Remote work and back pain during the COVID-19 pandemic in adults and older population in South Brazil

Saes-Silva, Elizabet; Saes, Mirelle de Oliveira; Meucci, Rodrigo Dalke; Meller, Fernanda de Oliveira; Schäfer, Antônio Augusto; Dumith, Samuel Carvalho

doi:10.1590/1413-81232023283.14362022

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ARTICLE • Ciênc. saúde coletiva 28 (03) • Mar 2023 • https://doi.org/10.1590/1413-81232023283.14362022 copy

Remote work and back pain during the COVID-19 pandemic in adults and older population in South Brazil

Trabalho remoto e dores nas costas durante a pandemia da COVID-19 em adultos e idosos no Sul do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to investigate the association between remote work and Back Pain during the COVID-19 pandemic, and to analyze this relationship according to the body mass index. Population-based, cross-sectional study carried in two cities in southern Brazil, in individuals aged 18 years and over. Data were collected through household interviews from October to January 2020/21. Outcomes: back pain (cervical, thoracic, lumbar/acute, chronic) and pain intensity. Exposure variable: remote work. For the analyses, Poisson regression with robust adjustment for variance was used, stratified by BMI (eutrophic vs overweight/obese), and restricted to those who had worked in the past month. 1,016 had worked during the pandemic, average 42 years old (SD = 14), varying from 18 to 93 years. Remote work was performed by 7.7% of the individuals. Prevalence of back pain: 25.6% (95%CI: 19.5 to 31.7%). Overweight/obese remote workers felt pain acute cervical pain PR = 2.82 (95%CI: 1.15 to 6.92); chronic low back PR = 1.85 (95%CI: 1.04 to 3.29); acute thoracic PR = 1.81(95%CI: 3.76 to 8.68) compared to those who did not work. About one in four remote workers reported back pain during of the COVID-19 pandemic. BMI proved to be an important moderator between outcomes and exposure variable.

Key words:
Teleworking; Back pain; COVID-19

Intervening variables	Description
Gender	Male/female
Age (years)	Categorized by age groups: 18-39, 40-5, ≥ 60
Asset index	The economic level was analyzed using the variable “asset index”. This variable was generated from a principal component analysis, taking into account household characteristics (number of pieces in the house and number of bathrooms) and household goods (freezer, tumble dryer, air conditioning, computer, internet and car ownership). The first component was extracted, which explained about 30% of the variance of all items (eigenvalue > 2.0). Based on household characteristics and some home appliances identified in the domiciles, which were used as a socioeconomic indicator. It was categorized in terciles (from lower to higher).
Sleep quality	The following question was used to determine sleep quality: How would you evaluate your sleep quality? It was categorized as: very good, good/fair, poor, very poor
Leisure time exercise	Based on the leisure section of the International Physical Activity Questionnaire (IPAQ) and defined as individuals who are engaged in any level of physical activity during their free time.
Body mass index (BMI)	Self-reported body weight and height and categorized as underweight and normal (up to 24.9 kg/m2); overweight (25.0 a 29.9 kg/m2) and obese (≥ 30.0 kg/m2).
Health variables (hypertension, depression, heart conditions)	Determined according to the following questions: Has any doctor diagnosed you as having high blood pressure/depression/heart conditions? Responses included yes, no, do not remember/do not know. For those who responded with “no” or “do not remember/do not know” it was considered “no”, and when the response was positive, “yes”. Categorized as No/Yes.
Fear of contracting Covid	Based on the Fear of COVID-19 Scale⁴. A score was generated in quintile and the last quintile was isolated. Categorized as No/Yes
Help with household chores	The following question was used: Have you had any help with daily chores (for example: cooking meals, cleaning the house, shopping)? Answers were: no, yes and ignored. They were dichotomized considering the “ignored” and negative responses as “no”, and the others as “yes. Categorized as No/Yes.
Covid Symptoms	All reported symptoms (cough, sore throat, fever, difficulty breathing, tiredness, diarrhea, loss of taste/smell, shivering, headache) were put together. The responses were considered as “yes” for any symptom reported and “no” for negative responses. Categorized as No/Yes.
Worse health perception	The following question was made: How would you evaluate your overall health? Responses included: excellent, very good, good, fair and poor. The responses considered as excellent, very good and good were considered as “no”, and the responses considered as fair and poor were considered as “yes”. Categorized as No/Yes.

