İlkokul Çocuklarında Kas-İskelet Sistemi Semptomları ve Ergonomik Risk Faktörlerinin Belirlenmesi

Abstract

Amaç: Bu kesitsel çalışmanın amacı, ilkokul öğrencilerinde kas-iskelet sistemi semptomlarının sıklığını, şiddetini ve okula/derse katılımı engelleme düzeyini; ayrıca ergonomik risk faktörlerinin yaygınlığını ve bu faktörlerle semptom düzeyleri arasındaki ilişkileri tanımlamaktır. Yöntem: Araştırma, Aralık 2023–Mayıs 2024 tarihleri arasında kamuya bağlı bir ilkokulda yürütülmüştür. Tabakalı rastgele örnekleme ile belirlenen 404 öğrenciye Cornell Kas-İskelet Sistemi Rahatsızlıkları (KİSR) Anketi ve Üst Ekstremite Değerlendirme Formu (ÜEDF) uygulanmıştır. Veriler, ders saatlerinde araştırmacı tarafından öğrencilerin oturuş pozisyonlarının gözlemlenmesi ve yüz yüze görüşme yöntemiyle toplanmıştır. Bulgular: Cornell KİSR anketi sonuçlarına göre genel kas-iskelet sistemi semptom prevalansı %65’tir. Öğrencilerin sırt çantası ortalama ağırlığı 3,93 ± 1,09 kg olarak bulunmuştur. ÜEDF değerlendirmesinde; %49,5’i “ergonomik risk puanı 2”, %43,1’i “ergonomik risk puanı 3” ve %7,4’ü “ergonomik risk puanı 4” kategorisinde yer almıştır. Çanta ağırlığı ≥4 kg olanlar ve günlük ≥3 saat teknolojik cihaz kullananlarda hem ÜEDF risk puanları hem de Cornell KİSR anketi semptom skorları anlamlı düzeyde daha yüksek bulunmuştur (p<.05). Sonuç: Çanta ağırlığı ve uzun süreli ders çalışma ile teknolojik cihaz kullanımı hem ergonomik risk düzeyini hem de kas-iskelet sistemi semptom sıklığı ve şiddetini artırmaktadır. ÜEDF risk puanı ile Cornell KİSR anketi semptom düzeyi arasında pozitif ve istatistiksel olarak anlamlı ilişki saptanmıştır.

Keywords

• Ergonomik risk
• İlkokul çocukları
• Kas-iskelet sistemi semptomu
• Okul çantası.
• Okul sağlığı

Determination of Musculoskeletal System Symptoms and Ergonomic Risk Factors in Primary School Children

Abstract

Objective: The aim of this cross-sectional study is to describe, among primary school students, the frequency and severity of musculoskeletal system symptoms and the degree to which they impede school/class attendance; additionally, to determine the prevalence of ergonomic risk factors and to characterize the relationships between these factors and symptom levels. Methods: The study was conducted from December 2023 to May 2024 at a public primary school. A stratified random sampling approach was used to select 404 students, who were then administered the Cornell Musculoskeletal Discomforts (MSD) Questionnaire and the Rapid Upper Limb Assessment (RULA). Data was collected through observations during class hours and face-to-face interviews with the researcher. Results: According to the Cornell MSD Questionnaire, the overall prevalence of musculoskeletal symptoms was 65%. The mean weight of students’ backpacks was 3.93 ± 1.09 kg. Based on the RULA, 49.5% of students were classified in ergonomic risk category 2, 43.1% in category 3, and 7.4% in category 4. Those carrying backpacks weighing ≥ 4 kg, and those using technological devices for ≥ 3 hours per day exhibited significantly higher ergonomic risk scores and Cornell MSD Questionnaire symptom scores (p < .05). Conclusion: Backpack weight, prolonged study time, and use of technological devices are associated with increased ergonomic risk levels as well as greater frequency and severity of musculoskeletal symptoms. A positive, statistically significant correlation was observed between the RULA risk score and Cornell MSD Questionnaire symptom levels.

