A Study to Derive the Impact of Online Classes on Posture among High School Students During COVID

Introduction

The impact of COVID-19 pandemic on the educational sector has resulted in widespread closure of schools and universities around the world. According to United Nations Educational Scientific and Cultural Organization (UNESCO), 60% students around the world had to transfer from an offline mode of education to a more flexible and challenging online mode due to pandemic.^1,2

In the traditional form of education, students sit for longer periods and for high school student population, the amount of time spent sitting is much higher which has been evidently linked with an increased prevalence of back discomfort.^2,3 The shift from traditional classes to online classes has introduced the possibility of students acquiring various habitual postures which may represent poor body alignment, causing various issues such as, altered relative participation of agonist and antagonist muscle and micro spasms acting as a contributory factor leading to functional disorders.^4,5 These functional disorders can lead to increased neck, mid & lower back, shoulder, and leg pain.^2-4

The objective of the current study in relation to previously mentioned reasons was to investigate the impact of online classes on neck pain, back pain, wrist pain and visual strain based on the frequency, duration, place of study and type of device used, also taking into consideration the physical activity of the students.

Materials and Methods

A 15-item survey questionnaire was meticulously designed to encompass the exploration of pertinent themes, namely, demographics, pre-COVID-19 and current online class participation percentages, weekly technology utilization for academic purposes, and pre-COVID-19 and current electronic device usage percentages. In this scientific study, we explored the multifaceted experience of discomfort during online classes, encompassing various body regions. We investigated the overall levels of pain, stress, fatigue, and concentration ability in comparison to pre-COVID-19 conditions. Additionally, we considered contributing factors such as the type of chair utilized, the number of computer monitors and other screens involved, as well as the body postures maintained throughout the classes, while also taking into account the average duration of uninterrupted online class participation. Students between the ages of 12-16 years from 5th to 10th standard of both the genders in schools of South Bangalore who attended online classes between September and December 2021 were included for completing questionnaire. School students who were already undergoing some form of treatment for existing musculoskeletal conditions were excluded from the study.

Ethical clearance was obtained from the institutional ethical committee, RV College of Physiotherapy.

Results

In this homogeneous study conducted in South Bangalore, comprehensive responses were obtained from 420 participants representing various schools. Among them, 227 (54%) were males, while 193 (45.9%) were females. About 126 (30%) of them were studying in 5th to 7th standards and 294 (70%) of them were studying in 8th-10th standards. Around 309 (73.6%) students had continuous online classes, while 111 (26.4%) had online classes occasionally. On analysis, 22 (7.1%) of these classes were for <1 hour, 21 (6.7%) classes were for 1 hour, 30 (9.7%) of the classes for <four hours, 123 (39%) classes were for four hours and 224 (72%) classes were for five hours (Figure 1).

About 214 (51%) of the students used phones, 42 (10%) students used tablets, 164 (39%) students used laptops (Figure 2).

According to the responses of the subjects, 195 (46.4%) students used table as the place for study, 66 (15.7%) of them used bed, 25 (6%) students used couch and 134 (31.9%) used table and chair.

On analysis, 98 (23.3%) students reported having discomfort, 191 (45.5%) reported experiencing discomfort sometimes, while 131 (31.2%) students reported no discomfort (Figure 3). About 71.66% students had low back pain, and 28.33% students reported no back pain. P value was <0.001, hence data was considered significant.

On analysis, 301 (71.7%) students experienced neck pain, 119 (28.3%) students reported no neck pain (Figure 4). On analysis, 105 (25%) of them had wrist / hand pain, 156 (37.1%) had occasional wrist pain, 159 (37.9%) did not experience any wrist/hand pain (Figure 5). 76.16% had back pain, 28.33% had no back pain. Statistical data was found to be significant (P <0.001).

Based on analysis, 14.3% students had no physical activity, 76.9% had physical activity for < 1 hour and 8.8% had physical activity for > 1 hour. Around 60.2% students reported physical activity and 25.7% reported having no physical activity. There was no correlation between physical activity and neck/back pain. Since P value was not equal to 0.001, data was found insignificant.

Discussion

The COVID-19 pandemic created a major shift in the way the classes were conducted, with a switch to mostly online learning due to stay-at home orders in an effort to contain the spread of the virus. The shift significantly increased the amount of time students spent online, specifically utilizing laptops, computers and mobile phones for class work and homework.

