Introduction
Information and communication technologies (ICT) have evolved greatly over the past 10 years and many employers now support or promote their employees to work from home. According to a narrative review published in 2015, telecommuting sometimes referred to as telework can be defined as a work practice that involves members of an organization substituting a portion of their typical work hours to work away from a central workplace—principally from home—using technology to interact with others as needed to conduct work tasks [
1]. Although the prevalence of telecommuting remains difficult to establish, it was estimated that nearly 60% of U.S. organizations allowed their employees to do some form of telecommuting in 2014 [
1]. In addition to reducing company costs related to space rental, telecommuting appears to increase workers’ well-being, autonomy and productivity, improve work-family balance and reduce work-related stress [
2,
3].
Even though telecommuting is becoming a new reality for many employees around the globe, several issues with regards to work-related health have been raised. A recent rapid review investigated the impact of telecommuting on individual workers’ mental and physical health [
4]. Twenty-three studies were included in the review and several health-related outcomes were looked at including pain, self-reported health and well-being. Among the reported results, the authors found that only two studies investigated pain outcomes. One study reported lower pain levels in male telecommuters compared to commuters [
5] while the other study found no difference between commuters and telecommuters [
6]. Evidence regarding physical outcomes and telecommuting was scarce and surprising to the authors given that physical health is a broad and well-studied topic in work ergonomics.
Musculoskeletal pain often affects workers and it is estimated that more than 30% of the workforce report pain several times a week [
7]. Primary headaches and neck pain are among the most common work-related health conditions [
8,
9] and both are highly prevalent in workers. Neck pain and primary headaches one-year prevalence is respectively estimated at around 48 and 46% in the worker population [
10,
11]. Current evidences suggest that risk factors for neck pain and headache carry both non-modifiable or modifiable risk factors. For both conditions, sex, age, previous musculoskeletal symptoms and history of head or neck injury are all individual risk factors of developing headache or neck pain [
10,
12‐
14]. In workers, and more specifically office workers, prolonged work position, repetitive movements, posture (neck and head), workstation design (keyboard position, mouse position, screen height) have all been associated with neck pain [
10,
12]. Long working hours in the same position including computer work is considered a headache risk factor [
11].
Given that several work-related risk factors are associated with headache and neck pain, it seems important to identify those of headache and neck pain in a telecommuting context including associated factors related to ergonomics and working conditions. This is particularly relevant given that the current sanitary crisis suddenly catapulted a significant proportion of workers in full-time telecommuting with very limited or no time to plan the transition. Although working from home was proposed to be a very effective tool for reducing the infection rate [
15], several telecommuters were forced to work in improvised home offices (kitchen, living room, office at home) for long hours with limited access to proper furniture and proper ICT equipment and resources. According to Lopez-Leon and colleagues, recommendation to work from home during the COVID-19 pandemic included establishing a dedicated workspace with comfortable chair, proper lighting and ventilation and adequate accessories such as a microphone, camera and noise-cancelling headphones [
16]. Many telecommuters now use computer headsets during their online meeting and overall telecommuting activities. The use of headsets creates an additional mechanical stress by adding weight on the head that in turn must be supported by neck muscles and passive structures. Using a wearable device such as a headset combined with an inadequate posture while working will force the wearer to adopt adaptative postures that can provoke localized muscle fatigue [
17] leading to a potential headache or neck pain episode.
The main objective of this study was to identify which telecommuting and individual factors are associated with headache and neck pain occurrence in telecommuters during a 5-day follow-up. A secondary objective of the study was to evaluate the impact of wearing a headset on headache and neck pain intensity in telecommuters. We hypothesized that previous experience of headache or neck pain combined with long working hours and an inappropriate working set-up will be related to headache and neck pain in telecommuters. We also hypothesized that wearing a headset will have an impact on headache and neck pain intensity in telecommuters.
Results
Baseline demographics
One hundred and sixty-two participants (49 males, 112 females and 1 not identifying as either male or female) were recruited for the study and included in the data analyses (Table
2).
