Working From Home During a Pandemic

Investigation of the Impact of COVID-19 on Employee Health and Productivity

Abstract

Objective: 

To determine ergonomic problems when working from home during the COVID-19 pandemic with regard to musculoskeletal pain, sleep conditions, physical activity, resting, equipment, and productivity.

Methods: 

In this cross-sectional study, office workers who switched to working from home during the COVID-19 pandemic participated in an online survey (n = 194). The data were interpreted using descriptive and multivariate regression analysis.

Results: 

A significant increase in back pain was revealed (P < 0.001). Significant weight gain was observed (P < 0.001) connected to a decrease in physical activity and an increase in the consumption of junk food. Despite the negative health impact, participants self-reported an increase in productivity.

Conclusion: 

The self-reported productivity was higher during the working from home, but a declining trend in employee health can be observed including low back pain and weight gain.

Following the declaration of the Novel Coronavirus Disease, COVID-19, a pandemic by the World Health Organization on March 11th, 2020, shutdown and self-isolation measures were quickly implemented in many countries, impelling many companies to ask their employees to continue working remotely from their homes, even after some quarantine measures were lifted.^1–3 The rapid shift in working conditions of millions of office workers raised some significant ergonomic considerations. The shift towards a “home-office” model was deemed advantageous as it minimized the transmission of the infection and mitigated unemployment risks and loss of gross domestic product.⁴ Accordingly, some larger architecture firms specializing in workspace design predict a “new normal” or a “hybrid reality” within which working at home will be a consistent part of daily working life on a continuing basis within the post-COVID world.^5,6

The proportion of jobs involving working from home has already been expanding for the past couple of decades.⁷ But following the impact of the pandemic, this number nearly quadrupled to 50% of the workforce in the United States.² Due to the pandemic, many companies had to abruptly adjust operations, many employees had to suddenly adapt to the working from home model.^3,8 Employees today exhibit higher dependence on ergonomic designs than before, considering the emergence of new jobs and transforming old ones as well as the paradigm shift in desk work conditions experienced in recent decades, such as workers interfacing with multiple monitors, or oppositely, utilizing small laptop and tablet screens today in stark contrast with the paper print-outs and typewriters of the past.⁹ Moreover, a new generation of workers shaped by a communication society, appears to be more inclined and motivated in terms of performing work from home.^10,11

In a typical home environment, furniture is selected based on emotional response, comfort perception, and build quality—not the features required to do work healthily and efficiently.¹² The dimensions, angles, and curvature of the furniture, support characteristics, the ability to enable tissue perfusion, as well as breathability are not always a concern. Additionally, the placement of the furniture and relationships between worktops and seating surfaces are rarely optimized for work. Therefore, it is safe to assume that the typical home conditions are unable to support the worker for extended periods of time, and in the long run, it can be expected that work productivity will suffer. Research has been investigating the relationship between employee wellbeing and productivity as well as other variables for decades,¹³ some research specifically focusing on ergonomic problems in desk jobs,^14,15 however, ergonomic problems, musculoskeletal pain, and working efficiency of employees who switched to the home working model during the pandemic have been investigated only by a very limited number of studies.^16–18

This study aims to examine ergonomic problems, musculoskeletal pain, working efficiency, and general health status in employees who have switched from home working model during the COVID-19 pandemic. To best of our knowledge this is the first study to evaluate ergonomic features, musculoskeletal pain, sleep status, resting methods, eating habits, and productivity related to the working from home experience during the pandemic.

METHODS

Study Design and Participants

The present study is an observational, descriptive, cross-sectional study. An online survey was conducted using a professional survey system (Qualtrics, USA) for 2 months (October to November 2020). Participants were recruited from companies that transitioned to working from home using purposive sampling to sample from certain professions. The inclusion criteria for the study were as follows: (i) must start working from home after the pandemic, (ii) must practice desk work using a computer; and the exclusion criteria were as follows: (i) working from home part-time (only on certain days of the week), (ii) starting work after the pandemic. All the participants had no previous experience of working from home and only started working from home after the pandemic. The total number of participants was 314, and 120 people (38.2%) were excluded from the analysis either because of incomplete response or for not meeting the inclusion criteria. A total of 194 participants were ultimately included in the study. Ethical approval was obtained from Gaziosmanpasa Training and Educational Hospital Ethics Committee (numbered 182–2020). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Data Collection Instrument

Data were collected through a survey that comprised 57 questions categorized under eight sections. The subject headings of the survey categories were as follows: (1) demographic characteristics and daily activities; (2) equipment features used in the home-working environment; (3) equipment features previously used in the work environment; (4) changes in work time during the working from home period; (5) environmental information on the home-workplace; (6) break-rest characteristics; (7) health status during the period of working from home; (8) working from home productivity (Table 1). The stages of the study were carried out in accordance with the recommendations regarding online research.¹⁹ Descriptive analyses of the data per section are provided below.

