Abstract
BACKGROUND:
The use of teleconsultation platforms enabling health professionals to provide advice especially in the new normal post COVID-19 situation has increased in both developing and developed countries. This teleconsultation has also expanded beyond that of post COVID-19 application to other purposes such as in the treatment of musculoskeletal pain.
OBJECTIVE:
The purpose of this commentary is to focus on presenting a feasible guide related to physical as well as psychological aspects in relation to computer based workers that could be taught to the computer-based workers using teleconsultation platforms.
METHODS:
A multi-criteria search was performed among available guidelines and approaches related to the physical and psychological aspects used for computer-based workers.
RESULTS:
A continuation of musculoskeletal pain creates a feedforward loop of pain and distress. Several conventional methods exist to manage musculoskeletal pain, however, the new normal situation following COVID-19 has rendered many of these moot, especially in computer based workers and with the increased reliance on teleconsultation platforms.
CONCLUSIONS:
During the COVID-19 pandemic, individuals were required to stay home due to varying levels of lockdown protocols and provide their usual services using online platforms both increasing sedentary behaviour in computer based workers and limiting the tools available to health professionals. Following in what is now the worldwide new normal post COVID-19 situation, individuals have adapted and accepted that they receive much of their necessary health advice using teleconsultation platforms as well.
Introduction
The presence of musculoskeletal disorders (MSDs) among computer-based workers, who sit for long time, is an international work related issue and the number of those users is increasing daily [1]. When combined with this increased prevalence of MSDs as a result of their awkward position during work, the costs associated with the treatment of these MSDs, necessitates the increased need for research and strategies for the prevention of such MSDs. The relationship between sitting duration in an awkward position and occurrence of MSD is an ever-increasing health concern [1]. Due to the associated occurrence of pain, computer based workers are unable to perform their work tasks due to ill-health, or only complete their work at a sub-standard level. Such pain even spills over from the workplace affecting their activities of daily living (ADL). However, the development of MSDs in office-workers appears to be multi-factorial with contributions coming from other individual, psychological, and other subfactors, such as physical inactivity [1].
Due to the COVID-19 pandemic and related lock-downs, home-based working increased in popularity. However, this increase in home-based working also resulted in an increased prevalence of MSD, not only beacuse of an increase in maintaining sitting postures for extended periods of time, but also because of lack of proper ergonomically designed workstations, and an increase in sedentary behaviour [2]. During COVID-19 and in the new normal post COVID-19 situation, the transition to telework for providing and receiving the services has become increasingly popular and has even become a necessary part in daily life of many individuals [3]. Such a transition proved challenging for both employees and employers. Employers had to ensure the feasibility and sustainability of their trade conjointly to satisfy their lawful commitments related to guaranteeing sound and secure working conditions [4]. While home-based working has many advantages, such as less commuting time, decreased need for office space, it also has many negative outcomes, such as the increased demands on mental health, which could impact employees’ demeanours and conduct towards their work [5]. In contrast to the work-based environment, most of the work-related risk factors and hazards are no longer under the control of the organisation. In the home-based setting, organisations were and are unable to conduct regular workplace and workstation risk assessments, with appropriate assessments and intervention training by experts and ergonomists. However, in the domestic or home office, teleworkers regularly set up their own workstations and work areas without help and using ill proportioned coffee tables, pressing sheets, kitchen tables, or antiquated work areas that are not fit-for-purpose [4, 6]. As such, there is an increased need to develop and introduce feasible and simplistic suggestions that could be instructed using teleconsultation on appropriate physical and psychological workplace and/or workstation set-up to prevent the development of MSD [7].
Methods
A multi-criteria search based on the need was performed among available guidelines and approaches related to the physical and psychological aspects using telehealth/telemedicine methods useful for computer-based workers. Based on the papers published after 2016, a summary of feasible guidelines useful for computer-based workers is presented here.
Teleconsultation for psychological aspects of health
Some of the psychological aspects of health are lifestyle, personality characteristics, and stress levels that could be improved by different techniques such as mental imagery [8]. Mental imagery or visualization, which is a mind-body technique, requires individuals to quasi-perceptually see and hear using their mind, without an actual external situation being present [9, 10]. Teleconsultation platforms can be employed to teach several mental imagery techniques such as yoga, inter alia deep breathing, meditation, positive thinking practices, and mindfulness. These practices have been demonstrated in some cases to successfully decrease reported pain levels and reduce chronic pain symptomology [10, 11]. While mental imagery and distraction techniques have been shown to be effective, the mechanisms involved remain poorly understood. Researchers have theorized that that mental imagery may lead to plasticity in pain-related neural networks and robust modulation of pain perception. Currently, there exists a paucity of research on the use of standardized mental imagery protocols, particularly for office workers, whose sedentary lifestyle contributes to the onset of chronic, musculoskeletal pain [11, 12].
Teleconsultation for physical aspects of health
The application of exercise programs via telephone counselling platforms requires such programs to be simple, inexpensive and viable exercise programs [13]. Despite these requirements, improving muscular fitness (muscular strength and muscular endurance) and cardiorespiratory endurance in computer workers with attention to their working hours are the needed components of an acceptable exercise program [14–16]. Muscular fitness training components of the protocol should emphasize certain muscle groups, particularly the neck, shoulders, and lower back. In addition, a focus on developing strength of the core muscles (diaphragm, pelvic floor, abdominals, and hip girdle) is imperative. A reasonable training protocol for muscular fitness training exercises could consist of performance three times weekly, utilizing 2-3 sets of 10-15 repetitions with a 10-15 second exercise duration [15]. Exercise demonstration can be difficult through the use of telecommunication, but previously-recorded videos, posters and illustrations, and point-by point guidelines can be helpful in explaining proper technique of the muscular fitness training components.
Conclusion
Although it is obvious that pain-modulating mechanisms are the side effect of physical movement and mental imagery. However, the quality of the initial explanations and guidance, ongoing reminders and the availability of appropriately qualified health professionals to answer questions are essential for the success of such teleconsultation exercise programs. Further, it is also necessary to receive feedback during teleconsultations or after online questionnaires. Attention to the ethical aspects of teleconsultation such as trust, privacy, and information security is another point that should be considered strongly. The whole process of therapy and the schedule for any contact, including teleconsultation, should be defined for the teleconsultation provider and also the computer based workers. In addition, both of them should be aware about unexpected technical issues, such as internet disconnection or some misunderstandings during consultation. If the computer-based worker does not receive expected consultations, what he/she has to do? Who is the person in charge for any penalty? etc., and other questions should be answered and be made clear before going through online platforms.
Limitations
While suggestions presented in previous papers have proved useful, they are not feasible in a home-based telecommunication setting. Likewise, the findings of this paper should not be transferred in whole to a work-place setting. Due to the novelty of this area of research, the findings of this aper are limited due to the small amount of research conducted to date.
Conflict of interest
The authors declare no potential conflicts of interests with respect to the research, authorship, and/or publication of this article.
Funding
No grant or funding was obtained for this research. The study was conducted through the researchers’ personal budget.
Ethical considerations
Not applicable.
Informed consent
Not applicable.
Footnotes
Acknowledgments
The authors would like to express their deepest appreciation to their colleague, Prof. Mahmoud Sheikh, for his kind academic support.