|Year : 2021 | Volume
| Issue : 2 | Page : 82-89
Association of complaints of arm, neck, and shoulders with physical and psychosocial risks factors among computer users of Nigerian bank employees
BA Tella1, AM Akinfeleye2, SN Oghumu3, AR Adeleye1
1 Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
2 Department of Physiotherapy, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
3 Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos; Department of Physiotherapy, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
|Date of Submission||06-Aug-2020|
|Date of Decision||12-Jan-2021|
|Date of Acceptance||02-Feb-2021|
|Date of Web Publication||25-May-2021|
Dr. S N Oghumu
Department of Physiotherapy, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar
Source of Support: None, Conflict of Interest: None
Background: Complaints of arm, neck, and shoulders (CANS) affects millions of computer users and are thought to be associated with physical and psychosocial risk factors. Assessing the risk factors of these complaints are imperatives for preventive measures in enhancing the effectiveness of clinical interventions, hence this study. Materials and Methods: A cross-sectional survey was conducted among 260 bankers whose major work task involved the use of desktop computers in Surulere Local Government Area, Lagos, Nigeria. Maastricht Upper Extremity Questionnaire (MUEQ) was used to collect the data. The MUEQ contains 95-item in seven main domains assessing physical and psychosocial risk factors with regards to work stations, posture during work, quality of break time, job demands, job control, and social supports. It also asked questions about the quality of the work environments and the occurrence of CANS. Data were summarized using descriptive statistics of frequencies and percentages, while Chi-square statistic tested the association of CANS with physical and psychosocial risk factors at a significance level of P ≤ 0.05. Results: A 70% 1 year prevalence rate of CANS was obtained. Poor body posture was significantly associated with the complaints of shoulder, arm, and elbow (P < 0.05). High job demand was significantly associated with the complaints of the shoulder and lower arm (P < 0.05), while poor work environment was significantly associated with the occurrence of CANS (P < 0.05). Conclusion: Physical and psychosocial risk factors of body posture, job demand, and work environment are associated with the prevalence of CANS among Nigerian bank employees.
Keywords: Computer use, mechanical factors, musculoskeletal discomfort, psychosocial factors
|How to cite this article:|
Tella B A, Akinfeleye A M, Oghumu S N, Adeleye A R. Association of complaints of arm, neck, and shoulders with physical and psychosocial risks factors among computer users of Nigerian bank employees. J Int Soc Phys Rehabil Med 2021;4:82-9
|How to cite this URL:|
Tella B A, Akinfeleye A M, Oghumu S N, Adeleye A R. Association of complaints of arm, neck, and shoulders with physical and psychosocial risks factors among computer users of Nigerian bank employees. J Int Soc Phys Rehabil Med [serial online] 2021 [cited 2021 Sep 17];4:82-9. Available from: https://www.jisprm.org/text.asp?2021/4/2/82/316910
| Introduction|| |
Complaints of arm, neck, and shoulder (CANS) are myriads of nonacute and nonsystemic musculoskeletal complaints of the neck and upper extremity with contingent time severity of symptoms in clinical presentation.,, It affects millions of computer users with grave economic and productivity impacts on individuals and establishments.,,
A universally accepted definition of CANS developed by a Delphi consensus strategy is musculoskeletal complaints of arm, neck, and/or shoulder not caused by acute trauma or by any systemic disease.,, Data from all over the world, especially from developed countries, have been collected and studies have shown that a large group of office workers might be at risk for CANS., In developing countries, such as Nigeria, Sudan, and Sri Lanka, an increase in the number of computer users due to rapid industrialization and telecommunication drive has led to an upsurge in complaints of musculoskeletal pain.,,,
