Musculoskeletal Disorders and Their Impact on Job Performance Among School Teachers in Buraydah City

Introduction: Musculoskeletal disorders (MSD) pose a significant challenge to the well-being and productivity of individuals and various occupational groups, including teachers. Among teachers, the prevalence of MSD has raised concerns globally, impacting their daily activities and overall quality of life. Buraidah and Saudi Arabia, like many other regions, face the implications of this issue. This study aimed to explore the prevalence and associated risk factors of MSD among teachers in Buraydah, providing valuable insights into the extent of the problem and potential areas for intervention. Methodology: An analytic cross-sectional study was conducted for three months, from April 1 to June 30, 2023, using the Arabic version of the standardized Nordic Musculoskeletal Disorder Questionnaire. This study was conducted in all schools in Buraydah City, Saudi Arabia. The study population was all schoolteachers (including principals, vice principals, etc.) in Buraydah City. The study analyzed responses from 648 teachers and 139 school workers using statistical tests, including chi-square tests and logistic regression models. Results: The results indicated a notable prevalence of MSD among teachers, with a significant association found between age, gender, and major depressive disorder (MDD) and MSD. The study reveals that females are at higher risk of MSD compared to males, emphasizing the need for gender-specific interventions. Moreover, the presence of MDD is identified as a significant contributor to MSD among teachers. However, certain demographic and lifestyle factors, such as marital status, level of school, smoking habits, and fixed rest times, do not show significant associations with MSD. Although age and years of experience are correlated, only age is found to significantly contribute to MSD. Regular exercise and BMI also do not emerge as significant contributors, although a lack of exercise shows a marginal impact. Conclusion: This study's findings have implications for educational institutions and policymakers, highlighting the need for tailored interventions to address MSD among teachers. It underscores the importance of ergonomic interventions, gender-sensitive approaches, and mental health support.


Introduction
The term "musculoskeletal disorders" (MSDs) refers to a group of periarticular conditions that affect the musculoskeletal system and primarily cause functional discomfort and everyday pain [1,2].Musculoskeletal disorders (MSDs) are more prevalent among schoolteachers, who are required to spend long periods of time standing, sitting, and engaging in repetitive tasks, such as grading papers or typing on a computer [3].
These disorders can affect the teacher's physical health, causing pain, discomfort, and movement limitations, ultimately impacting their ability to perform their job effectively [4].In addition to physical discomfort, MSDs can significantly impact a teacher's mental health and job performance.Teachers with MSDs may experience increased stress and anxiety, reduced job satisfaction, and difficulty meeting their job demands [5].Moreover, MSDs can lead to absenteeism and decreased productivity, ultimately impacting student learning and achievement [1,6].
In Saudi Arabia, a study conducted in 2020 by Alqahtani et al. [7] surveyed 261 high school teachers in Saudi Arabia and found that 73% of the respondents reported experiencing MSDs in at least one body part, with the highest prevalence being in the lower back (47.5%),neck (42.5%), and shoulders (33.3%).The study also found that female teachers reported a higher prevalence of MSDs compared to male teachers.They reported decreased work efficiency (73.2%), increased absenteeism (69.5%), and decreased job satisfaction (68.2%) [7].In another study done in Saudi Arabia, 79.2% reported experiencing MSDs in at least one body part, with the highest prevalence being in the neck (68.3%) and lower back (59.4%).This study reported decreased productivity (68.3%), increased absenteeism (57.4%), and decreased job satisfaction (46.5%) [8].
The high prevalence of MSDs among teachers in Saudi Arabia indicates a need for further studies identifying what teachers are struggling with so that ergonomic and other interventions can be identified to help reduce this burden among teachers.
To our knowledge, there are no studies exploring MSDs among schoolteachers in Buraydah City, and therefore, there are no data on the prevalence of MSDs among Buraydah City school teachers, their risk factors, or their impacts on performance.This study aimed to explore the prevalence and associated risk factors of MSD among teachers in Buraydah City, Saudi Arabia.The findings of this study could guide measures and strategies such as ergonomic interventions, physical activity programs, and education and awareness campaigns to prevent and manage MSDs among schoolteachers in Buraydah City and Saudi Arabia in general.

Study design and settings
An analytic cross-sectional study was conducted for three months, from April 1 to June 30, 2023, in all schools in Buraydah City, Saudi Arabia, targeting all school teachers and other school workers in Buraydah City.

Sample size
The minimum sample size (n) was calculated as follows: The minimum calculated sample size to achieve a precision of ±5% with a 95% confidence interval was 384 teachers.To compensate for possible inaccurate responses and the erroneous completeness of questionnaires, we recruited 400 teachers.

Sampling technique
A multistage random sampling technique was used to select participants.All schools in Buraydah city were divided into four clusters based on their location in the city (East, West, North, and South).Teachers from each cluster were further divided into two strata based on their gender (Male and Female).Finally, 50 teachers were selected by systematic random sampling from each subcluster, making 400 participants in total.

Data collection instrument and procedure
We used a validated, self-administered questionnaire with four parts.The first part of the questionnaire had questions regarding socio-demographics, such as age, gender, marital status, duration of experience in teaching, reported weight and height, medications or physical therapy for MSD, and any other diseases.The second part inquired about MSDs using the Arabic version of the standardized Nordic Musculoskeletal Disorder Questionnaire [9,10].The third part inquired about the working conditions, how many standing hours per day, how many lectures, and what postures they took when teaching.The fourth part inquired about the effect of MSDs on daily life activities and work, absenteeism, and sick leaves.
The investigators visited schools, sought permission from authorities, and attended teachers' morning staff meetings to recruit them.Before data collection, participants were given all information about the study, including the study aims and objectives, and invited to participate voluntarily.

Statistical analysis
Both descriptive and inferential statistical analyses of the data were carried out.Simple frequencies and percentages of the sociodemographic characteristics and other categorical variables were calculated and tabulated.Percentages were also calculated for multiple-answer questions.For continuous variables, median and IQR were reported as central tendency and dispersion measures, respectively.To find any significant association between categorical variables, Fischer's exact test was applied and interpreted.For continuous variables, the Kruskal-Wallis test was used to compare medians.Furthermore, to predict factors causing MSD symptoms, a binary logistic regression model with multiple predictors was created.The results of the model were presented as adjusted odds ratios (AOR).Statistical significance was established at a p-value of 0.05 or less with a 95% confidence interval.All the statistical calculations were performed using IBM Corp. Released 2020.IBM SPSS Statistics for Windows, Version 27.0.Armonk, NY: IBM Corp.

Ethical considerations
This study was approved by the ethics committee of Qassim province (Ref.No.: H-04-Q-001).Written consent was requested from participants before data collection.The study investigators requested approval from competent authorities and permission from the selected schools.There was no disclosure of the information obtained in this study to the hospital, legal or financial authorities, or anyone outside the study.The questionnaire collected anonymous information; no identifying data was collected, and participants had the right to withdraw.There was no disclosure of the information obtained in this study to anyone else outside of the study.

Results
As indicated in Table 1, the total study participants were 787; among them, 648 were teachers, and the remaining 139 were other people working in school.The median age was 43 years, and the median years of experience were 16.The gender distribution shows 65.1% females and 34.9% males.Most participants (89.2%) were married.School level distribution was 29.9% high school, 22.2% intermediate, and 47.9% primary school.Non-smokers account for 94.4%.The BMI distribution includes 27.6% normal, 33.4% obese, 37.4% overweight, and 1.7% underweight participants.Regular exercise was undertaken by 41.7%, while 58.3% did not.Most (61%) had no chronic diseases, while 14.3% had osteoarthritis.
Age   The most prevalent musculoskeletal problem was lower back discomfort (46%), followed by neck pain (38%).Notably, shoulder, ankle, and foot troubles share a prevalence of 26% (Figure 1).Among the other school staff, those who experienced MSD in the past 12 months reported a median of two days absent from work due to muscle or joint pain, compared to 0 days for those who did not experience such pain.Among teachers, those who experienced MSD in the past 12 months reported a median of three days of absence, while those without such pain reported zero days.The most used treatments were topical analgesics (40%), massage (36%), and oral analgesics (30%) (Figure 2).

