Front. Public Health Frontiers in Public Health Front. Public Health 2296-2565 Frontiers Media S.A. 10.3389/fpubh.2024.1399552 Public Health Systematic Review Musculoskeletal disorders among teachers: a systematic review and meta-analysis Tahernejad Somayeh 1 Hejazi Anahita 1 Rezaei Ehsan 1 Makki Faezeh 1 Sahebi Ali 2 3 Zangiabadi Zahra 1 * 1Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 2Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran 3Department of Medical Emergencies and Health in Disasters and Emergencies, Ilam University of Medical Sciences, Ilam, Iran

Edited by: Brent A. Baker, Centers for Disease Control and Prevention (CDC), United States

Reviewed by: Sabina Valente, Polytechnic Institute of Portalegre, Portugal

Milad Gholami, Arak University of Medical Sciences, Iran

Ebrahim Darvishi, Kurdistan University of Medical Sciences, Iran

Milad Derakhshan, Baqiyatallah University of Medical Sciences, Iran

 *Correspondence: Zahra Zangiabadi, Zahra.Zangiabadi8@gmail.com 04 10 2024 2024 12 1399552 24 04 2024 17 09 2024 Copyright © 2024 Tahernejad, Hejazi, Rezaei, Makki, Sahebi and Zangiabadi. 2024 Tahernejad, Hejazi, Rezaei, Makki, Sahebi and Zangiabadi

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 Introduction

As a result of the demands of their profession, teachers encounter a range of ergonomic risk factors and are highly susceptible to developing musculoskeletal disorders (MSDs). Accordingly, this systematic review and meta-analysis was carried out to examine the frequency of MSDs among teachers.

 Materials and methods

The present research followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and its protocol was registered in international prospective register of systematic review (PROSPERO) under the code CRD42024509263. To conduct the searches, various databases such as PubMed, Scopus, Web of Science, Science Direct, SID, ISC, and Google Scholar were utilized, and the search period was until February 7th, 2024 without time restriction. A random effects model was employed for meta-analysis, and I2 index was utilized to assess heterogeneity among the studies. Data analysis was carried out using STATA (version 14).

 Results

After an initial search across the mentioned databases, a total of 2,047 articles were identified. Following screening, study selection, and quality evaluation, 44 studies were ultimately chosen for meta-analysis, involving 15,972 teachers. The results of the meta-analysis revealed that the overall prevalence of MSDs among teachers is 68% (95% CI: 61–75, I2 = 99.2%, p < 0.001). Furthermore, the prevalence rates of MSDs in different body regions, such as the neck (47%), lower back (47%), shoulder (44%), upper back (37%), knee (35%), ankle (30%), wrist (27%), hip (22%), and elbow (13%), were reported.

 Conclusion

The overall prevalence of MSDs among teachers is relatively high. Neck and lower back pain are more common among them compared to other body regions. It is recommended that periodic occupational medicine examinations, training, and the implementation of ergonomic interventions for this occupational group focus on assessing the risk factors for MSDs, especially in the neck and lower back regions.

 Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=509263, identifier CRD42024509263.

 musculoskeletal disorders teachers risk factors prevention ergonomics section-at-acceptance Occupational Health and Safety Introduction

Work-related musculoskeletal disorders (WMSDs) are presently prevalent and expensive occupational health issues in both developing and developed nations (1, 2). Globally, WMSDs are a significant concern leading to substantial direct and indirect costs for employees, employers, and governments (3). To date, numerous studies have reported a wide range of risk factors associated with MSDs, which have been classified into four general categories: mental risk factors (4), individual and personality risk factors (5), biodynamic risk factors (6), and hidden risk factors (7).

Teachers are also among the professionals who encounter diverse ergonomic risk factors (8). Teachers’ responsibilities involve repetitive duties, fixed postures, and occasionally extended work hours (9). Apart from teaching (10), teachers also engage in evaluating students’ schoolwork or homework (11). Sometimes teachers have to lift heavy items, such as books, educational materials, and laptops. Additionally, due to the demands of their profession, teachers may maintain a posture for longer periods than recommended ergonomically, primarily because of the high mental workload, thereby exposing themselves to the challenges associated with prolonged static work. At times, teachers adopt awkward postures, such as tilting the neck backward while writing on the board or leaning the neck forward during tasks like reviewing lessons, assessing assignments, marking exams, using computers, and handling school administrative duties. Moreover, regularly writing on the board with hands positioned above shoulder level, standing for prolonged periods in improper positions during teaching, sitting inappropriately, and frequently twisting or bending from the side of the board towards the students and back can result in strains. These behaviors may adversely impact the musculoskeletal system of teachers (9, 12–21).

Teachers may find themselves pushing their physical, cognitive, and emotional limits to meet educational objectives. Insufficient time for recuperation can trigger or worsen pain symptoms, potentially leading to stress that adversely affects both physical and mental well-being of teachers and consequently impacts their professional performance (22). Besides physical and psychological aspects, individual factors such as the gender and age of teachers are also associated with MSDs (23). Given the crucial role that teachers play in enhancing and ensuring the quality of the education process, the well-being of their musculoskeletal system holds significant importance.

Research indicates a growing apprehension regarding the risk of WMSDs in the realm of education, with WMSDs generally being more prevalent among school teachers compared to other professional groups (13). Some studies have indicated WMSDs as a significant and costly occupational health issue, resulting in a decline in teachers’ quality of life (1), and sometimes, these disorders may necessitate teachers to take extended sick leave (8). Furthermore, WMSDs have been identified as a contributing factor to the premature retirement of teachers (24, 25). Another study indicated that the occurrence of MSDs among teachers could impact their daily tasks, such as work responsibilities, potentially resulting in higher rates of absenteeism (22).

Given the significance of MSDs as a prevalent and crucial occupational health issue in teaching profession (10), it appears essential to carry out thorough and credible epidemiological studies in the realm of MSDs among teachers. The prevalence of MSDs in various body parts can provide important information regarding some ergonomic risk factors associated with each occupation (26). Surveys show that so far, several studies have evaluated the prevalence of MSDs among teachers, but according to the results of our surveys, no comprehensive study was found that studied the overall prevalence and types of MSDs among this occupational group. Due to the importance of WMSDs, several systematic reviews and meta-analyses have been conducted to estimate the overall prevalence of MSDs among employees of different occupational groups, for example dentists (27), orthopedic surgeons (28), sanitary workers (29), firefighters (30), nurses (31, 32), operating room personnel (33), and physiotherapists (34, 35). In some studies, the prevalence of occupational low back pain among occupational groups has been specifically investigated (36, 37). The findings from each of these studies can be useful to assess the work ability index or develop strategies to enhance this index across the respective occupations.

Based on the aforementioned materials, understanding the overall prevalence of MSDs and the prevalence of these disorders in various body parts to reduce them is necessary for each occupational group. In fact, this knowledge is one of the most important measures for designing effective ergonomic interventions to maintain the health of the workforce. Hence, considering the significance of the topic, the present study aimed to provide more comprehensive information regarding the investigation of MSDs among teachers through a systematic review and meta-analysis. The findings of this study can serve as an important source of information for occupational health managers to develop more effective ergonomic interventions and ergonomic training programs to prevent teachers from suffering from MSDs.

