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Correlational study of ergonomic knowledge and level of MSK discomfort during online classes of 1st–4th year UST-CRS physical therapy students: a cross-sectional study
  1. Warrick Siy1,
  2. Zyra Mae Sicat2,3,
  3. Trisha Mae Bautista1,
  4. Andrei Formalejo1,
  5. Marx Emmanoelle Gatdula1,
  6. Ayhessa Ann Ico1,
  7. Carl James Julian1,
  8. Ma Cazandra Pabion1,
  9. Juan Lorenzo Reyes1,
  10. Nicholai Marian Santander1
  1. 1University of Santo Tomas, Manila, Philippines
  2. 2Department of Physical Therapy, NCR, Quezon City, Philippines
  3. 3Physical Therapy, University of Santo Tomas College of Rehabilitation Sciences, Manila, Philippines
  1. Correspondence to Carl James Julian;{at}


Introduction The abrupt transition of the mode of learning due to the COVID-19 pandemic resulted in an increase in complaints of musculoskeletal (MSK) discomfort among students in Higher Education Institutions (HEI). Inadequate physical space and equipment are one major cause of these complaints. Among HEIs, physical therapy (PT) students have sufficient background in managing MSK discomforts. However, this does not prevent them from experiencing pain and discomfort during online classes. This analytical cross-sectional study aims to determine the correlation between ergonomic knowledge and MSK discomfort among first-year to fourth-year PT students.

Methods and analysis The study will use two questionnaires, the Ergonomic Knowledge Questionnaire, and the Cornell Musculoskeletal Discomfort Questionnaire, that determine the level of ergonomic knowledge and MSK discomfort, respectively. This will be disseminated to 144 students through google forms. Results will then be analysed using Pearson Correlation Test. The study anticipates a correlation between the level of ergonomic knowledge and MSK discomfort among the participants.

Ethics and dissemination The study has been approved by the University of Santo Tomas-College of Rehabilitation Sciences Ethics Review Committee. The participants will receive the results prior to publication in a peer-reviewed scientific journal.

Trial registration number Philippine Health Research Registry with registry ID PHRR230216-005443.

  • Health Education
  • Quality of Life
  • Risk Factors
  • Surveys and Questionnaires

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  • The study established an analytical cross-sectional design wherein data collected from the participants are obtained one point in time.

  • The study design allows researchers to obtain data from the two survey questionnaires efficiently with good to high psychometric properties which determine their ergonomic knowledge score and MSK discomfort score.

  • A limitation of the study is its limited generalisability due to the participants belonging only to the physical therapy (PT) programme of the University of Santo Tomas College of Rehabilitation Sciences (UST-CRS).

  • The study is mainly designed to discover only the correlation, not the causation, between the level of ergonomic knowledge and MSK discomfort among the UST-CRS PT students.


The COVID-19 pandemic in 2020 caused a sudden shift from face-to-face learning to remote learning, resulting in increased musculoskeletal (MSK) discomfort among students due to limited space, lack of equipment and prolonged sitting.1 2 Physical therapy (PT) students not only acquire knowledge in ergonomics but also receive sufficient training to effectively address and alleviate MSK discomfort; however, studies have shown that they still experience MSK discomfort during online classes reporting 36.4% of respondents being affected by pain, and 66.9% continued to feel MSK discomfort.3–6 Ergonomics, which focuses on the structure and organisation of tasks to a person’s surroundings, is crucial in online learning to ensure safety and improve performance.7–9 Addressing educational issues by establishing a suitable environment for learning through ergonomics is critical for students' quality of life and can help reduce the onset and progression of MSK discomfort.10 11 Limited studies have explored the correlation between physical therapists' knowledge and ergonomics.12 The University of Santo Tomas College of Rehabilitation Sciences, which offers the PT program, quickly adapted to remote learning, and understanding the prevalence of MSK discomfort among its PT students can shed light on the knowledge-application gap.13

MSK discomfort persists among PT students despite academic preparations, highlighting the need to investigate this knowledge gap. In the Philippines, there is a lack of extensive research investigating the connection between ergonomic knowledge and its practical application, especially in professions like PT.14

This study aims to determine the correlation between ergonomic knowledge and MSK discomfort among UST 1st-year to 4th-year PT students. Specific objectives include determining each year’s correlation, the mean ergonomic knowledge score and the mean MSK discomfort score.

This study emphasises translating ergonomic knowledge into practice, promoting its incorporation into daily activities, and inspiring others. It also highlights the importance of educational materials, such as seminars and campaigns, to disseminate ergonomic knowledge, proper body mechanics and postural control.

The study is limited to University of Santo Tomas College of Rehabilitation Sciences (UST-CRS) PT students attending online classes synchronously and asynchronously, with prolonged sitting. It does not include other programmes in CRS due to curriculum differences. Moreover, it does not explore the impact of discomfort on learning or performance.

