9. These discomforts, including cervical spine pain and muscle tension, can significantly affect the work comfort and quality of life of health personnel10. The rise in musculoskeletal problems can also lead to increased absenteeism among workers11. Therefore, implementing effective preventive methods and early identification of health problems is essential12. Adopting appropriate risk management and health promotion strategies can help minimize the negative effects of computer work13, thereby improving the efficiency of the entire healthcare system14. In this context, the International Classification of Functioning, Disability and Health (ICF) can be a valuable tool for researching health personnel who spend a significant part of their working time in front of a computer. By using the ICF, it is possible to identify factors causing the aforementioned problems and develop appropriate treatment and prevention protocols to improve the health and work comfort of these workers15,16.

To date, there have been only two studies on remote work during the lockdown focused on office workers, with no research addressing the impact on health personnel17,18. This study aims to fill that gap by analyzing the impact of increased computer screen time during the COVID-19 pandemic on the upper musculoskeletal system among health personnel. In this article, we aim to classify the discomforts and limitations according to ICF classification categories experienced by health personnel using the computer during their professional duties.

Materials and methods

Study protocol

The study was prospective and conducted following the ethical principles of biomedical research outlined in the Helsinki Declaration. Each participant was informed about the purpose and methodology of the study and gave written informed consent to participate in it. Participants had the right to withdraw from the study at any stage. The study was approved by the Ethics Committee of the Karol Marcinkowski University of Medical Sciences in Poznań (Approval No. 173/20 dated February 12, 2020). The research has been officially registered within the Clinical Trials Registry under the identification number NCT04521010, accessible via the following link: https://clinicaltrials.gov/ct2/show/NCT04521010.

The study was conducted among employees of the Orthopedic and Rehabilitation Clinical Hospital named after Wiktor Dega in Poznań from March 2020 to May 2020 and consisted of three stages. In the first stage, a survey was conducted among all 1200 hospital employees (including medical personnel: doctors, nurses, physiotherapists, and non-medical personnel: office workers, technical and economic staff) regarding their health status in relation to the pandemic and whether they used a computer during work before the pandemic. Subsequently, a group of 460 employees who did not work on a computer during their professional duties before the pandemic but were required to work using a computer due to restrictions during the pandemic was identified. In the next stage, a clinical examination was performed by a medical rehabilitation physician and an orthopedist to confirm reported pain symptoms associated with computer work. The examination was extended to include imaging diagnostics to exclude previous injuries. Based on the inclusion and exclusion criteria, a total of 418 employees were ultimately included in the study.

The inclusion criteria were as follows: (1) employees whose computer work hours were extended during the pandemic, (2) employees who reported experiencing discomfort related to computer work in the questionnaire survey, and (3) employees in whom discomfort associated with computer work was confirmed in the clinical examination conducted by a rehabilitation physician and orthopedist.

The exclusion criteria were: (1) employees who worked full-time at a computer before the pandemic, (2) employees who did not work on a computer before the pandemic but had a medical history suggestive of chronic shoulder pain (e.g., previous shoulder injury, humerus fracture), elbow joint injury, or wrist joint injury, (3) employees with chronic neck pain syndrome (e.g., employees who had undergone cervical spine surgery), (4) employees with pre-pandemic neck, shoulder, elbow, or wrist pain confirmed in imaging studies conducted before the pandemic, (5) employees with nerve or muscle damage in the upper limb caused by stroke or compressive neuropathy (e.g., carpal tunnel syndrome), and (6) employees with diagnosed autoimmune inflammatory rheumatic diseases (e.g., rheumatoid arthritis, systemic connective tissue diseases).

The first group (Group 1) consisted of 125 employees (86 women and 39 men) who worked a maximum of 2 h per day on a computer during their professional duties due to the pandemic. The second group (Group 2) consisted of 154 employees (120 women and 34 men) whose computer screen time ranged from 3 to 5 h per day. The third group (Group 3) consisted of 139 employees (120 women and 19 men) whose computer screen time during their professional duties exceeded 6 h. In the next stage, identified deficits in the upper musculoskeletal system were coded into categories and qualifiers of the International Classification of Functioning, Disability and Health. Subsequently, an ICF profile was created, graphically presenting the percentage distribution of deficits in the studied groups depending on the time spent working on a computer. Additionally, the total frequency of deficits was analyzed depending on the computer screen time after the pandemic. A detailed study schema is presented in Fig. 1.Fig. 1 Research group schema.

Basic set of International Classification of Functioning, Disability and Health categories in the assessment of musculoskeletal deficits

Individual categories of deficits within the upper part of the musculoskeletal system included in the analysis were assigned appropriate code numbers and qualifiers according to the International Classification of Functioning, Disability and Health and developed by the WHO ICF Research Branch—Musculoskeletal ICF Core Sets profile19–21.

Deficits of the cervical spine assessed using ICF categories:

s710 Structure of head and neck—Qualifier 0 was assigned if no structural disorders confirmed by imaging diagnostics were found, Qualifier 1 if disc herniation without compression of nerve roots was visualized in imaging diagnostics, Qualifier 2 if discopathy at one level was visualized in imaging diagnostics, Qualifier 3 if multilevel discopathy with nerve root compression was visualized in imaging diagnostics, Qualifier 4 if multilevel nucleus pulposus herniation was visualized in imaging diagnostics.

b28010 Pain in head and neck—Qualifier 0 was assigned if no headaches or neck pain occurred, Qualifier 1 if headaches and neck pain occurred due to work with a score of 1–2 on the VAS scale, Qualifier 2 if headaches and neck pain occurred with a score of 3–5 on the VAS scale, Qualifier 3 if headaches and neck pain occurred with a score of 5–9 on the VAS scale, Qualifier 4 if headaches and neck pain occurred with a score of 10 on the VAS scale.

b7100 Mobility of joint functions—Qualifier 0 was assigned if the range of motion of the cervical spine was: extension 37–40 degrees, flexion 37–40 degrees, lateral bending 41–45 degrees, rotation 41–45 degrees, Qualifier 1 if the range of motion of the cervical spine was: extension 27–36 degrees, flexion 27–36 degrees, lateral bending 30–40 degrees, rotation 30–40 degrees, Qualifier 2 if the range of motion of the cervical spine was: extension 10–20 degrees, flexion 10–20 degrees, lateral bending 11–29 degrees, rotation 11–29 degrees, Qualifier 3 if the range of motion of the cervical spine was: extension 5 degrees, flexion 5–9 degrees, lateral bending 5–9 degrees, rotation 5–10 degrees, Qualifier 4 if the range of motion of the cervical spine was below 5 degrees in each plane.

b7350 Tone of isolated muscles and muscle groups—Qualifier 0 was assigned if there was normal muscle tension, Qualifier 1 if there was mild tension of the paravertebral muscles, Qualifier 2 if there was moderate tension of the paravertebral muscles, Qualifier 3 if there was significant tension of the paravertebral muscles, Qualifier 4 if there was stiffness in the cervical spine.