These complaints are reported to be multi-factorial in origin adduced to work-related and psychosocial risk factors which are dependent on individual and work settings variability., Among computer users, previous studies have shown that repetitive movements, awkward posture, positional time durations in the use of computers are work-related risk factors associated with the provocation of CANS, while gender, work time deprivation, insatiable work life, and lack of supports are psychosocial risk factors associated with the development of CANS.,,, Modern banking jobs rely heavily on the use of computers which necessitates the bankers repeated motion of the neck, arm, elbows, wrist, and fingers for data input and output of a variety of transactions., Hence, bankers are reported to be prone to work-related musculoskeletal pain.,,,
However, few studies had explored the prevalence of CANS and its association with risk factors among bankers.,,, In addition, studies on the association between the development of musculoskeletal pain and the use of computers by bankers are conflicting. In contrast to report of a significant association between work-related musculoskeletal pain and computer use among bankers,,,, one study observed no significant association between CANS and computer use among Turkish bankers. Both ergonomic and psychosocial factors are implicated in CANS among computer users.,
Although physical, ergonomic, and psychosocial risk factors of CANS have been studied among bankers, such reports relate more to bankers in the developed countries than the developing ones. The current belief asserts that in contextual terms, working conditions in the banking sectors of developed and developing countries differ in cultures, regulation, work settings, and style of management; thus suggesting differences in bio-psychosocial risk factors in the organizational atmospheres of the two worlds. Therefore, this study explored the prevalence of CANS, the predominance of bio-psychosocial risk factors and ultimately the association between these risk factors and CANS among computer users of Nigerian bank employees.
| Materials and Methods|| |
A cross-sectional analytical survey was conducted between November 2018 and January 2019 among 260 bankers aged 21–52 years in Surulere Local Government Area of Lagos State, Nigeria. A sample of convenience was used to recruit participants from all banks in Surulere Local Government. Sample size estimation was based on the prevalence rate of a previous study using the formula n = Z2 pq ÷ d2. Where n = minimum sample size required, Z = standard normal deviate at 95% confidence interval set at 1.96, P = proportion in target population estimated to have the particular characteristics of interest = 0.79 (previous prevalence rate of 79%), q = 1-p = 1–0.79 = 0.21, d = error of margin set at 0.05. Thus, n = 1.962 × 0.79 × 0.21 ÷ 0.052 = 255. However, a 35% drop out was estimated yielding n = 344. Inclusion criteria were bankers whose major task involved the use of desktop computers, with more than 1 year working experience, with a history of complaint of arms, neck and shoulder managed by surgical or nonsurgical interventions such as the use of medications and physical therapy. Bankers who did not meet the inclusion criteria were excluded from the study. The Health Research and Ethics Committee of a Nigerian University Teaching Hospital gave approval (ADM/DCST/HREC/APP/341) for this study. In addition, approval was obtained from the management of the selected banks and informed consents of all participants were obtained prior to participation.
The research instrument was the Maastricht Upper Extremity Questionnaire (MUEQ). Permission to use the MUEQ was sought and obtained by mail from the authors. The MUEQ consists of 95 questions for which completion time is approximately 20 min. The questionnaire covers the socio-demographic characteristics (age, gender, and employment status), as well as six other domains: Work stations, posture during work, quality of break time, job demands, job control, and social supports. In addition, a number of items assessed the quality of the work environments and the frequency and nature of extremity complaints in the neck, shoulder, upper arm, elbow, lower arm, wrist, and hand. Furthermore, several items specified the clinical manifestations of the complaint such as tingling, numbness, weakness, swelling, stiffness, fatigue, continuous pain, and change in skin color or temperature. The complaint cases were identified as participants who had complaints in their upper extremity body region for a minimal duration of 1 week during the preceding 12 months. All items were rephrased as statements in either a five-point scale (always-never) or a dichotomous statement (yes-no).
