key: cord-0847362-jtrak6gm
authors: McAllister, Megan J.; Costigan, Patrick A.; Davies, Joshua P.; Diesbourg, Tara L.
title: The effect of training and workstation adjustability on teleworker discomfort during the COVID-19 pandemic
date: 2022-03-22
journal: Appl Ergon
DOI: 10.1016/j.apergo.2022.103749
sha: d74ce75e467d1195ce148dc5a4f89ffd44fa8ca5
doc_id: 847362
cord_uid: jtrak6gm

Technological advancements have increased occupational flexibility for employees and employers alike. However, while effective telework requires planning, the COVID-19 pandemic required many employees to quickly shift to working from home without ensuring that the requirements for telework were in place. This study evaluated the transition to telework on university faculty and staff and investigated the effect of one's telework setup and ergonomics training on work-related discomfort in the at-home environment. Fifty-one percent of respondents reported increases in their existing discomfort while 24% reported new discomfort since working from home. These results suggest a need for ergonomic interventions including ergonomic training and individual ergonomic assessments for those who work from home.

Highlights 11

• This study surveyed university faculty and staff about their physical discomfort since 12 working from home 13

• Almost two-thirds of survey respondents (65%) spent more time at the computer and over 14 half of survey respondents (53%) changed their working position less frequently 15

Introduction 32

Technological advancements such as the proliferation of portable devices (e.g., laptops, 33 tablets) and the maturation of conferencing software have made telework a viable option to 34 increase occupational flexibility for employees and employers alike (Montreuil and Lippel, 35 2003) . The term telework describes work done from home or another remote location that uses 36 technologies to link work done remotely with that done at the central organization (Nilles, 1994 ; 37 Olson, 1981; Pinsonneault and Boisvert, 2001) . The increases in telework opportunities and the 38 number of individuals working remotely have prompted the need for research on telework 39 ergonomics to better understand the conditions that exist in telework settings and the needs of 40 teleworkers. 41

Researchers studying the benefits of telework and flexible work arrangements report that 42 voluntary telework, employer support, and proper workstation setups are the keys to its success. 43

The most important of these is that telework should be voluntary (Åborg et needed to set up their home workstation properly. This could mean that general ergonomic 120 training may be more helpful for workers than workstation-specific training, as such training 121 prepares workers for unforeseen circumstances, such as the COVID-19 pandemic when 122 ergonomists were not readily available to help workers with their home office workstations. 123

Ensuring that workers are provided with the general knowledge necessary to properly set up their 124 home workstation is an important first step; however, it is equally important to adapt ergonomic 125 services so that they may be offered virtually. created specifically to evaluate office work (Sonne, et al., 2012) . Similar to RULA, ROSA is a 133 scoring system based on body positioning; however, it also evaluates how the individual interacts 134 with their office equipment. Moreover, ROSA scores are positively correlated with 135 musculoskeletal discomfort (Sonne et al., 2012) and have good inter-observer reliability (Sonne 136 et al., 2012) . Simple observational analysis tools such as RULA and ROSA could be used by 137 ergonomists to evaluate a workstation virtually, although they would require photos of the 138 employee interacting with their workstation. Requiring photos introduces the potential for error 139 in the evaluation process as joint angles and body positions may be misrepresented due to an 140 J o u r n a l P r e -p r o o f incorrect viewing angle. These types of analyses are also time-consuming and inefficient. In a 141 situation such as that caused by COVID-19, where a large proportion of employees suddenly 142 began working from home, it is imperative to quickly identify ergonomic issues. Therefore, the 143 methods discussed above are inadequate. Another limitation is that these observational analysis 144 tools focus only on posture at one moment in time and do not consider factors such as workflow 145 and psychosocial demands of a job. Self-report techniques, including surveys by Blake and 146 Taylor (2021), allow for data to be collected that evaluate both the physical and psychosocial 147 demands of a job (David, 2005) . 148

In this study, we used a survey to evaluate the transition to telework on university faculty 149 and staff. We investigated the effect of ergonomics training on one's home office workstation 150 setup and the combined effectiveness of ergonomics training and workstation setup at mitigating 151 work-related discomfort in the at-home work environment. We also evaluated the feasibility of 152 using a survey, without any accompanying assessment (virtual or in-person), to have clients self-153 report the office equipment available to them. We hypothesized that workstations that were set 154 up according to ergonomic best practices and allowed for the most adjustability would be 155 associated with lower levels of reported discomfort. We also hypothesized that those workers 156 who had received ergonomic assessments and training on-campus would have improved home 157 office workstations and would experience less discomfort as a result. 158 They selected all that applied and added any extra features that were not included. 169

