|Year : 2020 | Volume
| Issue : 2 | Page : 50-55
A trend of cumulative trauma disorders in indian computer users: A comparison of surveys of the year 2009 versus 2019
Pooja Pankaj Mehta1, Chandanbala Ojas Maru2
1 Consultant Pediatric Occupational Therapist, Anmol Child Development Clinic, Kandivali (W), Mumbai, Maharashtra, India
2 Master's Student, Department of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
|Date of Submission||14-Feb-2020|
|Date of Decision||24-Feb-2020|
|Date of Acceptance||25-Mar-2020|
|Date of Web Publication||6-Jun-2020|
Dr. Pooja Pankaj Mehta
202, Punit Ganga, Gokhale Road, Dahanukar Wadi, Kandivali (W), Mumbai - 400 067, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Digitalization has resulted in increased computer use. Computer use involves repetitive movements and relatively static posture of neck, limbs, and trunk, contributing in cumulative trauma disorders (CTDs). Over a decade, ergonomic awareness has increased, but CTDs have prevailed. Objective: A comparison of 2009 versus 2019 surveys was done to understand CTD trends and to find the significance of the number of people affected due to hours per day computer use. Study Design: A comparison of two surveys was conducted to research trend in occurrences of CTDs. Methods: The sampling was done using the snowball method. Both surveys had identical research methodology and collected data of (n) 100 computer users of India with an age range of 20–50 years, i.e., total of N = 200 in combined surveys. Participants filled in the self-explanatory questionnaire on Google Forms that assessed areas of CTD pain, severity of pain, and functional performance during pain. Results: Data analysis showed a higher percentage of pain in the neck, eye strain, and back pain in computer users in both 2009 and 2019 surveys. There was an overall decrease in the percentage of computer users affected with CTDs from 86% to 70%, but anatomically, an increase in percentages of pain in the upper limb, headaches, and lower-back pain was reported in 2019. The relation between duration of computer use and number of computer users affected was found to be nonsignificant for both 2009 and 2019 surveys (χ = 3.5408; P = 1.7027 and χ = 1.3739; P = 0.5031, respectively, 95% confidence interval [CI] [4.605, 7.378]). Spearman's correlation showed no significant correlation between duration of computer use and severity of pain in both 2009 (r = 0.078; P = 0.443, 95% CI [−0.120, 0.270]) and 2019 (r = −0.085; P = 0.398, 95% CI [−0.277, 0.114]). Conclusion: The comparison of 2009 and 2019 surveys showed an overall decrease in the percentage of computer users affected with CTDs in the 2019 survey. An increase in upper-limb pain, headache, and lower-back ache percentages was noted, while upper-back pain, neck pain, and eye strain percentage showed a decreasing trend in the 2019 survey. The percentage of computer users affected with pain in the neck, pain in the back, and eye strain was higher than other CTD areas in both the surveys. The duration of computer use did not show a significant correlation to the presence of CTDs among computer users in both surveys.
Keywords: Ergonomics, Functional Performance, National Institute for Occupational Safety and Health, Repetitive Stress Injury, Visual Analog Scale
|How to cite this article:|
Mehta PP, Maru CO. A trend of cumulative trauma disorders in indian computer users: A comparison of surveys of the year 2009 versus 2019. Indian J Occup Ther 2020;52:50-5
|How to cite this URL:|
Mehta PP, Maru CO. A trend of cumulative trauma disorders in indian computer users: A comparison of surveys of the year 2009 versus 2019. Indian J Occup Ther [serial online] 2020 [cited 2022 May 25];52:50-5. Available from: http://www.ijotonweb.org/text.asp?2020/52/2/50/286119
| Introduction|| |
Cumulative trauma disorder (CTD), also known as work-related musculoskeletal disorder (WRMSD) or repetitive stress injury, is a condition that develops secondary to repetitive tissue microtrauma that exceeds the tissue's ability to heal itself. The National Institute for Occupational Safety and Health (NIOSH) bibliography on “CTDs in the workplace” has reported studies on CTD in computer users since 1991. Computer use involves repetitive movements in relatively static posture of upper limbs (while using a keyboard and mouse), trunk, and lower limb (while sitting for longer duration) and ergonomic hazards that contribute to CTDs. A review article of Goodman et al., 2012, suggested two models of practice based on ergonomic principles as effective interventional strategy for computer users with CTD. However, CTDs still prevail.,,
Hence, a comparison of two surveys 2009 versus 2019 was conducted to understand CTD trend over a decade. Digitalization has dramatically increased duration of computer use; hence the need to statistically analyze the effect of duration of computer use on CTDs. A study by Gerr, 2006, has shown that the observed effects of computer use hours-per-day to be heterogeneous. Resultant, the significance of number of people affected due to long working hours on computer was also explored in this study.
