Assessment of Health Issues and Online Working Ergonomics: A Case Study of the COVID-19 in Pakistan

The current study aims to evaluate and compare human factors and ergonomics during the lockdown of COVID-19 in Pakistan. The current research was done by conducting online surveys, using Nordic Musculoskeletal Questionnaire, Jenkin’s Sleep scale, and the COVID-19 Phobia scale. Data analysis was performed statistically by employing Microsoft Excel and Statistical Package for the Social Sciences (SPSS). The sample size considered for the current study was of 421 respondents. The results revealed that various ergonomics and other health issues occurred causing depression, anxiety, insomnia, hypertension, and PTSD. The most affected body parts were the neck (58.42%), shoulders (58.25%), lower back (45.95%), upper back (35.27%), lower legs (19.98%), wrist/hands (19.61%), hips/thighs (18.42%), knees (13.48%), and ankles/feet (8.8%). It has been concluded that an ergonomically designed workstation, adequate illumination, and specific adjustment of the screen of the display screen gadgets with eye level may assist in the prevention of the observed problems. Thereby, this study suggests that exercising and ergonomics can help to control health problems, caused as an effect of the COVID-19 pandemic.


INTRODUCTION
Improper workplace ergonomics, including online working, can have serious long-term health impacts on individuals. Due to the immediate lockdown, individuals were required to remain indoors, resulting in the need for all activities, including student classes, trainings, professional meetings, and official work to be conducted online from home [1].
In response to the COVID-19 pandemic, many sectors globally, including educational institutions and offices, were forced to shut down their in-person operations as a preventive measure to * Corresponding Author: abdullahkhalid624@gmail.com contain the spread of the virus and minimize it [2]. Initially, a complete lockdown was ensured as recommended by World Health Organization (WHO) (World Health Organization 2020). About 60% of the total populace was propelled to protect themselves from this dangerous infection. Albeit this lockdown delivered a few positive outcomes, it likewise prompted various difficulties, for example, monetary misfortune, joblessness, stress, and mental trauma [3].
In a likewise manner, Pakistan also imposed a similar strategy. When the first confirmed case of COVID-19 was reported, the government of Pakistan imposed a countrywide lockdown to prevent this disease transmission. Pakistan, being a developing country, has limited healthcare facilities and an unstable economy, thus many businesses and desk jobs were shifted to online work-from-home in order to avoid further economic losses [4]. Reportedly, individuals who worked from home encountered various challenges, while using online technologies and gadgets [5]. The majority of people were compelled to lead sedentary lifestyles, which are typically characterized by a penchant for comfort in all spheres, such as sitting still when using the internet and not regularly exercising. As a result, they were exposed to a significant risk of developing posture issues and other health problems [6].
Before the COVID-19 pandemic, the idea of working from home seemed like a fantasy. However, when the immediate lockdown was imposed, people were unable to adjust to the situation of working from home [7]. Certain physical issues like MSDs and severe pain in different body parts were observed during the lockdown [8]. After the examination, it was observed, that those who were working online from home were identified as having lower back torment because of prolonged sitting and a ton of energy consumption due to excessive usage of electronic equipment (computers, laptops, tabs, smartphones), rather than the other one who were not identified having coronophobia and were working from the office environment. This group was also identified as having higher coronaphobia as compared to the group, which continued to work offline from home [9].
Another study was carried out in Turkey to compare the MSDs before and during the lockdown. MSDs were found to be quite common among those who worked from home during the COVID-19 pandemic. The time spent on gadgets, such as computers, mobiles, and laptops increased drastically causing discomfort to forearms, pain in the neck, and rigidity in shoulders, causing De Quervain's syndrome and carpal tunnel syndrome. Similarly, a study carried out in Canada also revealed that computer users had suffered pain in the neck, shoulders, arms, and other body parts. [10]. There was a statistically significant rise in the severities of spinal pain, neck pain, and back pain during the isolation due to COVID-19 symptoms. Despite the fact that excessive use of smartphones and computers produced additional stress on posture, thereby, vast majority of people were willing to consider postural advice [10].
In China, a group of researchers conducted a study on assessing the lifestyle changes such as physical activities, emotional state of mind, and screen time exposure following the outbreak of COVID-19. According to the survey, people adopted a sedentary lifestyle owing to insufficient physical activities at home, more than 4 hours of screen time was observed in individuals among which young and adults have the highest prevalence of inadequate physical activities and screen exposure [11]. According to literature report, to understand the impact of online classes during COVID-19 and its effect on children, it was reported that parents were unaware that sitting with poor body posture would have a negative impact on their children's health. Many ergonomic difficulties, such as RSI (Repetitive Strain Injury), MSD (Musculoskeletal Disorders), and CTD (Cumulative Trauma Disorder) were possible with the growing age of children [12].
A study was conducted in Hong Kong to investigate the impact of online working on individuals during the lockdown period. This study investigated the ongoing BioScientific Review Volume 5 Issue 1, 2023 experience of the employer and employees in Hong Kong using SWOT analysis. Due to the small size of homes in Hong Kong, it has been proven challenging for employees to establish suitable workstations and work from home. An increased percentage of screen time was observed among individuals whereas people were spending less time with their families despite staying at home [13].
Aside from the physical health effects of COVID-19, many other studies have found that it has a negative impact on people's mental health. High rates of PTSD, depression, stress, anxiety, insomnia, and adjustment disorders were observed in many individuals who were working from home. Additionally, disrupted sleep patterns were common in many countries. The aforementioned symptoms were noted to be a consequence of a stress-inducing incident of the COVID-19 Pandemic, alterations in the work environment, or the passing of a dear person [14].