The next part of the survey focused on perceived discomfort while working. Participants 170 were shown a discomfort map with 23 body regions highlighted (Fig. 1A) and were asked to 171 select all the areas where they experience discomfort while working from home. For all the 172 regions where they indicated that they experience discomfort, they quantified that discomfort on 173 a scale from "No discomfort at all" to "Worst discomfort imaginable". They were asked to 174 quantify the degree of discomfort for the time before they started working from home (pre-175 pandemic) and for how they felt currently while working from home. Respondents selected all the areas where they experience discomfort while working from home. 179 B) For analysis, discomfort areas were defined for three regions: arm (purple), neck (blue), and 180 back (orange). (One-column fitting image) 181 182 Furthermore, we wanted to assess respondents' ergonomics knowledge to determine if it 183 was related to the quality of their home office workstation setup. They provided information 184 about any ergonomics training they received including the format in which this training took 185 place (e.g., online vs. in-person) and how this training came to be (e.g., initiated by employer vs. 186 self-directed). 187

Lastly, the survey asked questions related to psychosocial risk factors and demands 188 imposed by their living situation (e.g., number of people in the house, number of pets, 189 availability of a separate home office space…). While not a focus of the current paper, data 190 pertaining to these psychosocial risk factors were collected and their analysis will be detailed in a 191 subsequent paper. 192

Prior to beginning the study, the General Research Ethics Board at Queen's University 194 and the Oakland University Institutional Review Board reviewed and approved all elements of 195 the study, including the recruitment materials and the survey questions. 196

Study participants were all staff, faculty, and administration at Queen's University, a 198 large university that provides comprehensive ergonomic consulting services to all employees on 199 campus. We sent recruitment emails to the administrative assistants in all departments, asking 200 them to forward the email to their faculty and staff. All university employees who worked at 201 least part-time at a computer workstation and had been required to work from home during the 202 COVID-19 pandemic were invited to participate in this study. Employees who did not work at 203 computers for at least half of their workday were not recruited for this study. In total, 131 204 participants completed the survey and were included in the analysis. 205

All participants who completed the survey and provided their email address were entered 206 into a draw to win a $50 gift card to be used at local businesses. 207

As this study aimed to assess the chronic effects of the telework situation imposed by the 209 COVID-19 pandemic, we waited one full year after employees were originally forced to 210 transition to teleworking before distributing the survey. At that point, very few employees had 211 returned to their on-campus offices with the vast majority having settled into this "new normal". 212

Those who did return to their on-campus offices were doing so sporadically, as the campus was 213 not yet fully operational. This delay in distributing the survey ensured that any equipment that 214 would have been purchased/provided by the organization would have already been in place and 215 any policies surrounding expectations for working from home would have already been 216 developed. 217

J o u r n a l P r e -p r o o f As this study was developed in part to evaluate whether assessments of workstation 220 quality could be completed using a survey, a novel scoring system to represent workstation 221 quality was created. We had originally intended to develop our scoring system based on a 222 previously validated "Work Environment and Health (WEH) survey" that assesses the 223 adjustability of the workstation and its elements (Robertson et al., 2009 ). However, the specific 224 details of that analysis were not available, therefore we designed a tool for assessing the work 225 environment based on our understanding of what had been completed in that study and our 226 combined 20+ years of experience in assessing individual office workstations. In the survey we 227 provided a list of equipment and workstation configurations instructing respondents to "Select all 228 that apply". The options presented to participants are shown in Table 1 . 229 