TABLE 1 - Questionnaire to Assess Ergonomics, Musculoskeletal Pain, Work Duration, and Productivity

Questions	Variables	Method
(Q1) Indicate your routine activities during the daily working time	Nine different activities: data/text entry, data/text correction, file examination, speaking on the phone, answering e-mails, meeting attendance, making a presentation, light or heavy lifting, and an “other” option	Multiple input
(Q2) Please indicate the daily activity level in hours before and after the pandemic	Outside activities, indoor activity/standing, sedentary activities, and sleep (hours)	Short answers
(Q3) Which of the following fits the type of chair you use while working at home?	Ten different chair types: two different types of armchair, bar stool (with or without back support), dining chair (soft), small study chair (with or without arm support), manager's chair, high office chair, and couch/sofa.	Multiple input
(Q4) Did you buy the chair you use at home for working purposes?	Yes/no question	Binary
(Q5) How long have you been using this chair at home?	Six different time intervals: “less than one month,” “1–3 months,” “3–6 months,” “6–12 months,” “1–3 years,” and “more than 3 years.”	Single input
(Q6) Which of the following did you pay attention to while buying a chair for your home working purposes?	Six features (price, design, color, durability, brand, and reliability)	Multiple input
(Q7) Please indicate the ergonomic features of the chair used to work from home.	Seven different choices: backrest, neck rest, armrest, chair height adjustment, arm height adjustment, back support adjustment, and wheels.	Multiple input
(Q8) Does the chair you use while working at home meet your expectations for comfort?	Definitely yes, yes, unsure, no, definitely no.	Five-point Likert scale
(Q9) How would you evaluate your total daily computer usage time? (Please indicate average time in hours for both before and after the pandemic.)	Hours	Short answers
(Q10) Which of the following fits the type of desk you use at home	Eight different desk types: small computer table, coffee table, high-adjustable desk, dining table, coffee table, computer table, and laptop stand.	Multiple input
(Q11) Which one of the following is the type computer you use while working at home?	Six different choices: “Company laptop,” “Company desktop computer,” “Company tablet,” “My own laptop,” “My own desktop computer,” “My own tablet”	Multiple input
(Q12) How do you evaluate the screen height you use while working from home?	Three choices: below eye level, at eye level or above eye level.	Single input
(Q13) How often do you have to lean right / left / forward / backward while working at home because of reflections or glare on the screen?	Always, often, sometimes, rarely, never	Five-point Likert scale
(Q14) Which of the following option suits best for the distance between you and the screen while working from home?	Three choices: shorter than arm span, at arm span, and longer than arm span.	Single choice
(Q15) How often do you have to lean towards/approach the screen while working at home to see the small details / texts on the screen?	Always, often, sometimes, rarely, never	Five-point Likert scale
(Q16) Which option fits the mouse and keyboard you use at home?	Seven different choices: “Oversized Mouse/Fits all palm,” “Ergonomic Mouse,” “Small Size Mouse / Can be used with Fingertips,” “Oversized Numpad Keyboard,” “Ergonomic Keyboard,” “Small Size/No Numpad Keyboard,” “No mouse / laptop touchscreen”	Multiple input
(Q17) Are you using a phone or headphone?	Six different choices: “Cellphone,” “Wired headphone / microphone,” “Bluetooth headphone/ microphone,” “Laptop microphone,” “Landline phone,” “Desktop microphone”	Multiple input
(Q18) Which of the following ergonomic supports do you use? Please indicate separately before the pandemic and after starting to work from home.	Six different choices: back support, seat ring, foot support, laptop support, document holder, or arm support; before and after the pandemic.	Multiple input
(Q19) Which of the following fits the type of chair you used at your workplace before the pandemic?	Ten different chair types: two different types of armchair, bar stool (with or without back support), dining chair (soft), small study chair (with or without arm support), manager's chair, high office chair, and couch/sofa.	Multiple input
(Q20), Please indicate the ergonomic features of the chair used at your workplace before the pandemic.	Seven different choices: backrest, neck rest, armrest, chair height adjustment, arm height adjustment, back support adjustment, and wheels.	Multiple input
(Q21) Which one of the following is the computer you used at your workplace before the pandemic?	Six different choices: “Company laptop,” “Company desktop computer,” “Company tablet,” “My own laptop,” “My own desktop computer,” “My own tablet”	Multiple input
(Q22) How do you evaluate the screen height you used at your workplace?	Three choices: below eye level, at eye level, or above eye level	Single input
(Q23) Which of the following option suited best for the distance between you and the screen at your workplace before the pandemic?	Three choices: shorter than arm span, at arm span, and longer than arm span.	Single input
(Q24) Which one fits the mouse and keyboard you used at your workplace?	Seven different choices: “Oversized Mouse / Fits all palm,” “Ergonomic Mouse,” “Small Size Mouse/Can be used with Fingertips,” “Oversized Numpad Keyboard,” “Ergonomic Keyboard,” “Small Size/No Numpad Keyboard,” “No mouse / laptop touchscreen”	Multiple input
(Q25) Which option fits the mouse and keyboard you used at work?	Seven different choices: six different choices: “Cellphone,” “Wired headphone / microphone,” “Bluetooth headphone/ microphone,” “Laptop microphone,” “Landline phone,” “Desktop microphone”	Multiple input
(Q26) How has your daily working time changed with the transition to working from home?	Seven different time choices: “Increased more than 3 hours,” “Increased 1–3 hours,” “Increased less than one hour,” “No changes,” “Decreased less than one hour,” “Decreased 1–3 hours,” “Decreased more than 3 hours.”	Single input
(Q27) What do you think could be the reason for the change in working time in the working from home process? Please specify.		Open-ended question