FIGURE 1: Prevalence of pain in different body parts FIGURE 2: Treatment taken by teachers
The teachers who considered changing their jobs showed a significantly higher percentage of pain compared to those who did not consider changing their jobs (p<0.001)(Table 3).

MSD in past 12 months pvalue
No Yes Median N  Table 4 shows that teachers who reported being prevented from normal activities, who reported aches, pain, discomfort, numbness, and due to MSD, and who sought physician consultation for MSD in the past 12 months were significantly more likely to suffer from major depressive disorders than those who did not report such problems (p<0.001,p<0.007, and p<0.018, respectively).Teachers with MSD symptoms within the last seven days were significantly more likely to have a major depressive disorder (p<0.001)(Table 4).The chi-square test showed that MSD prevalence significantly increases with age (p<0.001).Females had a higher prevalence of MSD (67.0%) compared to males (33.0%) (p<0.001).Working hours, including fixed rest times (sitting), significantly affect MSD prevalence (p = 0.002), and years of job experience were significantly associated with MSD prevalence (p=0.041)(Table 5).

Discussion
The study's findings shed light on the significant prevalence of MSD among teachers and other school staff and would also help educational institutions and policymakers take measures to promote safe and healthy working conditions for teachers to prevent the development of MSDs and improve their work performance.The gender distribution displayed a majority of females (65.1%), highlighting the gender composition in the teaching profession and in teachers with MSD reported by other studies [1].The prevalence of MSD, as indicated by the self-reported symptoms, such as pain and discomfort, varied across body regions.Neck and lower back pain were particularly common, affecting 38% and 46% of participants, respectively.These results are comparable to other Saudi Arabian studies from Abba (59.2%) [11], Dammam (63.8%) [6], and a national-based survey (66.9%) [12].In contrast, a Japanese study showed a lower prevalence of back pain (20.6%) [13].Notably, the prevalence of MSD was high across multiple regions, underscoring the need for comprehensive interventions.
Our findings showed that most participants in both groups experienced symptoms such as aches, pains, discomfort, or numbness in the past 12 months.Among the other school staff, 78.4% reported such symptoms, while the teachers had a slightly higher prevalence at 83.3%, similar to the findings of other studies [3,13,14].Furthermore, the study examined whether these symptoms prevented participants from carrying out normal activities.It was observed that 73.6% of the teachers were affected, and 59.0% of the teachers had seen a physician for their condition in the past 12 months.These findings align with another study conducted in Cairo, Egypt [15].
The findings from this study underscore the substantial impact of musculoskeletal disorder (MSD) on both work performance and individuals' job considerations.Among teachers, the median number of absent days for those with MSD was three days, while those without such pain reported none.This significant difference (p<0.001)further substantiates the impact of MSD on work attendance.A similar study conducted in Italy found that there was a greater intention to call off work and leave the job among those diagnosed with MSD [16], aligning with another study conducted in Qassam, Saudi Arabia, that also showed a significant relationship between absenteeism and pain [17].Moreover, the association between job considerations and MSD among teachers was also significant (p<0.001).A higher percentage (94.3%) of participants contemplating job changes reported experiencing pain, highlighting the strong link between MSD and the inclination to explore alternative job options.Similar findings were reported by previous studies [13,18].Altogether, these findings emphasize the multifaceted influence of MSD, encompassing both absenteeism and job-related decision-making, underscoring the importance of holistic interventions to mitigate its effects and enhance overall workplace well-being.Age exhibits a positive and significant association with MSD (p=0.025).This finding underscores the influence of age on the likelihood of experiencing pain and emphasizes the need for age-sensitive interventions.Similar findings were reported by other studies conducted in Saudi Arabia [6,18].However, another study conducted in Saudi Arabia presents a contrasting result, showing no association of pain with age [19].Gender emerges as a significant predictor, with females reporting higher MSD rates compared to their male counterparts.The substantial difference highlights the gender-based disparities in MSD experiences.These findings are comparable to the findings of other studies conducted in Saudi Arabia and Cairo [15,18].Targeted interventions could enhance pain management strategies.Marital status, level of school, smoking habits, BMI categories, and fixed rest times were not significantly associated with MSD.These results suggest that these factors might not be associated with MSD.However, some of our study's findings contradict the previously conducted studies, which show that weight is significantly associated with MSD [6,17].While BMI categories do not independently predict MSD, the lack of regular exercise marginally increases the odds of experiencing pain.Although not statistically significant, further studies might focus on this as a potential intervention.Interestingly, the presence of major depressive disorder significantly correlates with a higher MSD prevalence (P<0.001).This association signifies the intricate interplay between mental and physical well-being, emphasizing the need for holistic approaches to address both conditions simultaneously.Teachers with major depressive disorders reported more MSD-related symptoms, activity limitations, and medical consultations.This is in contrast to the results of a study that shows no correlation between depression and MSD [20].However, MSD severity's association with MDD was not significant, underscoring the complex interplay between mental and physical health in educators.Age and years of experience, though showing a slight trend, do not exhibit a significant correlation with disability, aligning with another previous study indicating that these factors might not strongly influence such outcomes [17].Gender emerges as a significant determinant, with females facing higher disability rates.This could be attributed to biological differences, differing job roles, or varied coping mechanisms.Participants with major depressive disorders exhibited significantly higher odds of experiencing disability due to MSD, emphasizing the need for comprehensive health assessments and integrated care approaches.Similar findings were also reported by the study, showing the negative impact of MSD on quality of life among elementary school teachers [21].
Some limitations of this study include its cross-sectional design, which is unable to establish causal relationships between risk factors and MSD.The reliance on self-reported data for MSD might introduce recall bias or social desirability bias, affecting the accuracy of reported pain levels and associated factors.
Finally, the study's findings might not be easily generalizable to teachers in other regions or countries due to cultural, organizational, or educational system differences.