Shoulder girdle deficits assessed using the International Classification of Functioning, Disability and Health categories:

s720 Structure of the shoulder region: Qualifier 0 was assigned if no abnormalities of the shoulder girdle structure were detected in imaging diagnostics, Qualifier 1 if joint effusion was visualized in imaging diagnostics, Qualifier 2 if signs of shoulder girdle muscle overload were visualized in imaging diagnostics, Qualifier 3 if partial damage to the rotator cuff muscles was visualized in imaging diagnostics, Qualifier 4 if complete damage to the rotator cuff muscles and/or fracture of the scapular bone was visualized in imaging diagnostics.

b28014 Pain in upper limb: Qualifier 0 was assigned if there were no pain complaints in the shoulder girdle, Qualifier 1 if pain complaints occurred related to work with a VAS score of 1–2 points, Qualifier 2 if pain complaints occurred with a VAS score of 3–5 points, Qualifier 3 if pain complaints occurred with a VAS score of 5–9 points, Qualifier 4 if pain complaints occurred with a VAS score of 10 points.

b7100 Mobility of joint functions: Qualifier 0 was assigned if the range of motion of the shoulder girdle was: abduction 48–50 degrees, flexion 160–170 degrees, abduction 160–170 degrees, adduction 160–170 degrees, external rotation 80–90 degrees, internal rotation 75–80 degrees, Qualifier 1 if the range of motion of the shoulder girdle was: abduction 34–47 degrees, flexion 115–159 degrees, abduction 115–159 degrees, adduction 115–159 degrees, external rotation 60–79 degrees, internal rotation 55–74 degrees, Qualifier 2 if the range of motion of the shoulder girdle was: abduction 25–33 degrees, flexion 85–114 degrees, abduction 85–114 degrees, adduction 85–114 degrees, external rotation 45–59 degrees, internal rotation 40–54 degrees, Qualifier 3 if the range of motion of the shoulder girdle was: abduction 6–24 degrees, flexion 20–84 degrees, abduction 20–84 degrees, adduction 20–84 degrees, external rotation 10–44 degrees, internal rotation 10–40 degrees, Qualifier 4 if the range of motion of the shoulder girdle was: abduction below 5 degrees, flexion, abduction/adduction below 20 degrees, external/internal rotation below 10 degrees.

b7301 Muscle Strength: Qualifier 0 was assigned if the muscle strength of the shoulder girdle was 5 according to the Lovette scale, Qualifier 1 if the muscle strength was 4 according to the Lovette scale, Qualifier 2 if the muscle strength was 3 according to the Lovette scale, Qualifier 3 if the muscle strength was 1 or 2 according to the Lovette scale, Qualifier 4 if the muscle strength was 0 according to the Lovette scale.

Elbow joint deficits assessed using International Classification of Functioning, Disability and Health categories:

s730 Structure of upper extremity—elbow: Qualifier 0 was assigned if no changes were observed in imaging diagnostics, Qualifier 1 if joint effusion was detected in imaging diagnostics, Qualifier 2 if signs of joint overload were observed in imaging diagnostics, Qualifier 3 if inflammation of the lateral or medial epicondyle was demonstrated in imaging diagnostics, Qualifier 4 if structural changes in the ulnar bone were detected in imaging diagnostics.

b28014 Pain in upper limb—elbow: Qualifier 0 was assigned if there were no pain complaints in the elbow joint, Qualifier 1 if pain complaints occurred related to work with a VAS score of 1–2 points, Qualifier 2 if pain complaints occurred with a VAS score of 3–5 points, Qualifier 3 if pain complaints occurred with a VAS score of 5–9 points, Qualifier 4 if pain complaints occurred with a VAS score of 10 points.

b7100 Mobility of joint functions: Qualifier 0 was assigned if the range of motion of the elbow joint was: extension 145–150 degrees, flexion 145–150 degrees, supination 85–90 degrees, pronation 75–80 degrees, Qualifier 1 if the range of motion of the elbow joint was: extension 135–144 degrees, flexion 135–144 degrees, supination 80–84 degrees, pronation 72–74 degrees, Qualifier 2 if the range of motion of the elbow joint was: extension 75–134 degrees, flexion 75–134 degrees, supination 46–79 degrees, pronation 40–71 degrees, Qualifier 3 if the range of motion of the elbow joint was: extension 20–74 degrees, flexion 20–74 degrees, supination 10–45 degrees, pronation 10–39 degrees, Qualifier 4 if the range of motion of the elbow joint was: extension and flexion below 20 degrees, supination and pronation below 10 degrees.

Wrist joint deficits assessed using the International Classification of Functioning, Disability and Health categories:

s730 Structure of upper extremity—wrist: Qualifier 0 was assigned if no changes were observed in wrist joint imaging diagnostics, Qualifier 1 if joint effusion was detected in imaging diagnostics, Qualifier 2 if signs of joint overload were observed in imaging diagnostics, Qualifier 3 if features of carpal tunnel syndrome were demonstrated in imaging diagnostics, Qualifier 4 if structural changes in the wrist joint and metacarpophalangeal bones of the hand were detected in imaging diagnostics.

b28014 Pain in upper limb—wrist: Qualifier 0 was assigned if there were no pain complaints in the wrist joint, Qualifier 1 if pain complaints occurred related to work with a VAS score of 1–2 points, Qualifier 2 if pain complaints occurred with a VAS score of 3–5 points, Qualifier 3 if pain complaints occurred with a VAS score of 5–9 points, Qualifier 4 if pain complaints occurred with a VAS score of 10 points.

b7100 Mobility of joint functions: Qualifier 0 was assigned if the range of motion of the wrist joint was: extension 48–50 degrees, flexion 58–60 degrees, supination 19–20 degrees, pronation 28–30 degrees, Qualifier 1 if the range of motion of the wrist joint was: extension 35–47 degrees, flexion 40–57 degrees, supination 13–18 degrees, pronation 20–27 degrees, Qualifier 2 if the range of motion of the wrist joint was: extension 25–34 degrees, flexion 31–39 degrees, supination 10–12 degrees, pronation 15–19 degrees, Qualifier 3 if the range of motion of the wrist joint was: extension 6–24 degrees, flexion 15–30 degrees, supination 2–9 degrees, pronation 3–14 degrees, Qualifier 4 if the range of motion of the wrist joint was: extension and flexion below 5 degrees, supination and pronation below 2 degrees.

