Portable problems

Staff working away from the office are often simply issued a laptop and left
to get on with it but they have very real health needs that should not be
ignored.  By Dr Lynn McAtamney

With a sustained increase in both the work demands experienced by
individuals and the speed of access to information available to them, the
flexibility of using portable office equipment is understandably attractive.

A laptop, mobile telephone and modem permit a certain amount of control over
work schedules and work locations that cannot be achieved in a conventional office.
This may be required by the employer or used by individuals who find it more
convenient, or necessary, to work away from their office. Additionally it gives
people the choice of working outside traditional office hours.

When buying a portable computer there is little guidance on how to position
it for best posture or whether the keyboard is a comfortable size for the
user’s fingers. But there is plenty of information on the computer’s capacity,
speed and screen size. The freedom offered by the portable office more often
focuses on getting the work done than on ergonomic issues. As such, in
practice, the responsibilities of both the employer and employee can be
disregarded in the face of work demands. This is reflected in the numbers of
complaints of musculoskeletal problems in people who work away from a
conventional office.

Vickery1 surveyed the musculoskeletal problems of a group of 508 respondents
from a random sample of 626 staff who undertook office-based, manufacturing and
home-based occupations. Of these 40 per cent used laptops. Eighty-three per
cent of the sales force, who used laptops, reported one or more musculoskeletal
disorder and 14 per cent of those who used a laptop for more than one hour a
day reported significantly higher levels of elbow pain (p

It can be argued that this was just one sample and there can be many reasons
for reporting musculoskeletal problems. However, the responses reflect an
"at risk" group and management may well be storing up problems,
should they take the attitude of "out of sight, out of mind".

The TUC suggests that for every person who wins compensation for repetitive
strain injury there are another 50 who have not taken action. Out-of-court
settlements for employees have risen recently with Inland Revenue typists
Kathleen Tovey and Kathleen Harris being awarded £82,000 and £79,000
respectively.

The seductive convenience of an office away from the office allows
individuals to bypass the principles of ergonomics, through either a lack of
awareness or a lack of policy and agreement on working practices and working
environment set-up.

Ergonomics

The principles of ergonomics have been used to underpin the Manual Handling
Regulations, 1992 and the Display Screen Equipment Regulations, 1992. However,
these are not up to date with current laptop use and currently specify that
laptops are exempt unless they are used for extended periods of time. Given the
fact that use is increasing rather than decreasing it is wise to include all
staff issued with laptops in the requirements of the regulations to protect the
employee and the company.

The employer’s duty of care of course extends beyond just these regulations,
but equally the employee needs to incorporate self-care into their work away
from the office environment. Anyone who sits slouched, works at a laptop for
more than an hour, uses a laptop at the dining table or sunk into the settee
should have the basic common sense to realise that, in most cases, this is not
particularly healthy for their body. Yet, it is easier to override pain in the
shoulders, arms or back than to stop a job and complete it later.

Case study

The box below provides straightforward information on what employers should
do but things can go wrong even in the most responsible companies.

A 24-year-old woman was employed in a newly created sales promotion posting
in one such company. The work required considerable travel and she was a
motivated home-based employee who spent long hours working. She was provided
with a laptop, a mobile phone and a phone line into her home. She travelled
extensively by both car and train in the course of her work. Her work included
report writing, statistics preparation and answering over 70 e-mails a day. She
used her laptop on the dining table at home and also worked on the laptop on
the train. After three months she noticed pain in her right palm and hand and
by five months the symptoms had been diagnosed as carpal tunnel syndrome.

Her manager was supportive but probably lacked knowledge. He provided her
with a backpack that helped when travelling. The occupational health department
was pro-active and used specialist services to fast track her diagnosis and
treatment.

On ergonomic assessment it was apparent that her neck, shoulder, back and
hand postures were contributing to loading on the musculoskeletal system. Each
was simple to solve and it was unfortunate that a competent person within the
company had not undertaken identification, assessment and modification before
the condition had progressed.

The employee’s chair was substituted with one providing the correct
adjustment for her stature and the mouse was programmed for left-hand use as
this was her preferred hand. Alternative mouse designs were tested for comfort
and voice-activated software was introduced for reports.

Staff were asked to telephone rather than e-mail her and a headset was
provided to allow correct neck alignment while working on the telephone. She
was given a work and rest schedule which she maintained herself.

This company was probably heading for an expensive claim and the employee to
a less bright future. So, what should the company have done?

This organisation had excellent resources available and the solution to
this, and similar situations, is a three-pronged approach.