Conclusions
This study showed a high prevalence of MSD among teachers, highlighting the importance of addressing this issue for the well-being of educators.The study identifies key risk factors associated with MSD, including age and gender.MDD was also found to influence MSD.These findings emphasize the need for targeted interventions to alleviate pain and promote the overall health of teachers.Considering the high prevalence of MSD among teachers, implementing ergonomic interventions is crucial.Designing classrooms with adjustable furniture and promoting proper posture during teaching could reduce the strain on muscles and joints.Given the association between age and MSD, interventions should be tailored to different age groups.Younger teachers might benefit from preventive measures, while older teachers could benefit from pain management strategies.Recognizing the gender-based differences in MSD, design interventions that address the unique needs of male and female teachers.This might involve providing targeted exercises, workshops, or resources.Since major depressive disorder is linked to higher MSD, adopting an integrated approach to mental and physical health is essential.Collaboration between healthcare professionals specializing in both domains can yield comprehensive solutions.

TABLE 1 : Sociodemographic characteristics of study participants
IQR: Interquartile range, N: Frequency, %: Percentage When asked about experiencing troubles such as aches, pains, discomfort, or numbness in the past 12 months, most (78.4%) of the other school staff and 83.3% of teachers responded positively.Among other school staff, 71.9% reported being prevented from carrying out normal activities due to these troubles, compared to teachers (73.6%).In the past 12 months, 55.4% of other staff and 59% of teachers had sought medical consultation, and within the last seven days, 83.5% of other staff and 79.9% of teachers reported still having the symptoms (Table2).

TABLE 2 : Prevalence, impact, and severity of MSD in teachers and others working in school
N: Frequency, %: Percentage

TABLE 3 : Association of MSD with the performance of teachers and others working in school
IQR: Interquartile range, N: Frequency, %: Percentage, MSD: Musculoskeletal disorder

TABLE 4 : Association of major depression with MSD among teachers
N: Frequency, %: Percentage

TABLE 5 : Association of sociodemographic factors with MSD among teachers
Pain in

TABLE 6 : Risk factors for MSD among teachers
Regarding impacts of MSD and its associated factors, females had 2.906 times higher odds of experiencing disability due to MSD compared to males (p < 0.001) (Table7).