Keywords

• Ergonomic risk
• Primary school children
• Musculoskeletal symptoms
• School backpack
• School health

References

1. Afshari, M., Gheysvandi, E., Norian, R., & Kangavari, M. (2025). Cultural appropriateness of interventions to prevent and reduce musculoskeletal disorders among students: A systematic review. Ergonomics, 68(2), 187-212. https://doi.org/10.1080/00140139.2024.2315496
2. Alias, A. N., Karuppiah, K., How, V., & Perumal, V. (2020). Prevalence of musculoskeletal disorders (MSDS) among primary school female teachers in Terengganu, Malaysia. International Journal of Industrial Ergonomics, 77,102957. https://doi.org/10.1016/j.ergon.2020.102957
3. Ayed, H. B., Yaich, S., Trigui, M., Hmida, M. B., Jemaa, M. B., Ammar, A., ... & Damak, J. (2019). Prevalence, risk factors and outcomes of neck, shoulders and low-back pain in secondary-school children. Journal of Research in Health Sciences, 19(1), e00440. https://doi.org/10.1016/j.ergon.2020.102957
4. Ayvaz, Ö., Özyıldırım, B. A., İşsever, H., Öztan, G., Atak, M., & Özel, S. (2023). Ergonomic risk assessment of working postures of nurses working in a medical faculty hospital with REBA and RULA methods. Science Progress, 106(4), 00368504231216540. https://doi.org/10.1177/00368504231216540
5. Azabagic, S., Spahic, R., Pranjic, N., & Mulic, M. (2016). Epidemiology of musculoskeletal disorders in primary school children in Bosnia and Herzegovina. Materia Socio-Medica, 28(3), https://doi.org/164. 10.5455/msm.2016.28.164-167
6. Bai, Y., Kamarudin, K. M., & Alli, H. (2024). A systematic review of research on sitting and working furniture ergonomic from 2012 to 2022: Analysis of assessment approaches. Heliyon, 10(7). Article e28384. https://doi.org/10.1016/j.heliyon.2024.e28384
7. Balıkçı, T., Bezer M. (2015). Çocuklarda bel ağrısı. Türk Ortopedi ve Travmatoloji Birliği Derneği Dergisi, 14, 262-270. https://doi.org/10.14292/totbid.dergisi.2015.43
8. Breen, R., Pyper, S., Rusk, Y., & Dockrell, S. (2007). An ınvestigation of children's posture and discomfort during computer use. Ergonomics, 50(10), 1582-1592. https://doi.org/10.1080/00140130701584944

