Factors Associated with Musculoskeletal Disorders among Teachers

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1		Ahmad Asyraf Abdul Rahim	--	2037	2022-09-20 17:54:11	\|
2	Second-level heading format revision.	Lindsay Dong	-1 word(s)	2036	2022-09-26 03:26:18	\|

This entry is adapted from the peer-reviewed paper 10.3390/ijerph191811704

Musculoskeletal disorder (MSD) is a major health problem, which can lead to an enormous burden to the institution as well as chronic disability to the individual. Teachers are at risk of developing MSD due to the exposure to various ergonomic risk factors. Teachers of special education, for example, are expected to perform extra duty such as lifting and moving students, feeding food, changing diapers, and helping them in ambulation. The prevalence of MSD among regular teachers ranges from 48.7% to 73.7%, while the prevalence ranges from 38.7% to 94% in special education teachers. The MSD most commonly affects the shoulder, lower back, neck, and wrist. A growing body of evidence shows that MSD is significantly associated with the teachers’ individual, physical, and psychosocial factors. Individual factors related to MSD include age, duration of teaching experience, working hours, nap time, teaching burden, and partner. Physical factors, such as awkward posture, frequent lifting, carrying, transferring, toileting, changing diapers, rehabilitation, and feeding, have been proven to increase the risk of MSD. Perceived stress, fatigue, psychological distress, and depression have been identified as psychosocial risk factors. It is recommended to implement ergonomically designed workplaces, comprehensive ergonomic training, psychological approaches, and functional training among teachers at risk.

musculoskeletal disorders special education teachers ergonomics special education

1. Introduction

Musculoskeletal disorders (MSD) are a widespread occupational issue in the teaching profession, and teachers tend to have a high prevalence of MSD ^[1]^[2]. It is a massive burden on the institution, with expenses such as sick pay, missed productivity, retraining, legal fees, and injury benefits adding up quickly ^[3]. Musculoskeletal disorders, often known as “ergonomic injuries”, occur when the body’s muscles, ligaments, and tendons are used to perform tasks, often in awkward positions or repetitive tasks, resulting in discomfort and disability over time. MSD is most often suffered by teachers in the shoulder, lower back, knee, and wrist, which results in teachers most often suffering from shoulder tendinitis, intervertebral disc prolapses, knee osteoarthritis, and carpal tunnel syndrome ^[4]^[5]. Symptoms can range from mild and intermittent to extreme, chronic, and debilitating conditions and can include pain, swelling, numbness, and tingling in the affected region and joint movement restriction ^[6].

Ergonomics is a scientific field that focuses on understanding the interactions between humans and other system components. The ergonomics profession applies theory, concepts, data, and methodologies to design to maximize human well-being and effective system performance ^[7]. For example, repetitive strain injuries and other MSD problems, which can develop over time and result in long-term incapacity, must be avoided by proper ergonomic design. Ergonomists examine the work at hand and the demands placed on the user, the tools at hand (their size, shape, and suitability for the activity), and the information at hand to determine if a person and the technology being used are a good fit (how it is presented, accessed, and changed). Various advanced tools and mathematical modeling have been created to apply the ergonomics concept in work, including risk exposure monitoring, lean tools, and intervention ^[8]^[9]^[10].

Although teachers are putting forth great effort to educate childrens, specific work-related health issues have gone unnoticed. The problem is that musculoskeletal disorder cases among teachers are high, especially those working in special education schools or programs. This issue could be seen in a study conducted in Taiwan, which revealed that 94% of special education teachers have musculoskeletal disorders ^[11]. A special education teacher is defined as working with students with a wide range of learning, physical, mental, and emotional disabilities. Regular teachers’ job tasks can include a lot of sustained standing and head-down postures, such as during reading, assignment correction, and board writing ^[12]. When dealing with students with disabilities, special education teachers have an additional set of tasks and curricula compared to regular teachers; they also provide nursing care such as lifting and moving students, feeding food, changing diapers, and helping them in ambulation ^[13]. If this activity is not conducted correctly, it will increase the risk of musculoskeletal disorders.