Table 2
Baseline demographic data for responders and non-responders
Gender (M: F: O) | 39: 69: 1 | 10: 43: 0 |
Height (m) | 1.69 ± 0.10 | 1.74 ± 0.50 |
Weight (kg) | 71.16 ± 17.03 | 69.21 ± 17.85 |
BMI (kg/m2) | 24.85 ± 4.71 | 24.27 ± 6.55 |
Age (years) | 36.24 ± 11.05 | 35.21 ± 10.26 |
HIT-6 (/78) | 49.39 ± 9.37 | 50.96 ± 9.97 |
NBQ (/70) | 15.32 ± 12.23 | 21.15 ± 12.95 |
Baseline headache intensity | 2.40 ± 2.25 | 2.79 ± 2.48 |
Baseline neck pain intensity | 2.30 ± 2.09 | 3.40 ± 2.48 |
Baseline headache occurrence |
Yes (%) / No (%) | 66.97 / 33.03 | 69.81 / 30.19 |
Baseline neck pain occurrence |
Yes (%) / No (%) | 65.14 / 34.86 | 74.47 / 24.53 |
Home workstation |
Yes (%) / No (%) | 28.44/ 71.56 | 33.96/ 66.04 |
Baseline headset wearing |
Yes (%) / No (%) | 73.30 / 26.70 | 74.47 / 24.53 |
T-test results for independent variables showed no significant differences between participants that completed the follow-up and non-responders for height, weight, BMI, age, HIT-6 and baseline headache intensity (all p-values > 0.311). However, NBQ was higher in non-responders (p = 0.006) as well as baseline neck pain intensity (p = 0.004).
Associated factors of headache during the 5-day follow-up
Out of the 109 participants, 67 reported at least one headache episode during the follow-up compared to 42 who reported no headache episode. Demographic data for each group and bivariate associations for all independent variables are presented in Table
3.
Table 3
Demographic data for participants without headache and participants with follow-up headache occurrence
Baseline variables |
Gender (M: F: O) | 19: 22: 1 | 20: 47: 0 | 0.101 | – |
Height (m) | 1.70 ± 0.11 | 1.67 ± 0.09 | – | 0.073† |
Weight (kg) | 74.34 ± 15.50 | 69.17 ± 17.72 | – | 0.030† |
BMI (kg/m2) | 25.38 ± 4.71 | 24.52 ± 4.71 | – | 0.215† |
Age (years) | 37.83 ± 11.03 | 35.24 ± 11.03 | – | 0.153† |
HIT-6 (/78) | 45.07 ± 8.83 | 52.10 ± 8.70 | – | < 0.001† |
NBQ (/70) | 12.00 ± 12.02 | 17.40 ± 11.97 | – | 0.011† |
Baseline headache intensity | 1.00 ± 1.50 | 3.28 ± 2.20 | – | < 0.001† |
Baseline neck pain intensity | 1.50 ± 1.95 | 2.81 ± 2.03 | – | 0.004† |
Baseline headache frequency | 0.83 ± 1.48 | 2.10 ± 1.74 | – | < 0.001† |
Baseline neck pain frequency | 1.62 ± 2.26 | 2.94 ± 2.58 | – | 0.001† |
Home workstation Yes (%) / No (%) | 64.29 / 35.71 | 76.12 / 23.88 | 0.183 | – |
Baseline headset wearing Yes (%) / No (%) | 52.38 / 47.62 | 70.15 / 29.85 | 0.061 | – |
Follow-up variables |
Follow-up headset wearing Yes (%) / No (%) | 54.76 / 45.24 | 62.69 / 37.31 | 0.412 | – |
Follow-up telecommuting hours | 5.13 ± 2.04 | 5.50 ± 1.91 | – | 0.339* |
Follow-up headset wearing hours | 0.85 ± 1.49 | 1.70 ± 2.35 | – | 0.105† |
Following the Spearman rank test analysis, only the HIT-6 was retained to represent the clinical baseline variables related to headache occurrence. The final stepwise multivariate regression model to determine factors related to headache occurrence and the corresponding odds ratio are described in Table
4. At the end, 9.4% of the variance could be explained by the final model.
Table 4
Odds ratios, confidence intervals and p-values of factors associated with headache occurrence retained in the final stepwise model
HIT-6 | 1.094 (1.042–1.148) | < 0.001 | R2 = 0.094 |
Associated factors of neck pain during the 5-day follow-up
Out of the 109 responders, 77 reported at least one neck pain episode during the follow-up compared to 32 who reported no neck pain episode. Demographic data and bivariate associations for each group are presented in Table
5.