9. Choudhary, M. B., Choudary, A. B., Jamal, S., Kumar, R., & Jamal, S. (2020). The impact of ergonomics on children studying online during COVID-19 lockdown. Journal of Advances in Sports and Physical Education, 3(8), 117-120. https://doi.org/10.36348/jaspe.2020.v03i08.001
10. Contardo Ayala, A. M., Salmon, J., Timperio, A., Sudholz, B., Ridgers, N. D., Sethi, P., & Dunstan, D. W. (2016). Impact of an 8-month trial using height-adjustable desks on children’s classroom sitting patterns and markers of cardio-metabolic and musculoskeletal health. International Journal of Environmental Research and Public Health, 13(12), 1227. https://doi.org/10.3390/ijerph13121227
11. da Silva, L. B., Coutinho, A. S., da Costa Eulálio, E. J., & Soares, E. V. G. (2012). School furniture and work surface lighting impacts on the body posture of Paraíba's public school students. Work, 42(4), 579-587. https://doi.org/10.3233/WOR-2012-1369
12. Dawa, T., Dhendup, S., Pema, U., Edon, E., & Tshering, K. (2024). Weight of school backpacks and its impacts on students’ health: A cross-sectional study. RABSEL, 25(1), 42-48. http//doi.org/10.5281/zenodo.14524340
13. Delele, M., Janakiraman, B., Bekele Abebe, A., Tafese, A., & van de Water, A. T. (2018). Musculoskeletal pain and associated factors among Ethiopian elementary school children. BMC Musculoskeletal Disorders, 19, 1-8. https://doi.org/10.1186/s12891-018-2192-6
14. Dhara, P. C., Khaspuri, G., & Sau, S. K. (2009). Complaints arising from a mismatch between school furniture and anthropometric measurements of rural secondary school children during classwork. Environmental Health and Preventive Medicine, 14, 36-45. https://doi.org/10.1007/s12199-008-0055-8
15. Dugan, J. E. (2018). Teaching the body: A systematic review of posture interventions in primary schools. Educational Review, 70(5), 643-661. https://doi.org/10.1080/00131911.2017.1359821
16. El-Tallawy, S. N., Nalamasu, R., Salem, G. I., LeQuang, J. A. K., Pergolizzi, J. V., & Christo, P. J. (2021). Management of musculoskeletal pain: An update with emphasis on chronic musculoskeletal pain. Pain and Therapy, 10, 181-209. https://doi.org/10.1007/s40122-021-00235-2
17. Erdinc, O., Hot, K., & Ozkaya, M. (2011). Turkish version of the Cornell Musculoskeletal Discomfort Questionnaire: cross-cultural adaptation and validation. Work, 39(3), 251-260. https://doi.org/10.3233/WOR-2011-1173
18. Esin, M. N. (2014). Örnekleme. In S. Erdoğan, N. Nahcivan, & M. N. Esin (Eds.), Hemşirelikte araştırma: Süreç, uygulama ve kritik (2nd ed., pp. 169–192). Nobel Tıp Kitabevi.
19. Grimmer, K., & Williams, M. (2000). Gender-age environmental associates of adolescent low back pain. Applied Ergonomics, 31(4), 343-360. https://doi.org/10.1016/S0003-6870(00)00002-8
20. Hegazy, S. M., Abdallah, A. A., Ahmed, A. S., & Said, D. A. (2024). Effectiveness of parents-centered ergonomic educational ıntervention on their performance regarding safe musculoskeletal growth and development among their school-age and adolescent. International Egyptian Journal of Nursing Sciences and Research, 5(1), 114-143. https://doi.org/10.21608/ejnsr.2024.269163.1361
21. Heydari Abdolahi, F., Keramat Kar, M., & Heydari, P. (2022). Ergonomics-related musculoskeletal disorders among students during the covid-19 pandemic: A scoping review. Journal of Occupational Health and Epidemiology, 11(4), 311-320. http://dx.doi.org/10.61186/johe.11.4.311
22. Joergensen, A. C., Hestbaek, L., Andersen, P. K., & Nybo Andersen, A. M. (2019). Epidemiology of spinal pain in children: Astudy within the Danish National Birth Cohort. European Journal of Pediatrics, 178, 695-706. https://doi.org/10.1007/s00431-019-03326-7
23. Kurt, S., İbiş, S., Aktuğ, Z. B., & Aka, H. (2021). Üniversite öğrencilerinin kas iskelet sistemi rahatsızlıkları ile fiziksel aktivite düzeyi ve internet bağımlılığı arasındaki ilişkinin incelenmesi. Uluslararası Güncel Eğitim Araştırmaları Dergisi, 7(2), 709-721. ISSN: 2458-9373
24. Ludwig, O., Mazet, C., Mazet, D., Hammes, A., & Schmitt, E. (2016). Changes in habitual and active sagittal posture in children and adolescents with and without visual input–implications for diagnostic analysis of posture. Journal of Clinical and Diagnostic Research,10(2), SC14. https://doi.org/10.7860/JCDR/2016/16647.7283