(Q28) “How did your working hours change in the process of working from home?”	Four choices: “similar to working hours,” “earlier hours,” “later hours,” and “completely different.”	Single input
(Q29) “How did the meeting lengths change in the work-from-home process?”	Seven different time choices: (more than 2 hours longer), (1–2 hours longer), (0–1 hours longer), no change, (0–1 hour shorter), (1–2 hours shorter), (more than 2 hours shorter).	Single input
(Q30) Which room (s) do you use as a working environment in your home?	Seven different choices: “study room,” “living room,” “guest room,” “kitchen,” “bedroom”, “balcony/terrace”, and an “other” option.	Multiple input
(Q31) Which of the following matches the light and illumination level of your home working environment?	Five different choices: “sunny,” “bright,” “normal,” “dim,” and “dark.”	Single input
(Q32) Which of the following fits the sound and noise level of your home working environment?	Five different choices: “Quiet,” “Mostly quiet,” “Normal,” “Mostly noisy,” and “Noisy.”	Single input
(Q33) Do you share your work environment with other family members?	Seven different choices: “No, I don’t share,” “working partner,” “unemployed partner,” “Parents/In-laws,” “Kids,” “Pets,” and an “others” option.	Single input
(Q34) How often do you share your working environment?	Always, often, sometimes, rarely, never	Five-point Likert scale
(Q35) What changes have you made in your working environment after you started working from home?	Four different answers: “No changes,” “minimal changes,” “complete change,” and an “other” option	Single input
(Q36) How often do you change your work setting and move to a different work setting while working at home?	Six different answers: “I never change,” “more than 10 minutes,” “every 10–30 minutes,” “every 30–60 minutes,” “every 1–3 hours,” “more than 3 hours.”	Single Input
(Q37) Which of the following do you consider changing into among the work setting / positions?	Five different choices: “Standing,” “Lying down,” “Lying on the sofa,” “Different table/workplace,” and an “others” option.	Multiple input
(Q38) How do you maintain the balance between breaks-rests while working from home?	Seven different choices: “Every 10 minutes,” “Every 20 minutes,” “Every 30 minutes,” “Every hour,” “Every two hours,” “Every three hours,” “Every 4 hours and more”	Single input
(Q39) How are your meals and nutritional quality affected while working from home?	Four different propositions	Five-point Likert scale
(Q40) How did your weight change during the pandemic?	Kilograms	Short answers
(Q41) How did the quality time spent change for yourself and your family when working from home?	Five different choices: “much more time,” “more time,” “no change,” “less time,” “much less time.”	Five-point Likert scale
(Q42) How would you evaluate your daily rest quality while working from home?	Five different choices: “Much better quality,” “Better quality,” “Neutral,” “Less quality,” “much less quality”	Five-point Likert scale
(Q43) Which of the following do you do to rest?	Ten different choices: taking a nap, reading a book (seated), reading a book (lying down), watching TV (seated), watching TV (lying down), social media/surfing (seated), social media/surfing (lying down), listening music (seated), listening music (lying down) and an “others” option	Multiple input
(Q44) How long is your sleep time when working from home?	Hours	Short answers
(Q45) Please mark the option that best suits you in terms of your sleep quality.	Five different choices: good, mostly good, variable, mostly poor, insomnia	5-point Likert scale
(Q46) Please evaluate your sleep quality according to the period of working from home compared to before the pandemic	Five different choices: much better, better, same, worse, much worse	Five-point Likert scale
(Q47) How would you evaluate your general health condition, taking into account the time before the pandemic?	Five different choices: excellent, very good, good, fair, poor	Single input
(Q48) Do you have a hereditary or chronic condition/disease? Please specify if you have any	Yes/no question	Binary
(Q49) Do you smoke?	Eight different choices: no smoker, passive smoker, less than 3-pieces,3–10 piece daily,10–20 piece daily, one package daily,1–2 packages daily	Single input
(Q50) Has there been any change in your smoking status after the pandemic?	Six different choices: started again, quitted smoking, no change, decreased, increased	Single input
(Q51) Please rate the pain you experienced while working at the workplace, before the pandemic, according to different body regions. Rate your pain scores between 0 and 10 points. 0 points means you have no pain, 10 points means very severe pain.	Nine different body regions: neck, shoulders, upper back, elbows, wrists/hands, low back, hips/thighs, knees, ankles/feet	Visual analog scale
(Q52) Please rate the pain you experienced while working from home during the pandemic according to different body regions. Rate your pain scores between 0 and 10 points. 0 points means you have no pain, 10 points means very severe pain.	Nine different body regions: neck, shoulders, upper back, elbows, wrists/hands, low back, hips/thighs, knees, ankles/feet	Visual analog scale
(Q53) Please indicate if you have used painkillers / doctor's visit and sick leave use for your musculoskeletal pain during your working from home period.	Nine different body regions: neck, shoulders, upper back, elbows, wrists/hands, low back, hips/thighs, knees, ankles/feet	Multiple input
(Q54) How long have you been working from home continuously after the pandemic started?	Eight different choices: less than 15 days, 15–30 days, 1–2 months, 2–3 months, 3–4 months, 5–6 months, more than 6 months	Single input
(Q55) How would you evaluate your stress / comfort experience in the home environment during the pandemic compared with working at work?	More stressful, stressful, same, relaxed, more relaxed	Five-point Likert scale
(Q56) How do you evaluate your productivity / efficiency in the home environment in general compared to working in the workplace?	More efficient, efficient, same, inefficient, more inefficient	Five-point Likert scale
(Q57) How would you evaluate the quality of your work in the home environment compared to working at work?	Much better quality, better quality, same, poor quality, much poorer quality	Five-point Likert scale

