Comparison of Musculoskeletal Disorders in Gender

Nichelle Morgan

Research Question: Does the physical and psychosocial effects of musculoskeletal disorders differ between both male and female computer workers employed at the UWI St. Augustine Republic Bank Branch, Trinidad?

Introduction

A musculoskeletal disorder is defined as “injuries or disorders that affect the human body’s movement or musculoskeletal system, i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.” (Middlesworth, 2015). They are one of the most common occupational disorders that occur to employees both in and out of the office. When a worker experiences a musculoskeletal disorder, it has an impact on the quantity and quality of the work that they perform. Not only do these disorders affect the health of the worker, but it also affects the productivity of the organization and furthermore the economy (Nunes, 2012).

For this topic, there were very limited sources that discusses gender and its association with the development of musculoskeletal disorders. As there is very little focus on musculoskeletal disorders amongst computer workers in Trinidad, this study will seek to gain more information and a better understanding of the known and unknown causal factors of musculoskeletal disorders, how or why it may differ between genders and what methods can be implemented to reduce the risk of an employee developing these disorders in the future.

Problem Statement

As places of business become more dependent on technology, there has been the increase in the usage of desktop computers and laptops in the workforce. Therefore, this brings about one of the most common occupational health problems, i.e. musculoskeletal disorders. One of the many groups of workers who has experienced this occupational ailment are the employees that work with computers. This group mostly express concerns about pains in their necks, arms, and backs (Punnet, 1997). The age, gender and lifestyle choices of the individual are a few factors that contribute to musculoskeletal disorders. For Trinidad and Tobago, there is very limited research conducted on the effects of musculoskeletal disorders among computer workers. Considering the lack of information for this topic, it gives rise for further research to be done on this occupational disorder in Trinidad and Tobago.

Aim

The aim of this research question is to further examine the long term physical and psychosocial effects of musculoskeletal disorders amongst computer workers. Factors such as gender, age, exposure time to computers and lifestyle of the worker would be used as additional control measures in this study.

Theoretical Perspective

With regards to the possible causes and long term effects of musculoskeletal disorders at the workplace, there are four theories which aids in analysing these causal injuries. Kumar (2004, 2007) explains the four theories as follows:

1. The Multivariate Interaction Theory– encompasses all the factors [genetic, morphological, psychosocial, and biomechanical] that a biological entity uses while conducting work activities.
2. The Differential Fatigue Theory– speaks to the various and repetitive muscle movement in the body that occurs while the worker is performing various tasks. Each muscle would experience different levels of fatigue and this depends on the type of work being conducted and how much stress that the muscle is undergoing.
3. Cumulative Load Theory– where all the muscle pain or stresses are accumulated. These repetitive motions over time causes the muscles to become weak and in some cases even deformed.
4. Overexertion Theory– This is when the muscles become extremely overworked due to the amount of stress or pressure being placed on those muscles. The muscles would either experience pain all at once or the pain will accumulate over time.

The Differential Fatigue Theory is best suited to the discussion of causes of musculoskeletal disorders and its short and long term effects amongst computer workers. The neck, shoulder, back and arm muscles of the worker all undergo different levels of stress every day. The different levels stress in these muscles leads to the worker experiencing different types of pain while doing their job and even out of the office.

Research Question/Hypothesis

To further examine the long term physical and psychosocial effects of musculoskeletal disorders between male and female computer workers.

Hypothesis:

H_O: There is no association with the length of computer usage and the development of musculoskeletal disorders between genders.

H_A: There is an association with the length of computer usage and the development of musculoskeletal disorders between genders.

Definition of key terms

Visual Display Unit [VDU]– another term used to describe a computer monitor. A large projector can also be considered a VDU (TechTerms).

Video Display Terminal [VDT]– a computer terminal consisting of a screen on which data or graphics can be displayed (The Free Dictionary).

Carpal Tunnel Syndrome [CTS]– this is when there is pressure on the median nerve of the wrist. When this pressure is continuous, the arm or hand of the individual experiences tingling, numbness and pain (Faust, 2016).

Repetitive Strain Injury [RSI]– this is where an individual experiences pain in the muscles, nerves, and tendons after doing an activity that involves repetitive action (NHS UK).

Delimitations

The focus group for this research are the bank employees at the Republic Bank Limited branch located in the University of the West Indies, St. Augustine Campus.

Limitations

The group selected for the questionnaire may be too small and not a large enough representation of all staff members at Republic Bank Limited, Trinidad.

