key: cord-0895304-85dh40e3 authors: Miranda-Schaeubinger, Monica; Schwartz, Erin Simon; Sze, Raymond W.; Larsen, Ethan P. title: A Pilot Program of Virtual Ergonomics Consults for Radiology Staff Working From Home date: 2021-09-27 journal: J Am Coll Radiol DOI: 10.1016/j.jacr.2021.08.016 sha: 74d14f0bcbbf16c03a54e1b3ab7e6b5e24bdd584 doc_id: 895304 cord_uid: 85dh40e3 nan In March 2020, social distancing measures and other safety concerns related to the coronavirus disease 2019 (COVID-19) pandemic meant that all possible personnel and radiologists in the Department of Radiology at our institution who could work from home needed to do so on short notice. Although most radiologists already had a home workstation, most were not individually ergonomically optimized. Previously, nonradiologist staff did not have the ability to work from home and scrambled to adapt. Consequently, many traded their multimonitor workstations, task chairs, and desks for laptops on sofas and kitchen tables. Physical ergonomics is the study of how people exist within their environment, including the study of safe limits for motion and lifting and the design and configuration of workstations [1] . Poor working ergonomics has been well established to lead to increased risk of injury, hospitalization, and days missed from work. Recent data from the US Bureau of Labor Statistics indicate that 25% of musculoskeletal disorder (MSD)-related injuries that require missed days from work occur in the health care domain [2] . The Bureau of Labor Statistics defines MSDs as a comprehensive list of injuries including those caused by repetitive stress injuries, microtasks, and poor ergonomics [3] . There is no shortage of information regarding proper configuration of a computer-based workstation [4] . In the United States, configuration for computer-based workstations falls under the Occupational Safety and Health Administration. Improperly configured workstations can contribute to several MSDs and other lower-level discomforts [4] . Although self-configuration of a workstation is possible, having a consultation with a professional trained in ergonomics substantially expedites the process and increases the likelihood of improving the outcome. There is little published on remote ergonomic consultations, especially in the context of home workstations [5] . Our institution offers an on-site ergonomic workstation consult service through occupational health; however, there is presently no equivalent mechanism for home consultation. Based on casual inquiry with radiology personnel, few if any individuals from the department have used the in-hospital service. To address radiology's remote workstation service gap, we engaged our department's human factors engineer to develop and deploy a remote workstation ergonomics consultation service for all radiology staff. Our concern was 2-fold. First, a large number of support staff who were designated to work from home had institution-issued laptops but no assurance of designated workspaces in their homes. Second, the radiologists who have the computer equipment for full diagnostic workstations for home reading do not have reading-roomstandard desks at home and may not be familiar with tailoring their workstation to their ergonomic needs. In both cases, there was a potential for personnel to be spending an increased amount of time in ergonomically suboptimal workstations. Additionally, as we transition out of the pandemic, continuing hybrid work means work from home for many will continue. We sought to develop a remote ergonomic consultation program to address home workstation ergonomics within the confines of COVID-19 protocols. Starting with our previous in-person consult structure, we converted the process to be completed virtually with still images. To supplement the still images and identify pain points the participants may not be aware of, we electronically distributed an empirical self-administered and validated measure of personal discomfort, the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) [6, 7] . This project was deemed exempt by the institutional review board of our institution. Recruitment was conducted via an electronic survey [8] sent out to all eligible employees, with email reminders, announcements during virtual conferences, and QR access codes to facilitate enrollment. Inclusion criteria to participate in the consultations included any full-time employee of the department who was employed before March 2020 and was assigned to work from home because of the pandemic. Participants were asked to complete a questionnaire with items regarding their role(s) in the department, demographics, description of their workstations, and work behaviors. They were also required to complete the CMDQ and to upload pictures of them at their home workspace (taken from behind and from the side and of the desk setup) to the data collection platform. Once the study team reviewed the documents, an ergonomics consultation with the department's human factors engineer was scheduled. Thirty-minute ergonomic consultations took place via video conference. We used the information from the submitted pictures, which allowed us to tailor the assessment and recommendations to the specific needs of the individual. During the consultation, participants were asked about general physical activity and