Section 1: Demographic Characteristics and Daily Activities

In Section 1; we evaluated age, sex, height, weight, marital status, and profession information of the participants. We also asked routine job descriptions, physical activity of the participants before and after the pandemic (the questions benefited from the International Physical Activity Questionnaire.²⁰) (Table 1).

Section 2: Equipment Features Used in Home-Working Environment

Section 2 consists of equipment features used in the home working environment. Chair type whether the chair was specifically bought for working from home the usage time the points that participants consider while buying chairs in general, the ergonomic features of the chair (based on the Rapid Office Strain Assessment²¹). Only the participants who marked the specific types of chairs in Q3 were asked to answer Q4, Q5, Q6, and Q7 (Table 1).

In Q8, we evaluated the expectations from the chair being used during working from home in terms of comfort using a five-point Likert scale. Daily computer usage before and after the pandemic, the desk type used for working from home using eight different types of desks with pictures and an “other” option was provided if necessary the type of computer used for working from home, screen height, glare, and reflections on the screen forcing sitting position change the distance between the screen and the participant. Ergonomic difficulties and frequency of posture changes during working from home, the keyboard and mouse features, phone or headset usage, used ergonomic supports before and after the pandemic were also evaluated (Table 1).

Section 3: Equipment Features Previously Used in Work Environment

Section 3 consists of equipment features used in the workplace before the pandemic. We evaluated the type of chair the ergonomic features of the chair used in the workplace, computer type, screen height, the distance between the participant and the screen, the keyboard and mouse type, and the telephone and headset type before the pandemic in the workplace (Table 1).

Section 4: Changes in Working Time During the Working From Home Period

Section 4 evaluated the changes during working from home in terms of daily working time, the reasons for daily working time changes with an open-ended question, working hour ranges, and meeting lengths (Table 1).

Section 5: Environmental Information of the Home-Workplace

In Section 5, we evaluated working from home environment and questioned the room type used for working from home the light and illumination level the sound level, whether the participant shared the working environment with someone else, the frequency of the shared workplace the changes in the working environment after transitioning to work from home whether the participant changed the working environment during the workday and which spaces, places, or positions they have changed to (Table 1).

Section 6: Break-Rest and Nutrition Features

We evaluated the break and resting behavior of the participants when working from home and evaluated the frequency of the break-rest, meal and nutritional quality, changes in weight during the pandemic, quality time spent with your family and for yourself during working from the home period, daily rest quality, methods used to rest, sleep time, sleep quality, and sleep quality during working from home compared with before the pandemic (Table 1).

Section 7: Health Status During the Period of Working From Home

We evaluated the health status and musculoskeletal pain during the working from home period using multiple questions. The Nordic Musculoskeletal Questionnaire and Visual Analog Scale were used to assess work-related pain.²² We asked general health status, any comorbidities, smoke usage, the change in the number of cigarettes smoked during the pandemic and then evaluated musculoskeletal pain before the pandemic in the workplace, musculoskeletal pain during working from home period after the pandemic, usage of painkillers, doctor's visit and sick leave during the working from home period (Table 1).

Section 8: Working From Home Efficiency

We evaluated productivity during the working from home period with four questions, via self-assessment. We questioned the total duration of working from home after the pandemic started, the level of stress or comfort compared with the workplace, productivity compared with the workplace, quality of work compared with the workplace (Table 1).

Statistical Analysis

We used IBM SPSS ver. 20.0 software for the analysis. The Shapiro-Wilk test was employed to determine whether the variables were normally distributed. We calculated the means and standard deviations of continuous, normally distributed variables. We present the frequencies of categorical variables and compared them using the chi-squared test. For the comparison of the values before and after the pandemic, a paired samples t test was used. Thematic content analysis was used to analyze the open-ended question and the data were scanned twice by a single coder. The intraclass correlations were used to test reliability of the coder (which was 0.92). Later, coding units were created in the light of this data. Categorized patterns were reached by using coding units. Then, a frequency table was created according to the number of repetitions of the coding units for question 27. Multivariate stepwise linear regression analysis was conducted to explore the association of the low back pain increase and weight gain with other variables. The multivariate regression model included independent variables that were with Pp-values < 0.05 in the univariate analyses. An overall P-value < 0.05 was considered to reflect significance.

RESULTS

Section 1: Demographic Characteristics and Daily Activities

Descriptive and the physical activity results of the 194 participants (51%, men) were showed in Table 2. Outside activities were significantly decreased (P < 0.001) and indoor activities of the participants were significantly increased after the pandemic (P = 0.003). Sedentary activities and sleep duration of the participants were also increased significantly after the pandemic (P < 0.001 and P = 0.005, respectively).

TABLE 2 - Demographic Features, Physical Activity Results Before and After the Pandemic, and Job Descriptions of the Participants

Age, yrs∗	33.97 ± 7.6 (18–65)
Weight, kg∗	73.57 ± 16.2 (48–140)
Height, cm∗	171.35 ± 8.66 (150–193)
BMI, kg/m2 ∗	24.85 ± 4.16 (15.4–46.7)
Marital status, %, n
Single	47.9%, n = 93
Married	50.5%, n = 98
Engaged	0.5%, n = 1
Job, %, n
Engineer	35.6%, n = 69
Analyst	12.4%, n = 24
Academician	11.9%, n = 23
Software specialist	9.3%, n = 18
Banker	6.2%, n = 12
Marketing expert	5.7%, n = 11
İnterior architect	5.2%, n = 10
Executive	4.6%, n = 9
İntern	3.6%, n = 7
Consultant	3.6%, n = 7
Doctor	2.1%, n = 4

Physical Activity	Before the Pandemic	After the Pandemic	P Value∗∗
Outside activities∗	2.57 ± 2.03 (0–15)	1.49 ± 1.3 (0–8)	<0.001
Indoor activity/standing∗	2.68 ± 2.49 (0–15)	3.19 ± 2.31 (0–11)	0.003
Sedentary activities∗	8.22 ± 4.42 (0–16)	9.72 ± 3.99 (1–16)	<0.001
Sleep∗	7.38 ± 1.51 (1–13)	7.79 ± 1.85 (1–16)	0.005

Job descriptions, %, (n)
Creating/replying a e-mail	71.6, (139)
Attending an online meeting	68.5, (133)
Speaking on the phone	64.4, (125)
Fast data entry/text writing	48.4, (94)
Correcting data/text	46.9, (91)
Making presentation	44.3, (86)
Viewing/signing a file	32.9, (64)
Carrying light box/file	1, (2)
Carrying heavy items/equipment	0.5, (1)

^∗Represented as mean ± standard deviation (minimum–maximum) in hours.