b7301 Power of isolated muscles and muscle groups—right hand and left hand: Qualifier 0 was assigned if muscle strength measured by dynamometer was 34–36 Newtons, Qualifier 1 if muscle strength measured by dynamometer was 25–33 Newtons, Qualifier 2 if muscle strength measured by dynamometer was 10–24 Newtons, Qualifier 3 if muscle strength measured by dynamometer was 4–9 Newtons, Qualifier 4 if muscle strength measured by dynamometer was below 4 Newtons.

b7602 Coordination of voluntary movements: Qualifier 0 was assigned if there were no disturbances in coordination of voluntary movements, Qualifier 1 if discrete signs of motor coordination disorder of one non-dominant upper limb were present, Qualifier 2 if slight clumsiness in movement execution in one dominant upper limb predominated, Qualifier 3 if coordination disturbances and clumsiness occurred in one upper limb, Qualifier 4 if significant disturbances in coordination and execution clumsiness occurred in both upper limbs.

b7651 Tremor: Qualifier 0 was assigned if anintentional tremor of limbs was not observed, Qualifier 1 if a slight tremor of the non-dominant limb was observed, Qualifier 2 if a slight tremor of the dominant limb was observed, Qualifier 3 if an asymmetrical tremor of one upper limb was observed, Qualifier 4 if tremors of both upper limbs were observed.

b798 Neuromusculoskeletal and movement-related functions, other specified—paraesthesia: Qualifier 0 was assigned if there were no symptoms of hand numbness, Qualifier 1 if numbness of one finger in one hand occurred, Qualifier 2 if thumb numbness occurred bilaterally, Qualifier 3 if numbness of fingers II-V occurred bilaterally, Qualifier 4 if numbness of all fingers occurred bilaterally.

International Classification of Functioning, Disability and Health categories were applied to assess deficits in activity and participation:

d430 Lifting and carrying objects: Qualifier 0—if the worker had no difficulty lifting and carrying objects, Qualifier 1—if there were difficulties in lifting objects, Qualifier 2—if the worker lifted but did not carry the object, Qualifier 3—if there were difficulties in carrying objects, Qualifier 4—if there were significant difficulties in lifting and carrying objects.

d440 Fine hand use: Qualifier 0—if the worker had no difficulty with the precision of movement hand, Qualifier 1—if there were slight disturbances in the precision of movement in one limb, Qualifier 2—if there were disturbances in the precision of movement bilaterally, Qualifier 3—if there were disturbances in the precision of movement such as writing or drawing, Qualifier 4—if there were significant disturbances in the precision of movement.

d445 Hands and arms use: Qualifier 0—if there were no difficulties in using hands and arms, Qualifier 1—slight difficulties in using hands and arms on one side of the body, Qualifier 2—moderate difficulties in using hands and arms on both sides of the body, Qualifier 3—significant difficulties in using hands and forearms, e.g., patient has difficulty dressing upper body and buttoning shirts, Qualifier 4—if significant assistance is required with personal care tasks such as washing hair.

Next, a graphical representation was provided, showing the percentage distribution of qualifiers using color coding to emphasize differences in the type and frequency of deficits in the upper part of the musculoskeletal system depending on computer work time: Qualifier 0—no deficits in the assessed category, represented by dark green color if the percentage distribution ranges from 0 to 4%. Qualifier 1—low frequency of deficit occurrence in the assessed category, represented by light green color if the percentage distribution ranges from 5 to 24%. Qualifier 2—moderate occurrence of deficit in the assessed category, represented by yellow color if the percentage distribution ranges from 25 to 49%. Qualifier 3—high frequency of deficit occurrence in the assessed category, represented by orange color if the percentage distribution ranges from 50 to 95%. Qualifier 4—extremely high frequency of deficit occurrence in the assessed category, represented by red color if the percentage distribution ranges from 96 to 100%.

Statistical analysis

We provided the statistical assessment with Statistica 13.3 (TIBCO Software Inc., 2017, Palo Alto, CA, USA,

http:/statistica.io). The categorical variables are presented as counts and frequencies. The parameters of descriptive statistics are reported as mean values with standard deviations (SD) and median, minimum, and maximum levels. The Shapiro–Wilk test was used to assess the normality of test score distributions. The significance of differences in quantitative data between the three groups was evaluated using the non-parametric Kruskal–Wallis test. Post hoc analysis was conducted when statistically significant differences in measurements were found, using the Dunn test with Bonferroni correction. P-values less than 0.05 were considered to be statistically significant. The chi-square test (maximum likelihood) was applied to compare differences between 3 groups for categorical variables. P-values less than 0.05 were considered to be statistically significant. For post-hoc pairwise comparisons, we used two proportions test. We applied a Bonferroni correction and set the p-value cut-off as 0.017.

Results

Demographic analysis revealed that women constituted the majority of participants in each age group, with the group working more than 6 h, characterized by the oldest age, having the largest number of women. The studied groups significantly differed in gender distribution (p = 0.003) and age (p < 0.001). Analyzed groups of workers did not differ in anthropometric parameters: height, body weight, and BMI. The characteristics of the studied groups are presented in Table 1.Table 1 Characteristics of the study groups.

	Study groups	p	
Group 1	Group 2	Group 3		
Computer screen time (h/day)	up to 2 h	from 3 h-5 h	 > 6 h	
Size of the study group	n (%)	125	154	139	
GENDER n (%)	Females	86 (68.8%)	120 (77,9)	120 (86.3%)	0,003	
Males	39 (31,2%)	34 (22,1%)	19 (13,7%)	
AGE (years)	Average ± SD	38.5 ± 11.7	43.3 ± 11.4	46.9 ± 10.7	< 0.001	
Median	35	44	48	
Min–Max	23,0–64,0	22,0–68,0	22,0–68,0	
HEIGHT (cm)	Average ± SD	169.0 ± 8.5	169.5 ± 9.0	168.6 ± 8.2	0,773	
Median	169	168	168	
Min–Max	148,0–195,0	153,0–196,0	152,0–195,0	
BODY WEIGHT (kg)	Average ± SD	75.1 ± 17.8	75.9 ± 15.5	76.1 ± 17.4	0,724	
Median	73	74	73	
Min–Max	46,0–122,0	46,0–130,0	45,0–142,0	
BMI	Average ± SD	26.2 ± 5.4	26.3 ± 4.7	26.7 ± 5.6	0,787	
Median	25,3	26	25,5	
Min–Max	16,6–45,1	17,7–50,8	15,8–47,4	
Chi2, Kruskall-Wallis, BMI Body Mass Index, p statistical significance, SD Standard devation.