Table 5
Demographic data for participants without neck pain and participants with neck pain occurrence during the 5-day follow-up
Baseline variables |
Gender (M: F: O) | 14: 18: 0 | 25: 51: 1 | 0.455 | – |
Height (m) | 1.69 ± 0.09 | 1.68 ± 0.09 | – | 0.622† |
Weight (kg) | 71.92 ± 12.41 | 70.86 ± 16.43 | – | 0.316† |
BMI (kg/m2) | 25.10 ± 3.45 | 24.91 ± 4.66 | – | 0.220† |
Age (years) | 41.06 ± 12.49 | 35.56 ± 10.99 | – | 0.005† |
HIT-6 (/78) | 45.19 ± 8.26 | 49.30 ± 9.56 | – | 0.003† |
NBQ (/70) | 5.53 ± 6.02 | 15.68 ± 12.11 | – | < 0.001† |
Baseline headache intensity | 1.59 ± 2.08 | 2.47 ± 2.24 | – | 0.012† |
Baseline neck pain intensity | 0.66 ± 1.31 | 2.99 ± 2.49 | – | < 0.001† |
Baseline headache frequency | 0.97 ± 1.51 | 1.88 ± 1.78 | – | 0.005† |
Baseline neck pain frequency | 0.53 ± 1.37 | 3.22 ± 2.49 | – | < 0.001† |
Home workstation Yes (%) / No (%) | 21.88 / 78.12 | 31.17 / 68.83 | 0.327 | – |
Baseline headset wearing Yes (%) / No (%) | 56.25 / 43.75 | 66.23 / 33.77 | 0.325 | – |
Follow-up variables |
Follow-up headset wearing Yes (%) / No (%) | 50.00 / 50.00 | 63.64 / 36.36 | 0.186 | – |
Follow-up telecommuting hours | 5.39 ± 2.24 | 5.35 ± 1.85 | – | 0.921* |
Follow-up headset wearing hours | 1.43 ± 2.38 | 1.35 ± 1.98 | – | 0.401† |
Following the Spearman rank test analysis, only the NBQ was retained to represent baseline variables related to neck pain. The final stepwise multivariate regression model to determine associated factors of neck pain occurrence and the corresponding odds ratio are described in Table
6. In the end, 18.2% of the variance could be explained by the final model.
Table 6
Odds ratios, confidence intervals and p-values of factors associated with neck pain occurrence retained in the final stepwise model
NBQ | 1.182 (1.102–1.269) | < 0.001 | R2 = 0.182 |
Impact of headset on headache and neck pain intensity during the 5-day follow-up
For the second objective, t-test for independent groups showed no significant difference between participant that wore a headset during the follow-up and participants that did not wear a headset regarding participants headache mean intensity (p = 0.94) and participants neck pain mean intensity (p = 0.56).
Discussion
Several studies have investigated psychological and physical risk factors of neck pain and headache in workers’ populations. Albeit the broad base of knowledge of these conditions and their respective risk factors, there are far less evidence available regarding these two conditions in the context of telecommuting. The COVID-19 pandemic has triggered an unprecedented and sudden increase in the proportion of workers that are now working from home and several experts and observers argue that such increase will partially persist over time [
23‐
25]. Researchers have also raised concerns regarding this rapid shift to telecommuting and suggested that assessment of health risks and benefits of telecommuting are warranted [
26]. This study sought to explore the potential physical risk factors of neck pain and headache in the telecommuters’ population.