Literature Review

Within the last century, the corporate workforce has increased exponentially and with this there is also the increase in the number of computers and the length of time that workers spend these devices in the workplace. Even though this machine is very helpful with everyday work tasks, its use over extended periods of time begins to have negative effects on the physical health of the worker. These physical health effects that a computer worker will most likely experience is referred to as musculoskeletal disorders. The parts of the body such as the arms, neck, shoulders and back are the main problem areas and contribute to the development of musculoskeletal disorders (Eltayeb et.al 2007).

In an article written by Tittiranonda et.al (1999), it was mentioned that in the United States there was an increase in the number of the occurrence of musculoskeletal disorders in a ten-year period. The author also stated that the increase in cases involving musculoskeletal disorders is in conjunction with the increase of computer usage at the workplace.

One of the most common musculoskeletal disorders that several computer users experience is carpal tunnel syndrome. This disorder affects the wrists and fingers of the worker, thus limiting the movement of the hands and the pain ranges from light to severe (Faust, 2016). The Mayo Clinic (2014) indicated that there was scientific research was done to verify the link between extended computer use and carpal tunnel syndrome but the evidence to support this statement is limited. Similarly, in his study Kryger et.al. (2003) spoke about repetitive stress injury [RSI] with regards to the pain that workers experience in their forearm and mentioned that there were “inconsistent findings” in a few studies which were conducted to find the association between computer use and forearm pain.

Middlesworth (2015) divided the risk factors that contributes to musculoskeletal disorders into two categories, these are the Ergonomic and Individual risk factors. The Ergonomic risk factors consists of force, repetition, and posture, whereas the Individual risk factors are poor work practices, poor fitness, and poor health habits. For example, if the posture of the worker is poor throughout the entire workday, not only would it cause pain in the lower back, shoulders, and neck, but it would also lead to increased fatigue. Poor posture and the utilization of inadequate office equipment such as unsuitable computer chairs for extensive periods can also contribute to the development of musculoskeletal disorders. In terms of poor health habits and its relation to musculoskeletal disorders, it is not considered to be a major factor in the development of musculoskeletal disorders as there is very little research done to prove this as a fact. However, there is some correlation between poor fitness and the development of musculoskeletal disorders. For example, if an individual is not physically fit and is sitting at the desk most of the day, it heightens their chances of experiencing both muscle and joint pain.

With regards to gender and musculoskeletal disorders, one report stated that there is no evidence to confirm that gender is a main factor in the development of this occupational disease (Petreanu, 2015). However, in another study conducted by de Zwart (1997) it was found that as both working males and females age, they are at a higher risk of developing musculoskeletal disorders at the workplace. In another article, Madeleine et.al (2013) carried out an experiment on the long-term pain complaints amongst Danish computer users which resulted in the women having higher reports of pain complaints than the men.

Given the difference in opinions in the previous paragraph, this gives an indication that there is still more research to be done to find the association with gender and musculoskeletal disorder development. Trinidad and Tobago has many persons that are employed in the public sector and by carrying out a study in this area of occupational health, it would give some insight as to how musculoskeletal disorders affects the office worker and how we can reduce the number of cases of this occupational disease.

Research Design/Method

The quantitative design method would be used alongside with the true experimental design in this study. By pairing the quantitative method and the true experimental design, this would reduce the chances of bias during both pre-test and post-test stages.

Sample Populations and Participants

The population that this study will be sampling from are the employees of Republic Bank Limited in Trinidad that work with computers daily. The sample group will comprise of 100 employees that work with computers for more than six hours during the work day at the Republic Bank Limited, St Augustine Branch. The participants in this sample group were randomly chosen as this would allow for a fair distribution of participants to both the control group and the experimental group.

Data Collection Instruments, Variables and Materials

For this study, data would be collected by means of questionnaires and an experiment. The independent variable would be the exposure to computers during the work week [hours/week]. The dependent variables would be the musculoskeletal symptoms [back pains, neck pains, shoulder pains, arm, and wrist pains], gender, lifestyle and age of the employee.

The questionnaire would consist of closed ended questions which would gather data from the employees such as lifestyle choices, health, workspace comfort, etc. To ensure that the participants respond to the questions, there would be two supervisors [a research team representative and a representative from the Human Resources Department] present while the employees take the allotted time to fill out the questionnaire. After all the questionnaires have been completed, they would be collected immediately and handed over to the research team representative.

In terms of the experiment, it will be carried out at the workplace of the participants for a period of two months. In the first week, the experimental group [made up of 50 participants] would receive new ergonomically friendly computer desks and chairs, while the control group [also comprised of 50 participants] would be given a placebo. The employees would be required fill out a digital weekly log for eight working weeks to record whether there has been any decrease in muscle pains and at the end of each week the participants must submit these logs to the research team representative via the email address which was provided one day prior to the commencement of the experiment.

