Ergonomics of E-Learning Workstations and the Prevalence of Musculoskeletal Disorders-Study among University Students.

The prevalence of musculoskeletal disorders (MSD) has increased significantly in recent years. The COVID-19 pandemic has led to a fundamental change in the lifestyles, ways of learning and working patterns of the general population, which in turn, might lead to health consequences. The aim of this study was to evaluate the conditions of e-learning and the impact of the learning modality on the occurrence of musculoskeletal symptoms among university students in Poland. This cross-sectional study included 914 students who completed an anonymous questionnaire. The questions covered two time periods (before and during the COVID-19 pandemic) and were aimed at obtaining information about lifestyle (including physical activity using the modified International Physical Activity Questionnaire, 2007 (IPAQ), perceived stress and sleep patterns), the ergonomics of computer workstations (by Rapid Office Strain Assessment, 2012 (ROSA) method), the incidence and severity of musculoskeletal symptoms (by the Nordic Musculoskeletal Questionnaire, 2018 (NMQ)) and headaches. The main differences between the two periods were statistically significant according to the Wilcoxon test in terms of physical activity, computer use time, and severity of headaches. During the COVID-19 pandemic, there was a significant increase in MSD (68.2% vs. 74.6%) and their intensity (2.83 ± 2.36 vs. 3.50 ± 2.79 points) among the student population (p < 0.001). In the group of students with MSD, there was a high musculoskeletal load, due to the lack of ergonomic remote learning workstations. In future, a thorough study should be carried out, and there is an urgent need to raise students' awareness of arranging learning workstations according to ergonomic principles in order to prevent the occurrence of musculoskeletal problems.

Effect of Covid-19 lockdown/ compulsory work from home (WFH) situation on musculoskeletal disorders in India.

OBJECTIVE: To estimate self-reported musculoskeletal disorders among Indian population in work from home COVID-19 lockdown and its association on various socio-demographic and occupational factors among them. METHODS: The present cross-sectional study was conducted on working Indian professionals, through an online self-reported survey during the COVID-19 work from the home situation. Details about the perceived musculoskeletal discomforts, weight gain or loss, physical activity profile, number of working hours, total sedentary time, and satisfaction perceived with working from home were recorded from the participant responses and thereafter analyzed. RESULTS: A total of 281 responses were analyzed. 47.6% of respondents reported musculoskeletal disorders before lockdown, whereas 53.6% reported them during the lockdown period. 10% of respondents reported declination in physical activity. Finding of the chi-square for association and Spearman's rho correlation analysis suggested that gender, pre-existing musculoskeletal discomforts, current sedentary time, and long working hours are significantly associated with musculoskeletal discomforts during work from home COVID-19 lockdown. CONCLUSION: This study concluded the increment in the self-reported musculoskeletal disorders among working Indian professionals during work from home COVID-19 lockdown. The study also found the significant association between MSD and gender, working hours, sedentary time and pre-existing musculoskeletal discomforts.

Increased COVID-19 mortality in patients with rheumatic diseases: results from the CONTROL-19 study by the Italian Society for Rheumatology.

OBJECTIVES: To investigate differences in coronavirus disease 2019 (COVID-19) mortality between patients with rheumatic musculoskeletal diseases (RMD) and the general population in Italy. METHODS: We analysed the data from the national surveillance study promoted by the Italian Society for Rheumatology (CONTROL-19 database) including patients with RMD and COVID-19 between 26 March 2020 and 29 November 2020, compared with official data from the Italian population (within the same period) adjusted for age, sex and geographic location. The main outcome of the analyses was mortality. The relationship between RMD and mortality was analysed using adjusted logistic models and sensitivity analyses were conducted to support the robustness of our results. RESULTS: We included 668 RMD patients (62.7% with inflammatory arthritis, 28.6% with systemic autoimmune diseases), who had a mean age of 58.4 years and of which 66% were female. Compared to the general population, the RMD population showed an increased risk of death (OR 3.10 (95% CI 2.29-4.12)), independently from the differences in age and sex distribution. Even after considering the potential influence of surveillance bias, the OR was 2.08 (95% CI: 1.55-2.73). Such excess of risk was more evident in the subgroup of younger patients, and more consistent in women. Subjects with systemic autoimmune diseases showed a higher risk of death than patients with any other RMDs. CONCLUSIONS: Patients with RMD and COVID-19 infection evidenced a significant increase in mortality during the first pandemic phases in Italy. These findings support the need for strong SARS-CoV-2 prevention in patients with rheumatic diseases.

