Home schooling during the COVID-19 pandemic: a randomized controlled trial of online exercise and ergonomics advice protocols on upper body symptoms

Razieh Karimian, Kim Burton, MH Naghizadeh, M Karimian, CE Xirouchaki, M Sobhanipur, T Gholami

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Understanding of students' musculoskeletal health under home-schooling during the COVID-19 pandemic is limited. Objectives: (1) To investigate the prevalence and severity of musculoskeletal symptoms in home-schooled adolescents during the COVID-19 pandemic. (2) To evaluate the effect of an online exercise + ergonomics advice protocol on symptoms, compared with ergonomics advice alone. Design: Cross-sectional symptom survey identifying eligible participants, followed by a pragmatic randomized controlled trial. Setting: Online classes. Participants: Survey: 354 students (mean 16.6 years). Trial: 188 students with upper body musculoskeletal symptoms. Interventions: Randomization to three groups (physical therapy exercises + ergonomics postural advice, ergonomics postural advice alone, nonintervention control) stratified by the site of symptoms (neck, shoulder, upper back). Interventions were orally delivered online (via WhatsApp) supplemented with written/illustrative material. Follow-up occurred at 8 weeks. Outcome Measures: Survey: prevalence of symptoms (Nordic Questionnaire). Trial: primary outcome = change in intensity of upper body symptoms (visual analogue scale); secondary outcome = number of participants reporting improvement in upper body symptoms. Results: The 12-month prevalence of musculoskeletal disorders in the survey was 38% neck, 28% shoulder, and 35% upper back, with mean pain intensity of 3.6, 3.9, and 3.8, respectively, on 0–10 visual analogue scale: Two-thirds reported symptoms in multiple anatomical regions. In the trial, there was no statistically significant difference between the exercise + ergonomics group and ergonomics alone group on the primary outcome, yet both groups showed reduced symptom intensity compared with control (p <.001). More participants in the exercise + ergonomics group reported improvement than in the ergonomics advice alone group (p <.02). Conclusions: The prevalence of musculoskeletal symptoms was relatively high in home-schooled adolescents. Symptoms can be reduced by ergonomics advice with or without exercises, but the effect is enhanced by the addition of physical therapy exercises. The latter approach may be considered for improving schoolchildren's musculoskeletal health in the usual classroom setting.

Original languageEnglish
Number of pages9
JournalPM and R
Early online date9 Jan 2024
Publication statusE-pub ahead of print - 9 Jan 2024

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