# Teleworking and Musculoskeletal Disorders: A Systematic Review

Marc Fadel, Julie Bodin, Florence Cros, Alexis Descatha, Yves Roquelaure

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Marc Fadel, Julie Bodin, Florence Cros, Alexis Descatha, Yves Roquelaure. Teleworking and Musculoskeletal Disorders: A Systematic Review. International Journal of Environmental Research and Public Health, 2023, 20 (6), 10.3390/ijerph20064973. hal-04094584

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*Systematic Review*

# Teleworking and Musculoskeletal Disorders: A Systematic Review

Marc Fadel <fnref n="1" />,* ID, Julie Bodin <fnref n="1" />, Florence Cros <fnref n="2" />, Alexis Descatha <fnref n="1" />,<fnref n="3" /> ID and Yves Roquelaure <fnref n="1" />

**Abstract:** Teleworking has spread drastically during the COVID-19 pandemic, but its effect on musculo-skeletal disorders (MSD) remains unclear. We aimed to make a qualitative systematic review on the effect of teleworking on MSD. Following the PRISMA guidelines, several databases were searched using strings based on MSD and teleworking keywords. A two-step selection process was used to select relevant studies and a risk of bias assessment was made. Relevant variables were extracted from the articles included, with a focus on study design, population, definition of MSD, confounding factors, and main results. Of 205 studies identified, 25 were included in the final selection. Most studies used validated questionnaires to assess MSD, six considered confounders extensively, and seven had a control group. The most reported MSD were lower back and neck pain. Some studies found increased prevalence or pain intensity, while others did not. Risk of bias was high, with only 5 studies with low/probably low risk of bias. Conflicting results on the effect of teleworking on MSD were found, though an increase in MSD related to organizational and ergonomic factors seems to emerge. Future studies should focus on longitudinal approaches and consider ergonomic and work organization factors as well as socio-economic status.

**Keywords:** pain; musculoskeletal diseases; teleworking; public health; occupational health

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**Citation:** Fadel, M.; Bodin, J.; Cros, F.; Descatha, A.; Roquelaure, Y. Teleworking and Musculoskeletal Disorders: A Systematic Review. *Int. J. Environ. Res. Public Health* **2023**, *20*, 4973. https://doi.org/10.3390/ijerph20064973

Academic Editor: Ivo Iavicoli

Received: 30 January 2023

Revised: 28 February 2023

Accepted: 3 March 2023

Published: 11 March 2023

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**Copyright:** © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
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Attribution (CC BY) license (https://
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4.0/).

## 1. Introduction

The World Health Organization (WHO) and the International Labor Organization (ILO) define telework as: “the use of information and communications technology for work that is performed outside the employer’s premises” [1,2]. There are several terms related to this type of work, including remote work, which is the broadest term where the workplace can be anywhere outside the usual place, telework, which implies the usage electronic devises for remote work and home-based work/work from home (WFH), which can imply that the default working place is at home [1]. Hybrid work is a growing form of work which combines WFH and work in the office. In 2019, before the COVID-19 pandemic, 14% of workers in the European Union teleworked from home regularly or occasionally [3]. This number increased up to 40% of workers during summer 2020 following the multiple lockdowns and stabilized at 31% during spring 2022 [4]. The effect of teleworking on health seems to be contrasted both positively and negatively depending on the situations, with a predominant role of contextual factors [5-7]. Even before the pandemic happened, teleworking was implemented as a useful tool for allowing sustainable work and return to work, especially for workers with disabilities or who were suffering from chronic diseases, including cancer [8]. Indeed, traditional work environments may present barriers for these workers, especially those with cognitive limitations, and an adapted and familiar work environment at home may facilitate employment. Such accommodations require many changes in the work culture and vary significantly between countries [8]. Bouziri et al.

<footnote n="1">¹ Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)—UMR_S 1085, IRSET-ESTER, SFR ICAT, F-49000 Angers, France</footnote>

<footnote n="2">² GRePS UR 4163, Université Lumière Lyon 2, F-69007 Lyon, France</footnote>

<footnote n="3">³ Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine, Hosftra University Northwell Health, New York, NY 11021, USA</footnote>

<footnote>* Correspondence: marc.fadel@univ-angers.fr</footnote>
highlighted the potential health impact during the COVID-19 pandemic, as well as possible recommendations for decreasing the new related risk [9]. For example, during containment, telework decreased the risk associated with transportation but also showed the lack of ergonomic measures for home workstations and the work environment in general. Indeed, office work can be associated with musculoskeletal disorders (MSD) caused by multiple interlinking factors defined by the concept of professional exposome, including the under-stimulation of the musculoskeletal system, comorbidities, and work-related organizational factors [10]. MSD is a broad term that is referenced at any affection of the soft periarticular tissues, following the EU-OSHA (European Agency for Safety and Health at Work) [11]. Medically codified diseases are included in this definition, like carpal tunnel syndrome or rotator cuff disease, but unspecific conditions like low back pain or neck pain are also included. Although there were some studies on the impact of teleworking on mental health before the COVID-19 pandemic [12], few of them focused on MSD [13,14].

The aim of this systematic review was to make a synthesis of the literature on the effect of teleworking on MSD. A qualitative approach was chosen, since heterogenous methods and results were expected.

## 2. Methods

### 2.1. *Selection of Studies*

A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [15]. The following databases were searched for studies relevant to the subject with the help of a librarian: PubMed, Web of Science, Embase, Cairn, EBSCO databases, and Google Scholar. Musculoskeletal disorders (and related) were searched with teleworking/working at home (and related, see Supplementary Material S1). Keywords related to MSD were chosen to engulf the various aspects of the EU-OSHA's definition of MSD [11]. Only papers published since 1987 in English or French were included. Inclusion criteria were studies about workers (students were also included) exposed to teleworking/working at home, having an outcome related to MSD (whether pain, discomfort ...), and having a quantitative approach. Studies about telemedicine and domestic work were excluded from the review, as well as non-published studies (conference abstract) and reviews. There were no other restrictions for the studies, particularly on study design (before/after study, control group, or no control group). After the exclusion of duplicates, studies were included in two steps: selection on title and abstract and selection on the full paper. At each step, all studies were included or excluded by two different reviewers among MF, JB, AD, and YR. In case of disagreement, a consensus was obtained by a third reviewer that was different from the first two. A cross-reference approach was also implemented to identify potentially relevant studies that may have been missed in the initial selection step. The extraction of studies was completed on 5 May 2022.

### 2.2. *Extracted Data*

The following variables were extracted from the articles included at the final selection step: first author, year of publication, country, objective of the study, design, population, recruitment and data collection method, exclusion criteria, number of subjects included, data of inclusion and potential follow-up, definition of MSD outcome, confounding factors considered, main results, and conclusion of the authors and limitations.

