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<0.05). Additionally, 72 per cent of employees who used the laptop for four hours or more a day reported a significant increase in back pain (p<0.05) compared to those who used it less often. There was a higher level of reported low back pain in the laptop users (59 per cent) compared to the rest of the sample (49 per cent) that included industrial staff who undertook manual handling operations.
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.
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.
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.
l Provide policy and associated education specific to those who work away from the office
l Establish ergonomic assessments of the “workstation” and ensure that complies with DSE Regulations
l 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:
l Policy and agreement on best working practices that is issued at the start of employment or at a set date for existing staff
l Health and safety in the home (to protect family members and company equipment)
l A specified work schedule with rest breaks (with clear instruction to communicate if they are being violated due to work pressures)
l Specification of how work is assigned with realistic return times
l Education and assessment for sticking to regulations with guidelines and diagrams
l Provision of equipment with advice on how best to use it
l Provision of furniture with advice on how best to set it up
l Sickness reporting. Communication with line manager and other support, e.g. the occupational health department
l Security and insurance of person and property
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:
l The shoulders should be relaxed and comfortable. Both poor neck posture and incorrect keyboard/mouse height or position will contribute to poor posture.
l 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
l The elbows should be relaxed by the side, particularly on the side using the mouse.
l The back should be supported in the lumbar region around belt height and the shoulders should not be further forward than the hips
l The knees should be level with or slightly lower than the hips, and the feet should be well supported
l 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.
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.