Telework is a flexible work arrangement in which the employee can work away from the main office and instead work at a private home and satellite office by using information and communication technology.1 Because of the coronavirus disease 2019 (COVID-19) pandemic, work from home (WFH) has become the new normal around the world. Work from home was suggested to be an effective work style to control the spread of infection, maintain a good work-life balance, and reduce the commuting time.2 Before the pandemic, WFH was only adopted if home-working conditions, like a home office (desk, chair, computer, etc), were available. However, the pandemic forced a large number of workers to switch their work style to WFH.3 The incidence of WFH has increased to 50% since 2020 in Japan.3,4 In such a situation, home-working conditions may not be well adapted for an office setup.

The prevalence of musculoskeletal problems in the neck/shoulder and lower back among workers working with visual display terminal (VDT) was reported to be more than 30%.5,6 To prevent these health problems, the Ministry of Health, Labour and Welfare in Japan published guidelines for the working environment and health management of VDT workers.7 The guidelines gave recommendations concerning the working time, furniture (desk and chair), brightness in the room, and health care for VDT workers. The working conditions in the office that were designed according to the guidelines were considered ideal, while the guidelines were difficult to be applied in home-working conditions because of the variety of living furniture and technology devices.

The relationship of working conditions and low back pain of WFH during COVID-19 pandemic was surveyed by previous studies.8,9 The desk not well lit, lack of space on the desk, not having enough legroom, etc, were found to associate with the low back pain, while not using an office desk or chair did not show significant association with the low back pain among homeworkers. There was no detailed information about using living furniture in WFH. In Japan, because of the lifestyle (floor culture) and home space conditions, people seldom have their workspace at home. Living furniture, such as dining table and chair, sofa, etc, would be used in WFH. In addition to this, traditional furniture such as the low table (kotatsu), floor chair (zaisu), and floor cushion (zabuton), which are much different from western furniture, is still wildly used in Japanese families. A recent study10 showed that working with a floor cushion or sofa without a table developed stressful postures to the neck and lower back. There may be some living furniture, which is improper for the health of homeworkers and also affect the work performance. It is important to survey what kind of furniture and computers are used in WFH since the COVID-19 pandemic and the relationship between the home-working conditions and musculoskeletal problems as well as the work performance. As WFH becomes a common workstyle these days, managing health care and work performance of homeworkers are urgent topics. Therefore, the purpose of the study was to survey home-working conditions, especially the living furniture and computer use in terms of how furniture and computer use affects self-reported musculoskeletal problems and work performance for homeworkers.

The cross-sectional study was conducted among employees working in a major insurance company in Japan through an anonymous, self-administered questionnaire. More than 80% of company employees were WFH since the COVID-19 pandemic, and their jobs varied widely from sales to information technology (IT). The questionnaire was sent via email to 8000 homeworkers in September 2021. The study was approved by the ethics committee of the National Institute of Occupational Safety and Health in Japan (approval number: 2021N11). All participants provided confirmation of informed consent before answering the questionnaire.

The questionnaire collected data on the baseline characteristics of homeworkers, their work conditions, self-reported musculoskeletal problems, and work performance during their WFH setup. Baseline characteristic included sex, age, height, weight, job description, working hours per day (working time), days of WFH per week (working frequency), and number of breaks per hour (Table 1). Working conditions focused on the type of furniture (desk and chair) and computer used. Specifically, “desk” was subdivided into “work desk/PC desk,” “dining table,” “low table (kotatsu),” and “other tables (side table, kids’ desk, etc).” “Chair” was subdivided into “work chair with backrest,” “dining chair,” “sofa,” “floor chair with backrest,” “floor cushion without backrest,” and “other chairs (chair without backrest and arm support, highchair, etc).” “Computer” was classified as “desktop computer,” “laptop computer,” “laptop computer with additional monitor,” and “other computers (tablet computer, smartphone, etc).” With regard to work conditions, homeworkers were asked to select the option that was the most frequently used during WFH (eg, using dining table, dining chair, and laptop computer in most of work time but sometimes work with sofa and laptop computer would select dining table, chair, and laptop computer in the questionnaire). Self-reported musculoskeletal problems referred to the history of pain in the neck/shoulder and lower back during the WFH period. The severity of pain was evaluated by our original scale where 4 grades were considered according to previous studies5,11: grade 0 (no pain), grade 1 (pain not interfering with work), grade 2 (pain interfering with work), and grade 3 (pain interfering with work and leading to sick leave). Grade 0 was defined as “pain-free,” grade 1 was defined as “mild pain,” and grade 2 and 3 were combined and defined as “severe pain.” Subjective work performance was evaluated by asking about the feelings of working in the home conditions compared with the office using the following 5-point scale: “high,” “slightly high,” “same,” “slightly low,” and “low.” Of these, “high,” “slightly high,” and “same” were categorized as good work performance, while “slightly low” and “low” were categorized as poor work performance.

