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- SUBJECTS AND METHODS
- AUTHOR CONTRIBUTIONS
Computers are vital tools for obtaining information, enabling efficient communication, and earning a living. They are ubiquitous in the work place and the home; 56% of workers use computers on the job and 62% of households own a computer (1, 2). People who have difficulty using a computer may experience limitations at work and be unable to participate in computer-supported home activities such as using e-mail or the Internet.
One population at risk for computer use problems is people with arthritis. Arthritis affects 18% of adults ages 18–64 years (3) and is a leading cause of work disability; recent data from the US Centers for Disease Control and Prevention show that 30% of working-age adults with osteoarthritis (OA) have an arthritis-attributable work limitation (3). Other studies have documented work limitations in those with rheumatoid arthritis (RA) and fibromyalgia (FM) (4, 5). People with arthritis have difficulty performing physically demanding jobs (6), and therefore may select clerical or administrative positions that appear less physically demanding than labor and service jobs. However, these jobs often require intensive computer-related hand use (7). People with RA and FM report problems doing hand-intensive tasks (5, 7) such as using a computer.
People with arthritis may have difficulties performing computer tasks due to pain, restricted movement, muscle weakness, or fatigue. However, the specific limitations in computer use experienced by people with RA, FM, and OA may differ considerably due to the clinical manifestations of each disorder. People with RA have polyarticular synovitis, which can cause structural damage to the cervical spine, shoulders, elbows, wrists, hands, hips, knees, and feet (8). They often present with pain, stiffness, and restricted movement due to fixed deformities of the wrists and hands that may limit manipulation of computer input devices such as the mouse or keyboard. People with OA have noninflammatory joint disorders that can damage the cervical spine, lumbar spine, hands (carpometacarpal joint), hips, knees, and first metatarsal joint (8). This damage can cause pain and restricted movement that may limit their ability to sit or manipulate input devices. Common symptoms of FM are widespread myofascial pain, paresthesias, and fatigue (8). People with FM have minimal limitations in manipulating input devices, but may experience limitations in sitting or using input devices secondary to pain.
Computer use has been identified as a risk factor for pain and musculoskeletal disorders of the upper extremity in the general population without arthritis (9, 10). Postures during computer use, forceful keying, duration of computer use, work station set-up, and the psychosocial work environment have all been associated with upper extremity musculoskeletal disorders in computer users (9). The prevalence of computer-related upper extremity pain in a healthy working population ranges between 10% and 55% (11–13), and the prevalence of musculoskeletal disorders of the upper extremity ranges between 6% and 24% (11, 14). People with arthritis are more at risk to develop upper extremity musculoskeletal disorders than those without arthritis (8, 15–17). Therefore, it is of primary importance that causes of pain and discomfort be identified in computer users with arthritis so that interventions can be implemented to reduce their risks for injury.
Despite the potential negative effect of computer-related problems on work activities, little is known about the magnitude of problems experienced by people with arthritis during computer use (18–20). The purpose of this study was to describe the degree to which those with RA, OA, and FM report discomfort and problems using a computer. Three questions were addressed: 1) What is the prevalence of computer use discomfort and problems experienced in a sample of people with one of these conditions? 2) Are there differences in the magnitude of computer use discomfort and problems experienced by people with RA, FM, and OA? and 3) To what extent do problems affect overall computer use?
- Top of page
- SUBJECTS AND METHODS
- AUTHOR CONTRIBUTIONS
The physical demands of employment, including hand use, place people with arthritis at risk for work limitations. The results of this study indicate that many people with arthritis experience both discomfort and problems during computer use that could lead to work limitations. Respondents indicated the most discomfort when using their chairs, followed by keyboards and mice. However, there were differences in subgroup reports of discomfort for equipment items. More respondents with FM reported greater discomfort than those with RA and OA for all equipment items, although only the monitor reached significance. Significantly fewer respondents with RA reported severe discomfort using the chair than respondents with FM or OA. These results reflect characteristics of each diagnosis. FM is characterized by diffuse pain; therefore, it is not unexpected that more respondents with FM reported discomfort. Those with RA do not typically have structural damage in the low back (8) and therefore would be less likely to experience discomfort when sitting.
Computer use has been identified as a risk factor for discomfort in the general population without arthritis. The equipment items in this study that caused the most discomfort for those with arthritis, including the chair, keyboard, mouse, and monitor, have also been identified as risk factors for discomfort for all computer users (24). In the general population, this discomfort has been hypothesized to be related to repetition and awkward positioning caused by the different equipment items. Because those with arthritis may experience pain and discomfort even under ideal circumstances, it is not surprising that the prevalence of respondents reporting discomfort with computer use is considerably higher than the general population of computer users (RA 69.7%, FM 87.7%, OA 82.1%, general population 10% to 55% [11–13]).