In Table 2, the results of the analysis regarding the occurrence of various categories of dysfunctions within the upper part of the musculoskeletal system are presented, including the cervical spine and head, shoulder girdle, elbow joint, wrist joint, and hand, in three examined groups using a computer: up to 2 h (Group 1), from 3 to 5 h (Group 2), and above 6 h (Group 3), as well as the results of comparisons between these groups.Table 2 Frequency of disorders within the upper part of the musculoskeletal system depending on computer working hours.

		Study groups n (%)	p1	p2	
ICF category		Group 1	Group 2	Group 3	1 vs 2	1 vs 3	2 vs 3	
Cervical spine	
s710 Structure of head and neck	n (%)	2 (1.6%)	11 (7.1%)	10 (7.2%)	0.040*	0.030^	0.029^	0.974^	
b28010 Pain in head and neck	n (%)	33 (26.4%)a, b	70 (45.5%)a	75 (54.0%)b	< 0.001*	0.001^	< 0.001^	0.146^	
b7100 Mobility of joint functions	n (%)	81 (65.3%)	117 (76.0%)	109 (78.4%)	0.043*	0.050^	0.018^	0.625^	
b7350 Tone of isolated muscles and muscle groups	n (%)	8 (6.5%)a	21 (13.6%)	33 (23.7%)a,	< 0.001*	0.054^	< 0.001^	0.026^	
Shoulder region	
s720 Structure of the shoulder region	n (%)	5 (4.0%)	6 (3.9%)	6 (4.3%)	0.984*				
b28014 Pain in upper limb	n (%)	3 (3.4%)a, b	19 (12.3%)a	27 (19.4%)b	< 0.001*	0.007^	< 0.001^	0.095^	
b7100 Mobility of joint functions	n (%)	5 (4.0%)a	15 (9.7%)	27 (19.4%)a,	< 0.001*	0.066^	< 0.001^	0.018^	
b7301 Muscuar Strength	n (%)	3 (2.4%)a,	13 (8.4%)a	22 (15.8%)b	< 0.001*	0.032^	< 0.001^	0.051^	
Elbow joint	
s730 Structure of upper extremity -elbow	n (%)	4 (3.2%)	9 (5.8%)	6 (4.3%)	0.563*				
b28014 Pain in upper limb -elbow	n (%)	1 (0.8%)a	1 (0.6%)b	9 (6.5%)a, b	0.003*	0.841^	0.016^	0.005^	
b7100 Mobility of joint functions	n (%)	1 (0.8%	3 (1.9%)	5 (3.6%)	0.272*				
Wrist joint	
s730 Structure of upper extremity- wrist	n (%)	3 (2.4%)	9 (5.8%)	5 (3.6%)	0.329*				
b28014 Pain in upper limb -wrist	n (%)	7 (5.6%)a	16 (10.4%)b	33 (23.7%)a,b	< 0.001*	0.247^	< 0.001^	0,002^	
b7100 Mobility of joint functions	n (%)	4 (3.2%)a, b	21 (13.6%)a	18 (12.9%)b	0.003*	0.003^	0.004^	0.860^	
b7301 Power of isolated muscles and muscle groups -hand right	Average ± SD	38.1 ± 12.0a	35.3 ± 12.2	32.8 ± 10.9a	< 0.001**	0.076^^	< 0.001^^	0.103^^	
Median	36	32	30					
b7301 Power of isolated muscles and muscle groups -hand left	Average ± SD	36.4 ± 12.1a	34.1 ± 11.8b	30.5 ± 10.9a, b	< 0.001**	0.643^^	< 0.001^^	0.006^^	
Median	34	31	29					
Min–Max	20.0–78.0	10.0–80.0	0.0–78.0					
b7602 Coordination of voluntary movements	n (%)	0 (0.0%)a,	6 (3.9%)	9 (6.5%)a	0.003*	0.026^	0.004^	0.314^	
b7651 Tremor	n (%)	4 (3.2%)a,b	18 (11.7%)a	25 (18.0%)b	< 0.001*	0.009^	< 0.001^	0.128^	
b798 Neuromusculoskeletal and movement-related functions, other specified—paraesthesia	n (%)	7 (5.6%)a	16 (10.4%)b	33 (23.7%)a, b	< 0.001*	0.147^	< 0.001^	0.002^	
Activity and participation	
d430 Lifting and carrying objects	n (%)	7 (5.6%)a	16 (10.4%)	22 (15.8%)a	0.024*	0.147^	0.008^	0.169^	
d440 Fine hand use	n (%)	2 (1.6%)	10 (6.5%)	11 (7.9%)	0.036*	0.045^	0.018^	0.643^	
d445 Hands and arms use	n (%)	8 (6.4%)a	22 (14.3%)b	42 (30.2%)a,b	< 0.001*	0.034^	< 0.001^	< 0,001^	
ICF International classification of functioning, disability and health, n Number of individuals with dysfunction, p Statistical significance, SD Standard deviation. p1 comparison between 3 groups, *the maximum likelihood chi2 test (p < 0.05),**Kruskal–Wallis test (p < 0.05); p2- post hoc analysis, ^—two proportion test (p < 0.017), ^^ the Dunn test with Bonferroni correction (p < 0.05); a,b significance difference between two groups (after post hoc analysis).

In the examined groups, no significant difference was found in the occurrence of disorders in the structure of the shoulder girdle, elbow joint, or wrist joint. Employees who worked on the computer for less than 2 h showed significantly greater hand muscle strength (p < 0.001) and the lowest frequency of assessed disorders.

In individuals working over 6 h compared to those working up to 2 h, restricted range of motion of the shoulder girdle (p < 0.001), increased tension of paraspinal muscles (p < 0.001), weakened shoulder girdle muscle strength (p < 0.001), elbow joint pain (p = 0.016), wrist joint pain (p < 0.001), (coordination disorders (p = 0.004), difficulties in arm and hand use (p < 0.001) neuromuscular function disorders (p < 0.001), and limitations in lifting and carrying objects (p = 0.008) were significantly more frequently diagnosed. No significant difference was observed between employees working over 6 h and those working from 3 to 5 h in the above-mentioned aspects, such as range of motion of the shoulder girdle (p = 0.018), tension of paraspinal muscles (p = 0.026), shoulder girdle muscle strength (p = 0.051), coordination disorders (p = 0.314), and limitations in lifting and carrying objects (p = 0.169).

However, in the groups of employees using the computer for 3 to 5 h and above 6 h compared to health personnel working up to 2 h, head and cervical spine pain were significantly more frequent (p < 0.001), as well as shoulder girdle pain (p < 0.001 and limitations in wrist joint mobility (p = 0.003), and tremors (p < 0.001).

Additionally, in the group of employees working over 6 h compared to those working from 3 to 5 h, elbow joint pain (p = 0.005), wrist joint pain (p = 0.002), hand and arm use (p = 0.001) and neuromuscular function disorders (p = 0.002) were significantly more frequently diagnosed.