Methods and analysis

The researchers will use Analytical Cross-Sectional Study Design with the data collected from the UST-CRS PT students to understand health variables, evaluate the prevalence of health outcomes and identify population characteristics. Compared with other forms of observational research, cross-sectional studies do not establish a longitudinal interaction with participants.15 With this, this study aims to gather data from first to fourth year UST-CRS PT students, at one point in time to measure the correlation between ergonomic knowledge and their level of MSK discomfort during online classes.

Table 1 shows that participants must be either regular or irregular UST-CRS PT students from first to fourth year in the online class for the academic year 2023 to 2024. In addition, a study discovered unfavourable effects during 2 hours of prolonged sitting with clinically significant increases in discomfort to different parts of the body.16 With this, students who engage in at least 2 hours of prolonged sitting in synchronous and asynchronous online classes are eligible.16 In contrast, excluded are students who have taken a leave of absence, students with MSK discomfort before the implementation of online classes, students with MSK discomfort that may be due to other aetiology such as accidents, students whose other hobbies and sports cause discomfort with ≥2 hours of prolonged sitting postures such as visual arts and online gaming,2 17 and those with existing MSK conditions and/or other conditions unrelated to MSK that may cause discomfort15 to limit the effect of confounding factors on the findings.

Table 1

Eligibility criteria

Using the G*power tool to compute the effect size of 0.289 and the number of participants is adapted from a similar study exploring ergonomic knowledge and MSK disorders among students in India.18 Increasing 20% of the computed value to the total number of participants ensures leeway in case of withdrawal, thereby getting a sample size of 120, with a 95% CI and a 5% margin of error. This process will be performed through Quota Sampling wherein the researchers will divide the population of UST-CRS PT students into subgroups based on their year level, then determine the quota for each stratum. Lastly, the researchers will select the participants according to the inclusion and exclusion criteria.

The study will be conducted in the Philippines using an online platform. Online platforms ensure efficient and organised data collection and minimise the potential for clerical errors. The researchers will disseminate the recruitment materials via Facebook, which would be an effective platform given its massive audience, broad reach and student popularity. The researchers will give the consent form and survey through Google Forms to gauge who will participate. The researchers also aim to focus on UST as the primary school for the study, consulting students from CRS under the PT department. The researchers will conduct the study between the academic years 2022–2023 and 2023–2024. The recruitment and data gathering will start on June 2023 and will conclude on December 2023.

The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) measures the frequency of discomfort in a week and the level of discomfort experienced by an individual. The next portion of the questionnaire asks how discomfort affects participants' ability to carry out their activities. The questions in CMDQ include frequency and severity of MSK discomfort per region, including the neck, shoulder, upper back, upper arm, lower back, forearm, wrist, hip or buttocks, thigh, knee, lower leg and foot. Moreover, this assessment tool also asks how the pain or discomfort hinders or causes problems with their work. Additionally, this questionnaire indicates good psychometric properties and a validity score of 0.62–0.92 and reliability score (0.56–0.95, 0.59–0.97 and 0.60–0.94 for frequency, severity and interference scales) to determine the participants’ suitability to the study based on the inclusion and exclusion criteria which was also used to assess experience of discomfort in different parts of the body among Filipino college students during online classes.19 20

The second tool is an Ergonomic Knowledge Questionnaire composed of 35 items which aims to assess the level of knowledge of first–fourth year PT students on ergonomics. The Ergonomic Knowledge Questionnaire was used in Sirajudeen and Pillai’s study to assess computer professionals' knowledge of proper ergonomics in India. A study regarding the test–retest reliability of this 35-item questionnaire demonstrated fair (r=0.75) to high reliability (r=0.91) using the Pearson correlation coefficient.21 Moreover, another study on the questionnaire yielded a 0.98 overall content validity index, which signifies a good screening tool.22

As seen in figure 1, The researchers will initially acquire ethical approval from the UST-CRS Ethics Review Committee (ERC). Following this, the researchers will seek approval for the conduct of the study from the CRS office of the dean through a letter stating the purpose of the study, the reason researchers chose the PT students as the study’s participants and the request for obtaining the total number of students in the PT programme. The team will then conduct the recruitment process once approved by the dean’s office. The researchers will use recruitment materials such as posters and infographics containing the significance, benefits and risks of participating in the research. These would also include the eligibility criteria for participants to determine their suitability for the study. The researchers will also disseminate the Participant Information Sheet, Informed Consent Forms (ICF) and data privacy forms. Should any clarificatory questions arise on reading these forms, the participants are free to ask the researchers via email before consenting. The participants must submit a PDF file of their proof of enrolment to certify that they are a bonafide UST-CRS PT student for the academic years 2023–2024. Then, the three-part questionnaire will be distributed via Google forms and sent to participants' emails. The first part of the questionnaire, which collects the sociodemographic profile of the participants, will be disseminated. It will guide the final screening process to evaluate their eligibility to participate in the study. Then, the researchers will use Quota Sampling to gather the specific number of participants required to conduct the study.