| Methods|| |
Trend survey study design was selected, wherein a comparison of two surveys 2009 versus 2019 was done to understand the trend of CTDs over time in computer users. In this study design, a repeated cross-sectional study with a “time-lag” method is used to analyze the trend. This method helps eliminate the limitations of longitudinal and cross-sectional study by repeating waves of cross-sectional studies over a period of time and in principle does not investigate the same participants or sample. Thus, it is the combination of longitudinal processing of data and cross-sectional analyses. In this study, both surveys were conducted using an identical research methodology and the same selection criteria.
A web survey through E-mails and basic Google Sheets, using a snowball method of sampling, was conducted on computer users in 2009, and responses were collected for 2 months. Over a decade, upgradation of Google Sheets to Google Forms took place and Google Forms became convenient approach for survey studies. Hence, in 2019, a web survey using Google Forms was conducted on computer users, both desktop and laptop users, using the snowball method of sampling, through social media, social apps, and E-mails. Google Forms was so designed that if participants gave consent, they could participate in the study and fill in the form. Form link was open for responses for 2 months only, to maintain the same response collection technique, as in 2009. Postsampling, computer users of both the surveys were divided into three groups on the basis of duration of computer use to find the duration effect on percentage of computer users affected with CTDs.
- Group I: 1-3 h
- Group II: more than 3-5 h
- Group III: more than 5 h.
In 2009, 128 responses were received, of which 100 responses satisfied selection criteria, and were taken for statistical analysis, and in 2019, of the 145 responses received, 39 responses were from computer users residing outside India and the remaining 6 did not satisfy selection criteria. Thus, 100 responses satisfying selection criteria were taken for statistical analysis. Sample size (n) =100 for each survey and total sample N = 200 was determined. The study was conducted adhering to the principles of the “Declaration of Helsinki.” The eligibility for both the surveys were:
Inclusion criteria as follows: age group of 20-50 years, participants of either gender, residing in India, and participants who use computers (either laptop or desktop) regularly for more than 1 h on a daily basis for more than a year. Whereas, exclusion criteria were as follows: any past or current orthopedic and/neuromuscular conditions and symptoms of pain or musculoskeletal discomfort which began before the use of computers.
Participants were given a self-explanatory and self-administered questionnaire prepared on the basis of the NIOSH guidelines. It consisted of demographic data, personal lifestyle, occupational history including work demands and psychosocial factors at work, and duration of computer use. Areas of CTD affectations were assessed using the symptom questionnaire for CTD, whereas the Functional Assessment Scale (FAS) and Visual Analog Scale (VAS) assessed function and pain during/after computer use. The questionnaire took 10–15 min to fill.
VAS is a validated, subjective measure for severity of acute and chronic pain, wherein scores are recorded on an 11-point scale from 0 (no pain) to 10 (worst pain imaginable). It has a high test–retest reliability and feasibility. Recent studies suggested it's effective in use in web-survey research and the response distribution differences observed between traditional paper-based VAS and digital computer-based VAS were not statistically significant.
FAS is a 5-point scale from 0 (cannot perform the activity because of pain) to 4 (no pain for an activity), which grades the level of function of an individual under pain during an activity.
Data analysis was done using IBM SPSS (Statistical Package for the Social Sciences), Statistics for Windows, version 23, 2015, IBM Corp., Armonk, NY, USA. Descriptive data analysis was done for VAS scores, FAS scores, and pain areas marked in Symptoms Questionnaire for CTD to find the percentage of pain areas of CTDs and mean scores of FAS and VAS. Exploratory data analysis was done using a nonparametric test of correlation – Spearman's correlation rho (level of two-tailed significance) to find the correlation between duration of computer use, FAS scores, and VAS scores. Inferential data analysis using a nonparametric test – Chi-square test of independence (level of two-tailed significance) – was done to find the significance of number of people affected due to long working hours on computer.
| Results|| |
Demographic profiling of computer users showed an increase in the mean age from 31.2 ± 5.4 years (21, 50) in 2009 to 33.2 ± 7 years (22, 50) in 2019. Male computer users were 66 in 2009 and females were 34, while in 2019, males were 41 and females were 59. Thus, the trend change showed an increase in mean age and number of female computer users when compared to 2019.