Data Analysis Procedure

As the research would be focusing on the length of computer usage and its association with the development of musculoskeletal disorders between men and women, the SPSS program was chosen to analyse the data. After the data from the questionnaires and the weekly logs have been gathered, the researchers would then go through a series of steps to ensured that the data is properly analysed. The first step is to code the data from the weekly logs [hours/week versus the musculoskeletal symptoms] and the questionnaires. Secondly, the data would be edited and then placed into a computerised system. The data would then be cleaned as this would remove any errors that may offset the results and finally, the data will be modified.

Expected outcome

The results from the statistical analysis should indicate that there is indeed an association with the exposure time of computers and the development of musculoskeletal disorders between male and female computer workers.

Anticipated Ethical Issues

This study is being conducted with human beings as the test subjects. To ensure that the ethical rules in research are not broken, the research team took measures to ensure that all the data that was gathered from the participants were to remain confidential and used only for research purposes. This would be done by having the participants signing two consent forms, one before filling out the questionnaires and the other on the morning of the experimental trial. Secondly, the head of the research team would meet the Human Resources manager of the Republic Bank Limited prior to the experimentation period to discuss the purpose of the study, why their establishment and the St. Augustine branch was chosen and how the data gathered from the employees was to be utilized.

Preliminary Studies and Pilot Tests

Before the research team carries out the experiment, a pilot test will be given to 40 employees at the Republic Bank Limited branch. The purpose of this pilot test is to give an assessment of the estimated cost to run the experiment, gives an idea of how feasible the study is going to be and may also predict any possible adverse events during the test period.

Significance of study

The study of musculoskeletal disorders and its effects on computer workers is of key importance as it allows for a deeper understanding of the causal factors of the disorder. It also brings about ways in which the computer workers themselves may have contributed to the development of musculoskeletal disorders in their bodies. The study may also bring about possible solutions for reducing the physical and psychosocial health effects of this occupational disease amongst the computer workers not only at the Republic Bank, but also all corporate businesses in Trinidad and Tobago.

References

Christensson, Per. “VDU Definition.” TechTerms. (November 6, 2009). Accessed January 3^rd, 2017. http://techterms.com/definition/vdu.

de Zwart, B., Broersen, J., Frings-Dresen, M. et al. Int Arch Occup Environ Health (1997) 70: 352. Accessed on January 8^th, 2017. doi:10.1007/s004200050229.

Eltayeb Shahla et.al. 2007. Prevalence of complaints of arm, neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire. http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-8-68 Accessed on December 30^th, 2016.

Faust Katherine, Charles D. Jennings. “Carpal Tunney Syndrome”. 2016. http://orthoinfo.aaos.org/topic.cfm?topic=a00005 Accessed on January 3^rd, 2017.

Kryger A.I. et.al. “Does computer use pose an occupational hazard for forearm pain; from the NUDATA study”. Occup Environ Med 2003;60:e14. Accessed on January 3rd, 2017. doi:10.1136/oem.60.11.e14.

Kumar, Shrawan: Muscle Strength. Florida: CRC Press 2004.https://books.google.tt/books?id=IXRJ457fGp8C&pg=PA10&lpg=PA10&dq=differential+fatigue+theory&source=bl&ots=6ZQ3rQg2Kj&sig=1GtsSbEPM6fKvdB7LqBgHGyY8Hw&hl=en&sa=X&ved=0ahUKEwic67C-h6XRAhVBLSYKHStyBwwQ6AEIKTAC#v=onepage&q=differential%20fatigue%20theory&f=false Accessed on January 3^rd, 2017.

Kumar, Shrawan: Biomechanics in Ergonomics. Florida: CRC Press 2007. https://books.google.tt/books?id=gDbMBQAAQBAJ&pg=PA3&lpg=PA3&dq=Multivariate+Interaction+Theory&source=bl&ots=q43xFPztEH&sig=zFHmVwPfraPydVFtZgRF8YSyIX4&hl=en&sa=X&ved=0ahUKEwjfkJTdo5_RAhUI6CYKHWoVDCYQ6AEIWTAJ#v=onepage&q=Multivariate%20Interaction%20Theory&f=false Accessed on January 2^nd, 2017.

Madeleine, Pascal et.al. “Computer work and self-reported variables on anthropometrics, computer usage, work ability, productivity, pain, and physical activity” BMC Musculoskeletal Disorders201314:226. Accessed on December 8^th, 2017. DOI: 10.1186/1471-2474-14-226.

Mayo Clinic. Carpal Tunnel Syndrome: Risk Factors. 2014. http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/risk-factors/con-20030332 Accessed on January 3rd, 2017.