The pattern of upper limb deficits in computer workers presented in Table 3 illustrates the percentage distribution of the frequency of these deficits considering computer usage time.Table 3 Profile of ICF classification categories based on computer working time.

p Statistical significance, Kruskal–Wallis test (p < 0.05).

In the case of the left-hand extremely high frequency of deficit occurrence in all studied groups, increased muscle tension, limb tremors, and finger tremors were observed. In the group above 3 h and 6 h, shoulder girdle pain and limited shoulder range of motion were observed. In the group of workers working above 6 h, deficits were significantly more common: structural body disorders, headaches and neck pain, limited cervical range of motion, weakened shoulder girdle muscle strength, weakened left-hand muscle strength, and difficulties in using arms and hands.

In the category of high frequency deficit occurrence, weakened muscle strength in both hands was more frequently observed in all studied groups. In the group working above 3 h and 6 h, occurrences of headaches, cervical spine pain, shoulder girdle pain, limited shoulder range of motion, weakened shoulder girdle muscle strength, impaired coordination of voluntary movements, difficulties in lifting and carrying objects, and difficulties in using arms and hands were observed. In the group working above 6 h, more frequent occurrences of structural head and cervical spine disorders, shoulder girdle pain, elbow and wrist joint pain, limited wrist joint range of motion, and impaired precision of movement hand were observed.

In the category of moderate frequency deficit occurrence, moderate intensity of structural head and cervical spine disorders, headaches and neck pain, moderate limitation of cervical spine range of motion, shoulder girdle structural disorders, shoulder girdle pain, and limited mobility, as well as weakened muscle strength in both hands and difficulties in lifting and carrying objects, were observed in all studied groups. In the group working above 3 h and 6 h, weakened shoulder girdle muscle strength, limited elbow joint mobility, wrist joint structural disorders, wrist joint pain, impaired execution of voluntary movements, precision of movement hand, as well as difficulties in using arms and hands were observed. In the group of workers working above 6 h, structural elbow joint disorders, elbow joint pain, and limited wrist joint range of motion were observed.

Analyzing the cumulative distribution of deficit frequencies (Fig. 2), significantly more deficits were diagnosed in employees working over 6 h on the computer (p < 0.001). On average, 1.5 ± 1.3 deficits were diagnosed in employees working up to 2 h, 2.8 ± 1.7 deficits in those working from 3 to 5 h, and 3.7 ± 2.1 deficits in employees working over 6 h within the upper part of the musculoskeletal system.Fig. 2 Cumulative distribution of deficits depending on computer screen time.

Discussion

The COVID-19 pandemic has triggered long-term consequences among health personnel, partly due to increased working hours. Previous literature has described the impact of prolonged stress resulting from the pandemic on the health of health personnel22, as well as the prevalence of depression and occupational burnout23. However, the influence of computer screen time on health status and work quality has not been analyzed before. The results of our study suggest that increased computer working time during the COVID-19 pandemic may lead to a greater number of musculoskeletal complaints among health personnel. Our study results indicate that employees working over 6 h on the computer had the highest cumulative frequency of deficits (Fig. 2). How can this be explained? Already Ijamker et al.24, claimed we ought to undertake further studies to better understand the impact of computer work time on the occurrence of negative symptoms. Existing scientific literature indicates that computer users are at increased risk of musculoskeletal diseases25,26. As demonstrated by Gerr et al.27, complaints in the cervical spine, shoulders, arms, and hands may result from the user's posture and the number of hours spent using the computer per day or week. In our study, among employees using the computer for 3–5 h and above 6 h compared to health personnel working up to 2 h (Table 2 headache and cervical spine pain (p < 0.001), shoulder girdle pain (p < 0.001), limitations in wrist joint mobility (p = 0.003) and tremors (p < 0.001)) were significantly more frequent, along with coordination disorders of voluntary movements (p = 0.003), tremors (p < 0.001), impaired precision of movement hand (p = 0.036), and difficulties in using arms and hands (p < 0.001). Our results are in some respects consistent with the findings of Borhany et al.28, which demonstrate that over 40% of office workers using the computer for at least 3 h a day experienced headaches and cervical spine pain. Additionally, Alkahami et al.29 claim that neck pain is the most common type of musculoskeletal problem among computer users. It is worth noting that these studies focused on office workers, while our study pertains to health personnel who have duties beyond seated work. Furthermore, demographic analysis showed that women constituted the majority of respondents in each study group, with the group working over 6 h characterized by the oldest age (Table 1). Similarly, Malińska et al.30 identified prolonged computer screen time and older age as major factors contributing to neck pain among office workers.

The obtained results presented in graphical comparison according to the International Classification of Functioning, Disability and Health (ICF) classification (Table 3) indicate the frequency of deficits. Due to the extremely high frequency of deficits in all studied groups, the most frequently observed symptoms were increased muscle tension and tremors of limbs and fingers. In the groups with over 3 h and 6 h of computer use, pain in the shoulder girdle and limited range of shoulder movement were also frequently observed. Among employees working more than 6 h, deficits in the following ICF categories were significantly more frequent: disorders of the cervical spine and shoulder structure, headaches and neck pain, limited range of motion of the cervical spine, reduced strength of the shoulder girdle muscles, weakened muscle strength of the left hand, and impaired use of hands. Our results are consistent with Moreira et al.31, who observed a significantly increased frequency of musculoskeletal complaints among computer workers during lockdown, particularly concerning the neck, shoulders, and hands/wrists. The results of the detected frequency of deficits emphasize the importance of being aware of and subsequently implementing preventive actions and monitoring the health of healthcare workers, especially in the context of computer work, to reduce the risk of developing musculoskeletal diseases. We believe that it is worth paying attention to the research tool we use, the International Classification of Functioning, Disability and Health (ICF). It seems that the ICF questionnaire used in our study, combined with a medical examination, can provide many objective insights into deficits resulting from computer work, which may facilitate the implementation of preventive actions. According to Shete et al.32, a multidisciplinary approach yields better results compared to a conventional approach. As demonstrated by Bertelman et al.33, informing healthcare workers and employers about the frequency of complaints resulting from computer work is necessary to develop an appropriate strategy for preventing musculoskeletal disorders. Healthcare institutions and those responsible for occupational risk prevention among computer workers must consider multiple factors underlying musculoskeletal complaints in healthcare workers who work with computers.

Further research is needed, but it seems clear that there is a need to implement exercise programs to promote physical activity, considering the well-documented association between physical activity and health. Persistent or increased physical inactivity is likely to have medium or long-term implications for physical and mental health, as well as for the quality of life of individuals. More efforts should be made in occupational health to increase levels of physical activity in the workplace, particularly for groups at higher risk of inactivity or reduced physical activity, such as computer workers. Physically active individuals are more satisfied and alert34. Scientific literature provides evidence that physical exercise is beneficial for mental health because of reducing depression, negative mood, anxiety and improves self-esteem and cognitive function35.