25. McAtamney, L., & Corlett, E. N. (1993). RULA: a survey method for the investigation of work-related upper limb disorders. Applied Ergonomics, 24(2), 91-99. https://doi.org/10.1016/0003-6870(93)90080-S
26. Millî Eğitim Bakanlığı (MEB). (2024, Ekim). 2023-2024 Eğitim Öğretim İstatistikleri Açıklandı. https://www.meb.gov.tr/2023-2024-egitim-ogretim-istatistikleri-aciklandi/haber/34977/tr.
27. Miñana-Signes, V., Monfort-Pañego, M., & Rosaleny-Maiques, S. (2019). Improvement of knowledge and postural habits after an educational intervention program in school students. Journal of Human Sport and Exercise,14(1), 47–60. https://doi.org/10.14198/jhse.2019.141.04
28. Minghelli, B., Nunes, C., & Oliveira, R. (2021). Back school postural education program: Comparison of two types of interventions in improving ergonomic knowledge about postures and reducing low back pain in adolescents. International Journal of Environmental Research and Public Health, 18(9), 4434. https://doi.org/10.3390/ijerph18094434
29. Mongkonkansai, J., Veerasakul, S., Tamrin, S. B. M., & Madardam, U. (2022). Predictors of musculoskeletal pain among primary school students using smartphones in Nakhon Si Thammarat, Thailand. International Journal of Environmental Research and Public Health, 19(17), 10530. https://doi.org/10.3390/ijerph191710530
30. Mououdi, M. A., Akbari, J., & Mousavinasab, S. N. (2018). Ergonomic design of school backpack by using anthropometric measurements for primary school students (6–12 years). International Journal of Industrial Ergonomics, 67, 98-103. https://doi.org/10.1016/j.ergon.2018.05.001
31. NeJhaddadgar, N., Tavafian, S. S., Ziapour, A., Mehedi, N., Jamshidi, A. R., & Gahvareh, R. (2022). Effects of school-based educational program on backpack carrying behavior in teenage students. Journal of Primary Care & Community Health, 13, 21501319221086251. https://doi.org/10.1177/21501319221086251
32. Obinna, F. P., Sunday, A. A., & Babatunde, O. (2021). Ergonomic assessment and health implications of classroom furniture designs in secondary schools: A case study. Theoretical Issues in Ergonomics Science, 22(1), 1-14. https://doi.org/10.1080/1463922X.2020.1753259
33. Öztürk, N., & Esin, M. N. (2007). Ergonomik riskleri belirleme: Çalışanın Üst Ekstremitelerini Değerlendirme Formu’nun tanıtımı. TTB Mesleki Sağlık ve Güvenlik Dergisi, 8(30), 31-37.
34. Öztürk, N., & Esin, M. N. (2011). Investigation of musculoskeletal symptoms and ergonomic risk factors among female sewing machine operators in Turkey. International Journal of Industrial Ergonomics, 41(6), 585-591. https://doi.org/10.1016/j.ergon.2011.07.001
35. Sezgin, D. (2016). Yoğun Bakım Hemşirelerinin Kas İskelet Sistemi Sorunlarına İlişkin Semptomları Azaltma ve İş Görme Yeteneğini Arttırmada Ergonomik Risk Yönetim Programının Etkisi. (Yayınlanmamış doktora tezi). İstanbul Üniversitesi Sağlık Bilimleri Enstitüsü
36. Syazwan, A. I., Azhar, M. M., Anita, A. R., Azizan, H. S., Shaharuddin, M. S., Hanafiah, J. M., ... & Kasani, A. (2011). Poor sitting posture and a heavy schoolbag as contributors to musculoskeletal pain in children: An ergonomic school education intervention program. Journal of Pain Research, 4, 287-296. http://dx.doi.org/10.2147/JPR.S22281
37. Ullah, Z., Khan, S. C., Akbar, K., Shah, I. A., Ahmed, S., Khan, S. B., ... & Ahmed, U. (2022). Ergonomic risk assessment among private and govt middle school children of Hayatabad, Peshawar: a cross sectional survey: Ergonomic risk assessment among Private and Govt middle school children of Hayatabad. Pakistan Journal of Health Sciences, 3(06), 64-68. https://doi.org/10.54393/pjhs.v3i06.206
38. Yamato, T. P., Maher, C. G., Traeger, A. C., Wiliams, C. M., & Kamper, S. J. (2018). Do schoolbags cause back pain in children and adolescents? A systematic review. British Journal of Sports Medicine, 52(19), 1241-1245. https://doi.org/10.1136/bjsports-2017-098927
39. Yavuz, C. I., & Güler, Ç. (2019) Okul çantası ergonomisi ve sağlık. Sürekli Tıp Eğitimi Dergisi, 28(6), 447-451. https://doi.org/10.17942/sted.461024
40. Zaborova, V., Zolnikova, O., Dzhakhaya, N., Prokhorova, S., Izotov, A., Butkova, T., ... & Shafaei, H. (2023). Associations between physical activity and kyphosis and lumbar lordosis abnormalities, pain, and quality of life in healthy older adults: A cross-sectional study. In Healthcare, 11(19) 2651. ttps://doi.org/10.3390/healthcare11192651