We used the workstation elements listed in the survey to calculate a workstation score 231 based on the expected effect of the equipment on the user's posture. For example, a workstation 232 with a monitor, mouse, and keyboard would promote a better posture than a workstation with a 233 laptop alone. Likewise, a workstation with an adjustable office chair or a height-adjustable desk 234 would be considered an improvement over a workstation on a dining room table using a non-235 adjustable chair. As such, a workstation consisting of an office chair, a monitor, a keyboard, and 236 a mouse received a categorical score of 0 and was considered a baseline computer workstation 237 setup. A workstation consisting of less equipment than this baseline setup (i.e., working directly 238 on a laptop with no external keyboard or mouse or sitting on a non-adjustable dining room chair) 239 received a categorical score of -1. Conversely, a workstation consisting of more equipment than 240 the baseline setup (i.e., a height-adjustable desk or an additional monitor) received a categorical 241 score of +1. Of note, we initially implemented a weighted score to each element based on their 242 potential influence, where a score of 1 would be minimally influential and a score of 3 would be 243 maximally influential. However, we could not be certain that these elements were used properly 244 by the survey respondents and ultimately decided to remove the weighting of different elements. 245

We categorized data from the discomfort map into three key body regions that are the (Fig. 1B) . Respondents reporting discomfort in these 249 three body regions were then further subdivided into groups according to whether that 250 discomfort was new (discomfort did not exist before beginning to work from home), or 251 worsening (discomfort has worsened since beginning to work from home). We used a clinically 252 relevant threshold of +/-15 to indicate whether discomfort had increased or decreased, which is a 253 conservative value compared to those used in acute (Li et al., 2001; Todd et al., 1996) and 254 chronic settings (Tashjian et al., 2009; Wolfe and Michaud, 2007) . 255

Participants were grouped according to the type of ergonomics training they had 257 received. Anyone who received individualized or group-based ergonomics training and 258 assessments from an experienced professional was classified into the "In-person" group, those 259 who completed self-directed online searches (virtual webinars, ergonomics "tip sheets", general 260 "how-to" articles, and other such informational products) were classified into the "Online" group 261 and those having no training were placed into the "No training" group. 262

To test the association between workstation score, ergonomics training, and new and 264 worsening discomfort, we conducted a total of six loglinear analyses (new discomfort for arm, 265 neck, and back, and worsening discomfort for arm, neck, and back). A three-dimensional cross-266 table was obtained according to workstation score (poor = -1, baseline = 0, improved = 1), 267 ergonomic training (no training = 0, online self-directed = 1, in-person = 2), and new/worsening 268 discomfort in each of the three body regions (no = 0, yes = 1). We used backward elimination 269 with a significance of p<0.05 to identify which terms would be included in the final model. 270

Therefore, in our three-way model, we tested the significance of the main effect terms 271 (workstation score, ergonomic training, discomfort), two-way interactions between two of the 272 main effect terms, and the three-way interaction between all three main effect terms. 273

Results 274

We conducted our analysis on all 131 survey respondents. Of these respondents, 101 276 identified as females, 29 identified as males, and one preferred not to disclose; with the largest 277 proportion of respondents falling within the 35-44 years age range. We found that working 278 conditions worsened when working from home. Most respondents (71.0%) reported working 279 their usual 30-40 hours per week ( Fig. 2A) ; however, 64.9% of respondents reported that the 280 amount of time spent at the computer had increased since working from home, while only 3.1% 281 of respondents reported that the amount of time spent at the computer has decreased since 282 working from home ( Fig 2B) . Moreover, 53.4% of respondents reported changing positions less 283 frequently when working from home, while 17.6% reported no change, and 29.0% reported 284 changing positions more frequently since working from home ( Fig 2C) . In addition, most 285 respondents (51.9%) reported no change in the number of times they changed tasks (e.g., going 286 from computer to filing), while 22.1% reported changing tasks more frequently, and 26.0% 287 reported changing tasks less frequently (Fig. 2D) . 288 

A large proportion of respondents reported worsening and new discomfort since working 298 from home (Fig. 3) . In total, 51% of respondents reported worsening discomfort in one or more 299 regions: 34% reported worsening arm discomfort, 35% reported worsening neck discomfort, and 300 32% reported worsening back discomfort (Fig. 4) . Note that participants could report pain in 301 more than one region. Additionally, 24% of respondents reported new discomfort in one or more 302 regions: 18% reported new arm discomfort, 3% reported new neck discomfort, and 18% reported 303 new back discomfort. Only 7% of respondents reported an improvement in existing discomfort 304 since working from home: 3% reported improved arm discomfort, 5% reported improved neck 305 discomfort, and 3% reported improved back discomfort. (1.5-column fitting image) 313