The study has several limitations that should be noted. Firstly, it does not take into account other factors that may influence the occurrence of musculoskeletal disorders, such as the intensity of physical exertion outside computer work, lifestyle, or individual anatomical characteristics. The focus was solely on computer work time, neglecting other aspects of work such as the type of tasks performed, breaks taken, or ergonomic facilities used, all of which could affect the occurrence of musculoskeletal diseases. Additionally, the study lacks long-term follow-up of participants, preventing an assessment of the long-term impact of increased computer screen time on the musculoskeletal system. Furthermore, the study did not include a control group of healthcare personnel who were not exposed to increased computer screen time during the COVID-19 pandemic. The absence of such a comparative group makes it challenging to accurately determine to what extent the observed effects are directly related to increased computer screen time. Considering these limitations, further research is essential. This research should consider a broader range of risk factors and include a control group to provide a more precise assessment of the impact of computer screen time on the health of healthcare personnel.

Conclusions

Prolonged screen time at the computer is associated with an increased risk of limited range of motion of the cervical spine, shoulder girdle, pain in the wrist joints limited mobility, and impaired coordination during precise movements. The International Classification of Functioning, Disability and Health questionnaire supplemented with a medical examination enables the identification of the frequency of deficits associated with computer work. There is an urgent need for effective preventive measures to reduce the impact of prolonged computer use on the health of workers.

Acknowledgements

The authors would like to thank all healthcare workers of the Wiktor Dega Orthopedic and Rehabilitation Clinical Hospital in Poznań who voluntarily volunteered to participate in the research.

Author contributions

Conceptualization, E.L., M.L and P.L.; Investigation, E.L. and M.L.; Methodology, E.L, M.L, A.W. and P.L.; Writing—original draft, E.L.; Writing—review and editing, E.L., A.W. and P.L. All authors have read and agreed to the published version of the manuscript.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Data availability

The availability of the data underpinning this study can be accessed upon request from the corresponding author.

Competing interests

The authors declare no competing interests.