The descriptive data analysis showed a change in trend in terms of percentage of computer users affected with CTDs in 2009 versus 2019 surveys. The number of participants with pain in one or more areas decreased from 86% (in 2009) to 70% (in 2019). The percentage of computer users affected with pain showed a decrease for each area, except for pain in the upper limb, headaches, and lower-back pain [Figure 1].
|Figure 1: Comparison of Overall Cumulative Trauma Disorder Trend in Computer Users in 2009 and 2019 Surveys|
Click here to view
Data analysis of individual groups across the areas of affectations showed an increase in the percentage of computer users affected with CTD pain in all areas except in the lower back for Group I (1–3 h computer use). However, for Group II (>3–5 h computer use), a decrease in the percentage of computer users affected with CTD pain except for low backache was noted. Moreover, for Group III (>5 h computer use), an increase in the percentage of computer users affected with low backache, upper-limb pain, and lower-limb pain was noted. Thus, the percentage of computer users affected with low backache was found to have increased with an increase in the duration of computer use. A maximum increase of 36% was observed for pain in the upper limb, followed by headaches (9%) and low backache (5%). A maximum decrease of 33% was observed for pain in the upper back, followed by neck pain (29%) and eye strain (27%) [Figure 2].
|Figure 2: Percentage Difference in Number of Computer Users Affected in Duration Groups of 2009 versus 2019 Surveys|
Click here to view
Mean FAS score across groups has shown to be same overall (2.68), but Group II (>3 h to 5 h) shows an increased mean FAS score (3.47) in 2019, i.e., it showed better functional performance under pain than it did in 2009, even though mean VAS scores (2.27) for Group II across the decade has been same. Mean VAS scores for Group I showed an increase in pain intensity (2.68) in 2019, but the FAS scores, i.e., functional performance under pain, have remained nearly the same (2.42), while for Group III, VAS scores, i.e., pain intensity, have decreased and so functional performance has increased when compared from 2009 to 2019. Overall, FAS score of 2.68 can be interpreted as pain present while at work but can continue to work; and VAS score of 2.37 can be interpreted as pain being annoying to an uncomfortable type of pain [Table 1].
|Table 1: Comparison of Means of the Functional Assessment Scale Scores and Visual Analog Scale Scores across the Duration Groups in Computer Users of 2009 and 2019 Surveys|
Click here to view
As the level of significance set was P < 0.05, the exploratory data analysis using Spearman's correlation rho (ρ) showed a highly significant negative correlation between FAS scores and VAS scores in both 2009 (r = −0.570; P = 0.000, 95% confidence interval [CI] [−0.689, −0.421]) and in 2019 (r = −0.615; P = 0.000, 95% CI [−0.724, −0.476]). There is a positive significant correlation between duration of computer use and functional performance (measured by FAS scores) in 2019 (r = 0.215; P = 0.032, 95% CI [0.394, 0.019]) study but no significant correlation seen in 2009 (r = 0.001; P = 0.991, 95% CI [−0.198, 0.2]). There is no significant correlation between duration of computer use and pain intensity (VAS scores) in both 2009 (r = 0.078; P = 0.443, 95% CI [−0.120, 0.270]) and 2019 (r = −0.085; P = 0.398, 95% CI [−0.277, 0.114]) [Table 2].
|Table 2: Correlation between Severity of Pain, Functional Performance. and Duration Spent on Computer Use in Computer Users of 2009 and 2019 Surveys|
Click here to view
The Chi-square test of independence showed that the relation between duration of computer use and number of people affected was found to be not significant for both 2009 and 2019 samples. For 2009 survey: χ (2, n = 100) = 3.5408, P = 1.7027 and 2019 study: χ (2, n = 100) =1.3739, P = 0.5031, the results are not significant at P < 0.05, CI [4.605, 7.378] [Table 3].
|Table 3: Significance of Number of Computer Users Affected due to Working Hours on the Computer|
Click here to view
| Discussion|| |
The comparison of two surveys 2009 and 2019 was conducted to study the change in the trend of CTDs in computer users over a decade. Demographic profiling as per age showed an increase in mean age of computer users, which could be due to increase in retirement age and increased life expectancy with advanced medical science. While, an increase in number of female computer users could be due to increase in rate of education, employment, and computing tech use among females over a decade.