Most respondents received a score of average (0) or better (1) for their workstation 316 equipment. A total of 28 respondents (21%) scored a -1, which is less adequate than a basic setup 317 that would have a height-adjustable office chair, monitor, keyboard, and mouse. Seventeen 318 respondents (13%) scored a 0, equivalent to a basic setup, and 86 respondents (65%) scored a 1, 319

indicative of an improved workstation setup. As for ergonomic training, 43.5% of respondents 320 reported no training, while 51.1% reported having received an in-person ergonomic assessment 321 and 5.4% reported online training (e.g., Google search). A correlation analysis revealed no 322 relationship (r = 0.13, p = 0.16) between training and workstation score. 323

The six three-way loglinear analyses produced a final model that retained only the main 324 effects of workstation score, ergonomic training, and discomfort (p < .001 for the one-way 325 interactions in all loglinear analyses, see Appendix 2 Table S1 ). There were no significant lower-326 order interactions between main effects (i.e., workstation score × discomfort, workstation score × 327 training, training × discomfort, and workstation score × training × discomfort); removing all 328 lower-order interactions did not affect how well the model fits the data (Appendix 2 Table S1 ). 329

Discussion 330

In the present study, we evaluated the effect of transitioning to telework on university 331 faculty and staff, the impact of ergonomics training on home office workstation setup, and the 332 combined effectiveness of ergonomics training and workstation setup at mitigating work-related 333 discomfort in the telework environment. In the telework environment, participants tended to 334 work at the computer longer and move less, which is intuitive as work that was typically 335 completed in-person (e.g., meetings, teaching, collaborative research), moved from physical 336 spaces to the screen. With telework, moving or changing positions requires conscious effort and 337 an understanding that movement reduces the risk of many musculoskeletal problems, which is 338 unlikely without proper training. 339

We found that transitioning to telework had a negative effect on university faculty and compounded. We recognize that the data presented here did not account for these psychosocial 361 risk factors and that some people may be more accepting of a work-from-home situation, which 362 may reduce their reported discomfort, while others, less satisfied with their work-from-home 363 situation, may report higher levels of discomfort. These important but complex interactions will 364 be discussed in another paper. 365 Furthermore, we found a positive but insignificant (p=0.08) association between 366 workstation score and ergonomic training, where workstation scores improved slightly as 367 ergonomic training increased from "No training" to "Online" to "In-person". Many studies have 368

shown that office ergonomics training reduces reported musculoskeletal discomfort among office was about an hour in duration, whereas online training was not as structured and highly variable 377 between respondents. Since we did not ask respondents to quantify the time spent completing 378 self-directed learning online, we cannot control for the effect of training duration on our results. 379

It is possible that the lack of any observed differences between training groups is due to the 380 variability in training quality or quantity between training groups and further research is 381 warranted. 382

Lastly, the three-way loglinear analyses between discomfort, workstation score, and 383 ergonomic training produced a final model that retained only the highest-order interactions 384 (discomfort × workstation score × ergonomic training; p < .001 for one-way interactions in all 385 loglinear analyses). There were no significant interactions between ergonomics training, 386 workstation score, and either new or increased discomfort for any body region. That we found no 387 significant two-way or three-way interactions may be due to the high variability of discomfort 388 scores and the relatively low number of respondents (n=131). Discomfort is subjective, so there 389 is some inherent variability when individuals rate their discomfort, especially when asked to 390 compare their current discomfort to their previous discomfort. However, discomfort scales have 391 been validated and continue to be the most accurate and reliable measure of one's discomfort 392 (Karcioglu et al., 2018) . We reduced the inter-individual variability by asking participants to rate 393 their discomfort before and after transitioning to telework and calculating the difference in their 394 discomfort scores. By using "change in discomfort", we normalized these scores using each 395 respondent as their own control. However, this normalization required that participants recall 396 their discomfort from months ago, which poses its own challenges. Unfortunately, the nature of 397 our research question did not allow for meaningful objective observationschange in discomfort 398 could only be assessed subjectively by the respondent. Although the discomfort ratings were 399 variable and subjective, the reporting of new and worsening discomfort (24% and 51%, 400 respectively) raises serious concern for the telework environment. 401