Figure 1

Data gathering procedures.

Following this, the ergonomic knowledge questionnaire will be the second part of the form that will determine the level of their knowledge regarding ergonomics. Afterward, answering the CMDQ will be the last part of determining the participants’ level of discomfort. The time allotment for answering the questionnaires is 10–15 min. It will be open for seven (7) days for participants to answer. Progress saving will be allowed by default. After which, the forms will be closed. Only two members of the researchers will have permission in Google Drive. In addition, the devices required to access the drive will be password protected. Access and storage of data will be permitted for five (5) years after the completion of the study and deleted afterward.

The study will use descriptive statistics to summarise the demographic data and the questionnaires' findings. To ensure confidentiality, personal data collected from participants will undergo initial coding, following the procedures outlined in the ICF. Afterwards, researchers will transfer and organise it in Microsoft Excel for the comparative analysis phase of the study. The researchers will get the frequency and percentage to analyse the data obtained from the sex and year level while mean and SD for the age, presented using tables and through visualised data using graphs and charts.

The CMDQ score will be analysed by summing the rating values based on the #2 scoring guidelines,23 while the EKQ score will follow the scoring guidelines established by the questionnaire’s author. Data will be analysed per year level using the Mean Measure of Central Tendency using Microsoft Excel V.16.72.

Furthermore, the researchers will analyse the correlation between the scores from EKQ and CMDQ using the Pearson Correlation Test in SPSS V.29 to determine the correlation between the two variables. They will analyse the correlation between the level of Ergonomic Knowledge and MSK discomfort with a CI of 95% and an α value of 0.05. Subsequently, a Pearson correlation coefficient (r) will provide data to determine whether they have a significant relationship wherein a r-value of greater than 0 (> 0) corresponds to a positive correlation and an r-value of less than 0 (< 0) coincide with the negative correlation of the two variables. A positive correlation refers to a direct relationship, indicating that as ergonomic knowledge increases among students, there is a corresponding increase in the occurrence of MSK discomfort, and vice versa. On the other hand, a negative correlation signifies an inverse relationship, suggesting that higher ergonomic knowledge aligns with a lower incidence of MSK discomfort among students, and vice versa. Furthermore, having a value ranging between 0 and 0.3 implies a weak strength while a value that ranges greater than 0.5 implies strong strength (table 2). These values will determine the relationship strength of the two variables that the researchers aim to obtain. Scatter plots generated with SPSS V.29 will be employed to visually interpret the correlation results and further determine whether the correlation has a significant relationship. The researchers will establish an alternative hypothesis stating the presence of a significant correlation between the two variables. Additionally, obtaining a p value lower than 0.5 signifies the need to reject the null hypothesis.

Table 2

Pearson correlation coefficient value interpretation24

Patient and public involvement

The research did not involve patients directly, rather, it centred around PT students who were involved in the study’s design, conduct and results dissemination.

Ethics and dissemination

The study has been approved by the UST-CRS ERC. The study will follow the Philippine Health Research Ethics Board’s Declaration of Helsinki and Good Clinical Practice Guidelines. The data gathered will only be used in achieving the study’s objectives with consideration for the protection of the participants. The Data Privacy Act of 2012 will be abided by to protect the participant’s privacy and confidentiality.

The researchers’ primary objective is to provide relevant public health information, specifically medical ergonomics, through social media publications. The study’s results would also enable the researchers to provide participant education, giving them specific details on the importance of ergonomic knowledge and its translation to practice that would expectantly lead to decreased levels of MSK discomfort. The researchers also plan to disseminate the study’s results to the CRS Office of the Dean. Once the study concludes, the participants will receive the results and discussion through email.

Ethics statements

Patient consent for publication



  • Contributors Study conceptualisation, supervision and analysis: WS and ZMS. Writing of the background of the study: AAI, MEG and JLR. Writing of the knowledge gap: CJJ, TMB and NMS. Writing of objectives: MCP. Writing of significance: AF and AAI. Writing of delimitation: CJJ. Writing of study design: MEG. Writing of the description of participants: NMS. Writing of setting: AF. Writing of tools: AAI and CJJ. Writing of data gathering procedures: TMB and JLR. Writing of synthesis and analyses: MCP, CJJ and AAI. All authors substantially contributed to the preparation of the research and protocol manuscript as well as provided final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.