The comparison of surveys showed a decrease in the percentage of computer users affected with CTDs from 86% to 70%. This could be secondary to increase in awareness of computer ergonomics among computer users to prevent CTDs. Khan et al. in 2012 showed that 52% of computer users from different professional backgrounds showed ergonomic awareness, whereas Shantakumari et al. in 2013 showed that 44% of university students were aware of computer use ergonomics. The ergonomic awareness in these studies included computer users reading documents on computer ergonomics to prevent CTDs and/or having attended training programs for the same.,
The 2019 survey percentage of computer users affected with CTD (70%) was found to be less than the findings of studies by Basu et al., Kolkata, in 2014 (90%) and Oha et al., Estonia, in 2014 (77%) but higher than Borhany et al., Karachi, in 2018 (47%), suggesting that there has been a decrease in the percentage of computer users affected with CTDs in India; however, these results should be cautiously generalized due to small sample size of this study. Considering the high percentages of computer users being affected with CTDs, i.e., 70%, there is a need for the development of a highly proactive CTD prevention program implemented at a larger scale. As the current generation's computer use even for educational purposes has increased, inclusion of ergonomic awareness programs for computer use in higher education curriculum is recommended.
The descriptive data analysis of 2009 survey showed that 86% of computer users were affected with CTDs and the highest percentage for areas affected was for neck (93%), followed by eye strain (79%) and upper-back pain (65%). These findings were similar to the study by Talwar et al., Delhi, in 2009, while the number of computer users affected decreased in 2019 survey, but these areas of pain still showed higher affectations: neck pain (64%), followed by eye strain (52%) and upper-limb pain (50%). These high percentages of computer users affected with neck pain or upper-back pain and eye strain have been consistent for over more than a decade, as evident from previous studies., These studies noted that static and antigravity muscles are more affected. Furthermore, the NIOSH review showed that higher incidences of neck and shoulder aches are due to poor posture.
In addition, an increase in the percentage of upper-limb pain, headache, and low backaches was reported in 2019 survey. A maximum increase of 36% was observed in upper-limb pain, which could be collaborated to the fact that during the same study period, there has been a 55% increase in mobile users from 2013 (524.9 million) to 2019 (813.2 million) in India. Studies on effects of handheld device use on the musculoskeletal system have shown an increase in upper-limb pain, headaches, and neck pains., These findings can be correlated with a review of epidemiological studies that focused on WRMSDs or CTDs of neck and upper limb that concluded high work demands and low decision control in workplace can also contribute to or exacerbate neck and upper-limb symptoms., The study by Mohan et al., Bangalore, in 2019 also gave risk factors (other than physical factors) for the development of upper-limb and neck CTDs in computer users as psychological demands, low social support, high job demands, and less break time at workplace.
Furthermore, as the duration of computer use was analyzed, three groups were made on the basis of duration of their computer use. It was found that the percentage of computer users affected with low backache was found to have increased with an increase in the duration of computer use, similar to the findings of Khan and Siddiqui study in 2005. In 2019, 34% of computer users with neck pain belonged to Group III, similar to the finding of the study by Khan and Faizan, Nagpur, in 2016, where authors suggested that these findings could be due to static loading and repetitive movements of neck muscles, or few faulty ergonomics – forward neck posture while reaching mouse, too low monitor, and leaning forward to operate computer.
The findings of review study and correlational result [Table 2] of no significant correlation between duration of computer use and pain severity suggest that there is a need for in-depth study of psychosocial factors that cause CTDs in computer users and CTDs due to collaborative use of handheld devices and computers. This study showed no statistical significance in number of computer users affected to the duration of computer use [Table 3], suggesting that the duration of computer use was not a major contributing factor for CTDs in computer users, but other factors such as psychosocial and ergonomic computer workstation should be analyzed for affectations.
Limitations and Suggestions for Future Studies
The study sample size is comparatively small in both surveys, and hence, a generalization of results with caution is advised. For further research, an in-depth study of psychosocial factors and computer workstation analysis as factors contributing to CTDs should be done. Furthermore, collaborative impact of handheld device use and computers on the upper-limb CTDs should be studied.
| Conclusion|| |
The comparison of 2009 versus 2019 surveys showed changes in the percentage of computer users affected with CTDs. There was an overall decrease in the percentage of computer users affected with CTDs in 2019 than in 2009. There was a sharp increase in the percentage of computer users affected with headaches and upper-limb pain. The percentage of computer users with upper-back pain showed a decreasing trend. The percentage of computer users affected with neck pain, backache, and eye strain was higher than the percentage of CTDs in other areas in both the surveys. Thus, there is a need for the development of a highly proactive CTD prevention program and to be implemented at a larger scale. As the current generation's computer use even for educational purposes has increased, inclusion of ergonomic awareness education programs for computer use in higher education curriculum is recommended. Furthermore, the duration of computer use did not show a significant correlation to the presence of CTDs among computer users in both surveys.