Since the real cause of the ergonomic problem was difficult to identify, the musculoskeletal symptoms that developed have affected the quality of work, and teachers had to take an extended sick leave. According to a systematic study, musculoskeletal disorders in teachers are linked to various factors, including individual characteristics, such as gender and duration of service, physical factors, such as teaching posture, and psychological factors, such as stress ^[4]. According to Malaysian studies, stress has a significant role in musculoskeletal disorders among teachers ^[14]^[15]. Despite their potential for occupational health issues, the difference in the prevalence of MSD among regular and special education teachers is still limited. In addition, studies on MSD risk factors are still lacking, especially the teaching activities at risk of causing MSD in particular body parts among regular and special education teachers. Therefore, it is crucial to look at teachers’ risk factors for MSD, namely individual, physical, and psychological factors.

2. Individual Risk Factors

2.1. Effect of Age

While age has been significantly associated with MSD, the findings of the study are mixed, with some studies claiming that older teachers are more likely to develop MSD, and other studies have reported that younger teachers are more significant ^[4]^[16]. For example, in Germany, a study said that an increase in age would increase the prevalence of MSD among special education teachers (AOR = 1.03, 95% CI = 1.00–1.05) ^[17]. The most probable cause for the increased frequency of MSD among older teachers is that as people age, their muscle mass declines, they lose connective tissue flexibility, and the cartilage between their joints thins ^[18]. Furthermore, tissue repair slows as people become older, as the body deals with a lifetime’s worth of soft tissue injury.

2.2. Duration of Teaching Experience

The duration of teaching experience was significantly associated with MSD among special education teachers. According to H. K. Cheng et al., teachers with experience of more than three years were two times more likely to develop MSD than less experienced teachers ^[11]. The longer someone is exposed to occupational risk factors, the more likely they are to develop work-related disorders or injuries. Meanwhile, special education teachers with more than five years of experience were four times more likely to have MSD compared to teachers who worked for a shorter period, as reported in another study in Taiwan and supported by a study in Kelantan ^[13]^[19]. This may be due to experienced teachers being generally allocated to more challenging students, and as a result of their frequent burdensome responsibilities, microtrauma would develop over time ^[13].

2.3. Working Hours and Nap Time

Long weekly working hours exposed teachers to conditions that have been associated with MSD, such as prolonged standing, prolonged sitting, or awkward posture. Working hours have also been shown to have a direct effect on emotional fatigue and a significant impact on MSD and the dimensions of professional effectiveness and cynicism, according to studies ^[20]^[21]. For example, in Taiwan, special education teachers working more than five days per week had a four-fold higher risk of developing MSD than teachers working fewer than five days per week ^[11].

2.4. Teaching Burden and Partner

Generally, teachers with a more significant burden of teaching and nursing responsibilities on students with special needs are more likely to develop MSD. It has been proven in a study in Kelantan reported that a higher number of students has significantly increased the prevalence of MSD, and this is worsened by the absence of teaching partners in class (p = 0.046) ^[19]. Moreover, students with multiple impairments are extremely reliant and have a significant association with MSD. A study in Taiwan reported that students with multiple disorders increase the risk of MSD among teachers by more than two-fold compared to single disorder students ^[13]. Teachers had to serve appropriate assistance to those students in their daily tasks, such as diapering, eating, toileting, transferring, and rehabilitation. However, teaching partners might be helpful because they could share their burdens in managing children with disabilities, reducing the likelihood of MSD occurrence. This was proven by H. K. Cheng et al. in their studies that by having partners during a teaching in class, teachers would be less likely to develop MSD ^[11].

3. Physical Risk Factors

3.1. Regular Teaching Activities

Ergonomics risk factors are elements of work or activities that put individuals’ bodies under biomechanical stress, potentially leading to ergonomics-related diseases or injuries ^[22]. Awkward postures, static and sustained work postures, forceful exertion, and repetition are among them, and they pose a risk to the teachers in their everyday job.