Study Design and Data Collection
An online survey was carried out to collect the data. A Sample size of 500 individuals was gathered, out of which only 421 individuals responded. Among these, 314 were females, 103 were males, and 04 persons preferred not to inform about their gender. The age group of individuals ranged from 16-57 years. The study population was mainly divided into six groups of which 74.3% were students, 8.6% employees, 8.1% teachers, 2.4% office workers, 0.7% medical staff, and 5.9% others including freelancers, digital market workers, and engineers.

Figure 1. Categories of Individual's Responses during Survey
Web-based survey was developed through Google forms, which was distributed among selected groups of individuals. Sociodemographic data, fear of COVID-19, mental health, and musculoskeletal disorders during online working was among the key subjects. For this purpose, various scales were used to analyze the results. For example, Nordic Musculoskeletal Questionnaire (NMQ) was used for musculoskeletal disorders; [15], Jenkin's Sleep Scale (JSS-T) for assessing sleep quality [16], and the COVID-19 Phobia scale (C19P-S) were applied to study the effects fear of COVID-19 fear on mental health [17]. Data were Department of Life Sciences Volume 5 Issue 1, 2023 then analyzed statistically by applying oneway ANOVA and the Correlation test in SPSS (26.0).

Screen Time Estimations
COVID-19 was a surprise for students, occupational workers, and staff, as none of them were habitual of spending a significant amount of time in front of an electronic screen. Additionally, they were unaware of the appropriate working postures and healthy working environment. Thus, improper lighting, glare, inexact distance and angle of electronic screens from the user's eyes, resulted in irritated eyes, blurred vision, light sensitivity, and frequent severe headaches.

Workstation and Working Environment
According to the findings, 41.1% of the study population used an appropriate workstation, whereas 58.9% did not have such a facility as shown in  As expected, 64.4% of the respondents said that they sat randomly, 10.7% were laying on sofa whereas only 24.9% were sitting properly (Fig 3), while working or studying. This caused many ergonomic concerns such as musculoskeletal disorders, pain in the wrist, neck, shoulders, upper back, and lower back pains [18].

Screen Time
Majority of the study population used to spend less than 2 hours per day in front of a screen but during lockdown, screen usage increased to more than 8 hours. A positive correlation result was obtained between screen time before and during the lockdown, p-value = 0.00<0.05, proving the existence of a relationship between the groups, such as a perfect correlation, which is the null hypothesis.

Fear of COVID-19
As expected, fear of COVID-19 had a significant influence on all groups of the research population as shown in Table 2. It was demonstrated that the null hypothesis was accepted except for the last group, all groups were fearful of the COVID-19. A greater 61.75% of individuals responded that it makes them uncomfortable to think about COVID-19, out of which, office workers have the highest significant value. The thought of the COVID-19 pandemic made most of them uncomfortable (p = 0.114>0.05). Thereby, this information on social media about the virus made 63.42% of people nervous, which resultantly increased anxiety (p = 0.844>0.05). Groups 4 and 6 showed the highest p-value among others. Around 80.76% of people admitted that they were afraid of the widespread infection, spreading to their families (p = 0.646>0.05) out of which group 4 showed the maximum concern as they were frontline health workers. When asked about the nature of work and fear of infecting family, groups 3 and 6 showed significantly high p-value, 44.65% of people were worried and were unable to relax with news of the current situation on a daily basis. Groups 2, 4, and 6 of the study population showed the highest percentages and they were significantly different from other groups. The p-value was 0.018<0.05 which did not support the null hypothesis.  Table 3 displays the impacts of prolonged screen use. Some responses about blurred vision, light sensitivity, fatigue, and exhaustion had p-values more than the significant value of 0.05, which strongly supports the null hypothesis. Whereas, questions about frequent headaches and irritated eyes do not justify the null hypothesis as indicated in Table 3. A total of 71.96 % of people (p = 0.657> 0.05) reported having blurred vision after using a computer screen for a longer duration. The individuals who faced light sensitivity due to increased screen time were 72.44 % (p = 0.30>0.05). Fatigue and tiredness were the major issues observed among the study population with 89.06% of the total population (p =0.083>0.05). Increased screen time was predicted to cause frequent headaches and irritated eyes but the research group responded differently. Both had p-values of 0.029 and 0.03 correspondingly, which were less than the significant value. Screen use can cause visual abnormalities and other physical discomforts such as tearing, fatigued eyes, blurred vision, burning sensations, redness, double vision, and general eye fatigue. Secondary physical problems include a stiff neck, headache, backache, and general fatigue [19].