Table 1 provides the baseline characteristics of homeworkers. Most homeworkers (39.1%) were in the 40- to 49-year-old age group. Those belonging to the younger than 40-year group accounted for 26.3%, while those older than 50 years comprised 34.7%. In terms of working time, 31.3% reported working more than 7 hours but less than or equal to 8 hours, 25.3% reported working less than or equal to 7 hours, 22.6% reported working more than 9 hours, and 20.8% reported working more than 8 hours but less than 9 hours. The average working time was 8.37 ± 1.8 hours per day, whereas the prescribed working time in the company was only 7 hours. Most respondents (58.9%) reported having 1 or 2 breaks per hour. Twenty-eight percent reported no break time during WFH (28.0%), and 1.8% had more than 5 breaks per hour. In terms of WFH frequency, half of respondents (65.7%) reported having 4 or more days of WFH per week, and only 8.3% reported less than 2 days. Body height, weight, and job description are listed in Table 1.

Table 2 illustrates the working conditions among homeworkers. The most common desk used in the WFH setup was a work desk/personal computer (PC) desk (63.2%), followed by a dining table (18.6%), and a low table (12.9%). Homeworkers who chose “other tables” provided specific answers such as kids’ desk, camping table, side table, cabinet, and so on. More than half of homeworkers used a work chair with backrest (55.7%), followed by a dining chair (21.1%). The number of those who used a floor chair with backrest and a floor cushion without backrest were 5.6% and 6.0%, respectively. Few homeworkers used a sofa (2.3%). “Other chairs” accounted for 9.2% of all answers, and these included an exercise ball, kids’ chair, camping chair, etc. Half the homeworkers (50.0%) used a laptop computer without additional monitor, whereas 23.5% used a desktop computer, and 23.9% used a laptop computer with an additional monitor. There were 2.6% of homeworkers who used a tablet computer or smartphone. The most common combination of desk, chair, and computer was a work desk, work chair, and laptop computer (20.6%), followed by the combination of a work desk, work chair, and desktop computer (14.7%); work desk, work chair, and laptop computer with additional monitor (13.4%); and a dining table, dining chair, and laptop computer (9.2%).

Table 3 presents the musculoskeletal problems and work performance during WFH. In terms of pain in the neck/shoulder, 28.1% of homeworkers reported being pain-free, whereas 50.5% experienced mild pain and 21.4% experienced severe pain. For low back pain, 32.5% reported being pain-free, and 47.1% and 20.5% experience mild pain and severe pain, respectively. The percentage of good performance was 56.1% and poor performance was 43.9%.

Table 4 presents the result of logistic regression analysis on the association between neck/shoulder pain and working conditions during the WFH setup. Female workers were approximately 3 times more likely to develop mild neck/shoulder pain (OR, 3.11; CI, 2.62–3.69) and approximately 4 times more likely to develop severe neck/shoulder pain (OR, 4.47; CI, 3.62–5.51) compared with their male coworkers. Prolonged working time showed a higher risk for neck/shoulder pain. A working time of more than 9 hours was associated with an significantly higher risk of developing severe neck/shoulder pain compared with a working time of less than 7 hours (OR, 3.40; CI, 2.56–4.52). Using “other tables” showed a significant association with severe neck/shoulder pain (OR, 1.60; CI, 1.05–2.44), and using a floor cushion (OR, 2.23; CI, 1.33–3.74) and sofa (OR, 1.89; CI, 1.05–3.41) were associated with mild neck/shoulder pain. The age of homeworkers and the type of computer were not significantly associated with either the mild or severe neck/shoulder pain.

Table 5 presents the result of logistic regression analysis on the association between low back pain and working conditions during WFH. Female workers showed a higher risk for developing both mild low back pain (OR, 1.73; CI, 1.47–2.02) and severe low back pain (OR, 2.08; CI, 1.71–2.54) compared with their male coworkers. Longer working time was associated with both mild and severe low back pain. Use of “other tables” (OR, 1.70; CI, 1.12–2.57), floor chairs (OR, 2.29; CI, 1.29–4.04), and floor cushions (OR, 2.29; CI, 1.26 to 4.16) were associated with severe low back pain. Use of a floor chair (OR, 2.26; CI, 1.40–3.65) and a floor cushion (OR, 2.67; CI, 1.61–4.42) were also found to be associated with mild low back pain. The age of homeworkers and the type of computer were not associated with either mild or severe low back pain.