Effects of COVID-19 home confinement on musculoskeletal health and physical performance in a cross-sectional study: results of the COVID-19 era online survey.

Introduction: the global pandemic of COVID-19 is the unique health crisis, the populations were exposed to situations of unprecedented confinement, this represents a major public health challenge, with a high risk of developing musculoskeletal disorders. The objective of the present work is to identify the potential effects of sedentary behavior on musculoskeletal health and physical performance. Methods: after two months of confinement a survey was uploaded and shared on Google's online survey platform. Two research laboratories, University Moulay Ismail, University Ibn Tofail, promoted the survey which was developed on the basis of two questionnaires: the French version of the Nordic questionnaire musculoskeletal disorders and the French version of the Global Physical Activity Questionnaire (GPAQ). Results: out of 384 respondents, 209 (54.4%) were females 124 (32.3%) were between 30-49 years old (6.8%) and 123 (32%) had an underweight and overweight levels, respectively. One hundred and thirty-nine 139 (36.2%) reported sitting more than eight hours. The results of our survey show that many of our respondents had developed some sort of musculoskeletal pain during the confinement. One hundred and sixty two (42.2%) reported to have pain in the lower back region, 108 (28.1%) of participants reported to have pain in the neck region, 93 (28.2%) in the shoulder region, 97 (25.3) - in the upper back region and more women than men reported musculoskeletal pain in more than five regions. The results of our survey also show that 322 (83,9%) of the participants, after two months of confinement, were unable to do high intensity exercises for at least 10 min per day in their usual daytime activity, the prevalence of musculoskeletal pain differed across categories of body mass index (BMI) between males and females, (p<0.05). Conclusion: the results of this study show the existence of musculoskeletal disorders and deterioration in physical performance and strongly recommend the urgent implementation of prevention and remediation interventions.

Computer and Furniture Affecting Musculoskeletal Problems and Work Performance in Work From Home During COVID-19 Pandemic.

OBJECTIVES: We surveyed how home-working conditions, specifically furniture and computer use, affected self-reported musculoskeletal problems and work performance. METHODS: Questionnaires from 4112 homeworkers were analyzed. The relationship between subjective musculoskeletal problems or work performance and working conditions were determined by logistic regression analyses. RESULTS: More than half the homeworkers used a work desk, work chair, and laptop computer. However, approximately 20% of homeworkers used a low table, floor chair/floor cushion, or other furniture that was different from the office setup. Using a table of disproportionate size and height, sofa, floor cushion, and floor chair were associated with neck/shoulder pain or low back pain. Disproportionate table and chair, floor cushion, and tablet computer were associated with poor work performance. CONCLUSIONS: Disproportionate desk and chair, floor cushion/chair, and computer with small screen may affect musculoskeletal problems and home-working performance.

Cost analysis of chronic pain due to musculoskeletal disorders in Chile.

The magnitude of the cost of chronic pain has been a matter of concern in many countries worldwide. The high prevalence, the cost it implies for the health system, productivity, and absenteeism need to be addressed urgently. Studies have begun describing this problem in Chile, but there is still a debt in highlighting its importance and urgency on contributing to chronic pain financial coverage. This study objective is to estimate the expected cost of chronic pain and its related musculoskeletal diseases in the Chilean adult population. We conducted a mathematical decision model exercise, Markov Model, to estimate costs and consequences. Patients were classified into severe, moderate, and mild pain groups, restricted to five diseases: knee osteoarthritis, hip osteoarthritis, lower back pain, shoulder pain, and fibromyalgia. Data analysis considered a set of transition probabilities to estimate the total cost, sick leave payment, and productivity losses. Results show that the total annual cost for chronic pain in Chile is USD 943,413,490, corresponding an 80% to the five diseases studied. The highest costs are related to therapeutic management, followed by productivity losses and sick leave days. Low back pain and fibromyalgia are both the costlier chronic pain-related musculoskeletal diseases. We can conclude that the magnitude of the cost in our country's approach to chronic pain is related to increased productivity losses and sick leave payments. Incorporating actions to ensure access and financial coverage and new care strategies that reorganize care delivery to more integrated and comprehensive care could potentially impact costs in both patients and the health system. Finally, the impact of the COVID-19 pandemic will probably deepen even more this problem.

Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2021.

In 2021, as in prior years, the medical conditions associated with the most medical encounters, the largest number of affected service members, and the greatest number of hospital days were in the major categories of injuries, musculoskeletal disorders, and mental health disorders. Despite the pandemic, COVID-19 accounted for less than 2% of total medical encounters and bed days in active component service members. Injuries, musculoskeletal disorders, and mental health disorders detract from service members' individual readiness and deployability and hinder the ability to execute the missions of the Armed Forces. Continued focus on enhanced measures to prevent and treat such disorders is warranted.

Morbidity burdens attributable to various illnesses and injuries, deployed active and reserve component service members, U.S. Armed Forces, 2021.

As in previous years, among service members deployed during 2021, injury/poisoning, musculoskeletal diseases and signs/symptoms accounted for more than half of the total health care burden during deployment. Compared to garrison disease burden, deployed service members had relatively higher proportions of encounters for respiratory infections, skin diseases, and infectious and parasitic diseases. The recent marked increase in the percentage of total medical encounters attributable to the ICD diagnostic category "other" (23.0% in 2017 to 44.4% in 2021) is likely due to increases in diagnostic testing and immunization associated with the response to the COVID-19 pandemic.

Evaluation of work ability index and its association with job stress and musculoskeletal disorders among midwives during the Covid-19 pandemic.

BACKGROUND: Musculoskeletal disorders (MSDs) and work-related stress are among the factors that can negatively affect work ability. Given the importance of midwives' health, this study aims to evaluate the work ability of midwives and to investigate its association with the prevalence of MSDs and work-related stress in midwifery. METHODS: Ninety-one midwives participated in this study. Three questionnaires, including Nordic musculoskeletal questionnaire (NMQ) plus body map, Persian version of work ability index (WAI) questionnaire, and Health and Safety Executive (HSE) job stress questionnaire, were used to collect data. Finally, the association of MSDs, work-related stress, and individual characteristics with WAI among midwives was investigated. RESULTS: The highest rates of pain and discomfort were reported in the lower back and neck. The mean job stress was 116.08 with the highest scores on demand, role, and control subscales. The work ability among midwives was at an acceptable level of 39.07 on average. Inter-variable association analysis showed that the work ability was significantly associated with pain in the past 12 months and the number of coexisting MSDs. Job stress was not associated with work ability. CONCLUSIONS: Midwives' WAI was at an acceptable level despite high prevalence of MSDs in midwives, the confirmation of the possible correlation between MSDs and work ability, as well as the high job stress in midwifery. Since the present study was conducted during the Covid-19 pandemic, the high stress in midwives may be partly due to the pandemic and may not be permanent. However, this level of stress may reduce the midwives' work ability over a long time.

Relationships Between the Physical Work Environment, Postures and Musculoskeletal Pain During COVID-19: A Survey of Frequent Computer Users.

OBJECTIVE: To understand the flexible work practices during the COVID-19 pandemic and their impact on work-related musculoskeletal disorders (MSDs) and depression in frequent computer users. METHODS: An e-survey determined the extent of workplace changes and MSD, and the relationships between them using descriptive-statistics and chi-squared tests. RESULTS: Of 700 who commenced the survey, 511 were analyzed. Since the pandemic commenced, 80% of respondents reported they were working more from home; and 89% reported some musculoskeletal pain. Compared with prepandemic, more people worked in nonergonomic environments, computer configurations and body postures. Work location was associated with upper back pain ( P = 0.011); body posture with headache ( P = 0.027) and low back pain ( P = 0.003). CONCLUSION: Nonergonomic work environments of frequent computer users during COVID-19 are related to having upper back pain, whereas nonergonomic postures are related to having headache and low back pain.