This study was undertaken to analyze the association between neck/back pain and the duration of device use, taking into consideration gender, age, and the most frequent positions in which school students used their devices to attend online classes. In the present study, out of 420 participants, 73.6% attended continuous online classes. More than 82% of the classes were conducted for a duration of more than four hours. This increased the duration of sitting throughout the day among these students.

Although the general causal relationship between sitting and low back pain (LBP) has not yet been confirmed, prolonged sitting in unfavorable postures, as well as static sitting with continuous isometric muscular activity have been found to increase the risk of developing LBP.

Sitting-related LBP has been proposed to be caused by prolonged low static trunk muscle activity, which could lead to reconditioning of the lumbar spine.

Ongoing postural changes result in altered back muscle activity, spinal load, and trunk-thigh angle, factors that are thought to be unfavorable in the prevention of sittingrelated LBP, degenerative disc diseases and impaired muscle function.⁶

In the current study, >68% of the students showed discomfort due to prolonged sitting. The findings of previous studies have shown that holding a static and awkward posture for long periods during the work could lead to discomfort/pain and chronic fatigue.

The findings have also shown a correlation between other features of fatigue, such as degree and intensity, distress it causes, degree of interference with daily tasks, timing of weariness, and the severity of musculoskeletal discomfort/pain in various body locations.⁷ About 51% of the students in the present study used mobile phones,10% students used tablets, 39% students used laptops. It has been found that device used also has an impact on neck/back pain.

Computer use and musculoskeletal symptoms in the neck and upper extremities are widespread in contemporary life and both exhibit an upward trend. A possible causal link between use of computers and musculoskeletal symptoms in the neck and arm has been suggested by several earlier reviews. A community-based case-control study among women found a significant association of shoulder-neck diagnosis (58% of affected subjects had tension neck syndrome) with computer work ≥ 4 hours/ day.⁸

Based on the current study, most commonly used places to attend online classes were table and chair, followed by bed which tremendously affected their sitting posture. Previous studies have also shown that 34-50% of children and adolescents had varying degrees of poor posture.^9,10 Less than one-fifth of the children and adolescents maintain correct posture.¹¹ Most children have specific postural problems (e.g., shoulder asymmetry, kyphosis of the ribcage, or scapula tilt). In addition, some researchers suggested that schooled students have more severe posture problems compared to their unschooled peers.¹² Moreover, with the rapid growth of adolescents, their biomechanical state may change during this period.¹³

In the current study, 86% students reported no physical activity, 76.9% reported physical activity for < 1 hour, while 8.8% reported physical activity for > 1 hour. We found that the duration of physical exercise done has a more beneficial effect on neck/back pain.

A sedentary lifestyle is an undesirable feature of modern society, affecting a significant portion of the population. These developments are not only detrimental to physiological health and well-being due to increased obesity, diabetes and cardiovascular disease, but also to musculoskeletal health and well-being, with recent research suggesting that long periods of sitting and working (eight or more hours per day) is associated with increased neck, shoulder and back pain.

It is therefore reasonable to assume that sedentary behavior may induce musculoskeletal changes within the relatively rigid thoracic spine in young adults with low physical activity and contributes to dysfunction of adjacent spinal regions.¹⁴

In the current study, 62% of the students had wrist / hand pain while attending continuous online classes. When using a smart phone, all parts of the body are used: head, neck, shoulders, wrists, hands, and torso. It has been reported that the muscle activity and muscle fatigue of the neck extensor muscle increases as the neck flexion angle increases, which is common with the use of a smart phone.¹⁵

Previous research demonstrated that using electronic devices or other devices that require thumb to be used frequently will increase the strain on the thumb, and as a result, increases the prevalence of musculoskeletal problems.^7,16

Conclusion

Based on this study which involved 420 school students who attended continuous online classes, it was found that >71.7% of the students experienced neck/back pain, discomfort in wrist/hand and visual strain due to use of electronic devices and incorrect sitting posture in different places of study (bed, table). We recommend the students to maintain correct posture while attending online classes or while using various devices to prevent neck/back pain.

Limitations

The study was conducted using an online questionnaire, and thus it is difficult to know if the students understood all the questions.

The students were not observed as to how they were sitting in their respective places of study, so their exact posture cannot be commented on.

Conflicts of Interest

Nil