 Methods

The systematic review and meta-analysis were carried out following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (38). The study protocol is currently registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the code CRD42024509263. Various phases of the study, such as the search strategy, screening, study selection, quality assessment, and data extraction, were conducted following the PRISMA protocol. The final three stages, i.e., study selection, quality evaluation, and data extraction, were carried out independently by two researchers, with any disagreements resolved through group discussion.

Sources of information and search strategy

In this study, information sources include PubMed, Scopus, Web of Science, Science Direct, SID, ISC, Google Scholar, conference and congress articles, as well as the bibliography of selected articles and systematic review studies, which were utilized for searching and extracting relevant studies. To extract valid keywords, we recognized MeSH terms (formal words or phrases selected to denote specific biomedical concepts (39)), utilized the keywords from pertinent articles, and sought advice from scientific experts. The search strategies for all databases were developed using the following appropriate keywords:

“Teachers*,” “High school teachers*,” “Preschool teachers*,” “Secondary school teachers*,” “School teacher*,” “Primary school teachers*,” “Musculoskeletal disorder*,” “Musculoskeletal disease*,” “Work related Musculoskeletal disorder*,” “Muscle strain*,” “Musculoskeletal symptom*,” “Musculoskeletal complaint*,” “WRMSDs,” “Muscle problem*,” “Dysfunction*,” “Neck pain*,” “Musculoskeletal problem*,” “MSDs,” “Musculoskeletal pain*,” “Arthritis joint*,” “Arthritis bone*,” “Shoulder pain*,” “Elbow pain*,” “Back pain*,” and “Hand pain*.”

Additionally, several operators and search fields were utilized to combine keywords. The search period was until February 7th, 2024 without time constraints. Table 1 presents the search strategy for all database types.

Search strategy in various databases.

Database Search strategy
PubMed ((“Teachers*” OR “High school teachers*” OR “Preschool teachers*” OR “Secondary school teachers *” OR “School teacher*” OR “Primary school teachers *”) AND (“Musculoskeletal disorder*” OR “Musculoskeletal disease*” OR “Work related Musculoskeletal disorder*” OR “Muscle strain*” OR “Musculoskeletal symptom*” OR “Musculoskeletal complaint*” OR “WRMSDs” OR “Muscle problem*” OR “Dysfunction*” OR “Neck pain *” OR “Musculoskeletal problem*” OR “MSDs” OR “Musculoskeletal pain*” OR “Arthritis joint*” OR “Arthritis bone*” OR “Shoulder pain*” OR “Elbow pain*” OR “Back pain*” OR “Hand pain*”))
Scopus (((TITLE-ABS-KEY(“Teachers*”) OR TITLE-ABS-KEY(“High school teachers*”) OR TITLE-ABS-KEY(“Preschool teachers*”) OR TITLE-ABS-KEY(“Secondary school teachers*”) OR TITLE-ABS-KEY(“School teacher*”) OR TITLE-ABS-KEY(“Primary school teachers*”)) AND (TITLE-ABS-KEY(“Musculoskeletal disorder*”) OR TITLE-ABS-KEY(“Musculoskeletal disease*”) OR TITLE-ABS-KEY(“Work related Musculoskeletal disorder*”) OR TITLE-ABS-KEY(“Muscle strain*”) OR TITLE-ABS-KEY(“Musculoskeletal symptom*”) OR TITLE-ABS-KEY(“Musculoskeletal complaint*”) OR TITLE-ABS-KEY(“WRMSDs”) OR TITLE-ABS-KEY(“Muscle problem*”) OR TITLE-ABS-KEY(“Dysfunction*”) OR TITLE-ABS-KEY(“Neck pain*”) OR TITLE-ABS-KEY(“Musculoskeletal problem*”) OR TITLE-ABS-KEY(“MSDs”) OR TITLE-ABS-KEY(“Musculoskeletal pain*”) OR TITLE-ABS-KEY(“Arthritis joint*”) OR TITLE-ABS-KEY(“Arthritis bone*”) OR TITLE-ABS-KEY(“Shoulder pain*”) OR TITLE-ABS-KEY(“Elbow pain*”) OR TITLE-ABS-KEY(“Back pain*”) OR TITLE-ABS-KEY(“Hand pain*”))))
Web Of Science (WOS) (((TS = (“Teachers *”) OR TS = (“High school teachers *”) OR TS = (“Preschool teachers *”) OR TS = (“Secondary school teachers *”) OR TS = (“School teacher *”) OR TS = (“Primary school teachers*”)) AND (TS = (“Musculoskeletal disorder *”) OR TS = (“Musculoskeletal disease”) OR TS = (“Work related Musculoskeletal disorder *”) OR TS = (“Muscle strain”) OR TS = (“Musculoskeletal symptom*”) OR TS = (“Musculoskeletal complaint *”) OR TS = (“WRMSDs”) OR TS = (“Muscle problem *”) OR TS = (“Dysfunction *”) OR TS = (“Neck pain *”) OR TS = (“Musculoskeletal problem *”)OR TS = (“MSDs *”) OR TS = (“Musculoskeletal pain *”) OR TS = (“Arthritis joint *”) OR TS = (“Arthritis bone *”) OR TS = (“Shoulder pain *”) OR TS = (“Elbow pain *”) OR TS = (“Back pain *”) OR TS = (“Hand pain *”))))
Inclusion criteria

For this research, studies with focus on MSDs among teachers were included.

 Exclusion criteria

Review studies, case reports, intervention studies, non-English papers, letters to the editor, and reports on the prevalence of musculoskeletal injuries resulting from accidents were not included in the study.

 Study selection process

Initially, all identified articles were imported into EndNote X7 for organization. Following the removal of duplicates, the titles and abstracts of the remaining articles were reviewed based on specific criteria. Subsequently, potentially relevant articles were pinpointed, and two researchers separately examined the full text of these articles. Ultimately, articles meeting the eligibility criteria were chosen.

 Quality assessment and data extraction

During this phase, two researchers independently assessed the quality of the chosen studies utilizing the Appraisal tool for Cross-Sectional Studies (AXIS) (40). The scoring system of this tool assigns values from 0 to 20. For this study, articles scoring 12 or higher were included in meta-analysis (30). It is important to mention that no study was omitted from this research. In the following stage, two researchers separately gathered the data. In this phase, details such as the author’s name, sample size, gender distribution, average age of participants, prevalence of MSDs and their types, and assessment tools of each study were obtained and recorded in a pre-prepared checklist.

 Statistical analysis

To determine the variance of each study, the binomial distribution was utilized. Moreover, a weighted mean was used to combine the prevalence of MSDs across various studies. The weighting of each study was determined by its inverse variance. A simple random effects model was employed for conducting the meta-analysis.

The I2 index was utilized to assess the level of heterogeneity among the studies. Heterogeneity was categorized into various ranges: less than 25%, 25–50%, 50–75%, and above 75%, indicating no heterogeneity, medium heterogeneity, high heterogeneity, and very high heterogeneity, respectively (41). Begg’s test was employed to examine publication bias. Ultimately, the study data were analyzed using STATA software (version 14).

 Result Systematic review results

At first, a total of 2,047 articles were found in the initial database search. Subsequently, 1,724 studies were retained after eliminating duplicates and entered the screening phase. Following this process, 92 articles were selected for further full-text examination. Then, a total of 44 studies were eventually chosen for qualitative assessment. These 44 studies entered the meta-analysis phase (Figure 1). This study examined the prevalence of MSDs among 15,972 teachers. Among the 44 studies, 37 reported the overall prevalence of MSDs, involving 14,069 teachers. A summary of the characteristics of the selected studies is provided in Table 2.