Sincere gratitude and thanks to all participants for showing enthusiasm to participate in the survey. Special thanks to God and our dear parents, our friends, teachers, and colleagues for constant unconditional support, motivation, and guidance throughout the study.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
| References|| |
Desai A, Shah S. Screening and early intervention of cumulative trauma disorders in computer operators. Indian J Occup Ther 2004;36:41-45.
Haartz JC, Sweeney MH. Work-related musculoskeletal disorders: Prevention and intervention research at NIOSH. In: Cumulative Trauma Disorders in the Workplace Bibliography. Cincinnati, Ohio: US Department of Health & Human Services, Centre of Disease Control; 1995. p. 11-19.
Nadler S, Nadler JW. Cumulative trauma disorders. In: DeLisa JA, Gans BM, editors. Rehabilitation Medicine: Principles and Practices. 3rd
ed. Philadelphia: Lipponcott Raven; 1998. p. 1661-1673.
Goodman G, Kovach L, Fisher A, Elsesser E, Bobinski D, Hansen J. Effective interventions for cumulative trauma disorders of the upper extremity in computer users: Practice models based on systematic review. Work 2012;42:153-172.
Basu R, Dasgupta A, Ghosal G. Musculo-skeletal disorders among video display terminal users: A cross-sectional study in a software company, Kolkata. J Clin Diagn Res 2014;8:JC01-JC04.
Oha K, Animägi L, Pääsuke M, Coggon D, Merisalu E. Individual and work-related risk factors for musculoskeletal pain: A cross-sectional study among Estonian computer users. BMC Musculoskelet Disord 2014;15:181.
Borhany T, Shahid E, Siddiqui WA, Ali H. Musculoskeletal problems in frequent computer and internet users. J Family Med Prim Care 2018;7:337-339.
] [Full text]
Gerr F, Monteilh CP, Marcus M. Keyboard use and musculoskeletal outcomes among computer users. J Occup Rehabil 2006;16:265-277.
Sigmund E, Bad'ura P, Sigmundova D, Csmey L, Kalman M. Methodological aspects of trend studies and development of the HBSC study in the czech republic. Cent Eur J Public Health 2017;25:S4-S9.
Ostendorf JS, Rogers B, Bertsche PK. Ergonomics: CTD management evaluation tool. AAOHN J 2000;48:17-24.
Sheryl S, Ulin MS, Armstrong TJ. Analysis and design of jobs for control of work-related upper limb musculoskeletal disorders. In: Rehabilitation of the Hand and Upper Extremity. 6th
ed. Philadelphia: Elsevier Mosby; 2011. p. 1810.
Haefeli M, Elfering A. Pain assessment. Eur Spine J 2006;15 Suppl 1:S17-S24.
Couper MP, Tourangeau R, Conrad FG, Singer E. Evaluating the effectiveness of visual analog scales- A web experiment. Soc Sci Comput Rev 2006;24:227-245.
Khan R, Surti A, Rehman R, Ali U. Knowledge and practices of ergonomics in computer users. J Pak Med Assoc 2012;62:213-217.
Shantakumari N, Eldeed RA, Sreedharan J, Gopal K. Awareness and practice of computer ergonomics among university students. Int J Med Health Sci 2012;1:15-20.
Talwar R, Kapoor R, Puri K, Bansal K, Singh S. A study of visual and musculoskeletal health disorders among computer professionals in NCR Delhi. Indian J Community Med 2009;34:326-328.
] [Full text]
McMahan S, Lutz R. Computer use, workstation design training and cumulative trauma disorders in college students. Californian J Health Promotion 2004;1:38-46.
Barr AE. Approach to management of work-related musculoskeletal disorders. In: Rehabilitation of the Hand and Upper Extremity. 6th
ed. Philadelphia: Elsevier Mosby; 2011. p. 1782.
Sharan D, Mohandoss M, Ranganathan R, Jose J. Musculoskeletal disorders of upper-extremity due to extensive use of hand-held devices. Ann Occupat Environ Med 2014;26:22.
Chia SE, Chia HP, Tan JS. Prevalence of headaches among handheld cellular telephone users in Singapore: A community study. Environ Health Perspect 2000;108:1059-1062.
Mohan V, Inbaraj LR, George CE, Norman G. Prevalence of complaints of arm, neck, and shoulders among computer professionals in Bangalore: A cross-sectional study. J Family Med Prim Care 2019;8:171-177.
] [Full text]
Khan MY, Siddiqui MA. Prevalence of low back pain in computer-users. Pak J Med Sci 2005;21:159-163.
Khan AS, Faizan M. Neck-pain in computer-users. Panacea J Med Sci 2016;6:88-91.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]