The risk of bias was assessed following the Navigation Guide for systematic reviews in environmental and occupational health [16]. For each study, two different reviewers among MF, JB, AD, and YR assessed the nine risk of bias domains, although two of them were not applicable for the observational studies (randomization and selecting outcome reporting). The last risk of bias domain (other risk of bias) that was adapted for this systematic review thus focused on two aspects: the representativeness of the studied population to the general teleworker population and the presence of a control group. In the case of disagreement, a consensus was obtained among all four reviewers.
**3. Results**

Of the 205 studies included, 87 were duplicates and 76 were deemed irrelevant according to the title and abstract. Seventeen more studies were excluded for various reasons detailed in the flow chart (Figure 1). In the end, 25 studies were selected. Table 1 summarizes the characteristics of the studies included. An exhaustive summary of the studies is available in Supplementary Material S2. All studies were published during and after 2020, and only one study used data from before the COVID-19 pandemic [12]. There was a relatively good representation of countries throughout the world, with most of them coming from Asia [17–27] and Europe [12,28–34], and some from America and Australia [35–40]. Only three studies did not have a cross-sectional design: the first was a before/after study [28], the second was a prospective cohort [37], and the last was an interventional study [19].

<figure><img src="image_5.png" /><figcaption>**Figure 1.** Flow chart of the selection process.</figcaption></figure>
<table><caption>**Table 1.** Summary of data extracted from selected studies.</caption><thead><tr><th>Author</th><th>Country</th><th>Population</th><th>Number Included</th><th>Definition of MSD Outcome</th><th>Confounding</th><th>Results</th><th>Limitations of Authors</th></tr></thead><tbody><tr><td>Aegerter, 2021 *</td><td>Switzerland</td><td>Swiss office workers aged 18–65 years, working more than 25 h per week in sedentary office work, able to communicate in German, in the control cohort between January and April 2020, who answered the COVID-19-related questions in full and were working from home at the time of follow-up</td><td>58</td><td>NP severity and disability in the last 4 weeks: numeric rating scale and ND index</td><td>Fixed effects for workstation ergonomics, working hours at the computer, number of breaks during work, and time</td><td>No evidence that ND, number of work breaks, number of hours of computer work changed between pre-COVID-19 (WFH). Evidence of a 0.68-point reduction in NP intensity during the lockdown (95% CI 1.35 to 0.00). Possible increase of the effect of number of hours working on a computer and quality of workplace ergonomics on NP intensity. Possible decrease of the effect of the number of daily work breaks on ND. Strong evidence of poorer workstation ergonomics at home compared to the office</td><td>Population in the public sector, social desirability bias, low follow-up, retrospective report of workstation ergonomics at the office at follow-up, no objective criteria for assessing workstation ergonomics</td></tr><tr><td>Argus, 2021 *</td><td>Estonia</td><td>Job described as office work, working with a computer at least 6 h per day, age 18–60 years.</td><td>161</td><td>Modified NORDIC MSD questionnaire (personalized scale assessing the onset and evolution of the pain)</td><td>None</td><td>There were no statistically significant differences in the prevalence of MSP before and during the COVID-19 lockdown in different body areas and in total.</td><td>Questionnaire-based design, retrospective questions, and absence of data about psychosocial factors and pain intensity</td></tr><tr><td>Bailly, 2022 *</td><td>France, Switzerland</td><td>From the multicenter CONFI-LOMB study regrouping patients from hospitals and one private rheumatology: Adult who undergone a consultation for a common chronic LBP between 1 January 2020, and 17 March 2020 (start of the French lockdown)</td><td>360</td><td>Change in LBP intensity prior to the lockdown and during lockdown assessed by a 7-point Likert scale</td><td>None</td><td>In bivariate analyses, LBP increased in the case of teleworking during lockdown (p = 0.069) but not in the case of workstation dedicated to teleworking (p = 0.249) or equipment adapted to telework (p = 0.355)</td><td>Cross-sectional design, self-administered and anonymous computerized questionnaire patients from tertiary centers</td></tr></tbody></table>
<table><caption>**Table 1. Cont.**</caption><thead><tr><th>Author</th><th>Country</th><th>Population</th><th>Number Included</th><th>Definition of MSD Outcome</th><th>Confounding</th><th>Results</th><th>Limitations of Authors</th></tr></thead><tbody><tr><td>Deshmukh, 2020 *</td><td>India</td><td>IT professionals working 100% from home for at least a 6 month period</td><td>100</td><td>Nordic MSD Questionnaire</td><td>None</td><td>Results are difficult to interpret because of lack of details</td><td>Self-reported data, possibly underestimated their WMSDs to avoid being viewed negatively and small sample size</td></tr><tr><td>El Kadri Filho, 2022 *</td><td>Brazil</td><td>Employees of a Regional Labor Court who were teleworking specifically because of the need for social isolation</td><td>55</td><td>Nordic MSD questionnaire</td><td>None</td><td>Regions with the most complaints in the last 6 months and last 7 days were shoulders, neck, and wrists/hands. Posture and job demand exposure assessment was significantly correlated with MSK problems</td><td>Only workers in the labor judiciary, data collection eight months after the onset of the pandemic, cross-sectional design</td></tr><tr><td>Gerding, 2021 *</td><td>USA</td><td>All faculty staff, and administration employed by the University of Cincinnati</td><td>843</td><td>Level of discomfort numeric rating scale for several body regions</td><td>None</td><td>&gt;40% employees reported moderate to severe discomfort levels in the eyes/neck/head, upper back/shoulders, and lower back regions. Prior to COVID-19, 78.5% experienced little to no discomfort while working in their office setting, and 21.5% had moderate to severe discomfort. Increased glare and lack of having contact with the back of the chair increased discomfort for various body areas</td><td>Only staff from one public university, self-reported data on postures and discomfort, retrospective data, and low response rate (10%)</td></tr></tbody></table>