Headache
Our study showed that headache-related disability measured with the HIT-6 questionnaire was the only associated factors of headache occurrence following an adaptation to telecommuting. Only 9.4% of the variance could be explained by the final model that considered this associated factor. Although, it is well known that risk factors for headaches include several physical and psychological factors, these associated risk factors were only scarcely investigated in previous studies. A review investigating risk factors of chronic daily headache and migraine in Finnish municipal female employees highlighted several modifiable and non-modifiable risk factors [
27]. Among the complex and multifactorial phenomenon associated with chronic daily headache and chronic migraine, the authors found significant association between daily headaches and sleep-related disorders, temporomandibular disorders, obesity, caffeine overuse, medication overuse, and high baseline headache frequency. Non-modifiable risk factors included old age, lower socioeconomic status, family history of chronic daily headache, significant recent life events (often considered as stressful events), and head injury. Other studies reported similar associated risk factors for chronic daily headaches in the general population, but also identified female gender, comorbid pain conditions as well as head and neck injury as potentially modifiable risk factors [
28,
29]. Another study found that long working hours (more than 55 hrs per week) were associated with higher prevalence of headache. Our results suggest that most modifiable or non-modifiable risk factors in office workers such as female gender, working location (designed home workplace or not) and working hours were not present in telecommuters. According to these results, further ergonomic studies that involved measures of the workstation are needed to evaluate the long-term effects of telecommuting on headache.
Neck pain
The results of our study showed that only neck pain-related disability was associated with future neck pain occurrence following a certain adaptation to telecommuting and 18.2% of the variance could be explained by the final model that considered this associated factor. Although one could assume that associated risk factors may be similar for office workers and telecommuters with similar employment conditions, the effects of telecommuting on physical health were only scarcely investigated. In their recent rapid review investigating the impact of telecommuting on individual workers’ mental and physical health, Oakman et al. (2020) only found three studies exploring physical health [
4]. Their results suggest lower levels of pain (type or location not specified in the original study) in telecommuters and conflicting results with regard to self-reported health [
5]. Given the lack of evidence concerning neck pain and headache associated risk factors in telecommuters, our results can only be compared with known risk factors in office workers. A recent review found strong evidence that individual, and work related physical risk factors for neck pain included gender (increased risk in female), previous history of neck complaints whereas only limited evidence or conflicting evidence for several other individual and work-related factors, including ergonomics [
30]. Our results therefore suggest that, although telecommuting offers a flexible working context that is less limited by time and location, clinical neck pain risk factors in telecommuters are similar to those previously observed in office workers. However, our results did not show that gender was a neck pain associated factor. This result may be explained by the fact that most of our participants in both groups (without neck pain and with neck pain episodes) were females. These results echo previous work investigating the determinants of neck pain in the general working population [
10].
Finally, contrary to our second hypothesis, the addition of a wearable device such as a headset during telecommuting did not have an impact on headache and/or neck pain in telecommuters. Even if the addition of a headset combined with a non-adaptative workstation could induce localized neck muscle fatigue, it has no impact on headache and neck pain intensity.
Study strengths and limitations
The study was conducted remotely two months within the start of the COVID-19 pandemic in Canada and provides new insights into risk factors for headache and neck pain in telecommuters. It is, however, not without limitations. Attrition following the initial assessment was significant as several participants (32.7%) did not complete the 5-day follow-up. Systematic differences between responders and non-responders can introduce bias and lead to misleading interpretation of results. Such bias is believed to be limited in our study as statistical analyses showed that completers and non-completers were similar for baseline characteristics except for NBQ scores and baseline neck pain intensity. Even though the difference in disability between non-responders and responders was statistically and clinically significant [
22], including non-responders could have only improved the prediction model. In fact, higher NBQ scores will increase the ability of this questionnaire to determine associated factors of future neck pain among telecommuters. Given the restrictions imposed by the COVID-19 pandemic, it was not possible to further assess the participants’ health complaints and therefore impossible to determine whether any associated and/or specific underlying condition may have been responsible for neck pain and headaches. Generalization to specific neck pain syndromes or headache types may be precarious because the present study did not discriminate headache and neck pain types. In addition, the small sample size may limit the strength of the conclusion that was made in this study. Reweighting based on population estimates was not possible as no study investigating telecommuting and its relation to headache and neck pain has been conducted previously. Thus, further research is required to confirm the present results among a larger sample size and to determine if these results can be generalized to the global population. Other potential modifiable and non-modifiable factors in office workers such as marital and family status, smoking, posture, break during work, high work load and mental stress should also be investigated [
10,
31].
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