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
==== Refs
References

1. Hosseinzadeh P Zareipour M Baljani E Moradali MR Social consequences of the COVID-19 pandemic. A systematic review Invest. Educ. Enferm. 2022 40 1 e10 10.17533/udea.iee.v40n1e10 35485623
Hosseinzadeh, P., Zareipour, M., Baljani, E. & Moradali, M. R. Social consequences of the COVID-19 pandemic. A systematic review. Invest. Educ. Enferm. 40(1), e10 (2022).35485623 10.17533/udea.iee.v40n1e10
2. de Lucas AA Gavrila Gavrila S Del Val Núñez MT Workplace change within the COVID-19 context: The new (next) normal Technol. Forecast. Soc. Change 2023 194 122673 10.1016/j.techfore.2023.122673 37293385
de Lucas, A. A., Gavrila Gavrila, S. & Del Val Núñez, M. T. Workplace change within the COVID-19 context: The new (next) normal. Technol. Forecast. Soc. Change 194, 122673 (2023).37293385 10.1016/j.techfore.2023.122673
3. Lucki M Wareńczak A Chlebuś E Daroszewski P Lisiński P The ICF classification as a simple tool to aid in the assessment of healthcare services in a Non-COVID-19 hospital during the COVID-19 pandemic Healthcare (Basel) 2021 9 4 398 10.3390/healthcare9040398 33916092
Lucki, M., Wareńczak, A., Chlebuś, E., Daroszewski, P. & Lisiński, P. The ICF classification as a simple tool to aid in the assessment of healthcare services in a Non-COVID-19 hospital during the COVID-19 pandemic. Healthcare (Basel) 9(4), 398 (2021).33916092 10.3390/healthcare9040398
4. Tušl M Brauchli R Kerksieck P Bauer GF Impact of the COVID-19 crisis on work and private life, mental well-being and self-rated health in German and Swiss employees: A cross-sectional online survey BMC Public Health 2021 21 1 741 10.1186/s12889-021-10788-8 33865354
Tušl, M., Brauchli, R., Kerksieck, P. & Bauer, G. F. Impact of the COVID-19 crisis on work and private life, mental well-being and self-rated health in German and Swiss employees: A cross-sectional online survey. BMC Public Health 21(1), 741 (2021).33865354 10.1186/s12889-021-10788-8
5. De' R Pandey N Pal A Impact of digital surge during Covid-19 pandemic: A viewpoint on research and practice Int. J. Inf. Manage. 2020 55 102171 10.1016/j.ijinfomgt.2020.102171 32836633
De’, R., Pandey, N. & Pal, A. Impact of digital surge during Covid-19 pandemic: A viewpoint on research and practice. Int. J. Inf. Manage. 55, 102171 (2020).32836633 10.1016/j.ijinfomgt.2020.102171
6. Nakshine VS Thute P Khatib MN Sarkar B Increased screen time as a cause of declining physical, psychological health, and sleep patterns: A literary review Cureus 2022 14 10 e30051 36381869
Nakshine, V. S., Thute, P., Khatib, M. N. & Sarkar, B. Increased screen time as a cause of declining physical, psychological health, and sleep patterns: A literary review. Cureus 14(10), e30051 (2022).36381869
7. Chim JMY Chen TL Prediction of work from home and musculoskeletal discomfort: An investigation of ergonomic factors in work arrangements and home workstation setups using the COVID-19 experience Int. J. Environ. Res. Public Health 2023 20 3050 10.3390/ijerph20043050 36833747
Chim, J. M. Y. & Chen, T. L. Prediction of work from home and musculoskeletal discomfort: An investigation of ergonomic factors in work arrangements and home workstation setups using the COVID-19 experience. Int. J. Environ. Res. Public Health 20, 3050 (2023).36833747 10.3390/ijerph20043050
8. Dong H Zhang Q Liu G Shao T Prevalence of neck/shoulder pain among public hospital workers in China and its associated factors: A cross-sectional study Sci. Rep. 2020 10 12311 10.1038/s41598-020-69382-4 32704050
Dong, H., Zhang, Q., Liu, G. & Shao, T. Prevalence of neck/shoulder pain among public hospital workers in China and its associated factors: A cross-sectional study. Sci. Rep. 10, 12311 (2020).32704050 10.1038/s41598-020-69382-4
9. Guduru RKR Domeika A Obcarskas L Ylaite B The ergonomic association between shoulder, neck/head disorders and sedentary activity: A systematic review J. Healthc. Eng. 2022 2022 5178333 10.1155/2022/5178333 35356625
Guduru, R. K. R., Domeika, A., Obcarskas, L. & Ylaite, B. The ergonomic association between shoulder, neck/head disorders and sedentary activity: A systematic review. J. Healthc. Eng. 2022, 5178333 (2022).35356625 10.1155/2022/5178333
10. Mroczek B Łubkowska W Jarno W Jaraczewska E Mierzecki A Occurrence and impact of back pain on the quality of life of healthcare workers Ann. Agric. Environ. Med. 2020 27 1 36 42 10.26444/aaem/115180 32208577
Mroczek, B., Łubkowska, W., Jarno, W., Jaraczewska, E. & Mierzecki, A. Occurrence and impact of back pain on the quality of life of healthcare workers. Ann. Agric. Environ. Med. 27(1), 36–42 (2020).32208577 10.26444/aaem/115180
11. Mokhasi VR Fore-warned is fore-armed: Effect of musculoskeletal disorders on sickness absenteeism Cureus 2022 14 10 e30481 36415371
Mokhasi, V. R. Fore-warned is fore-armed: Effect of musculoskeletal disorders on sickness absenteeism. Cureus 14(10), e30481 (2022).36415371
12. Soares CO Pereira BF Pereira Gomes MV Marcondes LP de Campos GF de Melo-Neto JS Preventive factors against work-related musculoskeletal disorders: Narrative review Rev. Bras. Med. Trab. 2020 17 3 415 430 10.5327/Z1679443520190360 32368676
Soares, C. O. et al. Preventive factors against work-related musculoskeletal disorders: Narrative review. Rev. Bras. Med. Trab. 17(3), 415–430 (2020).32368676 10.5327/Z1679443520190360
13. Oakman J Kinsman N Stuckey R Graham M Weale V A rapid review of mental and physical health effects of working at home: How do we optimise health? BMC Public Health 2020 20 1 1825 10.1186/s12889-020-09875-z 33256652
Oakman, J., Kinsman, N., Stuckey, R., Graham, M. & Weale, V. A rapid review of mental and physical health effects of working at home: How do we optimise health?. BMC Public Health 20(1), 1825 (2020).33256652 10.1186/s12889-020-09875-z
14. Padma V Anand NN Gurukul SM Javid SM Prasad A Arun S Health problems and stress in information technology and business process outsourcing employees J. Pharm. Bioallied Sci. 2015 7 Suppl 1 S9 S13 10.4103/0975-7406.155764 26015763
Padma, V. et al. Health problems and stress in information technology and business process outsourcing employees. J. Pharm. Bioallied Sci. 7(Suppl 1), S9–S13 (2015).26015763 10.4103/0975-7406.155764
15 Maritz R Aronsky D Prodinger B The international classification of functioning, disability and health (ICF) in electronic health records. A systematic literature review Appl. Clin. Inform. 2017 8 3 964 980 10.4338/ACI2017050078 28933506
Maritz, R., Aronsky, D. & Prodinger, B. The international classification of functioning, disability and health (ICF) in electronic health records. A systematic literature review. Appl. Clin. Inform. 8(3), 964–980 (2017).28933506 10.4338/ACI2017050078
16. Cieza A Hilfiker R Chatterji S Kostanjsek N Ustün BT Stucki G The international classification of functioning, disability, and health could be used to measure functioning J. Clin. Epidemiol. 2009 62 9 899 911 10.1016/j.jclinepi.2009.01.019 19540718
Cieza, A. et al. The international classification of functioning, disability, and health could be used to measure functioning. J. Clin. Epidemiol. 62(9), 899–911 (2009).19540718 10.1016/j.jclinepi.2009.01.019
17. Moreira S Criado MB Ferreira MS Machado J Gonçalves C Mesquita C Lopes S Santos PC The effects of COVID-19 lockdown on the perception of physical activity and on the perception of musculoskeletal symptoms in computer workers: Comparative longitudinal study design Int. J. Environ. Res. Public Health 2022 19 12 7311 10.3390/ijerph19127311 35742554
Moreira, S. et al. The effects of COVID-19 lockdown on the perception of physical activity and on the perception of musculoskeletal symptoms in computer workers: Comparative longitudinal study design. Int. J. Environ. Res. Public Health 19(12), 7311. 10.3390/ijerph19127311 (2022).35742554 10.3390/ijerph19127311
18 Gosain L Ahmad I Rizvi MR Sharma A Saxena S Prevalence of musculoskeletal pain among computer users working from home during the COVID-19 pandemic: A cross-sectional survey Bull. Fac. Phys. Ther. 2022 27 1 51 10.1186/s43161-022-00110-x