Flowchart of study selection based on PRISMA.

The specifications of studies included in the meta-analysis.

First author/Year Country Sample size Total prevalence of MSDs Prevalence of MSD types Toolsa
Sankar (2024) (50) India 400 (female: 315 (78.75%)/ male: 85 (21.25%)) 69.8% Neck: 25.5% NMQ
Shoulder: 17.8%
Elbows: 6.0%
Wrist/hands: 11%
Upper back: 4.8%
Lower back: 9.8%
Hips/thigh: 24.3%
Knee: 23.3%
Ankle/feet: 14%
De Souza (2023) (22) Brazil 246 (female: 187/male: 59) NR Lower back: 40.7% NMQ
Elbow: 11%
Shoulder: 37.8%
Neck: 40.2%
Knee: 24.8%
Hip/thigh: 16.7%
Ankle/foot: 26%
Upper back: 32.1%
Wrist/hand: 29.7%
Da Cruz Teles (2023) (51) Brazil 326 76.1% NR NMQ
Grabara (2023) (52) Poland 254 (female: 203/male: 51) NR Lower back: 57.1% NMQ
Shoulder: 26.4%
Knee: 37.4%
Neck: 52.8%
Upper back: 38.6%
Ankles/foot: 23.6%
Wrist/hand: 22.8%
Hip/thigh:18.9%
Elbow: 11%
Ramírez-García (2023) (53) Ecuador 134 (female: 86/male: 48) 67% Neck: 69% NMQ
Shoulder: 46%
Back/lumbar: 49%
Elbow: 16%
Wrist/hand: 33%
AlMaghlouth (2022) (54) Saudi Arabia 404 (female: 211 (52.2%)/ male: 193 (47.8%)) 41.1% Neck: 62.1% NMQ
Shoulders: 69.8%
Elbows: 33.7%
Hands: 48.3%
Back: 80.2%
Hips/thighs: 45%
Knees: 62.9%
Ankles: 55%
Althomali (2022) (55) Saudi Arabia 251 (male:145/ Female:106) 93.63% Lower back: 72.91% NMQ
Neck: 49.8%
Shoulders: 66.93%
Elbows: 17.93%
Wrist/hands: 39.44%
Upper back: 42.63%
Hips/thighs/buttocks: 43.03%
Knees: 46.61%
Ankles/feet: 37.85%
Alajmi (2022) (56) Saudi Arabia 372 86% Right shoulder: 43.5% NMQ
Neck: 62.9%
Left shoulder: 51.6%
Upper back: 48.9%
Right humerus: 21.5%
Left humerus: 25.3%
Lower back: 53.8%
Right arm: 23.7%
Left arm: 23.7%
Right wrist: 24.7%
Left wrist: 18.8%
Hip: 39.2%
Right thigh: 26.3%
Left thigh: 24.7%
Right knee: 37.1%
Left knee: 40.9%
Right leg: 26.9%
Left leg: 25.8%
Right foot: 32.8%
Left foot: 36%11
Celikkalp (2022) (57) Turkey 416 64.9% Neck: 55.5% CMDQ
Lower back: 47.6%
Back: 53.4%
Elbow: 6.5%
Gabani (2022) (58) Brazil 958 43% Lower back: 11% Interview
Upper limb: 14%
Lower limb: 13%
De Souza (2022) (59) Brazil 245 NR Neck: 19.6% NMQ
Shoulders: 18.0%
Upper back: 12.3%
Elbows: 3.7%
Wrists/hands: 14.3%
Lower back: 19.3%
Hip/thighs: 8.6%
Ankles/feet: 13.1%
Knees: 12.7%
Fahmy (2022) (1) Egypt 310 (female: 205/ male: 105) 66.77% Neck: 56.1% NMQ
Shoulder: 53.2%
Lower back: 53.2%
One or both knee: 50.6%
Wrists/hands: 39%
Upper back: 33.2%
One or both ankles/feet: 28.7%
Elbow: 15.2%
Matias (2022) (60) Brazil 60 (female: 38/male: 22) 75% Cervical spine: 45% NMQ
Lumbar spine: 68.3%
Thoracic spine: 41.7%
Wrists/hands: 41.7%
Shoulders: 23.3%
Arms: 15.0%
Forearms: 6.7%
Hip: 23.3%
Thighs: 15%
Knees: 26.7%
Legs: 8.3%
Ankles/feet: 23.3%
Moreto (2022) (61) Perú 91 (male: 46/ Female: 45) 58.2% Shoulder: 51.6% NMQ
Neck: 52.7%
Wrists/hands: 52.7%
Elbow/forearms: 48.4%
Lumbar thoracic: 51.6%
Mekoulou Ndongo (2022) (62) Cameroon 179 84.3% Lower back: 43% NMQ
Shoulder: 35%
Neck: 33.5%
Knee:12.4%
Hips/thigh:11.2%
Wrist/hand:25.7%
Ankles/feet:1%
Elbow:4.5%
Upper back:25.1%
Althomali (2021) (63) Saudi Arabia 251 (male: 57.8%/ females: 42.2%) 87.3% Neck: 36.25% NMQ
Shoulders: 53.4%
Elbows: 16.3%
Wrist/hands: 30.3%
Upper back: 33.5%
Lower back: 62.55%
Hips/thighs/buttocks: 37.05%
Knees: 41.04%
Ankles/feet: 31.5%
Arshad (2021) (64) Pakistan 289 82.7% Neck: 50.2% NMQ
Shoulders: 44.3%
Elbows: 26.3%
Wrist/hands: 30.8%
Upper back: 43.3%
Lower back: 60.2%
One or both hips/thighs: 32.9%
One or both knees: 37.4%
One or both ankles: 48.4%
Abdel-Salam (2021) (65) Saudi Arabia 254 (female) 68.50% Low back: 68.4% Self-administered questionnaire
knee: 58.6%
Shoulder: 47.7%
Neck: 45.4%
Elbow: 23.6%
Wrist: 14.4%
Aldukhayel (2021) (66) Saudi Arabia 503 91% Back: 74.4% NMQ
Elbow: 13.1%
Shoulder: 57.5%
Neck: 48.5%
Knee: 10.1%
Wrist/hand: 22.1%
Vega-Fernandez (2021) (44) Chile 153 71.2% Neck: 44.4% NMQ
Shoulders: 32.7%
Neck/shoulders: 53.6%
Elbows: 13.7%
Wrist/hand: 26.8%
Any upper limb: 61.4%
Upper back: 32%
Low back: 43.1%
Any back: 51%
Hips/thigh: 24.2%
Knee: 34%
Ankles/feet: 24.8%
Any lower limb: 49%