stress levels. The results of the CMDQ questionnaire were disclosed and recommendations of low-cost adaptations of their home workstations were made based on the submitted pictures and observations from the consultation. Although elements such as lighting were included, they were not part of the primary focus of the activity. Department funds were not available to support ergonomic changes to home workstations. Additionally, any questions from the participants were addressed. Ergonomic consultations were conducted on 10 staff members who were working from home because of the pandemic. Feedback from some participants indicated that they received benefit from the consultation. Insights, such as feet elevation resulted in reduction of some targeted discomforts. The consult was based on the self-identified pain from the CMDQ; however, additional changes were suggested based on the pictures of their working environment and observations of posture. Although multiple angles helped provide a rough baseline of the participant's discomfort and workstation, the live video call allowed for interactive discussion. The dialogue enabled the consultant to offer real-time feedback to facilitate the participant in self-assessing with greater accuracy and further tailoring the workstation configuration to the participant's particular ergonomic needs and usage. The areas that were most affected by discomfort were neck (60%) and lower and upper back (40%) as shown in Figure 1 . To reduce MDS, changes to home workstations as a result of the consultations included new chairs, mice, monitors, and/or keyboards; adjustments of chair, monitor, and desk heights; and adjustments to the proximity of monitors. Specifically, during the ergonomic consult we found six instances where participants had their monitors too low, a potential cause of neck pain. The chair being too low for the desk (n ¼ 5) and the chair being too high for the user (n ¼ 3) were our next most frequent issues, which could contribute to pain points throughout the body. In almost all cases, it was recommended that the participant add elevation for their feet. Elevating the feet allows configuration of the chair to an appropriate height for their desk and avoids related discomfort in their hips, knees, and upper legs from their feet being inadequately supported. This work had limitations. Participant recruitment was difficult. Taking photos was an additional task on top of a busy workload during a very stressful period. Some potential participants were uncomfortable being evaluated on photos of themselves and their home workspaces. Some personnel accepted certain levels of discomfort as tolerable and "normal" and did not believe an ergonomics consultation to be of personal benefit. Although our experience was with a relatively small number of consultations, usability studies have observed and validated diminishing returns on user testing beyond 8 to 10 participants. It has been estimated that as many as 90% of issues will be found in evaluating 10 participants or fewer [9] . We applied the same principle to our observation of common ergonomic problems in home workstations and feel confident that our participants have demonstrated, and subsequently reduced, the most common ergonomics complaints for individuals working from home. In addition, a setup checklist was created and provided to the department for home and in-hospital workstation configuration. Finally, though underutilized during the pandemic, the program has been designated to be retained as a service to offer to newly hired radiologists and other hybrid workers in the future. An in-home consult will be offered once pandemic-related precautions are lifted, and particularly when radiologists receive hardware updates to their home reading workstations. As we shift to a hybrid in-person and remote workstyle, services such as remote ergonomic consultations will gain importance. Our experience provides some insight on how to prevent MSDs in employees who will work from home and demonstrates that a remote consult is viable. Chairs, monitors, and keyboards need to be properly set up with the guidance of ergonomic specialists to minimize MSD risk. Continuing to provide remote ergonomic consultations can equip us to be better prepared for continuing hybrid work arrangements in radiology services. An introduction to human factors engineering Injuries, illnesses, and fatalities. Number, incidence rates, and median days away from work for musculoskeletal disorders Injuries, illnesses, and fatalities. Occupational safety and health definitions Ergonomics standards and guidelines for computer workstation design and the impact on users' health-a review Computer workstation ergonomics: current evidence for evaluation, corrections, and recommendations for remote evaluation The agony of it all: musculoskeletal discomfort in the reading room Cornell Musculoskeletal Discomfort Questionnaires (CMDQ) The REDCap consortium: building an international community of software platform partners A mathematical model of the finding of usability problems is from the Department of Radiology, The Children's Hospital of Philadelphia The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Raymond W. Sze, MAMS, MD, is Associate Radiologist-in-Chief PhD: The Children's Hospital of Philadelphia, Department of Radiology