^∗∗Paired samples t test, significance level 0.05.

Section 2: Equipment Features Used in Home-Working Environment

The results of the Q3 which was evaluated chair type used while working from home presented in Table 3. Seventy three of the participants answered the Q4 and Q5 as they were limited to certain chair type answers. 79.4% of the participants bought for the chair working purposes. The majority of the participants reported they have been using the same chair used while working from home for more than 3 years (30.1%, n = 22) or 1 to 3 years (27.3%, n = 20). In Q6, the participants reported the features they considered when they bought the chair that was used when working from home as: price (28.3%, n = 55), endurance (20.6%, n = 40), design (19.5%, n = 38), reliability (9.2%, n = 18), color (6.7%, n = 13), and brand (5.15%, n = 10). The comfort expectations from the chair used for working from home were as follows: definitely no (12.4%, n = 24), no (32%, n = 62), unsure (22.2%, n = 43), yes (27.3%, n = 53), and definitely yes (6.2%, n = 12). As a result, most of the participants were not happy with the comfort level of their chairs while working from home. Q10 evaluated the desk type used working from home and the most common answer was the dining table (n = 104) and the rest were as follows: computer desk (21.1%, n = 41), study desk (19.5%, n = 38), height adjustable desk (6.1%, n = 12), laptop stand (5.15%, n = 10), desk (4.6%, n = 9), coffee table (2.5%, n = 5), small computer desk (1.5%, n = 3) and one participant reported using kitchen countertops and one participant reported using nothing.

TABLE 3 - Comparison of the Ergonomic Features Before and After the Pandemic

	Before Pandemic (Workplace)	During Pandemic (Working From Home)	P Value∗
Chair type (Q3–Q19)
Dining chair (Soft)	N/A	63	<0.001
Dining chair (Hard)	N/A	44
Armchair	5	37
Small work chair (with arm support)	42	33
Sofa bed/Double or triple sofa	N/A	32
Manager's chair	21	15
Ergonomic working chair	74	11
Small work chair (without arm support)	8	9
High working chair	49	7
Gamer's chair	2	4
Back support bar stool	N/A	4
Stool	1	2
Plastic folding chair	N/A	2
Bed	N/A	1
Ergonomic features of the chair (Q7–Q20)
Back support	129	44	<0.001
Neck support	55	15
Arm support	156	60
Seat height adjustment	166	64
Arm height adjustment	111	10
Back support adjustment	93	30
Wheels	154	56
Computer type (Q11–Q21)
Company laptop	120	102	<0.001
Company desktop computer	92	14
Company tablet	N/A	3
My own laptop	N/A	85
My own desktop computer	N/A	29
My own tablet	N/A	7
Screen height (Q12–Q22)
Above eye level	14	9	<0.001
Eye level	150	98
Below eye level	29	87
Distance to the screen (Q14–Q23)
Longer than arm distance	23	21	0.009
At arm distance	140	97
Shorter than arm distance	30	76
Mouse and keyboard type (Q16–Q24)
Oversized mouse/fits all palm	72	59	0.104
Ergonomic mouse	50	62
Small size mouse/can be used with fingertips	29	40
Oversized numpad keyboard	71	48
Ergonomic keyboard	36	26
Small size/no numpad keyboard	32	55
No mouse/laptop touchscreen	5	4
Phone or headphone usage (Q17–Q25)
Cellphone	135	164	0.032
Wired headphone/microphone	95	114
Bluetooth headphone/microphone	48	64
Laptop microphone	27	43
Landline phone	70	2
Desktop microphone	4	3

^∗Significance level <0.05.

The average time for daily computer usage was 7.28 ± 2.81 (1–14) hours before the pandemic and 9.48 ± 3.18 (1–16) hours during the pandemic while working from home. The average time for computer usage significantly increased during the pandemic (P < 0.001). Q15 evaluated the rates of postural changes during working from home and results were as follows: of the participants reported “sometimes” (36.6%, n = 71), “rarely” (23.2%, n = 45), “often” (20.1%, n = 39), “never” (14.9%, n = 29), and “always” (5.2%, n = 10).

Section 3: Equipment Features Previously Used in Work Environment

The chair type and the ergonomic features of the chair used for working from home were also significantly different compared with the workplace chair. The majority of the participants used a dining chair (soft or hard) during working from home compared with the workplace where participants were used ergonomic or high working chair. The participants mainly used their own desktop/laptop/tablet while working from home and met their own needs. Screen height was significantly “below eye level” and distance to the screen was “shorter than arm distance” while working from home compared with the workplace environment. Mouse or keyboard type was not significantly different between working from home and workplace. The cellphone and wired/Bluetooth or laptop microphone usage were significantly increased compared with the workplace (Table 3).

Section 4: Changes in Working Time During the Working From Home Period

The changes in daily working time after the pandemic, revealed that the majority of the participants (64.9%, n = 126) reported that the daily working time increased (more than 3 hours [19.6%, n = 38], 1 to 3 hours [38.7%, n = 75], less than 1 hour [6.7%, n = 13]). 19.1% (n = 37) of the participants reported no changes in daily working time and 15.9% (n = 31) of the participants reported that their daily working time decreased (more than 3 hours [5.7%, n = 11], 1 to 3 hours [5.2%, n = 10], less than 1 hour [5.2%, n = 10]).

The main topics affecting the changes in working time according to the participants were as follows: waiting for each other due to lack of coordination during online meetings, reduced time in traffic, the uncertainty of the pandemic, no guests during working hours and reduced break times, uncertain working hours, housework, increased demand because of the perception that one can work more because of the ease of access by superiors, focusing better and quieter working environment, loneliness, and boredom.

Most of the participants reported similar working hours during the working from home compared with the before the pandemic (44.3%, n = 86), but the meeting hours increased more than 2 hours according to the most of the participants (21.6%, n = 42).

Section 5: Environmental Information of the Home-Workplace

The majority of the participants reported that they are working in other rooms rather than a dedicated study room. The preferred workspaces of the participants during working from home were guest room (45.8%, n = 89), study room (32.9%, n = 64), living room (32.9%, n = 64), bedroom (26.8%, n = 52), kitchen (18%, n = 35), and balcony/terrace (13.9%, n = 27). The majority of the participants rated the work environment as optimal in terms of illumination and sound level. The most of the participants work alone and do not share the working room with anyone else (55.1%, n = 107). The frequency of the shared room when working was “Always” (9.2%, n = 18), “Often” (18%, n = 35), “Sometimes” (12.8%, n = 25), and “Rarely” (3%, n = 6). When we examined the changes at home after starting to work from home, most of the participants did not change anything (no changes, 51%, n = 99). The majority of the participants (60.8%, n = 118) reported no changes of work area or working position during working from home period. The majority of the participants who changed their work area changed to a different workplace or table or they continued to work lying on the sofa.

Section 6: Break-Rest and Nutrition Features

In Q38 we evaluated break and rest frequency of the participants during working from home. The results were as follows: “Every 10 minutes” (3.1%, n = 6), “Every 20 minutes” (1%, n = 2) “Every 30 minutes” (6.7%, n = 13), “Every hour” (34.5%, n = 67), “Every 2 hours” (28.4%, n = 55), “Every 3 hours” (15.5%, n = 30), “Every 4 hours and more” (10.8%, n = 21). Q39 evaluated nutrition and meal quality during working from home in four different propositions (Table 4). Q40 evaluated body weight changes during the pandemic, and 46.9% (n = 91) of the participants reported an increase in their weight (5.73 ± 4.39 kg) during the working from home period after the pandemic. 18% (n = 35) reported that they lost weight (6.13 ± 5.75 kg) and 35.1% (n = 68) reported no change. The quality time spent for themselves and with their families were evaluated and the majority of the participants reported that they spent “much more time” (18.6%, n = 36) and “more time” (39.7%, n = 77) after the pandemic. The daily rest quality of the participants during working from home evaluated and the results were as follows: neutral (28.9%, n = 56), better quality (25.3%, n = 49), less quality (24.2%, n = 47), much better quality (11.9%, n = 23), much less quality (9.8%, n = 19). The methods used for resting, sleep duration, sleep quality, and changes in sleep quality during working from home period and the results presented in Table 4.

TABLE 4 - Meal and Nutrition Changes of the Participants During Working From Home and Resting Methods, Sleep Duration, Sleep Quality, and Change in Sleep Quality After the Pandemic

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I eat more regularly	10.3% (n = 20)	36.1% (n = 70)	15.5% (n = 30)	23.7% (n = 46)	14.4% (n = 28)
I consume more home food	29.9% (n = 58)	40.2% (n = 78)	8.2% (n = 16)	13.9% (n = 27)	7.7% (n = 15)
I order more food from delivery services	3.1% (n = 6)	11.3% (n = 22)	12.4% (n = 24)	38.1% (n = 74)	35.1% (n = 68)
I consume more junk food	10.3% (n = 20)	29.9% (n = 58)	14.4% (n = 28)	28.9% (n = 56)	16.5% (n = 32)

Rest and sleep features
Resting methods	Taking a nap	70
	Read a book (seated)	24
	Read a book (lying down)	49
	Watching TV (seated)	42
	Watching TV (lying down)	85
	Social media/surfing (seated)	69
	Social media/surfing (lying down)	104
	Listening to music (seated)	33
	Listening to music (lying down)	51
	Playing video games	4
Sleep duration, hours	Less than 4 hours	1% (n = 2)
	5 hours	5.2% (n = 10)
	6 hours	13.4% (n = 26)
	7 hours	35.6% (n = 69)
	8 hours	35.1% (n = 68)
	9 hours	8.2% (n = 16)
	more than 10 hours	1.5% (n = 3)
Sleep quality	Good	12.9% (n = 25)
	Mostly good	29.4% (n = 57)
	Variable	40.2% (n = 78)
	Mostly poor	15.5% (n = 30)
	Insomnia	2.1% (n = 4)
Change in sleep quality after the pandemic	Much better	14.9% (n = 29)
	Better	25.3% (n = 49)
	Same	40.7% (n = 79)
	Worse	16% (n = 31)
	Much worse	3.1% (n = 6)

Section 7: Health Status During the Period of Working From Home

The analyses of Section 7 and 8 are core to the findings of the study and provided in a tabulated format, for ease of comparison, contrary to the previous six sections which were descriptive in nature. The participants mostly described their general health as good, and most of the participants had no comorbidities. Although the number of smokers is low, the increased consumed numbers in the majority of the smokers is striking (Table 5). Neck, low back, hip, and knee pain increased after the pandemic and working from home period, but only low back pain increased significantly. Interestingly the participants used medication for the neck pain mostly, but for the doctors’ visit and sick leave low back pain was the main reason (Table 6).