Middlesworth, Matt. “The Definition and Causes of Musculoskeletal Disorders (MSDs)”. Accessed on December 29^th, 2016. http://ergo-plus.com/musculoskeletal-disorders-msd/

NHS UK. Repetitive Stress Injury. 2016. http://www.nhs.uk/Conditions/Repetitive-strain-injury/Pages/Introduction.aspx Accessed on January 3rd, 2017.

Nunes, Isabel L. and Pamela McCauley Bush (2012). “Work-Related Musculoskeletal Disorders Assessment and Prevention, Ergonomics – A Systems Approach”. Accessed on January 8^th, 2017. DOI: 10.5772/37229.

Petreanu Viorica and Aurelia-Mihaela Seracin. 2015. Risk factors for musculoskeletal disorders development: hand-arm tasks, repetitive work. https://oshwiki.eu/wiki/Risk_factors_for_musculoskeletal_disorders_development:_hand-arm_tasks,_repetitive_work Accessed on January 8^th, 2017.

Punnet, Laura. “Visual Display Unit Work and Upper Extremity Musculoskeletal Disorders”. 1997:16. https://gupea.ub.gu.se/bitstream/2077/4159/1/ah1997_16.pdf Accessed on January 8^th, 2017.

Appendices

Appendix 1: Questionnaire

Good day participant,

My name is Nichelle Morgan and I am a postgraduate student in the Chemistry Department of the University of the West Indies, St. Augustine Campus. As a requirement for one of my core courses, I have been asked to create a questionnaire which looks at musculoskeletal disorders and the physical and psychosocial effects that it has on computer workers. Once this questionnaire has been completed in its entirety, the responses will be used to further explore the known and unknown causal factors of this occupational disease.

With regards to confidentiality, you will not be required to fill out your name or contact information on the questionnaire thus reassuring you that your responses will remain private. I appreciate you taking the time to participate in this study. If you have any questions, please feel free to contact me via my email address nichelle.morgan@my.uwi.edu . Once again, I thank you for taking part in this study.

Yours respectfully,

Nichelle Morgan

MSc. Occupational and Environmental Safety and Health,

Department of Chemistry,

The University of the West Indies, St. Augustine Campus.

1. What is your gender?

• Male •Female

2. Which age group do you belong to?

• 20-24 • 25-29

• 30-34 • 35-39

• 40-44 • >45

3. What is your ethnic background?

• Afro-Trinidadian • Indo- Trinidadian

• Chinese • Syrian

• Mixed • Other

4. How often do you exercise?

• Once a month • Twice a month

• 1-2 times a week • Everyday

• Never

5. How often do you purchase or consume fast food?

• Daily • 1-3 times a week

• Twice a month • Once a month

• Never

6. How long have you been employed at Republic Bank?

• <1 year • 1-4 years

• 5-9 years • 10-14 years

• 15- 19 years • >20 years

7. Do you use computers daily at work?

• Yes • No

8. If you responded Yes to Question 7, how many hours do you use the computer?

• < 2 hours • 2-4 hours

• 4-6 hours • 6-8 hours

9. While working with the computer, how often do you take a short break (besides lunch hour)?

• Never • Every 2 hours

• Every 4 hours • Depends on the work load

10. Do you experience any muscular pains while working?

• Yes • No

11. If you responded Yes to Question 10, which part of the body does this pain occur?

• Neck • Shoulders

• Upper back • Lower back

• Arms and Wrists • Legs

• All the above

12. How often do you experience these pains?

• Everyday • Every other day

• 1-2 times a week • Twice a month

• Once a month • Never

13. Select the pain intensity that you experience

• Mild • Some Discomfort

• Very Uncomfortable • Intense

• Unbearable

14. At times does the pain cause you to stop working?

• Yes • No

15. Was there an occasion where you missed working day/working days because of the pain?

• Yes • No

16. If you responded Yes to Question 15, how many days were you absent from work?

• 1-2 days • 3-5 days

• 2 weeks • 1 month

17. Is your office furniture (computer chair) comfortable?

• Yes • No

18. If your response to Question 17 is No, select the reason below

• Chair is not adjustable • The seat of the chair is too hard

• The back of chair does not support your spine properly

• Not enough leg room below desk

• All the above

Appendix 2: Budget

The estimated cost of the equipment required to carry out this study is $110,000. The cost of the ergonomically friendly chairs for the experimental group is $63,646.65 and the cost of the placebo chairs for the control group is $36,478.15. The rest of the funds ($9,845.05) would be distributed to the 100 participants as a token of appreciation for taking part in this study. There was a signed agreement between the sponsor of the equipment where they arranged to cover 60% of the cost while the research team will cover the remainder 40%.