After a proper explanation of the objectives of the study to the participants, a total of 337 copies of the questionnaire were distributed to various banks in Surulere Local Government Area of Lagos State, Nigeria, that satisfied the criteria for the study, and the completed copies were retrieved. Data were analyzed using Statistical Package of Social Sciences (SPSS) Statistics for Windows, Version 17.0. Chicago, Illinois, United States: SPSS Inc. and summarized using descriptive statistics of mean, standard deviation, frequencies, and percentages. Inferential statistics of Chi-Square tested the association among the variables and level of significance was set at P ≤ 0.05.
| Results|| |
Two hundred and sixty copies of the questionnaire were completed and returned out of the 337 distributed copies yielding a response rate of 77.2%. One hundred and forty-two (54.6%) of the respondents were female, while 118 (45.4%) were male. The mean age of the respondents was 29.82 ± 5.40 years. Majority (175, 67.3%) of the respondents were aged 21–30 years [Table 1]. The current positions of respondents are presented in [Table 1]. Two hundred and fifteen (82.7%) respondents had worked in their current position for 1–5 years, while 1 (0.4%) respondent had worked for >15 years as shown in [Table 1]. Two hundred and thirty eight (91.5%) respondents reported working 5 days weekly, 16 (6.2%) respondents reported working 6 days weekly, and 6 (2.3%) respondents worked 7 days weekly. One hundred and seventy-six (67.7%) respondents worked between 0 and 10 h daily, while 84 (32.3%) respondents worked > 10 h daily. One hundred and fifteen (44.2%) respondents worked 4–8 h behind the computer daily, while 145 (55.8%) respondents worked 9–16 h behind the computer [Table 1].
|Table 1: Sociodemographic characteristics and work profile of the respondents|
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Prevalence rates of CANS during the past 12-month are presented in [Table 2]. The result indicated that 182 (70%) respondents reported at least one complaint in the arm, neck, and shoulder, while 102 (39.2%) respondents reported at least one complaint in any upper musculoskeletal extremity which represented the neck, shoulder, hand, wrist, arm, and elbow. The most commonly reported complaints were symptoms of the neck (131, 50.4%) and the shoulder (124, 47.7%) followed by wrist complaints (87, 33.5%), hand complaints (85, 32.7%), upper arm complaints (77, 29.6%), lower arm complaints (46, 17.7%), and the least being elbow complaints (45, 17.3%). According to the distribution of complaints by anatomical locality, respondents reported higher complaints on both sides for the shoulder, elbow, and hand than complaints localized on either side.
|Table 2: One year prevalence and time course of management for complaints of arm, neck, and shoulders|
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However, there were exceptions in the report of upper arm and wrist complaints as respondents indicated higher complaints localized on their right sides [Table 2]. Very few respondents reported the longest period (more than 3 weeks) of complaints in the past 1 year. Twenty (7.7%) respondents received physiotherapy treatment, 74 (28.5%) received medications and 2 (0.8%) underwent surgery. During the past year, 27 (10.4%) respondents had been referred to the physician, 6 (2.3%) respondents had lost their jobs, 38 (14.6%) respondents reported being absent from work [Table 2]. Forty (15.4%) respondents reported that CANS hinder their work, while 43 (16.5%) respondents reported that upper extremity complaints were a hindrance to their leisure [Table 2].
One hundred respondents (38.5%) reportedly felt pain in their upper extremity immediately after work. Concerning reports on upper extremity musculoskeletal complaints generally, 101 (38.8%) respondents reported fatigue and exhaustion, 73 (28%) respondents reported stiffness in their fingers and 57 (21.9%) respondents reported tingling in their fingers, while 13 (5.0%) respondents suffered from swelling in their hands. Some respondents reported disappearance of these complaints awhile after activity, while others reported persistence of these complaints awhile after activity [Table 3]. On strategies adopted by respondents for pain reduction, 35 (13.5%) use mouse pads, file holders, foot supporters to reduce their pain, while 12 (4.6%) use neck collars to reduce their pain. The predominance of physical and psychosocial risk factors among respondents showed that 96 (36.9%) respondents had poor work posture, 252 respondents reported poor job control, 133 (51.2%) respondents reported poor job demands, 150 (57.7%) reported poor break time, 132 (50.8%) respondents had poor work environment, while 15 (5.8%) had poor social support [Table 3].