TABLE 5 - Health Status and Smoking Rates of the Participants

General health
Excellent	4.1% (n = 8)
Very good	16% (n = 31)
Good	52.6% (n = 102)
Fair	19.1% (n = 37)
Poor	8.2% (n = 16)
Comorbidities, no (%)	88.6% (n = 172)
Smoke usage
No smoker	63.4% (n = 123)
Passive smoker	4.6% (n = 9)
Less than three pieces	3.1% (n = 6)
3–10 piece daily	8.8% (n = 17)
10–20 piece daily	9.8% (n = 19)
One package daily	7.2% (n = 14)
1–2 packages daily	3.1% (n = 6)
Change in smoking after the pandemic
Started again	4.6% (n = 9)
Quitted smoking	1.5% (n = 3)
No changes	78.4% % (n = 152)
Decreased	4.1% (n = 8)
Increased	11.3% (n = 22)

TABLE 6 - Musculoskeletal Pain in Nine Body Regions Before and After Starting to Work From Home

Musculoskeletal Pain Before and After the Pandemic		Before the Pandemic in a Workplace	After the Pandemic, During Working From Home	P Value∗	Medication Usage	Doctor's Visit	Sick Leave
	Neck	3.07 ± 2.89	3.3 ± 2.95	0.200	30.41% (n = 59)	3.09% (n = 6)	0.52% (n = 1)
	Shoulders	2.94 ± 2.88	2.76 ± 2.94	0.334	20.10% (n = 39)	2.06% (n = 4)	0
	Upper back	3.8 ± 2.99	3.86 ± 3.14	0.779	24.23% (n = 47)	3.61% (n = 7)	0.52% (n = 1)
	Elbows	1.16 ± 2.03	1.07 ± 1.99	0.415	7.73% (n = 15)	0.52% (n = 1)	0
	Wrists/Hands	1.62 ± 2.39	1.59 ± 2.44	0.861	8.25% (n = 16)	2.06% (n = 4)	0
	Low back	3.14 ± 2.88	3.56 ± 3.29	0.03	17.53% (n = 34)	4.12% (n = 8)	1.55% (n = 3)
	Hips/Thighs	1.58 ± 2.46	1.77 ± 2.73	0.215	8.25% (n = 16)	3.09% (n = 6)	0.52% (n = 1)
	Knees	1.62 ± 2.4	1.73 ± 2.69	0.463	8.25% (n = 16)	1.03% (n = 2)	0
	Ankles/Feet	1.17 ± 2.13	1.14 ± 2.13	0.838	5.67% (n = 11)	2.58% (n = 5)	0.52% (n = 1)

^∗Paired samples t test, significance level <0.05 shown as bold.

Section 8: Working From Home Efficiency

During our study, the majority of the participants had been working from home for more than 6 months. The participants were less stressful, more efficient, and had better quality of work during working from home period according to the self-reported results (Table 7).

TABLE 7 - The Time, Stress Level, Productivity, and Quality of the Work After Starting to Work From Home

The time after starting to work from home
Less than 15 days	6.7% (n = 13)
15–30 days	5.2% (n = 10)
1–2 months	5.2% (n = 10)
2–3 months	7.2% (n = 14)
3–4 months	8.8% (n = 17)
5–6 months	7.7% (n = 15)
More than 6 months	59.3% (n = 115)
Self-assessed stress level during working from home compared with the workplace
More stressful or stressful	34% (n = 66)
Same	20.1% (n = 39)
Relaxed or more relaxed	45.8% (n = 89)
Self-assessed productivity during working from home compared with the workplace
More efficient or efficient	50.5% (n = 98)
Same	12.9% (n = 25)
İnefficient or more İnefficient	36.5% (n = 71)
Self-assessed quality of work during working from home compared with a workplace
Much better quality or better quality	43.2% (n = 84)
Same	39.7% (n = 77)
Poor quality or much poorer quality	17% (n = 33)

Outdoor Activities—Weight Gain and Nutrition Quality During the Pandemic While Working From Home

The participants reported that their outdoor activities significantly decreased during the pandemic. Although most of the participants reported that they ate more regularly (46.4%, n = 90), consumed more homemade food (71.1%, n = 138), ordered less food from delivery services, while consuming more junk food (46.4%, n = 90), the majority of the participants reported a weight gain (46.9%, n = 91). We searched for the independent variables that affected weight gain during the working from home period and formed a model using multivariate linear regression analysis. Indoor activity/standing (after the pandemic), eating junk food, elbow pain, and type of phone/microphone were the independent variables that affected weight gain during working from home and the coefficient of determination of the weight gain was 0.573, indicating that these four factors explain 57% of all variations in weight gain (Table 8).

TABLE 8 - Multivariate Stepwise Linear Regression Analysis of Factors Affecting Weight Gain and Low Back Pain

	B	SE	β	t	P Value
Weight gain∗
Constant	6.392	3.312		2.417	<0.001
Indoor activity/standing (after the pandemic)	–3.255	0.138	–0.411	–6.219	<0.001
Eating junk food	–1.245	0.213	–0.496	–2.307	<0.001
Elbow pain	–3.009	1.912	–0.232	–1.722	0.04
Type of phone/microphone
Low back pain∗∗
Constant	12.025	4.545		3.106	<0.001
Lumbar support usage before the pandemic	–1.337	1.278	–0.202	–8.508	<0.001
Stress level during working from home	–0.554	0.224	–0.256	–3.358	<0.001
General health status	–1.216	1.348	–0.052	–2.592	<0.001
Sleep duration	–1.534	0.321	–0.184	–4.401	<0.001
Rest quality during working from home	–0.211	0.258	–0.557	–2.582	0.031

β, standard regression coefficient; B, partial regression coefficient; SE, standard error.

^∗F = 2.913, R = 0.756, R² = 0.573.

^∗∗F = 5.407, R = 0.694, R² = 0.483.

Low-Back Pain Increase

The participants reported that their back pain significantly increased (P = 0.03) during the working from home period compared with before the pandemic. We used a multivariate linear regression model to determine the independent variables that affected low back pain. We included the independent variables which were significant in the univariate analysis. Lumbar support usage before the pandemic, stress level during working from home, general health status, sleep duration, and rest quality during working from home were the independent variables affected low back pain increase during working from home period of the participants and the coefficient of determination of the low back pain increase was 0.483, indicating that these five factors explain 48% of all variation in this difference (Table 8).