<table><caption>Table 1. *Cont.*</caption><thead><tr><th>Author</th><th>Country</th><th>Population</th><th>Number Included</th><th>Definition of MSD Outcome</th><th>Confounding</th><th>Results</th><th>Limitations of Authors</th></tr></thead><tbody><tr><td>Guler, 2021 *</td><td>Turkey?</td><td>Workers from companies that started working from home after the pandemic and who practice desk work using a computer</td><td>194</td><td>Nordic MSD Questionnaire and Visual Analog Scale for work-related pain</td><td>Multivariate analysis included independent variables with p-values &lt; 0.05 in the univariate analyses</td><td>Mean LBP significantly increased during pandemic (WFH) compared to before: 3.14 to 3.56 (p = 0.03). LBP was associated with lumbar support before the pandemic, stress level during WFH, general health status, sleep duration, and rest quality during WFH in the multivariate regression model</td><td>Cross-sectional design, low number of participants, some specific activities (treadmill, exercise bikes, pilates) were not considered separately, no evaluation of COVID infection during WFH, and no assessment of income changes during WFH</td></tr><tr><td>Houle, 2021 *</td><td>Canada</td><td>Participants aged between 18 and 65 years old and in a full-time telecommuting situation at least one week prior to enrollment</td><td>162</td><td>NP occurrence, intensity (numerical rating scale) and NP assessed by the Neck Bournemouth Questionnaire (NBQ)</td><td>Multivariate analysis with a stepwise method</td><td>70% reported at least one NP episode during follow-up. No work-related variables were associated with occurrence of NP episode, including presence of home workstation, headset wearing, telecommuting hours and headset wearing hours. Among telecommuters, NP-related disability was associated with future NP occurrence</td><td>Significant attrition following the initial assessment, impossibility to assess other health complaints, no distinction between headache and NP types, small sample size and no assessment of potential factors</td></tr><tr><td>Jain, 2022 *</td><td>India</td><td>University computer users at two Indian universities, over 18 years old, attending regular online classes, performing at least 150–200 min of PA per week</td><td>40</td><td>Corlett and Bishop's body part discomfort scale</td><td>None</td><td>The region with the highest discomfort on the Corlett and Bishop's scale before intervention was wrist/forearm (8.17 +/− 1.45), lower back (8.01 +/− 1.42), and neck (7.40 +/− 2.71)</td><td>Only university students</td></tr></tbody></table>
<table><caption>Table 1. *Cont.*</caption><thead><tr><th>Author</th><th>Country</th><th>Population</th><th>Number Included</th><th>Definition of MSD Outcome</th><th>Confounding</th><th>Results</th><th>Limitations of Authors</th></tr></thead><tbody><tr><td>Knardahl, 2022</td><td>Norway</td><td>All office workers from private and public organizations recruited from a previous project between 2004–2019</td><td>Cross-sectional sample: 7861 Prospective sample: 5258</td><td>Reported NP in the last four weeks with a four-level intensity scale and duration of complaint</td><td>Adjusted for working more than regular hours, gender, age, skill level, management responsibility, year of measurement (mixed effects regression)</td><td>NP not statistically associated with time working at home (hours): aOR and 95% CI compared to 0 h: 0 to 2 h, 0.93 (0.77–1.12), 2 to 5 h, 0.89 (0.71–1.11), 5 to 15, 0.82 (0.63–1.07), more than 15 h, 0.65 (0.38–1.11). Availability expectations was associated with NP</td><td>Changes in contents of office jobs between 2004–2020, subjective reports, and cross-sectional design</td></tr><tr><td>MacLean, 2022 *</td><td>Canada</td><td>Staff, administration, and faculty employed by Dalhousie University and primarily working from home with limited on campus access to offices and laboratories since lockdown</td><td>445</td><td>Changes in work-related discomfort since WFH (Likert scale) and current discomfort and pain using the Nordic MSD Questionnaire and a numeric rating scale</td><td>None</td><td>61% reported an increase in MSK pain. Area with most reported at least moderate pain were neck, shoulders, and lower back. Seat height and monitor distance were associated with MSK discomfort or pain, respectively β and 95% CI: 6.0 (3.1, 9.0) and 3.3 (0.5,5.9)</td><td>Population may be biased (more administrative, women), selection bias, model could not account for certain aspects of home workstation, self-assessed, anonymous WFH ergonomics and perceived musculoskeletal discomfort and pain</td></tr></tbody></table>
<table><caption>Table 1. *Cont.*</caption><thead><tr><th>Author</th><th>Country</th><th>Population</th><th>Number Included</th><th>Definition of MSD Outcome</th><th>Confounding</th><th>Results</th><th>Limitations of Authors</th></tr></thead><tbody><tr><td>Matsugaki, 2021 *</td><td>Japan</td><td>Population of workers currently in possession of an employment contract who responded that they mainly performed desk work and telecommuted at least once a week</td><td>3663</td><td>Reported occurrence of stiff shoulder, of LBP in the past 2 weeks, and the average severity of LBP on a numeric rating scale</td><td>Adjusted for age, sex, BMI, lifestyle habit (smoking, drinking, PA), number of days with poor mental health (past 30 days), income, educational background, working time, frequency of telecommuting, company size</td><td>Telecommuting environment factors (yes/no) associated with LBP were: aOR 95% CI, having enough light on desk 1.43 (1.18–1.73), having enough space to stretch legs 1.30 (1.10–1.54), having a place to concentrate on work 1.38 (1.17–1.64), having appropriate temperature and humidity comfort 1.32 (1.13–1.56), and having enough space on the desk 1.19 (1.02–1.39). Using an office desk or chair was no associated with LBP</td><td>History and medication of LBP are unknown, subjective report of home office, lifestyle factors, and working condition, and possibility of a selection bias (more WFH for LBP workers?)</td></tr><tr><td>Matsugaki, 2022 *</td><td>Japan</td><td>Population of workers currently in possession of an employment contract</td><td>12,774</td><td>Reported occurrence of stiff shoulder, of LBP in the past 2 weeks and the average severity of LBP on a numeric rating scale</td><td>Adjusted for age, gender, BMI, marital status, education, income, lifestyle habit (smoking, alcohol, PA), psychological status, company size</td><td>LBP was associated with frequency of teleworking aOR 95% CI compared to reference (Almost never): ≤1 d/w 1.18 (0.99–1.41), 2 to 3 d/w 1.27 (1.08–1.50), ≥4 d/w 1.15 (1.01–1.32), p-value of trend = 0.003. In a good telecommuting environment, OR did not increase with telecommuting frequency contrary to poor teleworking environment</td><td>Subjective assessment of work environment, potential unmeasured confounds, no consideration of duration of workers' telecommuting engagement and cross-sectional design</td></tr></tbody></table>
<table><caption>**Table 1. Cont.**</caption><thead><tr><td>Author</td><td>Country</td><td>Population</td><td>Number Included</td><td>Definition of MSD Outcome</td><td>Confounding</td><td>Results</td><td>Limitations of Authors</td></tr></thead><tbody><tr><td>Minoura, 2021 *</td><td>Japan</td><td>Respondents selected from panelists registered within a Japanese Internet survey agency</td><td>4227</td><td>Occurrence of LBP in the last month and time of appearance (before/after pandemic)</td><td>Adjusted for age, sex, weight, education, marital status, having children, outdoor PA during the COVID-19, psychological distress, smoking, alcohol, comorbidities, employment, income level, working time</td><td>LBP was associated with increased WFH (yes vs. no) among desk workers during the COVID-19 pandemic: aOR 2.13 (1.52–2.97)</td><td>Cross-sectional design, low response rate, potential selection bias, no information on medical LBP diagnosis and quality of work environment, residual confounders, possible time lag between survey and LBP</td></tr><tr><td>Moretti, 2020 *</td><td>Italy</td><td>Population of mobile workers employed as administrative officers that moved to work remotely since the beginning of COVID-19 health emergency</td><td>51</td><td>Brief Pain Inventory for assessing LBP and NP</td><td>None</td><td>Main regions for MSK pain were the lower back (41.2%) and the neck (23.5%). Since WFH, NP worsened for 50% participants (N = 6), and 38.1% for LBP (N = 8)</td><td>Small sample size, population of a single Italian region, cross-sectional design, some confounders could not be assessed</td></tr><tr><td>Muniandy, 2022 *</td><td>Malaysia</td><td>Lecturers and students of UMS who were actively involved in teaching and learning during the pandemic period</td><td>842</td><td>Back pain intensity using a numeric rating scale</td><td>None</td><td>Among newly diagnosed back pain lumbar region was the most frequent (62.1%), and LBP increased after lockdown. Poor ergonomic sitting was associated with mild LBP: OR CI 95% 2.0 (1.2–3.6)</td><td>Population of predominantly people higher formal education, survey online accessibility</td></tr><tr><td>Oakman, 2022 *</td><td>Australia</td><td>Participants from across Australia, aged 18 years or older, working from home at least 2 days per week during the period following declaration of the COVID-19 pandemic in Australia, currently living in Australia</td><td>924</td><td>MSD pain frequency using a 5-point Likert scale and intensity using a 3-point Likert scale</td><td>None</td><td>After the pandemic, WFH increased for most participants (92.9%). Over 70% reported pain or discomfort at the end of their working day, with a higher level of neck/shoulder pain and hips/legs/feet pain for females</td><td>Potential selection bias due to the geographical and gender sample repartition, cross-sectional design</td></tr></tbody></table>
<table><caption>**Table 1. Cont.**</caption><thead><tr><th>Author</th><th>Country</th><th>Population</th><th>Number Included</th><th>Definition of MSD Outcome</th><th>Confounding</th><th>Results</th><th>Limitations of Authors</th></tr></thead><tbody><tr><td>Prieto-González, 2021 *</td><td>Slovakia</td><td>Pedagogues in Slovakia during the introduction of online classes (January 2021 during COVID-19 pandemic), working in Slovakia in primary, secondary, tertiary, or special needs schools and aged between 18 and 65 years</td><td>782</td><td>Pain intensity using a numeric rating scale</td><td>None</td><td>74.84% reported cervical pain and 67.68% reported LBP. The number of days of online classes/week was associated with increased pain intensity: 1/w 3.33 (1.17), 2/w 3.17 (1.07), 3/w 3.46 (1.18), 4/w 3.51 (1.08), and 5/w 3.58 (1.01). Teachers not complying with ergonomic recommendations and sitting most of the time had a higher level of pain intensity</td><td>Potential selection bias, detailed medical information available</td></tr><tr><td>Radulović, 2021 *</td><td>Croatia</td><td>Telecommunications company workers working from home for eight months (from 16 March to 4 December 2020) before joining the study</td><td>232</td><td>Changes in MSD pain before and after WFH using a 3-point Likert scale</td><td>None</td><td>Among reported LBP, 39.1% had stronger pain when working at home than in the office. Complaint of more severe pain at home than in the office was correlated with not having an ergonomic chair or office desk, longer working hours at home, disturbance at home and women</td><td>No limitations reported</td></tr><tr><td>Regmi, 2022 *</td><td>India</td><td>Working population and students across India</td><td>1302</td><td>Frequency of work-related MSD symptoms while using a digital 4-point Likert scale</td><td>None</td><td>88% reported work related MSK disorders among which 45% had these symptoms for the first time. MSK symptoms were not statistically associated with WFH (OR 0.61, 95% CI 0.34–1.09), but there were associated with hours of work at home >8 h/d (3.06, 1.89–4.96)</td><td>Convenience sampling, students and health care sector population, general health issues and other ocular problems not considered</td></tr></tbody></table>
<table><caption>Table 1. *Cont.*</caption><thead><tr><th>Author</th><th>Country</th><th>Population</th><th>Number Included</th><th>Definition of MSD Outcome</th><th>Confounding</th><th>Results</th><th>Limitations of Authors</th></tr></thead><tbody><tr><td>Rodriguez-Nogueira, 2021 *</td><td>Spain</td><td>Workers at two Spanish universities employed for at least six months, actively teleworking during the confinement period (between March and May 2020)</td><td>472</td><td>Nordic MSD Questionnaire adapted to Spanish</td><td>None</td><td>There was a decrease of pain reported overall during confinement compared to the previous 12 months (p < 0.001)</td><td>Self-reported stress, pain and PA, cross-sectional design, population of two Spanish universities</td></tr><tr><td>Šagát, 2020 *</td><td>Saudi Arabia</td><td>Resident in Saudi Arabia staying in Riyadh before and during the quarantine, aged between 18 and 64 years</td><td>463</td><td>Location and intensity of pain on a numerical scale</td><td>None</td><td>Among subject who WFH or did distance learning during quarantine, there was more MSK pain reported compared to before (48.3% vs. 3.9%). Pain intensity was higher during quarantine than before for subjects WFH or distance learning: mean pain (2.64 vs. 1.97). Subjects who telework or had distance learning had statistically higher MSK pain compared to those who did not (2.63 vs. 2.27)</td><td>Certain measurements not included (inflammatory biomarkers, vitamin D levels), assessment of LBP intensity four weeks after confinement, no inclusion of chronic conditions hospitalized patients</td></tr><tr><td>Siqueira, 2020 *</td><td>Brazil</td><td>Brazilian individuals aged between 18 and 59 years</td><td>424</td><td>Frequency (4-point Likert scale) and MSK pain assessed by the "MSD Pain Investigation Questionnaire"</td><td>None</td><td>Individuals WFH reported statistically higher frequency of pain than those working in the usual workplace. Individuals WFH had increased frequency of pain during pandemic compared to before in the neck (1.23 vs. 1.05), shoulders (1.33 vs. 1.13), and upper back (1.41 vs. 1.20)</td><td>Potential reporting bias on data before pandemic</td></tr></tbody></table>
<table><caption>**Table 1. Cont.**</caption><thead><tr><th>Author</th><th>Country</th><th>Population</th><th>Number Included</th><th>Definition of MSD Outcome</th><th>Confounding</th><th>Results</th><th>Limitations of Authors</th></tr></thead><tbody><tr><td>Tezuka, 2022 *</td><td>Japan</td><td>Full-time workers of the two non-ferrous metal companies, aged 20 years or more, and non-teleworker before the emergency declaration</td><td>917</td><td>Presence of physical symptoms (from leading symptoms in the National Lifestyle Survey of Japan) not due to COVID-19 infection during the emergency</td><td>Adjusted for age, sex, BMI, marital status, occupational status, and stiff shoulders before the emergency declaration</td><td>Telework frequency was statistically associated with LBP during emergency declaration: compared to 0 days of telework, aOR and 95% CI, 1–2/w 3.83 (1.41–10.36), 3–4/w 6.09 (2.33–15.94), 5 or more/w 5.57 (2.22–14.00)</td><td>Cross-sectional design, potential recall bias, potential selection bias due to the low response rate (34.6%), high percentage of men in the sample and survey distribution method</td></tr><tr><td>Widianawati, 2020 *</td><td>Indonesia</td><td>WFH workers during the COVID-19 pandemic in Indonesia</td><td>50</td><td>MSD pain assessed by a numerical scale</td><td>None</td><td>28% of workers reported complaints of low MSD with an average pain value of 50.44. The most frequent regions for pain were the neck and the lower back</td><td>No limitations reported</td></tr></tbody></table>