Khalid (2021) (67) Pakistan 921 (male: 686 (74.8%)/ female: 232 (25.2%)) 70.8% Neck: 17% Self-administered questionnaire
Upper extremity: 28%
Lower extremity: 9.1%
Lower back: 16.6%
Souza (2021) (68) Brazil 304 24.3% Back: 15.5% NMQ
Upper limbs: 16.1%
Lower limbs: 12.5%
Alharbi (2020) (69) Saudi Arabia 400 (male) 62.5% Shoulder: 47.9% Self-administered questionnaire
Neck: 41.3%
Lower back: 59.2%
Elbow: 11.7%
Wrists/hand: 8.8%
Lower limbs: 43.3%
Amit (2020) (70) Philippines 200 74.5% Neck: 47.5% Musculoskeletal burdens work hazards (H-9-2016) questionnaire
Lower back/waist: 56.0%
Shoulder: 45.0%
Arm/elbow: 33.0%
Hand/wrist: 44.0%
Leg/foot: 56.5%
Alias (2020) (71) Malaysia 212 40.1% Neck: 22.6% NMQ
Shoulder: 22.2%
Upper back: 26.4%
Lower back: 25.0%
Elbow: 10.4%
Hands: 9.9%
Arm: 11.3%
Knee: 28.8%
Thigh: 18.4%
Feet: 32.5%
Arvidsson (2020) (72) Sweden 246 (female) 21% Neck: 40% NMQ
Shoulder: 34%
Feet:11%
Hand: 16%
Lower back: 38%
Chand (2020) (73) Pakistan 255 (female: 164 (64.3%)/ male: 91 (35.7%)) 88.9% Neck: 48.5% Self-administered questionnaire
Shoulder: 46.6%
Upper back: 25.6%
Lower back: 45.4
Elbow: 4.6%
Wrist/hand: 12.2%
Hip:9.5%
Leg: 23.3%
Knee: 21.8%
Ankle: 15.3%
De Souza (2020) (47) Brazil 224 NR Neck: 19.6% NMQ
Thoracic: 33.9%
Shoulder: 18.8%
Elbow: 11. 11%
Wrist: 15.1%
Low back: 20.1%
Hip/thigh: 9.4%
Knee: 13.8%
Ankle/foot: 26.8%
Kraemer (2020) (74) Brazil 25 (male: 18 (72%)/female: 7 (28%)) 100% Neck: 56% NMQ
Shoulder: 48%
Lower back: 60%
Upper back: 40%
Wrists/hands: 32%
Elbow: 8%
Ng (2019) (75) Malaysia 367 (female: 318 (86.6%)/male: 49 (13.4%)) 80.1% Neck: 75.5% CMDQ
Shoulder: 80.1%
Upper back: 56.4%
Upper arm: 91.3%
Lower back: 59.9%
Forearm: 89.6%
Wrist: 93.2%
Hip/buttocks: 40.9%
Thigh: 91.8%
Knee: 88%
Lower leg: 90.5%
Foot: 87.7%
Converso (2018) (76) Italy 429 55.5% Lower back: 70. 6% NMQ
Upper back: 84%
Neck: 75.6%
Shoulder: 56.3%
Hips/thigh: 49.6%
Knee: 49.6%
Wrist/hand: 38.7%
Ankles/feet: 16.8%
Elbow: 16%
Ojukwu (2018) (77) Nigeria 352 (female: 260/ male: 92) 70.2% Shoulder: 62.3% NMQ
Neck: 57.9%
Vaghela (2018) (78) India 314 71.95% Neck: 20.7% NMQ
Shoulder: 33.12%
Elbow: 4.3%
Wrist/hand: 15.75%
Upper back: 29.97%
Lower back: 49.92%
Hip/thigh: 7.01%
Knee: 33.73%
Ankle/foot: 25.41%
Solis-Soto (2017) (79) Bolivia 517 86% Neck: 47.2% NMQ
Upper back: 35.8%
Hips/thighs: 31.9%
Lower back: 33.1%
Shoulder: 34.6%
Upper extremities: 46.7%
Upper extremities back: 63.7%
Ankles/feet: 30.4%
Wrist/Hands: 25.7%
Knees: 37.5%
Zamri (2017) (80) Malaysia 1,482 48% Neck: 60.1% NMQ
Shoulder: 60.1%
Low back: 48%
Arvidsson (2016) (81) Sweden 375 (female) NR Lower back: 36% NMQ
Shoulder: 38%
Neck: 44%
Foot: 12%
Hand: 17%
Ceballos (2015) (82) Brazil 525 (female: 452/male: 73) 73.5% Lower back: 18.3% Self-administrated questionnaire
Shoulder: 31.6%
Neck: 27.2%
Wrists/hands: 17.9%
Knee: 18.1%
Ankles/feet: 24%
Hip/thigh: 11%
Elbow: 4.4%
Upper back: 27.8%
Karakaya (2015) (83) Turkey 104 36% Lower back: 38% NMQ
Neck: 39%
Shoulders: 28%
Elbows: 9%
Wrists/hands: 16%
Hips/thighs: 12%
Knees: 22%
Ankles/feet: 33%
Upper back: 32%
Shuai (2014) (13) China 328 NR Shoulder: 52.29% NMQ
Neck: 63.43%
Lower back: 47.14%
Wrist/hand: 25.14%
Ankles/foot: 21.14%
Knee: 26.57%
Hip/thigh: 16.57%
Elbow: 13.14%
Upper back: 37.71%
Cheng (2013) (84) Taiwan 323 94% Shoulder: 76.2% NMQ
Lower back:74.6%
Neck: 65.9%
Darwish (2013) (20) Saudi Arabia 240 79.17% Lower back: 63.8% NMQ
Shoulder: 45.4%
Neck: 42.1%
Leg: 40.0%
Wrist: 16.2%
Elbow: 10.0%
Mohammadi (2013) (85) Iran 231 (male: 141/female: 90) NR Neck: 72.7% NMQ
Shoulder: 51.3%
Upper back: 62.6%
Lower back: 44.8%
Knee: 59.3%
Durmus (2012) (18) Turkey 602 (male: 312/female: 290) 60.3% Neck: 47.9% Self-administrated questionnaire
Knee: 30.9%
Lower back: 74.9%
Shoulder: 55.9%
Elbow: 11%
Back: 42.7%
Ankle/foot: 29.5%
Wrist/hand: 23.4%
Hip/thigh: 15.4%
Korkmaz (2011) (16) Turkey 900 51.4% Neck: 42.5% Self-administered questionnaire
Upper back: 36.9%
Lower back: 43.8%
Shoulder: 28.7%
Elbow: 8.0%
Wrist: 13.4%
Hip: 8.4%
Knee: 32.0%
Ankle: 21.8%
Neck: 42.5%