|Table 3: Rate of Symptoms and risk factors of complaints of arm, neck, and shoulders among respondents|
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Chi-square analysis showed that there was a significant association between poor body posture and the presence of complaints of the shoulder, upper arm, elbow, and lower arm (P < 0.05) [Table 4]. In addition, Chi-square analysis showed that there was a significant association between poor job demand and the presence of shoulder and lower arm complaints (P < 0.05) [Table 5]. There was no significant association between poor break time and the presence of upper musculoskeletal complaints [Table 6]. A significant association was however observed between poor work environment and the presence of complaints of the neck, shoulder, lower arm, and wrists (P < 0.05) [Table 7]. There was no significant association between social support and the presence of upper musculoskeletal complaints (P > 0.05) [Table 8].
|Table 7: Association between respondents complaints and poor work environment|
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| Discussion|| |
This study investigated the association between CANS and the bio-psychosocial risk factors among bankers who use desktop computers at work in Surulere Local Government Area of Lagos State, Nigeria. Majority of the respondents were aged 21–30 years, worked as teller and customer care officers, and spent at least 9 h on the computer each day of the 5 working days of the week with a minimum of 4 h working on the computer. This result is not unexpected as it corroborates the report that bankers in developing country like Ghana work assiduously in competitive manner to meet the turnover demand pressured on them by their Government, hence, workforce profile cannot be any different from bankers in Nigeria who may even have higher turnover demand with a more demanding work profile as revealed in this study.
In the past 1 year, this study found the highest prevalence of complaints in the neck; followed by the shoulder, wrist, and the hand. This finding is in tandem with previous studies which found a higher prevalence in the neck than any region of the upper quarter of the body.,,, It is reported that CANS are associated with more than 5 h use of computers per day, as evident by the 70% prevalence of CANS observed among respondents of this study with a range of 4–9 h time spent on the computer. This may be as a result of forward head flexion for a long period of hours causing overuse of neck muscles, affecting changes in the muscular responses and passive structures of the cervical spine. A previous study showed that holding the neck in a bent posture and working in the same posture for prolonged periods of time were both significantly associated with neck pain. However, the prevalence rate obtained in this study is lower compared to those of the previous studies.,,, One major difference between this study and the previous studies is that of the study population, majority of the previous studies were not conducted among bankers who use computers. Risk factors for CANS are a combination of physical factors and occupational related factors. Although one of the previous studies was conducted in the same population as this study about 11 years ago, the lower prevalence rate obtained in this study reveals a 24% decrease in prevalence rate of CANS among bankers in Surulere, Lagos over a period of a decade. This might be accrued from a decade long increased modification of potential risk factors among the studied population. In addition, based on the anatomical localization, complaints on the right side were higher than that of the left side. This supports the findings of Ranasinghe et al., that complaints of the right upper extremity were reported more frequently than those on the left extremity. Ranasinghe et al. opined that upper extremity dominance had an involvement in the localization of CANS.
In addition, this study found that in terms of chronicity of symptoms, majority of the respondents reported acutely (<2 weeks) presenting CANS. Very few respondents reported subacute (<3 months) presentation of CANS. This corroborates the findings of Bruls et al., who reported that majority of their participants with <3 months of CANS experienced a decline in severity within the first 6 weeks. Similarly, it had been observed that majority of individuals presenting with CANS showed quick relief from complaints within a short time. Furthermore, our study observed that majority of respondents' symptoms disappear awhile after activity which echoes the work-related nature of CANS and musculoskeletal connection in its etiology.