– Provide policy and associated education specific to those who work away
from the office

– Establish ergonomic assessments of the "workstation" and ensure
that complies with DSE Regulations

– Provide appropriate equipment for the office away from the office

Of course policy needs to be disseminated to all those to whom it applies in
a format that makes it interesting to read. Listed below are some of the issues
that should be addressed:

– Policy and agreement on best working practices that is issued at the start
of employment or at a set date for existing staff

– Health and safety in the home (to protect family members and company
equipment)

– A specified work schedule with rest breaks (with clear instruction to
communicate if they are being violated due to work pressures)

– Specification of how work is assigned with realistic return times

– Education and assessment for sticking to regulations with guidelines and
diagrams

– Provision of equipment with advice on how best to use it

– Provision of furniture with advice on how best to set it up

– Sickness reporting. Communication with line manager and other support,
e.g. the occupational health department

– Security and insurance of person and property

Risk assessment

Establishing an ergonomic risk assessment process that includes a DSE
assessment is a more practical approach to meet all the various risks and
working environments in which non-office based staff might work. As a quick
guide to postural risk the RULA assessment2 can be used (this can be downloaded
free on www.cope-ergo.com).

The risk assessment needs to touch on all the tasks undertaken, such as when
working on the laptop or desktopcomputer at home and elsewhere as required,
driving posture and manual handling of items from the vehicleor in the home.

The key to looking at working posture at a laptop or desktop computer is to
check for the following:

– The shoulders should be relaxed and comfortable. Both poor neck posture
and incorrect keyboard/mouse height or position will contribute to poor
posture.

– The neck should not be bent down to see the screen. This can cause neck
discomfort and contribute to arm pain. Portable DSE sloping raisers are useful
and if the laptop is used at home a keyboard and mouse can be plugged in to
allow flexibility of neck and hand positions

– The elbows should be relaxed by the side, particularly on the side using
the mouse.

– The back should be supported in the lumbar region around belt height and
the shoulders should not be further forward than the hips

– The knees should be level with or slightly lower than the hips, and the
feet should be well supported

– The keyboard and screen should be positioned in front of the user so the
body is not twisted

Similar guidelines can be set up for the driving position, with the length
of driving time controlled and best practice used in manual handling items from
the vehicle.

One of the hardest concepts to educate users about is the demand made by
static loading, that is to say when postures are maintained for extended
periods, especially if they are not well supported.

"Change your posture frequently" is the equivalent saying
"eat your greens". It is only when individuals have pain that they appreciate
the wisdom of this simple advice. Our bodies were not designed to be in front
of a monitor for the major proportion of our working day. A person working away
from the office environment does not have the same opportunities for
socialising and discussions with colleagues that stop a user from staying
focused on the screen for long periods. It is therefore important to put these
pauses into their working time in a different way.

Some people need to be given a structure to stick to for their working
schedule while others are able to incorporate short breaks into their work
patterns without any problem. It requires good communication, education and
management to establish this important balance that enables people to achieve
their work targets without pushing themselves beyond their limits, leading to
musculoskeletal problems.

For issues that are flagged up by employees as potential problems, there
should be clear guidelines on where they can get information or support. As
well as the manager, the occupational health department can play a leading role
in providing practical support.

If the assessment identifies the need for equipment such as a monitor stand
or peripherals, it is easier for both the employee and manager if an agreed
list of products and suppliers has already been established with the purchasing
department. In this way the ergonomic features of any piece of equipment will
have been checked and the process for purchasing will be simpler.

In summary, the issues regarding musculoskeletal risks in the office away
from the office are already known and solutions are available. A policy, a
self-assessment programme for risks, practical education and proactive
management of these employees with support from the occupational health team is
necessary to enable them to achieve their career aims without long-term
consequences to their musculoskeletal health.

References

1. Vickery J (2000) An epidemiological survey of musculoskeletal disorders,
and their clinical management in a large company in the U.K. MSc Thesis, Robens
Centre for Health Ergonomics, University of Surrey.

2. McAtamney L, Corlett EN (1993) RULA. A survey method for investigation of
work-related upper limb disorders. Applied Ergonomics. 24(2): 91-99.

Use of ergonomics

– Design equipment and working
environment to best match the user’s fit and functional requirements

– Design out poor postures or work activities that add
avoidable mental and/or physical loading to the individual

– Prevent musculoskeletal injuries

– Improve performance

What employers should do

– Provide practical education and
awareness of risks with clear guidelines on laptop use as outlined in the
company home worker policy

– Establish a remote system for a useful risk assessment to be
undertaken at the main place(s) of use, which incorporates practical advice and
solutions to risks identified.

– Work with the purchasing department, occupational health
department and a group of users to establish a list of approved equipment, DSE
peripherals, backpacks or other items that are required to make it possible for
staff to undertake their work more comfortably. The size and shape of display
cases can create a particularly difficult manual handling problem for staff.

– Establish clear guidelines on the use of portable equipment.

– Decide on the provision of DSE furniture for home workers

– Ensure strong communication links between peripatetic staff
and support they require both through their line managers and via occupational
health.

Employees equally must take
responsibility for their own health by:

– Adhering to the employer’s policy

– Taking adequate and appropriate breaks

– Reporting issues or concerns early to their line manager (who
has a duty to listen and act responsibly)

– Ensuring confidentiality of company files

– Establishing security precautions for person and property

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