NMQ, Nordic Musculoskeletal Questionnaire; CMDQ, Cornell Musculoskeletal Discomfort Questionnaires.

NR, not reported.

 Characteristics of included studies

According to the findings of the meta-analysis, 68% (95% CI: 61–75, I2 = 99.2%, p < 0.001) of teachers experienced MSD symptoms in at least one region of their body. The level of heterogeneity among the reviewed studies, as indicated by the I2 index in this study, was very high (Figure 2). The findings of the subgroup analysis on the prevalence of MSDs across different body regions are presented in Table 3. As per the results, the lower back and neck had the highest prevalence, respectively, at 47% (95% CI: 40–55, I2 = 99.1%, p < 0.001), and 47% (95% CI: 41–52, I2 = 98%, p < 0.001), while the elbow had the lowest prevalence of MSDs at 13% (95% CI: 11–16, I2 = 93.5%, p < 0.001). Additionally, I2 values calculated for all investigated regions were notably high.

The overall prevalence of MSDs among teachers and the 95% confidence interval for each of the reviewed studies and all studies.

Meta-analysis results for different body regions.

MSDs Number of studies Sample size Prevalence of MSDs 95% CI I2 Begg’s test Egger’s test
Lower back 41 15,112 47% 40–55% 99.1% p = 0.946 p = 0.003*
Neck 41 14,710 47% 41–52% 98% p = 0.982 p = 0.306
Shoulder 38 12,675 44% 39–50% 97.9% p = 0.555 p = 0.493
Wrist 34 10,287 27% 19–35% 99.1% p < 0.001* p = 0.963
Elbow 31 9,715 13% 11–16% 93.5% p < 0.001* p < 0.001*
Upper back 29 10,216 37% 30–45% 98.7% p = 0.574 p = 0.071
Knee 27 8,807 35% 27–43% 98.8% p = 0.108 p = 0.445
Ankle 27 8,634 30% 21–38% 99.1% p = 0.015* p = 0.006*
Hip 25 8,437 22% 18–27% 97.4% p = 0.001* p = 0.001*

CI, confidence interval; I2, I squared. The asterisk (*) indicates a significant difference (p < 0.05).

 Risk of bias assessment

Begg’s test results (p = 0.075) in Figure 3 reveal that there was no significant publication bias in the prevalence of overall MSDs among teachers. However, based on the outcomes of this test, the publication bias in the prevalence of MSDs in the regions of the wrist, elbow, ankle, and hip was significant.

Publication bias based on Begg’s test for overall prevalence of MSDs among teachers.

 Discussion

The present systematic review and meta-analysis aimed to examine the frequency of MSDs among teachers. After assessing 44 articles, the meta-analysis results revealed that the overall prevalence of MSDs among teachers is 68%, with the highest prevalence in the neck (47%), and lower back (47%). Furthermore, the prevalence rates of MSDs were also determined for other regions such as the shoulder (44%), upper back (37%), knee (35%), ankle (30%), wrist (27%), hip (22%), and elbow (13%).

The findings of one review study indicated that the occurrence of MSDs among general teachers varies from 48.7 to 73.7%, whereas a prevalence range of 38.7 to 94% was noted among special education teachers (8). In a separate review study by Erick and Smith focusing on the prevalence of MSDs and associated risk factors among school teachers, MSD prevalence was reported to range from 39 to 95%, with the most significant pain experienced in the upper back, neck, and upper limbs (14). The overall prevalence of MSDs in the present study was consistent with these studies. Additionally, neck pain was estimated to be the most common musculoskeletal disorder in this study and the aforementioned studies. However, although the prevalence of low back pain in the present study was estimated to be as high as neck pain, the study by Erick and Smith reported lower prevalence rates for low back pain compared to the upper back, neck, and upper limbs.

Analyzing the findings from the research previously conducted and the present study reveals that numerous teachers face the risk of MSDs as a result of being exposed to ergonomic hazards such as awkward postures and extended periods of standing (42). Prolonged standing can lead to issues such as leg swelling and pain, varicose veins, back discomfort, and neck and shoulder pain, as well as other physical ailments. Moreover, extended periods of standing reduce the blood flow to the muscles, which can hasten the onset of fatigue, resulting in muscle pain in the arms, back, and neck (43).

In various professions, the frequency of MSDs holds significant importance, and numerous studies have been carried out in this field. In a review conducted by Lietz et al., the prevalence of MSDs among dental practitioners varied from 10.8 to 97.9%, with the highest rate (58.5%) observed in the neck region (27). According to findings from another review study, the prevalence of MSDs among orthopedic surgeons was documented as 73.8% (28). In a different review study conducted among sanitary workers, the worldwide occurrence of MSDs was 40.52% (29). The comparison between the findings in the literature and the present study indicate that the prevalence rates of MSDs among teachers are higher than those among sanitary workers. However, when compared to the prevalence of these disorders among orthopedic surgeons and dentists, there was no much difference. Moreover, in most of the mentioned studies, the neck and lower back were among the most common regions affected by MSDS symptoms, which is consistent with the results of the present study.

Therefore, teaching at school is considered one of the professions with the highest global prevalence of MSDs (44). Researchers have highlighted that the job responsibilities of teachers, such as instructing students, lesson planning, grading assignments, and performing school administrative tasks, can lead to discomfort in their upper and lower limbs (9, 19). Some research has identified physical factors such as extended periods of standing and awkward writing postures as exacerbating factors for MSDs (45). Besides physical ergonomic risk factors, individual and psychosocial risk factors can also play a role in the occurrence of MSDs. For instance, factors including work experience, age, gender, body mass index (BMI), type of school, and number of students have been identified as contributors to MSDs (44). Furthermore, another study indicated that psychosocial elements such as elevated work demands, limited job control, high stress levels, job dissatisfaction, monotonous tasks, and inadequate social support are significantly linked to the prevalence of WMSDs among school teachers (1). In addition, the researchers stated that sleep disorders can also lead to MSDs (46). Regarding the teaching profession, De Souza et al. demonstrated that poor sleep quality was markedly correlated with the onset of musculoskeletal symptoms among teachers (47).

According to the results of the present study, the prevalence of MSDs among teachers, especially in the neck and lower back regions, is high. Therefore, it is necessary to consider effective coping strategies, including ergonomic risk factor assessments, periodic screening of teachers for MSDs (48), designing ergonomic interventions, and conducting necessary training courses, to reduce and control MSDs. The findings of this study can likely be useful for planning and implementing corrective measures, which could lead to more effective educational services provided by teachers and, consequently, improve the quality of the educational system. These measures can include ergonomic interventions based on teaching correct postural behavior and corrective exercises, which have been effective in reducing MSDs in many occupational groups (49).

 Limitations

This study had several limitations. Initially, there was heterogeneity among the studies, possibly stemming from variations in tools, sample sizes, and cut-off points in the original studies. As another limitation of this study, it is worth noting the inability to report the incidence of MSDs by gender, as this data was not available in the original studies. Furthermore, due to the limited number of tools assessed for MSDs within subgroups, conducting instrument-based subgroup analysis was not feasible. The present study was also limited by the fact that it included only research published in English.

 Conclusion

The present systematic review and meta-analysis was conducted with the aim of investigating the prevalence of MSDs among teachers. The results indicate that the overall prevalence of MSDs among teachers is 68% and the highest prevalence is related to the neck (47%), and lower back (47%). This high prevalence rate of MSDs compared to other occupational groups is noteworthy and shows that MSDs among teachers can lead to a decrease in their work ability index. Therefore, it is strongly recommended to take necessary measures to prevent MSDs, especially in the neck and back regions among teachers. It is suggested that in the future, comprehensive studies be conducted in relation to the identification of ergonomic risk factors in the teachers’ work environment and the design of ergonomic interventions for them. In addition, it is recommended that teachers be periodically screened for MSDs. Perhaps the implementation of these corrective measures will reduce the prevalence of MSDs among this occupational group.

 Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

 Author contributions

ST: Project administration, Writing – original draft, Writing – review & editing. AH: Writing – original draft, Investigation. ER: Investigation, Writing – original draft. FM: Writing – original draft, Methodology. AS: Writing – original draft, Data curation, Formal analysis, Software. ZZ: Writing – original draft, Project administration, Writing – review & editing.

 Funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The systematic review design of the present study (research number 402001018) was approved and financially supported by the Health in Disasters and Emergencies Research Center at Kerman University of Medical Sciences.

All authors thank the Health in Disasters and Emergencies Research Center at Kerman University of Medical Sciences. This article was derived from the research project, which was supported by this research center.

 Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

 Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

 References Fahmy VF Momen MAMT Mostafa NS Elawady MY. Prevalence, risk factors and quality of life impact of work-related musculoskeletal disorders among school teachers in Cairo, Egypt. BMC Public Health. (2022) 22:2257. doi: 10.1186/s12889-022-14712-6, PMID: 36463148 Eyvazlou M Asghari A Mokarami H Bagheri Hosseinabadi M Derakhshan Jazari M Gharibi V. Musculoskeletal disorders and selecting an appropriate tool for ergonomic risk assessment in the dental profession. Work. (2021) 68:1239–48. doi: 10.3233/WOR-213453, PMID: 33867383 Tajvar A Daneshmandi H Dortaj E Seif M Parsaei H Shakerian M . Common errors in selecting and implementing pen–paper observational methods by Iranian practitioners for assessing work-related musculoskeletal disorders risk: a systematic review. Int J Occup Saf Ergon. (2022) 28:1552–8. doi: 10.1080/10803548.2021.1905993 Darvishi E Meimanatabadi M. The rate of subjective mental workload and its correlation with musculoskeletal disorders in bank staff in Kurdistan, Iran. Procedia Manuf. (2015) 3:37–42. doi: 10.1016/j.promfg.2015.07.105 Darvishi E Ghasemi F Sadeghi F Abedi K Rahmati S Sadeghzade G. Risk assessment of the work-related musculoskeletal disorders based on individual characteristics using path analysis models. BMC Musculoskelet Disord. (2022) 23:616. doi: 10.1186/s12891-022-05573-6, PMID: 35761242 Mahdavi N Motamedzade M Jamshidi AA Darvishi E Moghimbeygi A Heidari MR. Upper trapezius fatigue in carpet weaving: the impact of a repetitive task cycle. Int J Occup Saf Ergon. (2018) 24:41–51. doi: 10.1080/10803548.2016.1234706 Darvishi E Osmani H Aghaei A Moloud EA. Hidden risk factors and the mediating role of sleep in work-related musculoskeletal discomforts. BMC Musculoskelet Disord. (2024) 25:256. doi: 10.1186/s12891-024-07387-0, PMID: 38566113 Abdul Rahim AA Jeffree MS Ag Daud DM Pang N Sazali MF. Factors associated with musculoskeletal disorders among regular and special education teachers: a narrative review. Int J Environ Res Public Health. (2022) 19:11704. doi: 10.3390/ijerph191811704 Chong EYL Chan AHS. Subjective health complaints of teachers from primary and secondary schools in Hong Kong. Int J Occup Saf Ergon. (2010) 16:23–39. doi: 10.1080/10803548.2010.11076825, PMID: 20331916 Erick P Smith D. Musculoskeletal disorder risk factors in the teaching profession: a critical review. OA Musculoskelet Med. (2013) 1:29. doi: 10.13172/2052-9287-1-3-939 Coledam DHC Júnior RP Ribeiro EAG de Oliveira AR. Factors associated with musculoskeletal disorders and disability in elementary teachers: a cross-sectional study. J Bodyw Mov Ther. (2019) 23:658–65. doi: 10.1016/j.jbmt.2018.05.009, PMID: 31563385 Cardoso JP Ribeiro IDQB Araújo TMD Carvalho FM Reis EJFBD. Prevalence of musculoskeletal pain among teachers. Rev Bras Epidemiol. (2009) 12:604–14. doi: 10.1590/S1415-790X2009000400010 Shuai J Yue P Li L Liu F Wang S. Assessing the effects of an educational program for the prevention of work-related musculoskeletal disorders among school teachers. BMC Public Health. (2014) 14:1–9. doi: 10.1186/1471-2458-14-1211 Erick PN Smith DR. A systematic review of musculoskeletal disorders among school teachers. BMC Musculoskelet Disord. (2011) 12:1–11. doi: 10.1186/1471-2474-12-260 Abdulmonem A Hanan A Elaf A Haneen T Jenan A. The prevalence of musculoskeletal pain & its associated factors among female Saudi school teachers. Pak J Med Sci. (2014) 30:1191–6. doi: 10.12669/pjms.306.5778 Korkmaz NC Cavlak U Telci EA. Musculoskeletal pain, associated risk factors and coping strategies in school teachers. Sci Res Essays. (2011) 6:649–57. doi: 10.5897/SRE10.1064 Gholami M Choobineh A Karimi MT Dehghan A Abdoli-Eramaki M. Investigating Glenohumeral joint contact forces and kinematics in different keyboard and monitor setups using Opensim. J Biomed Phys Eng. (2023) 13:281. doi: 10.31661/jbpe.v0i0.2210-1450 Durmus D Ilhanli I. Are there work-related musculoskeletal problems among teachers in Samsun, Turkey? J Back Musculoskelet Rehabil. (2012) 25:5–12. doi: 10.3233/BMR-2012-0304, PMID: 22398261 Yue P Liu F Li L. Neck/shoulder pain and low back pain among school teachers in China, prevalence and risk factors. BMC Public Health. (2012) 12:1–8. doi: 10.1186/1471-2458-12-789 Darwish MA Al-Zuhair SZ. Musculoskeletal pain disorders among secondary school Saudi female teachers. Pain Res Treat. (2013) 2013:1–7. doi: 10.1155/2013/878570, PMID: 23970968 Chiu TTW Lam PKW. The prevalence of and risk factors for neck pain and upper limb pain among secondary school teachers in Hong Kong. J Occup Rehabil. (2007) 17:19–32. doi: 10.1007/s10926-006-9046-z, PMID: 16933144 de Souza JM Tebar WR Delfino LD Tebar FSG Gobbo LA Franco M . Association of Musculoskeletal Pain with Sedentary Behavior in public school teachers: the role of habitual physical activity. Pain Manag Nurs. (2023) 24:196–200. doi: 10.1016/j.pmn.2022.08.005, PMID: 36100514 Ehsani F Mohseni-Bandpei MA Fernández-De-Las-Peñas C Javanshir K. Neck pain in Iranian school teachers: prevalence and risk factors. J Bodyw Mov Ther. (2018) 22:64–8. doi: 10.1016/j.jbmt.2017.04.003, PMID: 29332759 Maguire M O’Connell T. Ill-health retirement of schoolteachers in the Republic of Ireland. Occup Med (Lond). (2007) 57:191–3. doi: 10.1093/occmed/kqm001, PMID: 17317705 Brown J Gilmour WH Macdonald EB. Return to work after ill-health retirement in Scottish NHS staff and teachers. Occup Med (Lond). (2006) 56:480–4. doi: 10.1093/occmed/kql075, PMID: 16893946 Tahernejad S Razeghi M Abdoli-Eramaki M Parsaei H Seif M Choobineh A. Recommended maximum holding time of common static sitting postures of office workers. Int J Occup Saf Ergon. (2023) 29:847–54. doi: 10.1080/10803548.2022.2085418, PMID: 35659501 Lietz J Kozak A Nienhaus A. Prevalence and occupational risk factors of musculoskeletal diseases and pain among dental professionals in Western countries: a systematic literature review and meta-analysis. PLoS One. (2018) 13:e0208628. doi: 10.1371/journal.pone.0208628, PMID: 30562387 Vasireddi N Vasireddi N Shah A Moyal A Ng M Seshadri D . 