Majority of the respondents of this survey had prescribed medications for treatment, while few received physiotherapy. This suggests that physiotherapy services had low referral compared to physician services among the respondents of this study. The management of CANS is thought to consist of an initial analgesic prescription and then a referral for physiotherapy. Thus, more awareness is needed especially in the study population for the role of physiotherapy in the management of CANS among physicians and individuals with CANS. Furthermore, respondents in this study reported the consequence of CANS to include absence from work, hindrance from work, and hindrance from leisure; which corroborates the reports of previous studies., Thus, apart from the health consequences of complaints of arm, neck, and shoulder, their effects may also translate to huge economic burden to the individual and their establishments including the entire society because of reduction in productivity.
Again, this study showed that more than half of the respondents reported high job demand, poor work environment, and lack of time for a break. These findings are reflections of the predominance of psychosocial risk factors among the studied population. Conversely, more than a third of the respondents reported poor posture at work which indicates that respondents were not ergonomically compliant with their work. The consequences of these risk factors were absence from work and lack of job satisfaction as reported by respondents in this study which also corroborates the reports of previous studies., However, despite the presence of psychosocial risk factors among respondents, they reported experiencing high social support. This finding corroborates the report that workers especially in the banking sector experience good social support from their organization and co-staff as compensatory measures for stress induced by poor working environment and high job demand. Nevertheless, this study found support for the association between work postures and the development of complaints of shoulder, upper arm, elbow, and lower arm. This finding is consistent with the report that working with lifted shoulders and performing repetitive tasks were significantly associated with CANS. Similarly, complaints of shoulder and lower arms were significantly associated with job demand among the respondents in this study. This may be connected with the increased use of the shoulder and forearm of the upper extremity lever for a variety of job demand. Furthermore, the results indicated that work environment was the strongest predictor for CANS symptoms as it was significantly associated with complaints of neck, shoulder, lower arm, and the wrist. That work environment is the strongest predictor for CANS in this study is at variance with the report of Eltayeb et al., that job demands were the strongest predictor for CANS symptoms among their respondents.
However, a major limitation to our study is that reports of complaints might have been biased due to the fact that respondents had to report complaints that occurred in the past 12 months which might have introduced recall bias. In addition, this study was not concerned with the current state of respondents' CANS and thus data was not sought on respondents' complaints from the beginning to the completion of the study. Furthermore, respondents' selection of consequences and treatments of CANS in this study may be biased especially as data were not sought from them on the combination of consequences and treatments of CANS. Thus, further studies on the prevalence and pattern of CANS among bankers in Nigeria should endeavor to incorporate combination of consequences and treatments administered for CANS in data collection. Finally, this study is delimited to Nigerian bankers who use desktop computers; hence findings in this study may not be applicable to bankers who use laptops for transactions.
| Conclusion|| |
This study has been able to ascertain that CANS is prevalent in bankers whose major work task is with the use of desktop computers, it is higher in females than in male with most complaints on both sides rather than on either side, and it provides further evidence that physical and psychosocial risk factors have important associations with CANS.
The knowledge of the presence of both physical and psychosocial risk factors of CANS gained through the use of the MUEQ should be employed to create preventive strategies to improve bankers efficiency in the use of computers, inform institutional bodies such as banks of proper workstation ergonomics and psychosocial demands of work, while health professionals should avail themselves with the use of the MUEQ as a research tool for both analytical and comprehensive approach of complaints of the upper quadrant of the body. In the concept of preventive rehabilitation, the role and scope of expertise of the physiotherapists must be enlarged in providing advice and education towards proper ergonomics. Review of work stations designs should be conducted routinely especially among computer users of institutions to suit old employees and also employed as part of assessments for new employees to reduce the prevalence of CANS. Furthermore, intervention to reduce CANS should target worksite psychosocial variables as observed in this study.
Implication for further study
It is recommended that more research should be channeled to this area in other populations apart from those with established studies, and further studies on different interventional models are required to develop an effective preventive strategy for this relatively common and underestimated problem.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]