BMI: body mass index, ND: neck disability, NP: neck pain, LBP: low back pain, WFH: work from home, OR: odds ratio, MSD: musculoskeletal disease, PA: physical activity.

<footnote>* During COVID-19 pandemic studies.</footnote>
The majority of the populations included in the studies were office workers who had mandatory teleworking caused by lockdowns [17-19,23-25,27-29,31-38,40]. One study focused on participants already suffering from low back pain before implementation of telework [30], whereas others studies excluded participants with a history of MSK disorders or serious medical conditions [19,23,25,28,29,37]. The number of participants varied, ranging from 40 [19] to 12,774 [20]. Validated questionnaires were used in almost half of the studies included [17-19,28,29,31,34,35,37,38], with the most used one being the Nordic musculoskeletal questionnaire. Other outcomes included numerical scales and Likert type scales assessing the intensity and/or the frequency of pain or the evolution of pain before and after implementation of lockdowns (associated with WFH). Most articles inquired about pain from various region of the body, but some focused on either neck pain [12,28,37] or lower back pain [20-22,30].

Adjusted analyses assessing the effect of teleworking and MSD were conducted in eight studies [12,18,20-22,26,28,37]. Adjustment variables selected were often different, and related to demographic data (age, sex, education, income, marital status), lifestyle habits (smoking, alcohol, physical activity), comorbidities, general work factors (working hours management responsibility, occupational stress), and work factors specifically related to teleworking (working hours at home, frequency of telecommuting, ergonomic factors of the home office). Seven studies had a control group [12,20,21,26,28,32,40], which was a before intervention control for one study [28], or participants who did not WFH, or who had very few days teleworking.

The most reported MSD were low back pain and neck pain. Some studies did not find any association between MSD disorders and telework [12,24,28-30,34]. Others found an increase in prevalence or intensity of MSD pain during lockdowns (WFH) compared to before [17,18,23,25,33,36,38-40], or when comparing groups of different telework frequency [20,22,25,26,32,40]. Certain ergonomic factors and psychosocial factors were associated with increased intensity or frequency of musculoskeletal pain. [12,18,23,24,28,32,33,35,36,38]. For example, having an appropriate location to WFH with sufficient space and less demanding workloads decreased the effect of WFH on MSD.

Table 2 shows the risk of bias assessment for all the studies included. Overall, the risk of bias for the studies was high. Only five studies had low or probably low risk of bias for the specific criteria in this review, which were the representativeness of the population and the presence of a control group [20,21,26,28,40].
<table><caption>**Table 2.** Assessment of risk of bias according to the Navigation Guide for systematic reviews in environmental and occupational health [16].</caption><thead><tr><th>Name</th><th>1. Are the Study Groups at Risk of Not Representing Their Source Populations in a Manner That Might Introduce Selection Bias?</th><th>2. Was Knowledge of the Group Assignments Inadequately Prevented (i.e., Blinded or Masked) during the Study, Potentially Leading to Subjective Measurement of Either Exposure or Outcome?</th><th>3. Were Exposure Assessment Methods Lacking Accuracy?</th><th>4. Were Outcome Assessment Methods Lacking Accuracy?</th><th>5. Was Potential Confounding Inadequately Incorporated?</th><th>6. Were Incomplete Outcome Data Inadequately Addressed?</th><th>7. Does the Study Report Appear to Have Selective Outcome Reporting?</th><th>8. Did the Study Receive any Support from a Company, Study Author, or Other Entity Having a Financial Interest in any of the Exposures Studied?</th><th>9. Did the Study Appear to Have Other Problems That Could Put It at a Risk of Bias? Population Studied Does Not Represent General Teleworker Population or No Control Group</th></tr></thead><tbody><tr><td>Aegerter 2021</td><td>Probably low</td><td>Not applicable</td><td>Probably low</td><td>Low</td><td>Probably low</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably low</td></tr><tr><td>Argus 2021</td><td>Probably low</td><td>Not applicable</td><td>Probably low</td><td>Low</td><td>Probably high</td><td>Probably high</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Bailly 2022</td><td>Low</td><td>Not applicable</td><td>Probably low</td><td>Probably low</td><td>Probably high</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Deshmukh 2020</td><td>High</td><td>Not applicable</td><td>Probably low</td><td>Low</td><td>High</td><td>Probably low</td><td>Not applicable</td><td>Probably low</td><td>High</td></tr><tr><td>El Kadri Filho 2022</td><td>Low</td><td>Not applicable</td><td>Low</td><td>Low</td><td>High</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Gering 2021</td><td>High</td><td>Not applicable</td><td>Probably high</td><td>Probably high</td><td>Probably high</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Guler 2021</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Low</td><td>Probably high</td><td>Probably high</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Houle 2021</td><td>Probably high</td><td>Not applicable</td><td>Probably low</td><td>Low</td><td>Probably high</td><td>Probably high</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Jain 2022</td><td>Probably high</td><td>Not applicable</td><td>Probably high</td><td>Low</td><td>Probably high</td><td>Probably high</td><td>Not applicable</td><td>Low</td><td>High</td></tr><tr><td>Knardahl 2022</td><td>Low</td><td>Not applicable</td><td>Probably low</td><td>Probably low</td><td>Low</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>MacLean 2022</td><td>Probably high</td><td>Not applicable</td><td>Probably low</td><td>Low</td><td>Probably low</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Matsugaki 2021</td><td>Low</td><td>Not applicable</td><td>Low</td><td>Low</td><td>Low</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably low</td></tr><tr><td>Matsugaki 2022</td><td>Low</td><td>Not applicable</td><td>Low</td><td>Probably low</td><td>Low</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Low</td></tr><tr><td>Minoura 2021</td><td>Low</td><td>Not applicable</td><td>Probably low</td><td>Probably low</td><td>Low</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Moretti 2020</td><td>Probably high</td><td>Not applicable</td><td>Probably low</td><td>Low</td><td>High</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Muniandy 2022</td><td>Probably high</td><td>Not applicable</td><td>Probably high</td><td>Probably low</td><td>Probably high</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Oakman 2022</td><td>Probably high</td><td>Not applicable</td><td>Probably low</td><td>Probably low</td><td>High</td><td>Probably high</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Prieto-Gonzalez 2021</td><td>Probably high</td><td>Not applicable</td><td>Probably high</td><td>Probably high</td><td>Probably high</td><td>Low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr></tbody></table>
<table><caption>Table 2. *Cont.*</caption><thead><tr><th>Name</th><th>1. Are the Study Groups at Risk of Not Representing Their Source Populations in a Manner That Might Introduce Selection Bias?</th><th>2. Was Knowledge of the Group Assignments Inadequately Prevented (i.e., Blinded or Masked) during the Study, Potentially Leading to Subjective Measurement of Either Exposure or Outcome?</th><th>3. Were Exposure Assessment Methods Lacking Accuracy?</th><th>4. Were Outcome Assessment Methods Lacking Accuracy?</th><th>5. Was Potential Confounding Inadequately Incorporated?</th><th>6. Were Incomplete Outcome Data Inadequately Addressed?</th><th>7. Does the Study Report Appear to Have Selective Outcome Reporting?</th><th>8. Did the Study Receive any Support from a Company, Study Author, or Other Entity Having a Financial Interest in any of the Exposures Studied?</th><th>9. Did the Study Appear to Have Other Problems That Could Put It at a Risk of Bias? Population Studied Does Not Represent General Teleworker Population or No Control Group</th></tr></thead><tbody><tr><td>Radulovic 2021</td><td>Probably low</td><td>Not applicable</td><td>Probably high</td><td>Probably high</td><td>High</td><td>Low</td><td>Not applicable</td><td>Probably low</td><td>Probably high</td></tr><tr><td>Regmi 2022</td><td>Probably high</td><td>Not applicable</td><td>Probably low</td><td>Probably low</td><td>Probably high</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>High</td></tr><tr><td>Rodriguez-Nogueira 2021</td><td>Probably high</td><td>Not applicable</td><td>Probably low</td><td>Low</td><td>Probably high</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Sagat 2020</td><td>Low</td><td>Not applicable</td><td>Probably high</td><td>Probably low</td><td>Probably high</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably high</td></tr><tr><td>Siqueira 2020</td><td>Probably high</td><td>Not applicable</td><td>Probably low</td><td>Probably high</td><td>High</td><td>Probably low</td><td>Not applicable</td><td>Low</td><td>Probably low</td></tr><tr><td>Tezuka 2022</td><td>Probably high</td><td>Not applicable</td><td>Low</td><td>Probably high</td><td>Low</td><td>Probably low</td><td>Not applicable</td><td>Probably low</td><td>Probably low</td></tr><tr><td>Widianawati 2020</td><td>Probably high</td><td>Not applicable</td><td>Probably low</td><td>Probably high</td><td>High</td><td>Low</td><td>Not applicable</td><td>Probably low</td><td>High</td></tr></tbody></table>

Risk of bias assessment; red cell = high, orange cell = probably high, light green = probably low, dark green = low.
## 4. Discussion

This exhaustive systematic review found conflicting results on the effect of teleworking on MSD, although an increase in nonspecific MSD related to organizational and ergonomic factors seemed to emerge.

Globally, there may be an important effect of the context of teleworking. Several reports have highlighted the strong points and limits of new form of work like teleworking [41,42]. Having a good ergonomic environment, having a good relation between workers and managers, being autonomous at work, and a reasonable workload are all potential critical ergonomic and organizational factors that could prevent the potential negative impact of telework beyond MSD. Several studies in this review reported poor ergonomic work conditions linked to the abrupt change caused by lockdowns [38,39]. A study which focused on workers with a history of LBP found an increase of pain in case of teleworking during lockdown, although this association was not significant when considering workers with a dedicated workstation for teleworking [30]. Another one, though of low evidence, suggested that an ergonomic intervention could lower the risk of MSD [19]. Thus, potential future studies on ergonomic interventions, including information and training, as well as adapted equipment, would be important [43].

Telework brings many advantages, such as the flexibility of workhours or the possibility of work accommodations for people with work limitations. This emphasizes the importance of having data concerning effects on health. The effects of teleworking on other factors, like personal life and work life balance, are also complex, as some studies report positive effects on this point while others report a negative effect with increased technostress and a more blurred border [44,45]. Being sedentary is also an important aspect of teleworking that could influence the risk of MSD, as teleworking decreases break time and activity interruptions, as well as small movements happening during work [45].

A previous integrative review by dos Santos et al. found that musculoskeletal pain increased during the lockdowns, especially in the lower back and neck regions, which could be explained by an increased sedentary lifestyle, poor posture, and increased physical load due to household chores [14]. However, compared to this review, more studies were found due to the updated search, and the risk of bias was assessed. Another review by Oakman et al. on the mental and physical health effects of working at home identified only three studies related to physical health-related outcomes with conflicting conclusions [13].

The heterogenous results of our review could be explained by several factors. First, the studies included were heterogenous, with a varying number of subjects and methods for selecting the participants and populations included. Indeed, some studies recruited participants from universities or public administration [28,32,34–36,38], while others recruited participants from private employers [17,18,26,29,33] or from the general population [12,20–22,24,25,27,37,39,40]. Second, most studies likely had a high risk of bias, particularly when considering confounding, control groups, and the representativeness of the population studied. Only eight studies considered confounders in the statistical analyses, and among them, six were extensively adjusted for potential confounders [12,20–22,26,28]. Most studies also adopted a cross-sectional design, which can lead to reverse causation bias or differential reporting of outcome. Finally, the effect of teleworking of MSD may be different in relation to socioeconomic status and to how telework was implemented. Before the pandemic, workers doing telework were mostly highly qualified and voluntary workers, though from 2022, teleworkers can also be voluntary but also less qualified, with less autonomy. Another result of this systematic review is that all MSD were subjective, for example, the reporting of pain intensity or frequency or reporting change in pain before and after lockdown. There were no medical diagnoses of MSD, like carpal tunnel syndrome or sciatica. However, studies suggest that in the tertiary sector MSD are unspecific, with symptoms like chronic back pain or neck pain [41,42]. The COVID-19 pandemic context is also a potential strong confounder, and most of the studies included assessed the risk of telework on MSD during the pandemic. This systematic
review shows the scarcity of evidence of this before the COVID-19 pandemic and shows
the need to continue monitoring the effect of telework.

The main limitation of this review is the lack of quantitative analysis and grading. No pulled risk effects and grading were calculated because of the heterogenous methodologies and bias of the included studies. However, our systematic review adopted an exhaustive research protocol on several databases and all articles were selected by at least two different reviewers. The assessment of bias was done in a similar manner, and a category specific to the aim of this review was added. Thus, the qualitative synthetic approach allowed us to highlight the strengths and weaknesses of the different studies assessing the effect of teleworking on MSD. There was a change in the initial protocol for this systematic review in which we aimed to assess the effects of WHF on several health outcomes. However, we quickly focused on MSD, as the number of studies have drastically increased in the last two years. Another potential limit is the lack of MeSH keywords for "Teleworking" before 2021. This could potentially lead to missing studies before this date, but an exhaustive variety of terms were used to retrieve all relevant studies. Lastly, only studies in English or French were considered.

**5. Conclusions**

This systematic review brought to light the necessity of further research to understand
the potential effect of teleworking on the risk of MSD. The conceptual model of Beckel and
Fisher demonstrates the need for global integrative approaches of teleworking situations
that consider the whole work environment in addition to the usual confounders of MSD [46].
MSD and teleworking are challenges that will need to be addressed by researchers and
decision makers. Indeed, the flexibility of teleworking and hybrid work seems to be a
key factor to promote sustainable work and return to work for workers with disabilities.
Future studies should focus on longitudinal approaches and consider ergonomic and work
organization factors as well as socio-economic status.

**Supplementary Materials:** The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/ijerph20064973/s1, Supplementary Material S1: Strings used for searching the selected databases; Supplementary Material S2: Full summary of data extracted from selected studies.

**Author Contributions:** Conceptualization, M.F., J.B., F.C., A.D. and Y.R.; methodology, M.F., J.B., F.C., A.D. and Y.R.; formal analysis, M.F., J.B., F.C., A.D. and Y.R.; data curation, M.F. and J.B.; writing original draft preparation, M.F. and J.B.; writing review and editing, F.C., A.D. and Y.R.; supervision, A.D. and Y.R. All authors have read and agreed to the published version of the manuscript.

**Funding:** This study was funded by a national grant from the ANSES (French Agency for Food, Environmental and Occupational Health & Safety) which had no implication in the methodology, results or writing of the paper ("Convention de recherche et développement" Anses/Inserm 2021-CRD10).

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** The data presented in this study are available in the article.

**Acknowledgments:** The authors would like to thank Catherine FAÏS, Librarian, for improving the search strings.

**Conflicts of Interest:** The authors declare no conflict of interest.

**References**

1. ILO. COVID-19: Guidance for Labour Statistics Data Collection. In *Defining and Measuring Remote Work, Telework, Work at Home and Home-Based Work*; International Labour Organization: Geneva, Switzerland, 2020.

2. WHO; ILO. Healthy and Safe Telework. Available online: http://www.ilo.org/global/publications/books/WCMS_836250/lang-en/index.htm (accessed on 27 October 2022).
3. Eurostat. Statistics. Available online: https://ec.europa.eu/eurostat/datab browser/view/lfsa_ehomp/default/table?lang=en (accessed on 27 October 2022).

4. Eurofound. *Fifth Round of the Living, Working and COVID-19 e-Survey: Living in a New Era of Uncertainty*; European Foundation for the Improvement of Living and Working Conditions: Luxembourg, 2022.

5. Buomprisco, G.; Ricci, S.; Perri, R.; Sio, S.D. Health and Telework: New Challenges after COVID-19 Pandemic. *Eur. J. Environ. Public Health* **2021**, *5*, em0073. [CrossRef]

6. Eurofound. *Employee Monitoring and Surveillance: The Challenges of Digitalisation*; Publications Office of the European Union: Luxembourg, 2020.

7. Samek Lodovici, M.; Ferrari, E.; Paladino, E.; Pesce, F.; Frecassetti, P.; Aram, E.; Hadjivassiliou, K.; Junge, K.; Hahne, A.S.; Drabble, D.; et al. *The Impact of Teleworking and Digital Work on Workers and Society: Special Focus on Surveillance and Monitoring, as Well as on Mental Health of Workers*; European Parliament: Luxembourg, 2021; ISBN 978-92-846-8253-9.

8. Linden, M. Telework Research and Practice: Impacts on People with Disabilities. *Work* **2014**, *48*, 65–67. [CrossRef]

9. Bouziri, H.; Smith, D.R.M.; Descatha, A.; Dab, W.; Jean, K. Working from Home in the Time of COVID-19: How to Best Preserve Occupational Health? *Occup. Environ. Med.* **2020**, *77*, 509–510. [CrossRef]

10. Roquelaure, Y.; Luce, D.; Descatha, A.; Bonvallot, N.; Porro, B.; Coutarel, F. Un modèle organisationnel de l'exposome professionnel. *Med. Sci.* **2022**, *38*, 288–293. [CrossRef]

11. EU-OSHA. *Work-Related Musculoskeletal Disorders: Prevention Report*; European Agency for Safety and Health at Work: Luxembourg, 2008; Available online: https://osha.europa.eu/en/publications/report-work-related-musculoskeletal-disorders-prevention-report (accessed on 12 January 2023).

12. Knardahl, S.; Christensen, J.O. Working at Home and Expectations of Being Available: Effects on Perceived Work Environment, Turnover Intentions, and Health. *Scand. J. Work. Environ. Health* **2022**, *48*, 99–108. [CrossRef] [PubMed]

13. Oakman, J.; Kinsman, N.; Stuckey, R.; Graham, M.; Weale, V. A Rapid Review of Mental and Physical Health Effects of Working at Home: How Do We Optimise Health? *BMC Public Health* **2020**, *20*, 1825. [CrossRef] [PubMed]

14. dos Santos, I.N.; Pernambuco, M.L.; da Silva, A.M.B.; de Andrade Ruela, G.; de Oliveira, A.S. Association between Musculoskeletal Pain and Telework in the Context of the COVID-19 Pandemic: An Integrative Review/Associacao Entre Dor Musculoesqueletica e Teletrabalho No Contexto Da Pandemia de COVID-19: Uma Revisao Integrativa. *Rev. Bras. Med. Trab.* **2021**, *19*, 342–351. [CrossRef] [PubMed]

15. Liberati, A.; Altman, D.G.; Tetzlaff, J.; Mulrow, C.; Gøtzsche, P.C.; Ioannidis, J.P.A.; Clarke, M.; Devereaux, P.J.; Kleijnen, J.; Moher, D. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. *J. Clin. Epidemiol.* **2009**, *62*, e1–e34. [CrossRef]

16. Woodruff, T.J.; Sutton, P. The Navigation Guide Systematic Review Methodology: A Rigorous and Transparent Method for Translating Environmental Health Science into Better Health Outcomes. *Environ. Health Perspect.* **2014**, *122*, 1007–1014. [CrossRef] [PubMed]

17. Deshmukh, T.S.K.; Phadke, S.D. Impact of Work from Home (WFH) Related Behavioural, Psychological & Ergonomic Factors on Work Related Musculoskeletal Disorders in It Professionals during COVID 19 Pandamic And Need of Guided Tele Physiotherapy: An Online Social Networking (Osn) Survey. *Int. J. Res. Anal. Rev.* **2020**, *7*, 383–397.

18. Guler, M.A.; Guler, K.; Guneser Gulec, M.; Ozdoglar, E. Working From Home During a Pandemic: Investigation of the Impact of COVID-19 on Employee Health and Productivity. *J. Occup. Environ. Med.* **2021**, *63*, 731–741. [CrossRef]

19. Jain, R.; Verma, V.; Rana, K.B.; Meena, M.L. Effect of Physical Activity Intervention on the Musculoskeletal Health of University Student Computer Users during Homestay. *Int. J. Occup. Saf. Ergon.* **2022**, *29*, 25–30. [CrossRef] [PubMed]

20. Matsugaki, R.; Ishimaru, T.; Hino, A.; Muramatsu, K.; Nagata, T.; Ikegami, K.; Tateishi, S.; Tsuji, M.; Matsuda, S.; Fujino, Y.; et al. Low Back Pain and Telecommuting in Japan: Influence of Work Environment Quality. *J. Occup. Health* **2022**, *64*, e12329. [CrossRef]

21. Matsugaki, R.; Muramatsu, K.; Tateishi, S.; Nagata, T.; Tsuji, M.; Hino, A.; Ikegami, K.; Fujino, Y.; Matsuda, S. CORoNaWork Project Association Between Telecommuting Environment and Low Back Pain Among Japanese Telecommuting Workers: A Cross-Sectional Study. *J. Occup. Environ. Med.* **2021**, *63*, e944–e948. [CrossRef] [PubMed]

22. Minoura, A.; Ishimaru, T.; Kokaze, A.; Tabuchi, T. Increased Work from Home and Low Back Pain among Japanese Desk Workers during the Coronavirus Disease 2019 Pandemic: A Cross-Sectional Study. *Int. J. Environ. Res. Public Health* **2021**, *18*, 12363. [CrossRef] [PubMed]

23. Muniandy, R.K.; Mudin, K.; Yeap, B.T.; Voo, S.K.P. Increased Incidence and Aetiological Factors of Back Pain among Universiti Malaysia Sabah Staff and Undergraduates during the COVID-19 Lockdown Period. *Med. J. Malays.* **2022**, *77*, 185–188.

24. Regmi, A.; Suresh, J.; Asokan, R. Changes in Work Patterns during COVID-19 Lockdown and Its Impact on the Eyes and Body. *Clin. Exp. Optom.* **2022**, *1–7*. [CrossRef]

25. Šagát, P.; Bartík, P.; Prieto González, P.; Tohănean, D.I.; Knjaz, D. Impact of COVID-19 Quarantine on Low Back Pain Intensity, Prevalence, and Associated Risk Factors among Adult Citizens Residing in Riyadh (Saudi Arabia): A Cross-Sectional Study. *Int. J. Environ. Res. Public Health* **2020**, *17*, E7302. [CrossRef]

26. Tezuka, M.; Nagata, T.; Saeki, K.; Tsuboi, Y.; Fukutani, N. Association Between Abrupt Change to Teleworking and Physical Symptoms During the Coronavirus Disease 2019 (COVID-19) Emergency Declaration in Japan. *J. Occup. Environ. Med.* **2022**, *64*, 1–5. [CrossRef]
27. Widianawati, E.; Khorioni, A.; Nugroho, B.Y.S.; Wulan, W.R. The Ergonomics Design of Work-From-Home Facility during COVID-19 Outbreak InIndonesia and Its Implications for Musculoskeletal. *Pak. J. Med. Health Sci.* **2020**, *14*, 1619–1622.

28. Aegerter, A.M.; Deforth, M.; Johnston, V.; Sjøgaard, G.; Volken, T.; Luomajoki, H.; Dratva, J.; Dressel, H.; Distler, O.; Elfering, A.; et al. No Evidence for an Effect of Working from Home on Neck Pain and Neck Disability among Swiss Office Workers: Short-Term Impact of COVID-19. *Eur. Spine J.* **2021**, *30*, 1699–1707. [CrossRef]

29. Argus, M.; Pääsuke, M. Effects of the COVID-19 Lockdown on Musculoskeletal Pain, Physical Activity, and Work Environment in Estonian Office Workers Transitioning to Working from Home. *Work* **2021**, *69*, 741–749. [CrossRef]

30. Bailly, F.; Genevay, S.; Foltz, V.; Bohm-Sigrand, A.; Zagala, A.; Nizard, J.; Petit, A. Effects of COVID-19 Lockdown on Low Back Pain Intensity in Chronic Low Back Pain Patients: Results of the Multicenter CONFI-LOMB Study. *Eur. Spine J.* **2022**, *31*, 159–166. [CrossRef] [PubMed]

31. Moretti, A.; Menna, F.; Aulicino, M.; Paoletta, M.; Liguori, S.; Iolascon, G. Characterization of Home Working Population during COVID-19 Emergency: A Cross-Sectional Analysis. *Int. J. Environ. Res. Public Health* **2020**, *17*, 6284. [CrossRef]

32. Prieto-González, P.; Šutvajová, M.; Lesňáková, A.; Bartík, P.; Buľáková, K.; Friediger, T. Back Pain Prevalence, Intensity, and Associated Risk Factors among Female Teachers in Slovakia during the COVID-19 Pandemic: A Cross-Sectional Study. *Healthcare* **2021**, *9*, 860. [CrossRef]

33. Radulović, A.H.; Žaja, R.; Milošević, M.; Radulović, B.; Luketić, I.; Božić, T. Work from Home and Musculoskeletal Pain in Telecommunications Workers during COVID-19 Pandemic: A Pilot Study. *Arch. Ind. Hyg. Toxicol.* **2021**, *72*, 232–239. [CrossRef]

34. Rodriguez-Nogueira, O.; Leiros-Rodriguez, R.; Benitez-Andrades, J.A.; Alvarez-Alvarez, M.J.; Marques-Sanchez, P.; Pinto-Carral, A. Musculoskeletal Pain and Teleworking in Times of the COVID-19: Analysis of the Impact on the Workers at Two Spanish Universities. *Int. J. Environ. Res. Public Health* **2021**, *18*, 31. [CrossRef] [PubMed]

35. El Kadri Filho, F.; Roberto de Lucca, S. Telework during the COVID-19 Pandemic: Ergonomic and Psychosocial Risks among Brazilian Labor Justice Workers. *Work* **2022**, *71*, 395–405. [CrossRef]

36. Gerding, T.; Syck, M.; Daniel, D.; Naylor, J.; Kotowski, S.E.; Gillespie, G.L.; Freeman, A.M.; Huston, T.R.; Davis, K.G. An Assessment of Ergonomic Issues in the Home Offices of University Employees Sent Home Due to the COVID-19 Pandemic. *Work* **2021**, *68*, 981–992. [CrossRef] [PubMed]

37. Houle, M.; Lessard, A.; Marineau-Bélanger, É.; Lardon, A.; Marchand, A.-A.; Descarreaux, M.; Abboud, J. Factors Associated with Headache and Neck Pain among Telecommuters—A Five Days Follow-Up. *BMC Public Health* **2021**, *21*, 1086. [CrossRef] [PubMed]

38. MacLean, K.F.E.; Neyedli, H.F.; Dewis, C.; Frayne, R.J. The Role of at Home Workstation Ergonomics and Gender on Musculoskeletal Pain. *Work* **2022**, *71*, 309–318. [CrossRef]

39. Oakman, J.; Kinsman, N.; Lambert, K.; Stuckey, R.; Graham, M.; Weale, V. Working from Home in Australia during the COVID-19 Pandemic: Cross-Sectional Results from the Employees Working From Home (EWFH) Study. *BMJ Open* **2022**, *12*, e052733. [CrossRef]

40. Siqueira, L.T.D.; Santos, A.P.D.; Silva, R.L.F.; Moreira, P.A.M.; Vitor, J.d.S.; Ribeiro, V.V. Vocal Self-Perception of Home Office Workers During the COVID-19 Pandemic. *J. Voice* **2023**, *37*, 144.e15–144.e22. [CrossRef] [PubMed]

41. EU-OSHA. The Digitalisation of Work: Psychosocial Risk Factors and Work-Related Musculoskeletal Disorders. Available online: https://osha.europa.eu/en/publications/digitalisation-work-psychosocial-risk-factors-and-work-related-musculoskeletal (accessed on 19 December 2022).

42. Roquelaure, Y. Musculoskeletal Disorders and Psychosocial Factors at Work. Available online: https://www.etui.org/publications/reports/musculoskeletal-disorders-and-psychosocial-factors-at-work (accessed on 1 December 2022).

43. Cruz-Ausejo, L.; Copez-Lonzoy, A.; Vilela-Estrada, A.L.; Valverde, J.J.; Bohórquez, M.; Moscoso-Porras, M. Can Working at Home Be a Hazard? Ergonomic Factors Associated with Musculoskeletal Disorders among Teleworkers during the COVID-19 Pandemic: A Scoping Review. *Int. J. Occup. Saf. Ergon.* **2022**, *1–10*. [CrossRef] [PubMed]

44. Camacho, S.; Barrios, A. Teleworking and Technostress: Early Consequences of a COVID-19 Lockdown. *Cogn. Technol. Work.* **2022**, *24*, 441–457. [CrossRef] [PubMed]

45. Gajendran, R.S.; Harrison, D.A. The Good, the Bad, and the Unknown about Telecommuting: Meta-Analysis of Psychological Mediators and Individual Consequences. *J. Appl. Psychol.* **2007**, *92*, 1524–1541. [CrossRef] [PubMed]

46. Baker, P.M.A.; Moon, N.W.; Ward, A.C. Virtual Exclusion and Telework: Barriers and Opportunities of Technocentric Workplace Accommodation Policy. *Work* **2006**, *27*, 421–430.

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