63. Prevalence of work-related musculoskeletal disorders among orthopedic surgeons: a systematic review and meta-analysis. Spine J. (2023) 23:S32. doi: 10.1016/j.spinee.2023.06.116 Tolera ST Assefa N Gobena T. Global prevalence of musculoskeletal disorders among sanitary workers: a systematic review and meta-analysis. Int J Occup Saf Ergon. (2023) 30:1–43. doi: 10.1080/10803548.2023.2293390 Tahernejad S Farahi-Ashtiani I Veisani Y Ghaffari S Sahebi A Makki F. A systematic review and meta-analysis of musculoskeletal disorders among firefighters. J Saf Res. (2023) 88:374–81. doi: 10.1016/j.jsr.2023.11.009 Clari M Godono A Garzaro G Voglino G Gualano MR Migliaretti G . Prevalence of musculoskeletal disorders among perioperative nurses: a systematic review and META-analysis. BMC Musculoskelet Disord. (2021) 22:1–12. doi: 10.1186/s12891-021-04057-3 Soylar P Ozer A. Evaluation of the prevalence of musculoskeletal disorders in nurses: a systematic review. Med Sci. (2018) 7:1–485. doi: 10.5455/medscience.2017.06.8747 Tavakkol R Kavi E Hassanipour S Rabiei H Malakoutikhah M. The global prevalence of musculoskeletal disorders among operating room personnel: a systematic review and meta-analysis. Clin Epidemiol Glob Health. (2020) 8:1053–61. doi: 10.1016/j.cegh.2020.03.019 Gorce P Jacquier-Bret J. Global prevalence of musculoskeletal disorders among physiotherapists: a systematic review and meta-analysis. BMC Musculoskelet Disord. (2023) 24:265. doi: 10.1186/s12891-023-06345-6, PMID: 37016332 Vieira ER Schneider P Guidera C Gadotti IC Brunt D. Work-related musculoskeletal disorders among physical therapists: a systematic review. J Back Musculoskelet Rehabil. (2016) 29:417–28. doi: 10.3233/BMR-150649, PMID: 26577282 Sahebi A Nateghinia S Golitaleb M Alizadeh S Jahangiri K. The prevalence of low back pain in emergency medical services personnel: a systematic review and meta-analysis. Nurs Pract Today. (2022) 9:193–201. doi: 10.18502/npt.v9i3.10221 Chen C Xiao B He X Wu J Li W Yan M. Prevalence of low back pain in professional drivers: a meta-analysis. Public Health. (2024) 231:23–30. doi: 10.1016/j.puhe.2024.03.007, PMID: 38603976 Mother D Liberati A Tetzlaff J Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. (2009) 6:e1000097. doi: 10.1371/journal.pmed.1000097, PMID: 19621072 Baumann N. How to use the medical subject headings (MeSH). Int J Clin Pract. (2016) 70:171–4. doi: 10.1111/ijcp.12767 Downes MJ Brennan ML Williams HC Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open. (2016) 6:e011458. doi: 10.1136/bmjopen-2016-011458 Orlewski J Orlewska E. Effects of genetic polymorphisms of glutathione S-transferase genes (GSTM1, GSTT1, GSTP1) on the risk of diabetic nephropathy: a meta-analysis. Pol Arch Med Wewn. (2015) 125:649–58. doi: 10.20452/pamw.3045, PMID: 26252359 Hasheminejad N Amirmahani M Tahernejad S. Biomechanical evaluation of midwifery tasks and its relationship with the prevalence of musculoskeletal disorders. Heliyon. (2023) 9:e19442. doi: 10.1016/j.heliyon.2023.e19442 Shaikh AS Shelke RD. Studies assessing the effects of prolonged standing at work: a review. Int J Adv Eng Res Sci. (2016) 3:236873:77–80. doi: 10.22161/ijaers/3.10.15 Vega-Fernández G Lera L Leyton B Cortés P Lizana PA. Musculoskeletal disorders associated with quality of life and body composition in urban and rural public school teachers. Front Public Health. (2021) 9:607318. doi: 10.3389/fpubh.2021.607318, PMID: 34141698 Alias AN Karuppiah K How V Perumal V. Does prolonged standing at work among teachers associated with musculoskeletal disorders (MSDs)? Malaysian J Med Health Sci. (2020) 16:281–289. Tahernejad S Ghaffari S Farahmandnia H Farahi-Ashtiani I Sahebi A Tahernejd A. Sleep disorders among healthcare workers during the COVID-19 pandemic: an umbrella review and meta-analysis. Nurs Pract Today. (2024) 11:22–23. doi: 10.18502/npt.v11i1.14939 De Souza JM Pinto RZ Tebar WR Gil F Delfino LD Morelhão PK . Association of musculoskeletal pain with poor sleep quality in public school teachers. Work. (2020) 65:599–606. doi: 10.3233/WOR-203114, PMID: 32116278 Saberi HR Rabiei H Zare A Jazari MD Malakoutikhah M. Analysis of the research subjects and hot topics of occupational diseases through the web of science from 1975 to 2021. Front Public Health. (2022) 10:1009203. doi: 10.3389/fpubh.2022.1009203, PMID: 36164385 Makki F Hasheminejad N Tahernejad S Mirzaee M. Evaluation of the effect of corrective exercise intervention on musculoskeletal disorders, fatigue and working memory of office workers. Int J Occup Saf Ergon. (2024) 30:532–42. doi: 10.1080/10803548.2024.2323332, PMID: 38654525 Sankar G Ganesan V Katam I Bincy K. Musculoskeletal pain and its ergonomics risk factors among school teachers from Tamil Nadu, India: a cross-sectional study. Int J Occup Saf Health. (2024) 14:60–8. doi: 10.3126/ijosh.v14i1.54019 da Cruz TF Espinosa MM Santos EC. Factors associated with symptoms of musculoskeletal disorders in public school teachers in Cuiabá-MT, Brazil. Enferm Glob. (2023) 22:341–79. doi: 10.6018/eglobal.553891 Grabara M. The association between physical activity and musculoskeletal disorders—a cross-sectional study of teachers. PeerJ. (2023) 11:e14872. doi: 10.7717/peerj.14872, PMID: 36852223 Ramírez-García CO Lluguay-Quispillo DJ Inga-Lafebre JD Cuenca-Lozano MF Ojeda-Zambrano RM Cárdenas-Baque CC. Musculoskeletal disorders in primary school teachers. Sustain For. (2023) 15:16222. doi: 10.3390/su152316222 AlMaghlouth MK Alserhani NM Aldossary FA Alabdulqader MA Al-Dhafer BA. Prevalence, patterns, and risk factors of work-related musculoskeletal diseases among teachers in the Eastern Province, Saudi Arabia: a community-based retrospective cross-sectional survey. Cureus. (2022) 14:e32178. doi: 10.7759/cureus.32178 Althomali OW. Long-term prevalence and risk factors of musculoskeletal disorders among the schoolteachers in hail, Saudi Arabia: a cross-sectional study. Biomed Res Int. (2022) 2022:–3610196. doi: 10.1155/2022/3610196 Alajmi DM Bin AMS Bin SNS Almutairi AS. Musculoskeletal disorders associated with depression and psychosocial risk factors among female teachers in Riyadh region, Saudi Arabia. J Family Med Prim Care. (2022) 11:3754–60. doi: 10.4103/jfmpc.jfmpc_188_22, PMID: 36387646 Çelikkalp Ü Irmak AY Aydın GÖ Metinoğlu M. Musculoskeletal disorders and the affecting factors among teachers: an example from Turkey. Work. (2022) 72:1015–24. doi: 10.3233/WOR-210070, PMID: 35634823 Gabani FL Mesas AE da Silva Santos MC González AD de Andrade SM. Chronic musculoskeletal pain and occupational aspects among Brazilian teachers. Int J Occup Saf Ergon. (2022) 28:1304–10. doi: 10.1080/10803548.2021.1906030, PMID: 33784956 de Souza JM Tebar WR Delfino LD Tebar FSG Gobbo LA Pinto RZ . Relationship between physical activity domains and musculoskeletal disorders in public school teachers. Int J Ind Ergon. (2022) 92:103379. doi: 10.1016/j.ergon.2022.103379 Matias NM Bezerra LÂ Nascimento SE Ferreira PG Raposo MC Melo RD. Correlation between musculoskeletal pain and stress levels in teachers during the remote teaching period of the COVID-19 pandemic. Fisioterapia em Movimento. (2022) 35:e35140. doi: 10.1590/fm.2022.35140 Moreto WYC. Riesgos Ergonómicos asociados a molestias musculoesqueléticas en trabajo remoto en docentes de la UGEL de Picota. Memoria Investig Ing. (2022) 23:118–34. doi: 10.36561/ING.23.10 Mekoulou Ndongo J Bika Lele EC Guessogo WR Meche LP Ayina Ayina CN Guyot J . Musculoskeletal disorders among secondary school teachers in Douala, Cameroon: the effect of the practice of physical activities. Front Rehabil Sci. (2022) 3:1023740. doi: 10.3389/fresc.2022.1023740, PMID: 36589714 Althomali OW Amin J Alghamdi W Shaik DH. Prevalence and factors associated with musculoskeletal disorders among secondary schoolteachers in hail, Saudi Arabia: a cross-sectional survey. Int J Environ Res Public Health. (2021) 18:6632. doi: 10.3390/ijerph18126632, PMID: 34203032 Arshad H Hgul K Anwar K Bilal H. Prevalence, pattern of musculoskeletal pain disorders and related factors among female school teachers. Children. (2021) 15:1923–6. doi: 10.53350/pjmhs211581923 Abdel-Salam DM Almuhaisen AS Alsubiti RA Aldhuwayhi NF Almotairi FS Alzayed SM . Musculoskeletal pain and its correlates among secondary school female teachers in Aljouf region, Saudi Arabia. J Public Health. (2021) 29:303–10. doi: 10.1007/s10389-019-01127-8 Aldukhayel A Almeathem FK Aldughayyim AA Almeshal RA Almeshal EA Alsaud JS . Musculoskeletal pain among school teachers in Qassim, Saudi Arabia: prevalence, pattern, and its risk factors. Cureus. (2021):13. doi: 10.7759/cureus.17510 Khalid F Asif M Iqbal M Sonam S Iqbal Z Ahmad A. Musculoskeletal pain and its associated risk factors in school teachers of Lahore. Age (mean+ SD). (2021) 232:22–5. Souza CS Cardoso JP Aguiar AP Macêdo MMSR da Silva OJ. Work-related musculoskeletal disorders among schoolteachers. Rev Bras Med Trab. (2021) 19:140–50. doi: 10.47626/1679-4435-2020-545, PMID: 34603409 Alharbi TA Abadi S Awadallah NJ. Prevalence and risk factors of musculoskeletal pain among governmental male secondary school teachers. Middle East J Fam Med. (2020) 18:77–85. doi: 10.5742/MEWFM.2020.93752 Amit LM Malabarbas GT. Prevalence and risk-factors of musculoskeletal disorders among provincial high school teachers in the Philippines. J UOEH. (2020) 42:151–60. doi: 10.7888/juoeh.42.151, PMID: 32507838 Alias AN Karuppiah K How V Perumal V. Prevalence of musculoskeletal disorders (MSDS) among primary school female teachers in Terengganu, Malaysia. Int J Ind Ergon. (2020) 77:102957. doi: 10.1016/j.ergon.2020.102957 Arvidsson I Gremark Simonsen J Lindegård-Andersson A Björk J Nordander C. The impact of occupational and personal factors on musculoskeletal pain-a cohort study of female nurses, sonographers and teachers. BMC Musculoskelet Disord. (2020) 21:1–18. doi: 10.1186/s12891-020-03640-4 Chand RK Roomi MA Begum S Mudassar A. Prevalence of musculoskeletal disorders, associated risk factors and coping strategies among secondary school teachers in Fiji. Rawal Med J. (2020) 45:377–81. Kraemer K Moreira MF Guimarães B. Musculoskeletal pain and ergonomic risks in teachers of a federal institution. Rev Bras Med Trab. (2020) 18:343–51. doi: 10.47626/1679-4435-2020-608, PMID: 33597985 Ng YM Voo P Maakip I. Psychosocial factors, depression, and musculoskeletal disorders among teachers. BMC Public Health. (2019) 19:1–10. doi: 10.1186/s12889-019-6553-3 Converso D Viotti S Sottimano I Cascio V Guidetti G. Musculoskeletal disorders among preschool teachers: analyzing the relationships among relational demands, work meaning, and intention to leave the job. BMC Musculoskelet Disord. (2018) 19:1–8. doi: 10.1186/s12891-018-2081-z Ojukwu CP Anyanwu GE Eze B Chukwu SC Onuchukwu CL Anekwu EM. Prevalence, pattern and correlates of work-related musculoskeletal disorders among school teachers in Enugu, Nigeria. Int J Occup Saf Ergon. (2018) 27:267–77. doi: 10.1080/10803548.2018.1495899 Vaghela NP Parekh SK. Prevalence of the musculoskeletal disorder among school teachers. Natl J Physiol Pharm Pharmacol. (2018) 8:1–201. doi: 10.5455/njppp.2018.8.0830218082017 Solis-Soto MT Schön A Solis-Soto A Parra M Radon K. Prevalence of musculoskeletal disorders among school teachers from urban and rural areas in Chuquisaca, Bolivia: a cross-sectional study. BMC Musculoskelet Disord. (2017) 18:1–7. doi: 10.1186/s12891-017-1785-9 Zamri EN Moy FM Hoe VCW. Association of psychological distress and work psychosocial factors with self-reported musculoskeletal pain among secondary school teachers in Malaysia. PLoS One. (2017) 12:e0172195. doi: 10.1371/journal.pone.0172195, PMID: 28234933 Arvidsson I Gremark Simonsen J Dahlqvist C Axmon A Karlsonˆ B Björk J . Cross-sectional associations between occupational factors and musculoskeletal pain in women teachers, nurses and sonographers. BMC Musculoskelet Disord. (2016) 17:1–15. doi: 10.1186/s12891-016-0883-4 Ceballos AGDCD Santos GB. Factors associated with musculoskeletal pain among teachers: sociodemographics aspects, general health and well-being at work. Rev Bras Epidemiol. (2015) 18:702–15. doi: 10.1590/1980-5497201500030015 Karakaya IÇ Karakaya MG Tunç E Kıhtır M. Musculoskeletal problems and quality of life of elementary school teachers. Int J Occup Saf Ergon. (2015) 21:344–50. doi: 10.1080/10803548.2015.1035921 Cheng H-YK Cheng C-Y Ju Y-Y. Work-related musculoskeletal disorders and ergonomic risk factors in early intervention educators. Appl Ergon. (2013) 44:134–41. doi: 10.1016/j.apergo.2012.06.004 Mohammadi G. Musculoskeletal complaints among high school teachers. J Musculoskelet Res. (2013) 16:1350010. doi: 10.1142/S0218957713500103