Gosain, L., Ahmad, I., Rizvi, M. R., Sharma, A. & Saxena, S. Prevalence of musculoskeletal pain among computer users working from home during the COVID-19 pandemic: A cross-sectional survey. Bull. Fac. Phys. Ther. 27(1), 51. 10.1186/s43161-022-00110-x (2022).10.1186/s43161-022-00110-x
19. 17. https://www.icf-core-sets.org/en/page1.php
20. Brockow T Cieza A Kuhlow H Sigl T Franke T Harder M Stucki G Identifying the concepts contained in outcome measures of clinical trials on musculoskeletal disorders and chronic widespread pain using the international classification of functioning, disability and health as a reference J. Rehabil. Med. 2004 10.1080/16501960410015371 15841604
Brockow, T. et al. Identifying the concepts contained in outcome measures of clinical trials on musculoskeletal disorders and chronic widespread pain using the international classification of functioning, disability and health as a reference. J. Rehabil. Med.10.1080/16501960410015371 (2004).15841604 10.1080/16501960410015371
21. Fresk M Grooten WJA Brodin N Backlund LG Arrelöv B Skånér Y Kiessling A Mapping information regarding the work-related disability of depression and long-term musculoskeletal pain to the international classification of functioning, disability and health and ICF core sets Front. Rehabil. Sci. 2023 2 4 1159208 10.3389/fresc.2023.1159208.PMID:37200737;PMCID:PMC10185752
Fresk, M. et al. Mapping information regarding the work-related disability of depression and long-term musculoskeletal pain to the international classification of functioning, disability and health and ICF core sets. Front. Rehabil. Sci. 2(4), 1159208. 10.3389/fresc.2023.1159208.PMID:37200737;PMCID:PMC10185752 (2023).10.3389/fresc.2023.1159208.PMID:37200737;PMCID:PMC10185752
22. Hoedl M Bauer S Eglseer D Influence of nursing staff working hours on stress levels during the COVID-19 pandemic: A cross-sectional online survey HeilberufeScience 2021 12 3–4 92 98 10.1007/s16024-021-00354-y 34522573
Hoedl, M., Bauer, S. & Eglseer, D. Influence of nursing staff working hours on stress levels during the COVID-19 pandemic: A cross-sectional online survey. HeilberufeScience 12(3–4), 92–98 (2021).34522573 10.1007/s16024-021-00354-y
23. Yin C Ji J Cao X Jin H Ma Q Gao Y Impact of long working hours on depressive symptoms among COVID-19 frontline medical staff: The mediation of job burnout and the moderation of family and organizational support Front. Psychol. 2023 15 14 1084329 10.3389/fpsyg.2023.1084329
Yin, C. et al. Impact of long working hours on depressive symptoms among COVID-19 frontline medical staff: The mediation of job burnout and the moderation of family and organizational support. Front. Psychol. 15(14), 1084329 (2023).10.3389/fpsyg.2023.1084329
24. Ijmker S Huysmans MA Blatter BM van der Beek AJ van Mechelen W Bongers PM Should office workers spend fewer hours at their computer? A systematic review of the literature Occup. Environ. Med. 2007 64 4 211 222 10.1136/oem.2006.026468 17095550
Ijmker, S. et al. Should office workers spend fewer hours at their computer? A systematic review of the literature. Occup. Environ. Med. 64(4), 211–222 (2007).17095550 10.1136/oem.2006.026468
25. Wahlström, J. Ergonomics, musculoskeletal disorders and computer work [review]. Occup Med 200555168–176.
26. Chim JMY Chen TL Prediction of work from home and musculoskeletal discomfort: An investigation of ergonomic factors in work arrangements and home workstation setups using the COVID-19 experience Int. J. Environ. Res. Public Health 2023 20 4 3050 10.3390/ijerph20043050 36833747
Chim, J. M. Y. & Chen, T. L. Prediction of work from home and musculoskeletal discomfort: An investigation of ergonomic factors in work arrangements and home workstation setups using the COVID-19 experience. Int. J. Environ. Res. Public Health 20(4), 3050 (2023).36833747 10.3390/ijerph20043050
27. Gerr F Marcus M Monteilh C Epidemiology of musculoskeletal disorders among computer users: Lesson learned from the role of posture and keyboard use [review] J. Electromyogr. Kinesiol. 2004 14 25 31 10.1016/j.jelekin.2003.09.014 14759747
Gerr, F., Marcus, M. & Monteilh, C. Epidemiology of musculoskeletal disorders among computer users: Lesson learned from the role of posture and keyboard use [review]. J. Electromyogr. Kinesiol. 14, 25–31 (2004).14759747 10.1016/j.jelekin.2003.09.014
28. Borhany T Shahid E Siddique WA Ali H Musculoskeletal problems in frequent computer and internet users J. Family Med. Prim. Care. 2018 7 2 337 339 10.4103/jfmpc.jfmpc_326_17 30090774
Borhany, T., Shahid, E., Siddique, W. A. & Ali, H. Musculoskeletal problems in frequent computer and internet users. J. Family Med. Prim. Care. 7(2), 337–339 (2018).30090774 10.4103/jfmpc.jfmpc_326_17
29. Alhakami AM Madkhli A Ghareeb M Faqih A Abu-Shamla I Batt T Refaei F Sahely A Qassim B Shami AM Alhazmi AH The prevalence and associated factors of neck pain among ministry of health office workers in Saudi Arabia: A cross sectional study Healthcare (Basel) 2022 10 7 1320 10.3390/healthcare10071320 35885845
Alhakami, A. M. et al. The prevalence and associated factors of neck pain among ministry of health office workers in Saudi Arabia: A cross sectional study. Healthcare (Basel) 10(7), 1320 (2022).35885845 10.3390/healthcare10071320
30. Malińska M Bugajska J Bartuzi P Occupational and non-occupational risk factors for neck and lower back pain among computer workers: A cross-sectional study Int. J. Occup. Saf. Ergon. 2021 27 4 1108 1115 10.1080/10803548.2021.1899650 33704014
Malińska, M., Bugajska, J. & Bartuzi, P. Occupational and non-occupational risk factors for neck and lower back pain among computer workers: A cross-sectional study. Int. J. Occup. Saf. Ergon. 27(4), 1108–1115 (2021).33704014 10.1080/10803548.2021.1899650
31. Moreira S Criado MB Ferreira MS Machado J Gonçalves C Mesquita C Lopes S Santos PC The effects of COVID-19 lockdown on the perception of physical activity and on the perception of musculoskeletal symptoms in computer workers: Comparative longitudinal study design Int. J. Environ. Res. Public Health 2022 19 12 7311 10.3390/ijerph19127311 35742554
Moreira, S. et al. The effects of COVID-19 lockdown on the perception of physical activity and on the perception of musculoskeletal symptoms in computer workers: Comparative longitudinal study design. Int. J. Environ. Res. Public Health 19(12), 7311 (2022).35742554 10.3390/ijerph19127311
32. Shete KM Suryawanshi P Gandhi N Management of low back pain in computer users: A multidisciplinary approach J. Craniovertebr. Junction Spine 2012 3 1 7 10 10.4103/0974-8237.110117 23741122
Shete, K. M., Suryawanshi, P. & Gandhi, N. Management of low back pain in computer users: A multidisciplinary approach. J. Craniovertebr. Junction Spine 3(1), 7–10 (2012).23741122 10.4103/0974-8237.110117
33. Bertelmann T Heutelbeck A Bopp S Sagebiel LL Eichberg S Hallier E Hilgers R Quiering C Hoerauf H Prevalence of back pain among german ophthalmologists Ophthalmic Res. 2021 64 6 974 982 10.1159/000517574 34348327
Bertelmann, T. et al. Prevalence of back pain among german ophthalmologists. Ophthalmic Res. 64(6), 974–982 (2021).34348327 10.1159/000517574
34. Ammar A Brach M Trabelsi K Chtourou H Boukhris O Masmoudi L Bouaziz B Bentlage E How D Ahmed M Effects of COVID-19 home confinement on eating behaviour and physical activity: Results of the ECLB-COVID19 international online survey Nutrients 2020 12 1583 10.3390/nu12061583 32481594
Ammar, A. et al. Effects of COVID-19 home confinement on eating behaviour and physical activity: Results of the ECLB-COVID19 international online survey. Nutrients 12, 1583 (2020).32481594 10.3390/nu12061583
35. Callaghan P Exercise: A neglected intervention in mental health care? J. Psychiatr. Ment. Health Nurs. 2004 11 476 483 10.1111/j.1365-2850.2004.00751.x 15255923
Callaghan, P. Exercise: A neglected intervention in mental health care?. J. Psychiatr. Ment. Health Nurs. 11, 476–483 (2004).15255923 10.1111/j.1365-2850.2004.00751.x