Variable	N	%
Gender
Male	515	50.7
Female	501	49.3
Age (yr)
18-39	456	44.9
40-59	443	43.6
60 or over	117	11.5
Asset index (tercile)*
1 (lower)	260	26.1
2	346	34.7
3 (higher)	391	39.2
Sleep quality
Very good/good	739	72.7
Fair	187	18.4
Poor/very poor	90	8.9
Physical activity
No	786	77.4
Yes	230	22.6
Body mass index *
Underweight/normal	342	35.3
Overweight	383	39.5
Obese	244	25.2
Depression
No	941	92.6
Yes	75	7.4
Fear of contracting COVID-19*
No	836	83.6
Yes	164	16.4
Help with household chores
No	452	44.5
Yes	564	55.5
Covid symptoms
No	754	74.2
Yes	262	25.8

	Crude analysis			Adjusted analysis *
Exposure: remote work (yes)	Effect measure PR	95% CI	p-value	Effect measure PR	95% CI	p-value
Outcomes:	Effect measure PR	95% CI	p-value	Effect measure PR	95% CI	p-value
Back pain	1.31	0.96;1.79	0.085	1.34	0.98;1.84	0.068
Acute back pain	1.11	0.65;1,91	0.697	1.09	0.64;1.84	0.748
Chronic back pain	1.49	0.96;2.33	0.077	1.57	0.98;2.50	0.059
Cervical (neck, shoulders) pain	1.38	0.69;2.79	0.360	1.29	0.64;2.58	0.474
Thoracic pain	0.82	0.38;1.75	0.597	0.95	0.44;2.06	0.891
Low back pain	1.22	0.82;1.83	0.328	1.24	0.84;1.84	0.268
Acute cervical (neck, shoulders) pain	2.46	1.11;5.44	0.027	2.11	0.89;5.00	0.089
Chronic cervical (neck, shoulders) pain	0.66	0.19;2.27	0.501	0.61	0.19;2.00	0.409
Acute thoracic pain	0.74	0.21;2.54	0.623	0.78	0.24;2.55	0.676
Chronic thoracic pain	0.86	0.33;2.24	0.760	1.06	0.40;2.81	0.903
Acute low back pain	0.88	0.42;1.85	0.739	0.85	0.42;1.72	0.654
Chronic low back pain	1.53	0.91;2.56	0.105	1.69	0.98;2.92	0.058
Back pain intensity	1.19	0.85;1.66	0.299	1.25	0.89;1.74	0.193

	Crude analysis			Adjusted analysis *
Exposure: remote work (yes)	Effect measure PR	95%CI	p-value	Effect measure PR	95%CI	p-value
Outcomes:	Effect measure PR	95%CI	p-value	Effect measure PR	95%CI	p-value
Back pain	0.78	0.33; 1.84	0.21	0.79	0.32; 1.92	0.591
Acute back pain	0.74	0.21; 2.59	0.632	0.76	0.19; 3.01	0.688
Chronic back pain	0.82	0.24; 2.79	0.746	0.89	0.26; 3.02	0.844
Cervical (neck, shoulders) pain	1.21	0.23; 6.44	0.820	1.15	0.22; 5.88	0.869
Thoracic pain	0.61	0.14; 2.68	0.504	0.74	0.17; 3.19	0.686
Low back pain	0.61	0.19; 1.98	0.402	0.56	0.20; 1.54	0.257
Acute cervical (neck, shoulders) pain	1.37	0.13; 14.27	0.792	1.30	0.04; 44.9	0.883
Chronic cervical (neck, shoulders) pain	1.10	0.12; 10.36	0.935	0.71	0.22; 2.25	0.551
Acute thoracic pain	**	**	**	1.81	3.76; 8.68	< 0.001
Chronic thoracic pain	0.97	0.21; 4.36	0.965	0.91	0.18; 4.53	0.906
Acute low back pain	0.76	0.17; 3.39	0.714	0.61	0.16; 2.34	0.468
Chronic low back pain	0.41	0.05; 3.18	0.393	0.70	0.11; 4.59	0.707
Back pain intensity	0.54	0.23; 1.27	0.155	0.50	0.19; 1.31	0.158

	Crude analysis			Adjusted analysis *
Exposure: remote work (yes)	Effect measure PR	95%CI	p-value	Effect measure PR	95%CI	p-value
Outcomes:	Effect measure PR	95%CI	p-value	Effect measure PR	95%CI	p-value
Back pain	1.56	1.12; 2.16	0.009	1.59	1.15; 2.19	0.006
Acute back pain	1.39	0.75; 2.59	0.288	1.41	0.79; 2.54	0.244
Chronic back pain	1.67	1.00; 2.77	0.049	1.67	0.98; 2.85	0.059
Cervical (neck, shoulders) pain	1.47	0.74; 2.93	0.266	1.39	0.72; 2.69	0.328
Thoracic pain	0.96	0.39; 2.32	0.918	1.10	0.47; 2.61	0.818
Low back pain	1.44	0.94; 2.21	0.095	1.47	0.98; 2.20	0.064
Acute cervical (neck, shoulders) pain	3.10	1.30; 7.43	0.012	2.82	1.15; 6.92	0.025
Chronic cervical (neck, shoulders) pain	0.54	0.13; 2.34	0.407	0.50	0.12; 2.05	0.334
Acute thoracic pain	1.25	0.34; 4.64	0.737	1.17	0.41; 3.39	0.765
Chronic thoracic pain	0.77	0.22; 2.68	0.683	1.01	0.31; 3.32	0.991
Acute low back pain	1.02	0.42; 2.45	0.966	1.04	0.48; 2.25	0.930
Chronic low back pain	1.80	1.04; 3.13	0.036	1.85	1.04; 3.29	0.038
Back pain intensity	1.46	1.02; 2.07	0.037	1.51	1.07; 2.13	0.018

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva