Ergonomic Stress Index for Video Display Terminal Operators

DR. NAMRATA ARORA CHARPE*and DR. VANDANA KAUSHIK**

* Assistant Professor, Resource Management, Banasthali Vidyapith, Banasthali

** Head and Associate Professor, Family Resource Management, College of Home Science, MPUAT, Udaipur

ABSTRACT

Video display terminals (VDTs) are important components of almost every modern office. Working on a VDT is mainly static
in nature, associated with very limited use of muscles leading to postural stress. It is important to consider these postural
stressors in the workstation if health risks and low performance levels are to be avoided. Human efficiency and well being are
critical factors in determining the effectiveness of industry and business. Ergonomic approach to workstation and work design
is the latest approach in systems design and management in order to reduce productivity losses. The reduction in postural
stress is fundamental to ergonomic workstation design taking into consideration the fact that the job and machine should be
so designed in order to fit into the user’s requirements. The study aimed at development of an inventory to assess the level of
ergonomic stress on VDT operators. The sample comprised 200 VDT (100 male and 100 female) operators. The inventory was
standardized with test-retest reliability estimate of 0.88 at 0.01 level of significance.

KEYWORDS: Ergonomic risk factors, VDT workstation, Musculoskeletal Problems

INTRODUCTION

The growing importance of VDTs in today’s professional world has led to a new pattern in work lives. Working on a
VDT is characterized by static, sometimes awkward postures, exercising just a few sets of muscles for prolonged
periods. The factors generally associated with the VDT work are perceptions of intensified workload, monotonous
work, limited job control, low job clarity, long working hours, static postures for long durations and, same work at
long stretches. Conceptual models illustrating factors that influence the development of work related MSDs are used
to describe causal relationship between certain generic workplace risk factors (external exposure) and
musculoskeletal health. The probability of disorder is greatest where physiological, psychological and mechanical
axes of the work overlap. Sitting for long periods without an opportunity to stand up and move around is a way in
which employees are exposed to static loading of tissues primarily in the lumbar area of the back. It is mainly caused
due to continuous pressure on selected muscles due to static postures. The human body works as a machine where
muscles affect each other’s working, that is hindered in a static work like one at a VDT. In a sitting posture, the
worker is subject to continuous stress on almost all postural muscles that affect various parts of the body. With poor
posture, muscles are less efficient, and work at a biomechanical advantage, so they have to work harder all the time.
In awkward postures, the joints are more susceptible to injuries and the muscles have less capacity for exerting
force. Slumping for short periods is not a problem, but such postures often assumed for long periods places stress on
all levels of the back, neck, shoulder and arms. The impact of VDT work on the human body starts to come into
being in the span of about one year. Most of the times the workers tend to avoid such symptoms as they vanish as
they take rest but reappear as a new workday begins. The problems increase with every passing day in similar
conditions on the VDTs. Whenever humans engage into static work, impairment comes into being. There has
always been a loss. The impact is measurable, in long term, in terms of health and safety costs, injury and illness
rates, lost work time, treatment duration, and worker’s compensation costs. Working on a computer is considered to
be highly monotonous where monotony stems from repetition of work for long periods of time. Monotonous jobs
can erode a worker’s initiative and enthusiasm and can lead to absenteeism and unnecessary turnover.

The activity at VDT work includes typing or scrolling and continuous staring at the monitor. The body gets very
little opportunity to move while working on a VDT. While static work circulation is inadequate, and in static
awkward postures, even in the absence of external force demands, considerable discomfort arises. Rest schedules are
rarely planned in the VDT workplace, and if planned not followed. Usually the worker remains so indulged in work
that they do not find it right to break the flow of work. The VDT work is already sedentary, lack of breaks makes the
condition even worse leading into accumulation of lactic acid in the muscles in high amounts. Most of the corporate
employees report problems regarding pains linked to reduction in health, work performance and productivity.
Workers suffering from work related pains generally reports health related limitations in job performance. The costs
of work can be concluded as continuous pain in various body parts till the work is in progress. But, at the same time,
the pains vanish as soon as the worker quits work but occur again when the work starts. When the human body is at
work, it is required to meet demands like moving the body or body parts, transporting or moving other objects and
maintaining the body posture. If it is not done so, the body parts may get adversely affected and thus lead to
discomfort and in rare cases to serious injuries. Work related musculoskeletal disorders (WRMSDs) also known as
repetitive strain injuries (RSIs) are defined as disorders of the muscles, tendons, peripheral nerves, vascular system
and other tissues. They can result from or be aggravated by intense, repeated, sustained, or insufficient recovery
from exertions. The MSDs are characterized by being multi-factorial in origin, and that they develop over periods of
time. When a worker works on a VDT, the upper body is in working position, characterized mainly by a static
bending or extension of the back or static position of the wrists while working with the mouse or the keyboard. For
upper extremity disorders there is evidence of a causal relationship with the risk factors like repetitive tasks, forceful
tasks and the combination of repetition and force (NRC Corporation, 2001). Holding the head to the side or forward
may lead to neck fatigue and pain. Neck pain arises if awkward postures are adopted to compensate the problems in
the visual system while working with VDTs. Studies suggest that using a computer keyboard with the forearms
unsupported has been proposed as a causal factor for neck/shoulder and arm/hand diagnoses. Hands have a major
role to play while working on a computer, thus shoulder and elbow joint have active participation. Sauter (1991)
suggested that there exist very high levels of shoulder girdle discomfort in VDT users and it is necessary that the
control of cervicobrachial pain syndromes is given attention. Low job control has found to be related to neck, back
and shoulder discomfort. Various studies have concluded that there exists a strong evidence of a positive correlation
between shoulder pain and awkward or static posture. As quoted in www.cdc.gov, there is an evidence of a positive
association between highly repetitive tasks, thus pose a strain on hands and arms of the workers. The Hartford Loss
Control Department (2002) suggests that upper arms should be kept near sides of the body to minimize the strain
and incidence of pain in the region. The work risk factors have a positive relationship with neck and upper limb
MSDs with combinations of repetition, force and postural work factors for elbow MSDs and hand/wrist tendinitis
(NIOSH, 1997). Relative to their strength, fingers and fore arm muscles are used with a lot of force when keying,
mousing or handling files or books. Studies suggest that perceived increased workload (increased time working
under deadline and increased job pressure) demand is positively associated with neck, shoulder and hand-wrist
symptoms. Improper setups of the work stations and improper use of body lead to misalignment of the back leading
to impairments in mid and lower back. Mid back pain is always aggravated by certain movements and postures and
is relieved by making them more relaxed in certain postures. Poor body mechanics has always been associated with
lower back pain. Even light burdens could be risk factor for sudden low back pain because of the risk of buckling in
the relaxed state. Back pain may be intermittent or constant; superficial or deep; or dull and aching, throbbing, or
sharp and stabbing, depending on the cause and type of pain. Usually local pain resolves gradually over days to
weeks, but if not addressed in time, this pain may lead to some serious injury. The studies reviewed suggest an
association between back disorders and perceptions of intensified workload as measured by indices of both
perceived time pressure and workload.

The worker on the workstation bears the cost of such injuries in terms of decline in well being and efficiency, while
the employers have to pay the cost in terms of low productivity and absenteeism of their employees and increased
medical costs. Karwowski (1997) suggests that the rise in work related health problems often lead to decrease in
productivity, quality and efficiency in the workplace. Self overload has been one of the greatest problems for VDT
operators and proves to be a productivity killer. Optimized productivity is considered to be a high professional
priority to assure job retention and progression. This has led to overload, and the costs of injuries can be very high
from an economic view point. Working conditions at VDT workplace are of interest because of their potential to
cause musculoskeletal pains, to cause injuries, or to exacerbate pain from existing musculoskeletal conditions. Pain
is related to reductions in nearly every aspect of productivity (www.medicalnews today.com), workers with pain are
five times more likely to report health related limitations in job performance. Boles et al.(2004) suggested that
objective measures such as counting sick days or productivity measurement techniques can be beneficial in
determining statistical relationships with health risks and conditions.

METHOD

Ergonomic Stress Index (ESI) was developed on the lines of the Likert summated rating scale in order to recognize
the common causes of discomfort and pain symptoms experienced by the workers at VDT workplace.

The Ergonomic Stress Index (ESI) was initially developed with 45 items depicting various pain symptoms,
discomforts and complaints related to VDT workstations.

The items were so developed as to be comprehendible. Items were kept short, limited to one idea and comprised
simple terminology keeping in mind that the set of items is optimized and the items are easy to understand. The
items were created primarily from an in – depth study of subject matter and later on through brainstorming with
number of experts. The tool of items was given to a group of 150 experts in the field of orthopedics and
physiotherapy to rate the items at 6 levels of zero (No symptom) to 5 (Unbearably severe). The specific goals were
to understand respondents’ reactions to alternative ways of phrasing inventory items; reword items to improve
clarity; eliminate redundant items; and obtain feedback on the length, format, and clarity of the instructions and
initial draft. On the basis of insights from the experts, directions were simplified and confusing items were
eliminated or reworded. Based on the ratings of the experts, the item correlation and item differences were computed
for item analysis.

STUDY FINDINGS

A set of 27 items was finally selected. The major factors considered under the items were in the heads of

1. Headaches (specifying the major area and frequency of discomfort)

2. Eye dryness, sore eyes and other discomforts like halos around objects

3. Discomforts related to wrists and fingers

4. Pain in shoulders and back

5. Discomforts in lower body parts

6. Other complaints regarding workplace

The statistical analysis of the items depicted item correlation value higher than 0.8 and also high item discrimination
(with t-values ranging from 3.84 to 10.05). The final inventory with 27 items was administered on a sample 0f 200
respondents i.e. 100 males and 100 females in the age group of 29-35 years working in IT industry for at least three
years.

Scoring: In the final version of 27 items inventory on ergonomic stress at workplace, item responses were to be
elicited on a Likert-type scale that range from zero (No symptom) to 5 (Unbearably severe).

Reliability of inventory: After item –analysis the inventory was subjected to test of reliability to find out the
consistency in providing results after repeated use. The reliability was found by calculating the correlation
coefficient (Cronbach’s alpha) of scores.

Test-Retest method was used to estimate the reliability of the inventory. The respondents were supposed to give their
responses on the inventory at an interval of 6 months on the same set of items. The reliability of the inventory was
then estimated by the correlation (Cronbach’s alpha) between the two sets of scores. The accuracy of this method
rests on the assumption that the participants are fundamentally the same during two test periods, thus it was made
sure that all the participants were the same for both test periods.

Table 2: Reliability Estimate of the Ergonomic Stress Index (ESI)

Method Reliability
Test-Retest 0.88

The internal consistency estimate of 0.88 (p<0.01) using Cronbach’s alpha indicates high reliabilityof the inventory.

Validity of the inventory: The tool was validated to ensure its dependability in recognizing the ergonomic risk
factors in the VDT workplace. A number of measures were adopted to establish the content and construct validity
viz., creation of items after thorough literature, scanning and brainstorming with panel of 150 experts. The Panel
was requested to comment on appropriateness of the items to the concept that help in suitably modifying the
inventory without affecting the meaning of desired aspects to be enquired in the item.

Ergonomic Stress Index (ESI) was designed for assessing the severity of risk factors in the VDT workplace. The
severity of ergonomic risk factors can be assessed by cumulative scores of any single dimension or the total
inventory. Weighted score is assigned for each response opted and the scores obtained by individual respondent on
27 items are added.

Scoring, Norms and Interpretation: z-Score norms were developed for interpretation of the raw scores in order to
find out the severity of ergonomic risk factors in the VDT workplace by testing the z-Scores as per norms given in
table 3.

Table 3 z-Score Norms for Ergonomic Stress Index (ESI)

Mean: 87.50 SD: 3.50 N=200

Raw Score z-Score Raw Score z-Score

64 -6.71 88 +0.14
65 -6.42 89 +0.42
66 -6.14 90 +0.71
67 -5.85 91 +1.00
68 -5.57 92 +1.28
69 -5.28 93 +1.57
70 -5.00 94 +1.85
71 -4.71 95 +2.14
72 -4.42 96 +2.42
73 -4.14 97 +2.71

74 -3.85 98 +3.00
75 -3.57 99 +3.28
 76 -3.28 100 +3.57
77 -3.00 101 +3.85
78 -2.71 102 +4.14
79 -2.42 103 +4.42
80 -2.14 104 +4.71
81 -1.85 105 +5.00
82 -1.57 106 +5.28
83 -1.28 107 +5.57

84 -1.00 108 +5.85

85 -0.71 109 +6.14
86 -0.42 111 +6.42
87 -0.14 112 +6.71

Norms for Interpretation of z-Score and Ergonomic Risk Factor Severity

Range of Raw Scores Range of z-Scores Severity of Ergonomic Risk Factors

107 and above +5.57 and above Extremely High
100-106 +3.57 to +5.28 Very High
92-99 +1.28 to +3.28 High
84-91 -1.00 to +1.00 Moderate
76-83 -3.28 to -1.28 Low
69-75 -5.28 to +3.57 Very Low
68 and below -5.57 and below Extremely Low

DISCUSSION

It is important to address the risk factors involved in VDT work. If attended in time, these risk factors can be
reduced and can help maintain the productivity of the workers. In general, there is a combination of high demands in
a job and a low amount of control over the situation can lead to physical and mental stress. Stress in the workplace
can have many origins or may come from one single event. It can have an impact on employee and the employer
alike. The stress factors and work conditions, which contain these risks, are always present when the requirements
exceed the worker’s threshold limits for performing tasks. The major reason of lost productivity is quoted as the
onset of WRMSDs in the early stages of the job. Studies reveal that as the number of health risk factors increase, so
does the percentage of employees reporting work limitation. According to Burton et al. (2005), health risk factors
represent additional costs of lost productivity. These risk factors are exacerbated when awkward postures come into
being. If the upper body pain and fatigue could be reduced or eliminated, it can be imagined how better the
productivity would be in both quality and quantity. Workload is a part of occupation and thus stress is a part of life.
The complaints arise usually from increased pace of work or pressure to meet deadlines resulting in improper rest
schedules, thus leaving very less scope for the body to refresh during work. Humans try to adapt to the situations
and are generally capable of doing this but adaptability comes at a cost. It is unjustified to expect the jobs to be
stress-free but the amount of stress can be minimized and managed. As duration of stress gets extended, the
individual’s efforts and resources of coping start diminishing. Such working conditions result in pain and functional
impairment and exacerbation of the improper functioning of the body parts involved in the performance of work.
Buckle (2002) suggested a relationship between the performance of work and the occurrence of neck and upper limb
MSDs is evident. The intervention strategies in the workplace for the reduction of both exposure and effect should
focus upon factors within the work organization as well as actively involving the individual worker.

If the symptoms persist for many consecutive days, they affect work and other activities; it becomes important that a
therapy is sought. The workplace conditions should be justified in terms of the safety and well being of the workers
who are going to accomplish work in it. Prevention of injury and illness is, obviously, the best approach, but
comprehensive health care and safety programmes should be designed to reduce corporate sector’s workplace
injuries, absenteeism or related expenses.

The inventory Ergonomic Stress Index can be used to assess the level of severity of ergonomic risk factors at the
VDT workplace and appropriate strategies can be further designed to prevent musculoskeletal problems and check
decline in worker’s efficiency and productivity.

REFERENCES:

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3. A Critical Review of Epidemiological evidence for Work Related Musculoskeletal Disorders of the Neck,
Upper Extremity and Low Back. http://www.cdc.gov/niosh/docs/97-141/ergotxt7.html (as retrieved on 28th
Dec 2010)

4. The Hartford Loss Control Department 2002. Warming up to on-the-job exercise: Effectiveness of exercise
programmes in preventing or relieving musculoskeletal disorders. Loss Control Tips: Technical Information
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