The Disparities in Patient Portal Use Among Patients With Rheumatic and Musculoskeletal Diseases: Retrospective Cross-sectional Study.

BACKGROUND: During the COVID-19 pandemic, the shift to virtual care became essential for the continued care of patients. Individuals with rheumatic and musculoskeletal diseases (RMDs) especially require frequent provider visits and close monitoring. To date, there have been limited studies examining inequities in health technology use among patients with RMDs. OBJECTIVE: Our goal was to identify characteristics associated with patient portal use before and after the COVID-19 pandemic in a convenience sample of patients with RMDs from a large academic medical center. METHODS: In this cross-sectional study, Epic electronic medical record data were queried to identify established patients of the University of North Carolina Hospitals adult rheumatology clinic between November 1, 2017, through November 30, 2019. Demographic and clinical data were collected to compare MyChart (Epic's patient portal) users with nonusers before and after the COVID-19 pandemic. MyChart activation and use were modeled using logistic regression and adjusted odds ratios, and confidence intervals were estimated. RESULTS: We identified 5075 established patients with RMDs who met the inclusion criteria. Prior to the pandemic, we found that younger age (P<.001), suburban residence (P=.05), commercial/state insurance (P<.001), military insurance (P=.05), and median income >US $50,000 (P<.001) were associated with significantly higher odds of MyChart activation. Male sex (P<.001), being of Black or African American (P<.001) or "other" race (P<.001), Spanish as a primary language (P<.001), rural residence (P=.007), Medicaid insurance (P<.001), and median income of

SARS-CoV-2 vaccine safety in adolescents with inflammatory rheumatic and musculoskeletal diseases and adults with juvenile idiopathic arthritis: data from the EULAR COVAX physician-reported registry.

BACKGROUND: There is a lack of data on SARS-CoV-2 vaccination safety in children and young people (CYP) with rheumatic and musculoskeletal diseases (RMDs). Current vaccination guidance is based on data from adults with RMDs or CYP without RMDs. OBJECTIVES: To describe the safety of SARS-COV-2 vaccination in adolescents with inflammatory RMDs and adults with juvenile idiopathic arthritis (JIA). METHODS: We described patient characteristics, flares and adverse events (AEs) in adolescent cases under 18 with inflammatory RMDs and adult cases aged 18 or above with JIA submitted to the European Alliance of Associations for Rheumatology COVAX registry. RESULTS: A total of 110 cases were reported to the registry. Thirty-six adolescent cases were reported from four countries, most with JIA (42%). Over half (56%) reported early reactogenic-like AEs. One mild polyarthralgia flare and one serious AE of special interest (malaise) were reported. No CYP reported SARS-CoV-2 infection postvaccination.Seventy-four adult JIA cases were reported from 11 countries. Almost two-thirds (62%) reported early reactogenic-like AEs and two flares were reported (mild polyarthralgia and moderate uveitis). No serious AEs of special interest were reported among adults with JIA. Three female patients aged 20-30 years were diagnosed with SARS-CoV-2 postvaccination; all fully recovered. CONCLUSIONS: This is an important contribution to research on SARS-CoV-2 vaccine safety in adolescents with RMDs and adults with JIA. It is important to note the low frequency of disease flares, serious AEs and SARS-CoV-2 reinfection seen in both populations, although the dataset is limited by its size.

Safety of Biologic-DMARDs in Rheumatic Musculoskeletal Disorders: A Population-Based Study over the First Two Waves of COVID-19 Outbreak.