Musculoskeletal Disorders
The effects on various body parts were observed and all of the data supported the null hypothesis since the p-values in all of the responses were greater than the significant value of 0.05 as shown in Fig 4. The most affected body parts were the neck (58.42%), shoulders (58.25%), upper back (35.27%), lower back (45.95%), wrist/hands (19.6%), hips/thighs (18.42%), knees (13.48%), ankles/feet (8.8%), and lower legs (19.98%).

Figure 4.2 Percentage on Effects on All Body Parts Collectively
On querying about any troubles in various body parts, respondents replied with the p-value of 0.670, which supports the null hypothesis. Whereas, in connection with the effects on working ability, they responded with a greater p-value that was 0.086>0.05. The effects on people's health owing to increasing screen time had the highest p-value 0.983, among all the questions that supported the null hypothesis to the maximum. Working in the same position for an extended period had the greatest impact on the neck, shoulders, and lower back of individuals. Their p-value The current study demonstrated that a p-value of 0.459>0.05 and a poor working posture has an effect on the body parts with the most severe impact on the neck and shoulders. People had to deal with unsuitable screen positions for their eyes due to a lack of proper workstations at home, which had a substantial impact on their neck and shoulders and has a p-value of 0.305. When asked about the effect of inappropriate rest breaks on their body parts, individuals supported the null hypothesis with a p-value of 0.09 and the highest percentages of aches in the shoulders and neck. MSDs are caused by inadequate ergonomic aspects of the workplace, such as sitting and placement of keyboard/input devices, monitors, accessories, such as telephone and general concepts relating to postural issues. MSD affects several joints and causes pain in the neck, shoulder, lower back, upper back, wrist/hand, knees, and elbow [20]. Previous literature has shown that the issues addressed in this section can be coped up by taking adequate breaks, exercising, and stretching body parts such as the shoulders, neck, arms, legs, upper back, lower back, ankles/feet, and hips/thighs [21]. People felt a loss of taste and smell (p =0.498>0.05) as well as fever with cough or flu (p =0.075>0.05) as a prime symptom of COVID-19 symptom. People who experienced these symptoms and had their behaviour and everyday working routine affected may have assumed that they were infected with coronavirus due to psychological and mental abnormalities. Interrogation of whether the study population about sleeping disturbances and used to fall asleep again revealed the response of p-value of 0.114 and 0.122, correspondingly. Individuals experienced tiredness because of the stress and anxiety caused by COVID-19, with a p-value of 0.106. The findings strongly supported the null hypothesis and demonstrated that the lockdown period harmed people's physical and psychological well-being. During the COVID-19 pandemic, people suffered significant psychological distress in the form of anxiety, depression, and posttraumatic symptoms. Globally, the findings were relatively consistent in terms of severity, such as, the majority of participants had mild-moderate symptoms with just a few having severe symptoms [22].

Conclusion
The concept of remote work was introduced during the pandemic crisis, but due to its novelty, it led to physical health problems such as musculoskeletal disorders. One of the observed reasons for having musculoskeletal disorders was the lack of adequate workstations.
The most affected body parts were the neck, shoulders, upper back, lower back, wrist/hands, hips/thighs, knees, ankles/feet, and lower legs. It was concluded in the current study that all of these circumstances led towards a decline in people's mental and physical health badly by causing anxiety, depression, stress, hypertension, insomnia, and PTSD. Appropriate workstation, proper lighting, and specific adjustment of computer, laptop, and mobile screen from eye level were all necessary to overcome the aforementioned factors. Experts should give guidelines and exercises on workstation ergonomics to avoid long-term health problems.