3.2. Special Education Teaching Activities

It is tough to teach physically and mentally impaired students. Unlike regular teachers, special education teachers spend a significant part of their workdays on jobs that need them to move and posture in ways that stress their bodies. In Hong Kong, a study revealed that teachers with MSD spent a significantly longer time in static trunk posture (p < 0.05) and trunk flexion for more than 10° (p < 0.0125) when compared to regular teachers ^[23]. This can be observed when helping the student in ambulation and performing activities. Special education teachers are regularly asked to lift and carry students, aid them in positioning, transfer students from one location to another, change diapers, feed, pull and push, and stand for lengthy periods. In Taiwan, special education teachers who did not involve in diaper changing, feeding, toileting, grooming, transferring, rehabilitation, and getting in and out of a vehicle were proven to be less likely to develop MSD than those teachers who were involved with the tasks (p < 0.01) ^[13].

Furthermore, students identified as having multiple impairments that needed multidimensional attention and had difficulty taking care of themselves, increasing the teacher’s effort and risk of MSD. This has been proven by Atikah et al. that assisting in diaper changing (p = 0.011) and toileting (p = 0.007) among the dependent special needs students were the significant factors of MSD among the special education teachers ^[19].

3.3. Different Body Areas

Different physical risk factors can cause MSD in different areas of the body. This has been proven by H. K. Cheng et al., where assist feeding has caused MSD in the shoulder area twice as much as any other task (OR = 2.077, 95% CI = 1.125–3.833) ^[11]. While performing these actions, the shoulder offers stability, mobility, or both. At the same time, teachers would need to regulate the kid’s bobbing head (shoulder acting as a stabilizer) and feed the child (shoulder moving). In addition, teachers may need to massage a kid’s chewing muscles and avoid aggravating their spastic mouth movements if they have weak oral mobility, such as reflexive biting ^[11].

4. Effect of Psychological Factors on MSD

As they lead their classes and create learning opportunities for their students, teachers continuously navigate complicated social conditions in the classroom. Teachers’ work-related stress has grown dramatically over the previous decade, resulting in one of the highest rates of burnout, with many teachers quitting or retiring early ^[24]^[25]. On the other hand, teachers experience greater tiredness, weariness, headaches, and tension than other professionals ^[26]. Therefore, psychological stress is another aspect to consider in addition to the factors associated with MSD.

Teacher stress is characterized as unpleasant, negative feelings, such as anger, irritation, worry, despair, and nervousness, experienced by teachers due to some part of their work. These conditions could be seen in a study in Selangor where pain catastrophizing, fear-avoidance belief towards physical activity and towards their job, severe anxiety, depression symptoms, and somatizing tendency were all likely to cause MSD among teachers ^[15]. Teachers may be anxious due to challenges in the educational system and demands from schools, students, parents, and the community. Teachers experience significant psychological stress due to high job expectations, limited work control, and inadequate social support ^[27].

It has been discovered that special education teachers have a high degree of perceived stress. In the United States, special education teachers were shown to have a high score on the Perceived Stress Scale and Professional Quality of Life, reflecting the stress and fatigue faced by the teachers ^[28]. This might be since special education teachers are expected to meet the specific requirements of their students, along with the stress of dealing with special students’ learning challenges and violent conduct, which exacerbates special education teachers’ predicament. A study among special education teachers in Nigeria reported that about four in every ten teachers had psychological distress, representing many-fold the rates reported in the general population ^[29]. Furthermore, 26.8% of teachers reported mild stress, 8.9% moderate depression, and 2.8% moderately severe or severe depression in a study in Oregon, USA ^[30].

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Ahmad Asyraf Abdul Rahim

Mohammad Saffree Jeffree

Dayang Maryama Ag Daud

Nicholas Pang

Mohd Fazeli Sazali

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Update Date: 26 Sep 2022

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