The telework environment varies from home to home and may not be an ideal suggesting that forced telework during the COVID-19 pandemic may be related to an increased 409 risk of work-related musculoskeletal disorders. In our study, only 7% of respondents reported an 410 improvement in discomfort since transitioning to telework. Perhaps even more alarming is that 411 24% of respondents reported new discomfort when working from home that they did not 412 experience when working at their office. Furthermore, more than half (51%) of the respondents 413 reported an increase in the severity of their pre-existing work-related discomfort since 414 transitioning to their telework environment. These alarming proportions suggest a need for 415 ergonomic interventions for those who work from home. 416

With telework being a potentially permanent solution for many employees (Barrero et al., 417 2021; Bick et al., 2020), we must develop more effective ergonomic standards and best practices 418 for employees working from home to help mitigate the influence of telework on reported 419 discomfort, especially for those with pre-existing musculoskeletal discomfort. As suggested by 420 Michael and Smith (2015) , telework should always be supported by workplace ergonomics 421 programs that provide training, conduct risk assessments, and alleviate potential risks of work-422 related musculoskeletal disorders. The most effective telework ergonomics program would 423 include three components: 1) an individualized assessment to uncover risks and provide solutions 424 to mitigate injury risk in the home office workstation 2) proper ergonomic office equipment for 425 the home office, and 3) a training component to provide employees with necessary ergonomics 426 knowledge about work practices and body positioning. Amick et al. (2003) found that workers 427 who received ergonomic training plus a highly adjustable office chair reduced musculoskeletal 428 symptoms over the workday. In comparison, simply adding an adjustable ergonomic office chair 429 while not providing training on its use and setup did not mitigate the musculoskeletal discomfort 430 (Amick et al., 2003) . As highlighted by our findings, these ergonomics training programs for 431 teleworkers should also emphasize the importance of taking breaks and/or changing position 432 every 30 minutes to help mitigate the risks associated with not changing position as frequently 433 while working from home (Davis & Kotowski, 2014) . Although individualized assessments may 434 not seem possible in a telework environment, Blake and Taylor recently validated an approach to 435 provide employees with virtual assessments (2021). Their proposed approach included three 436 parts: 1) a pre-assessment discomfort survey (much like the one we used in this study), 2) videos 437 of the employee working at their workstation, and 3) a live virtual assessment where the assessor 438 provides recommendations for improving the workstation (Blake and Taylor, 2021). Therefore, if 439 we could limit workstation variability by ensuring that everyone has a baseline workstation when 440 working from home (adjustable chair, mouse, keyboard, monitor) and provide training on 441 adjusting this workstation, we would expect a reduction in reported discomfort among 442 teleworkers. 443

Although we found a positive trend between ergonomics training and workstation scores, 444 we did not find any interactions between ergonomics training, workstation scores, and 445 discomfort. One reason may be that the survey and the workstation score did not assess the 446 interaction between the employee and their workstation. In our survey, we asked respondents to 447 select the equipment that was available in their home workstation. That we found no interaction 448 between workstation score and discomfort suggests that the mere availability of equipment does 449 not relate to one's comfort at their workstation. A more robust approach would be to develop a 450 framework that considers how well the equipment fits the employee and how they are using the 451 adjustable elements of their workstation. 452

In summary, employees working in a telework environment should be supported by an 453 ergonomics program that provides adjustable office equipment, necessary ergonomics training, 454 and a virtual assessment to ensure proper workstation setup. Future work should include the 455 development of a standardized telework package, such that any employee who transitions to 456 teleworking is provided the same set of adjustable ergonomic office equipment, the training 457 needed to adjust this equipment, and access to a trained ergonomist who can help address any 458 unique issues faced in setting up the equipment in the home office. Although it would be an 459 added cost for employers in the short term, implementing this type of program would standardize 460 home office setups such that discomfort is person-specific. Such a program could improve 461 employee morale and productivitybenefits that employers could use to justify the added cost 462 of implementing a progressive ergonomics program. However, it is important to note that this 463 system only works if all three elements are presenta sufficiently adjustable workstation, 464 appropriate training, and person-specific alterations are all needed. Without all three elements, 465 the discomfort might persist or even worsen when a worker transitions to a teleworking 466 arrangement. 467

Acknowledgments 468

We would like to thank employees from Queen's University for their time and 469 participation in our survey. 

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