This study aims to explore disease patterns of coronavirus disease (COVID-19) in patients with rheumatic musculoskeletal disorders (RMD) treated with immunosuppressive drugs in comparison with the general population. The observational study considered a cohort of RMD patients treated with biologic drugs or small molecules from September 2019 to November 2020 in the province of Udine, Italy. Data include the assessment of both pandemic waves until the start of the vaccination, between February 2020 and April 2020 (first), and between September 2020 and November 2020 (second). COVID-19 prevalence in 1051 patients was 3.5% without significant differences compared to the general population, and the course of infection was generally benign with 2.6% mortality. A small percentage of COVID-19 positive subjects were treated with low doses of steroids (8%). The most used treatments were represented by anti-TNF agents (65%) and anti-IL17/23 agents (16%). More than two-thirds of patients reported fever, while gastro-intestinal symptoms were recorded in 27% of patients and this clinical involvement was associated with longer swab positivity. The prevalence of COVID-19 in RMD patients has been confirmed as low in both waves. The benign course of COVID-19 in our patients may be linked to the very low number of chronic corticosteroids used and the possible protective effect of anti-TNF agents, which were the main class of biologics herein employed. Gastro-intestinal symptoms might be a predictor of viral persistence in immunosuppressed patients. This finding could be useful to identify earlier COVID-19 carriers with uncommon symptoms, eventually eligible for antiviral drugs.

Increased prevalence of work-related musculoskeletal disorders among physiotherapists during the COVID-19 pandemic: A Commentary.

BACKGROUND: COVID-19 is an exceptionally infectious virus that contaminates various systems and increases the demands on physiotherapists in the management of patients. OBJECTIVE: The purpose of this commentary was to describe the impact of the COVID-19 pandemic among physiotherapists at the workplace. METHODS: Explore the anxiety and stress levels of the physiotherapists during the pandemic and its consequence on the mental health. RESULTS: The COVID-19 pandemic has altered the approach of rehabilitation services to patients and increased the prevalence of work-related musculoskeletal disorders (WMDs) among physiotherapists. CONCLUSION: Physiotherapists must exercise due caution and diligence while managing these patients to protect themselves from contracting the infection and avoid WMDs.

The Effects of COVID-19 Lockdown on the Perception of Physical Activity and on the Perception of Musculoskeletal Symptoms in Computer Workers: Comparative Longitudinal Study Design.

Lockdown resulting from the pandemic led to a change in the health habits of the computer workers community. Sedentary work, together with less active lifestyles, aggravated by the COVID-19 pandemic leads to impacts on physical activity (PA) and can contribute to the development of musculoskeletal symptoms (MSS). Aim(s): Understand the effects of lockdown on the perception of physical activity levels and on the perception of frequency of musculoskeletal symptoms, over periods of 12 months and 7 days, in computer workers. Methods: Longitudinal comparative study between 2019 (M1) and 2021 (M2), over 18 months, in 40 volunteer participants. The inclusion criteria were full-time workers aged between 18 and 65 and the exclusion criteria included diagnosis of non-work-related medical conditions. In addition to a socio-demographic questionnaire, the Nordic musculoskeletal questionnaire (NMQ) was used to evaluate the MSS and the International Physical Activity Questionnaire (IPAQ), was used to analyse the perception of the level of PA. These questionnaires were used in two assessment stages (M1 and M2). McNemar test and Wilcoxon paired test were used to evaluate the effect of lockdown on the perception of PA, and on the perception of frequency of musculoskeletal symptoms. Results: The MSS prevalence in the previous 12 months increased significantly in the neck (M1: 45.0%, M2: 62.5%, p = 0.046), in the shoulders (M1: 37.5%, M2: 55.0%, p = 0.033), and in the hands/wrists (M1: 25.0%, M2: 45.0%, p = 0.019). The mean pain score increased in the shoulders (1.43 ± 2.24, 2.35 ± 2.55, p = 0.003) and in the elbows (0.18 ± 0.59, 0.60 ± 1.34, p = 0.015). No differences were found in the PA between M1 and M2, but the weekly mean sitting time increased from 4.75 ± 2.26 to 6.26 ± 2.65 (p < 0.001). Conclusion: After 18 months it became clear that MSS perception increased mainly in the neck, shoulders and hands/wrists with a significant increase in pain intensity in the shoulder and elbow regions. The weekly sitting time increased significantly. Further studies are needed in order to determine the impact of teleworking in a pandemic context. But multifactor behind these results should be taken into account by health institutions and those responsible for the Prevention of Occupational Risks in Computer Workers in order to adopt educational strategies for the promotion of Physical activity (PA), in these workers.