There were 2 types of problems identified by respondents: finding a comfortable position (chair and monitor) and manipulating objects (keyboard and mouse) (Table 1). The number of reported problems followed a similar pattern of the discomfort reports: the greatest percentage of the sample reported problems with the chair, followed by the keyboard, mouse, and monitor. More respondents identified problems with using a computer than reported discomfort, suggesting that discomfort and problems should be considered separately when determining interventions for computer users with arthritis.
The problems listed in the ComPS for the mouse and keyboard primarily relate to manipulation, so it is not surprising that those with RA and OA, disorders characterized by both pain and restricted movement, reported problems in these areas. However, those with FM have very subtle impairments in movement such as clumsiness and stiffness (8, 25), and their primary limiting factor is diffuse pain. Based on the type of impairments characteristic of each disorder, those with RA and OA should have reported more problems with the keyboard and mouse than those with FM. In this study, those with FM reported more problems. There are several possible explanations for these results: people with FM may have increased clumsiness related to abnormalities in sensory processing or fatigue (8), the presence of diffuse rather than localized pain may result in problems in manipulation, or those with movement limitations may have found methods to adapt their environment more easily than those with diffuse pain, resulting in fewer perceived problems.
The effect of the problems on overall computer use provides a global estimate of computer limitations caused by the problems. The percentages of respondents with limitations are almost precisely the same as the percentages of respondents with problems for each equipment item (Figures 2 and 3), suggesting that the more problems a person had, the greater the computer limitation. To confirm these results, we ran post hoc Spearman's correlations to determine the association between the number of problems and the effect of these problems. All of the associations were moderate (r ranged from 0.43 to 0.47) and significant (P < 0.001), supporting the association between problems and limitations. In recent years, numerous products have been designed to reduce discomfort and problems experienced during computer use, such as adjustable chairs and monitors and adapted keyboards and mice. Providing people with arthritis with appropriate strategies and equipment to prevent computer problems may significantly reduce work limitations and prevent those with arthritis from discontinuing computer use.
Figure 3. Percentage of the sample reporting the effect that their problems had on their ability to use a computer by diagnostic subgroup (rheumatoid arthritis [RA; n = 178], fibromyalgia [FM; n = 81], or osteoarthritis [OA; n = 56]) for each equipment item. The number in parentheses is the overall number of people reporting the effect that their problem has on their ability to use a computer for that diagnosis. * = a diagnosis significantly contributed to the ordinal regression model; # = a specific diagnosis significantly contributed to the model (P ≤ 0.01).
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Many respondents appeared to be experiencing work disability: 40.6% were unemployed, which is much higher than the unemployment rate of the general Pittsburgh population (5.2%) (26). Of the respondents who were working, 86.8% reported using a computer at work, which is much higher than the general US working population (56%) (1). Most of our respondents worked in administrative or managerial jobs that require intensive computer use. A high percentage of workers (82.2%) reported that computer use at work was very important. The high percentage of respondents reporting administrative and managerial jobs tends to support the idea that workers with arthritis may work in these types of jobs because they view them as less physically demanding.
In addition, 94% of respondents reported that they used a computer at home, which is considerably higher than the computer use reported by the general US population for this age range (69%) (1). One explanation for this higher level of computer use is that people with arthritis use their home computer as a mechanism for tasks such as shopping or banking, or to obtain health information. However, an alternative hypothesis is that this sample was a convenience sample that subjects self-selected to participate in the study because they had an interest in computer use. Computer use in the home environment has a greater potential to place people at risk for upper extremity musculoskeletal disorders, because people often do not set up their home computer environment to facilitate performance and reduce risk factors. People with arthritis should have both their work and home computer set-ups evaluated to ensure that both sites facilitate effective computing.
This study examined a convenience sample of people with arthritis. The respondents may represent a select sample of those who have trouble using a computer and therefore were interested in completing the survey. This bias may have overestimated the prevalence of computer problems. The study also had a nonresponse rate bias (65%) and the response rate differed by diagnosis: those with RA were twice as likely to respond to the survey as those with FM or OA. This differential response rate may have also overestimated the prevalence of problems in one or more groups. It is quite likely that nonrespondents either used a computer very little or had few perceived computer use problems. Respondents with severe impairments may not have responded because their impairments precluded computer use. This survey did not take into account the effect of differences in computer use patterns, the effect of different environmental factors such as the set-up of the work station, or the psychosocial environment, all of which have been reported in the literature as affecting computer use (9).
This study confirmed that a large percentage of computer users with a spectrum of arthritis disorders experience discomfort and problems during computer use, resulting in limitations in their ability to participate in computer activities. The extent of problems is of concern due to the effect that these limitations may have on their ability to use a computer for work-related tasks that appear to be very important for many workers, and the increased risk of people with arthritis developing musculoskeletal disorders of the upper extremity related to computer use. The ability to use a computer appears to be one method to prevent work limitations and eventual work disability, as well as a vital tool for both work and home activities. Therefore, health professionals must work with people with arthritis to identify problems experienced during computer use and implement computer workstation modifications to ensure safe, effective, and comfortable use of all computer equipment. Future studies should compare and contrast computer usage issues between those with and without arthritis, and more accurately describe the problems and coping strategies.