DISCUSSION

In this study, we evaluated ergonomic features, musculoskeletal pain, and self-reported work performance during working from home. The study revealed that employees who switched to working from home during the pandemic process were caught unprepared in many ways. Chair type, desk type, and computer type used for working from home were mostly inappropriate and the participants largely met their needs by their own immediately available means.

We aimed to examine all ergonomic aspects of working from home. We realized that the ergonomic needs of the employees were met insufficiently due to the rapid changes introduced by the pandemic. This finding shows parallels to previous research on the subject. In a study conducted by Davis et al,⁴ workstations of the participants were evaluated in the early stages of the pandemic, they found that equipment used during working from home was not as suitable as the workplace. Another study found that the pandemic negatively affected the workers’ performance especially in women and individuals with disability, and the home office ergonomics was a crucial factor.¹⁶ In our study, the participants were using less ergonomically appropriate equipment. For example, the majority of the participants stated that they utilized dining chairs/tables, additionally most of the participants stated that they did not buy new equipment specifically for working from home. The majority of the chairs used, for example, were purchased before the pandemic (57.4%, more than 1 year before). Moreover, most of the computer equipment used during working from home was also provided by the participants themselves. Screen height and the distance between the screen and participants were also inappropriate according to our results. All these findings illustrate that employees have not fully been able to adapt to the process of working from home during the pandemic. Considering that most employees have been working from home for more than 6 months and will continue to do so for some time, it is safe to assume that the problems related to musculoskeletal pain that we identified will only be exacerbated.

We evaluated working hours during working from home period in this study. The majority of the participants reported a significant increase in the time spent using a computer and more daily working time and meeting times compared with the actual workplace experience. We also found an increase, although not significant, in the neck, upper back, hip, and knee pain. Interestingly, the area of the body where painkillers are used the most was the neck and upper neck. Low back pain was the main reason for the doctors’ visit due to pain and sick leave. The study by Bloom et al²³ concluded that working from home caused fewer sick days. We only evaluated the musculoskeletal pain-related sick days of the participants and only seven out of the 194 participants called in sick during the working from home period.

The analysis indicated that the use of non-ergonomic equipment increased the severity of low back pain significantly (P = 0.03). We found that the lack of lumbar support, stress levels, general health status, sleep duration, and rest quality were the independent variables affecting low back pain increase during working from home. A study conducted by Toprak Celenay et al¹⁸ compared the musculoskeletal pain of people who stayed at home to continue to work for a period of 3 months of lockdown and found that low back pain increased in the stay-at-home group, similar to our study. Another study by Siqueira et al,¹⁷ conducted after the pandemic, showed an increased frequency of pain in the neck, shoulder, and upper back regions in working from home group. Our study included fewer participants who worked from home for a longer period of time and we evaluated pain levels using an 11-point rated visual analog scale. A comparison of the findings indicates increasing pain levels as employees continue to work in sub-optimal conditions.

The participants consistently described a decrease in their outdoor activities and an increase in their indoor activities. As a result, nearly half of the participants (46.9%) reported an increase in their weight during the working from home period. An online survey conducted by Flanagan et al²⁴ in the early stages of the pandemic reported similar results as most people reported eating healthy and cooking at home more but because of the decreased physical activity, weight gain was reported in 27.5% of the participants. Our study was conducted more than 6 months after the pandemic started, as a result, we found nearly half (46.9%) of the participants reported an increase in weight.

In our study, we aimed to evaluate productivity during working from home using three different self-assessed questions asking stress levels, productivity, and quality of the work output compared with the workplace before the pandemic. The participants stated that during the working from home period, they were more relaxed, more efficient, and they outputted better quality of work. The findings show parallels to a study conducted before the pandemic, Bloom et al²³ compared the productivity of two groups: one working from home and the other at actual workplace, and found that the working from home group was more efficient in terms of performance increase and working hours.

Limitations

The first limitation of the study is most of the questions were including ergonomic features were self-reported. Secondly, evaluating musculoskeletal pain before the pandemic might cause a bias, as asking pain experience prior to the time of the survey. Thirdly, even though the amount of data collected with the survey is highly detailed, cross-sectional and respondents covered a large demographic, the number of participants was limited. Fourthly, the specific activities that can be practiced at home via treadmill, such as exercise bikes, pilates, etc were not considered separately. Another limitation of the study is not evaluating whether the employees contracted COVID during the working from home period. Lastly, we did not consider the income changes of the participants while working from home.

CONCLUSION

In conclusion, the study revealed that many employees who rapidly switched to the working from home model following the pandemic were caught off guard and had to adjust by their own means. Significant increases were observed in the complaints of low back pain of employees due to ergonomic deficiencies. In addition, weight gain was observed compared with before the pandemic. It is possible to foresee that for employees who are expected to work from home, the employers should be advised to bear the burden in terms of either providing or contributing to the purchase of ergonomically appropriate task furniture and accessories. Also, based on the problems we see in terms of adjusting the task premises, it should be advised that educational programs that would address the quality-of-life issues for employees should be developed.

As we have identified in our study, many of the problems show an increase in severity and impact as the working from home period extends. Therefore, the data acquired in future studies should be useful in terms of plotting a trajectory for the severity of the problems identified in this study. In a future study, a larger sample pool with extended demographic coverage might be able to pinpoint the exact reasons for the problems identified in this study.

Even though COVID-19 might be taken under control in a matter of months or few short years, it should be expected that the working from home model is here to stay, therefore, studies such as this one and others of the same nature will continue to be relevant for some time to come.