Patients with Musculoskeletal Disorders Presenting to the Emergency Department: The COVID-19 Lesson.

BACKGROUND: Musculoskeletal disorders (MSKDs) are the most common class of complaints among patients presenting for care in the Emergency Department (ED). There is a non-urgent patient population with musculoskeletal complaints attending ED services that creates a burgeoning waiting list and contributes to overcrowding in Emergency Departments (EDs), which is a major concern worldwide. The recent (Coronavirus disease-19) COVID-19 pandemic is an unprecedented challenge that is revealing the structural and situational strengths and weaknesses of healthcare systems. METHODS: This study retrospectively and prospectively assessed patients presenting to the Emergency Department before and after the COVID-19 outbreak (from 21 February 2019 to 3 May 2019 and from 21 February 2020 to 3 May 2020) with non-traumatic or low-severity musculoskeletal conditions to test the hypothesis that these patients should have access to care outside the ED and that the COVID-19 outbreak has changed patients' care and health perception. RESULTS: A total of 613 patients were identified, and 542 of them (87.56%) participated in a personalized survey. From this number, 81.73% of the total accesses took place in 2019, and only 18.27% of the accesses took place during the first outbreak and lockdown. More than 90% of patients admitted to the ED accessed care during the day shift in both periods. A total of 87.30% of patients presenting to the ED with a MSKD followed their general practitioner's (GP) advice/referral in 2019, and 73.87% did so in 2020. The differences in the means of transport to the ED was statistically significant (p-value 0.002). CONCLUSIONS: The outbreak and lockdown period confirmed that there is an inappropriate use of the ED related to patients with MSKD. However, the ED appears to be the only available solution for these patients. New services and pathways are therefore needed to enhance MSKD management and reduce ED crowding. Additional observational studies shall be developed to confirm and compare our findings with those of various EDs. The main limit of the inferential part of the study is probably due to the small sample of patients in 2020.

Outcomes of SARS-CoV-2 infection among children and young people with pre-existing rheumatic and musculoskeletal diseases.

OBJECTIVES: Some adults with rheumatic and musculoskeletal diseases (RMDs) are at increased risk of COVID-19-related death. Excluding post-COVID-19 multisystem inflammatory syndrome of children, children and young people (CYP) are overall less prone to severe COVID-19 and most experience a mild or asymptomatic course. However, it is unknown if CYP with RMDs are more likely to have more severe COVID-19. This analysis aims to describe outcomes among CYP with underlying RMDs with COVID-19. METHODS: Using the European Alliance of Associations for Rheumatology COVID-19 Registry, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, and the CARRA-sponsored COVID-19 Global Paediatric Rheumatology Database, we obtained data on CYP with RMDs who reported SARS-CoV-2 infection (presumptive or confirmed). Patient characteristics and illness severity were described, and factors associated with COVID-19 hospitalisation were investigated. RESULTS: 607 CYP with RMDs <19 years old from 25 different countries with SARS-CoV-2 infection were included, the majority with juvenile idiopathic arthritis (JIA; n=378; 62%). Forty-three (7%) patients were hospitalised; three of these patients died. Compared with JIA, diagnosis of systemic lupus erythematosus, mixed connective tissue disease, vasculitis, or other RMD (OR 4.3; 95% CI 1.7 to 11) or autoinflammatory syndrome (OR 3.0; 95% CI 1.1 to 8.6) was associated with hospitalisation, as was obesity (OR 4.0; 95% CI 1.3 to 12). CONCLUSIONS: This is the most significant investigation to date of COVID-19 in CYP with RMDs. It is important to note that the majority of CYP were not hospitalised, although those with severe systemic RMDs and obesity were more likely to be hospitalised.