Validation of self-screening assessment to identify work-related musculoskeletal health status in computer users: Modified Delphi method

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Rujiret Upiriyasakul
Keerin Mekhora
Julaporn Pooliam
Wattana Jalayondeja
Chutima Jalayondeja


The objective of this study was to develop a tool for self-detection of the work-related musculoskeletal disorders (WMSDs), were named WMSDs self-assessment algorithm, to identify WMSDs' health status as a tool for screening in the workplace. This study was cross-sectional research to validate content of the WMSDs self-assessment algorithm.  The algorithm was scoped aim to identification of WMSDs’ health status (“Good”, “Fair”, and “Poor”) for computer users. Criterion of each status was developed by protocol of in-depth interview, reviewed evidence, and finally validated by a modified Delphi technique with twelve professional physical therapists, including face-to-face discussion and iterated questionnaire. Consensus threshold was set at a ranking of more than 80% of respondents with the median score more than 4.9. The contents of irritability of symptoms which are presented by worsen symptoms during resting position or self-active testing were included consensus threshold (Percent agreement from 90.9 to 100 of Delphi respondent with median score≥5). Likewise, being positive result from excluded conditions were included to commit “Poor” status criterion. These inclusions were completed the algorithm which is swim lane portions and connection arrows to decide the WMSDs’ health status through user guideline, question in general, and question in regions, neck and upper back, shoulder, forearm, wrist, and finger. In conclusion, the algorithm can be used by healthcare practitioners in occupational-related organizations to generally characterize the WMSD’ health status. However, the algorithm may be modelled to identify the WMSD’ health status by healthcare practitioners or individuals with a developed version in form of web or mobile application.

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Buckle PW, Devereux JJ. The nature of work-related neck and upper limb musculoskeletal disorders. Appl Ergon. 2002;33:207–17.

Janwattanakul P, Pensri P, Sinsongsook T, Jiamjarasrungsri W SS. Prevalence, contributing factors and economic loss of work-related musculoskeletal symptoms among office workers in company in Bangkok metropolis area [Internet]. Social Security Office; 2013 [cited 2021 June 12]. Available from:

Barbe MF, Barr AE. Inflammation and the pathophysiology of work-related musculoskeletal disorders. Brain Behav Immun. 2006;20(5):423–9.

Ugbolue UC, Hsu WH, Goitz RJ, Li ZM. Tendon and nerve displacement at the wrist during finger movements. Clin Biomech. 2005;20(1):50–6.

Stanam A, Golla V, Vasa S, Taylor R. Exposure to computer work and prevalence of musculoskeletal symptoms among university employees: A cross-sectional study. J Environ Health. 2019;81(7):14–8.

Okezue OC, Anamezie TH, Nene JJ, Okwudili JD. Work-related musculoskeletal disorders among office workers in higher education institutions: a cross-sectional study. Ethiop J Health Sci. 2020;30(5):715-24.

Eltayeb S, Staal JB, Kennes J, Lamberts PH, De Bie RA. Prevalence of complaints of arm, neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire. BMC Musculoskelet Disord. 2007;8:68. doi: 10.1186/1471-2474-8-68.

Nanthavanij S RT. Survey study of notebook computer use and preferred work postures among thai university students. Thammasat Int J Tech. 2008;13(4):62–75.

Browne CD, Nolan BM, Faithfull DK. Occupational repetition strain injuries. Guidelines for diagnosis and management. Med J Aust. 1984;140(6):329–32.

Wilson A. Effective management of musculoskeletal injury: a clinical ergonomics approach to prevention, treatment and rehabilitation. Churchill Livingstone; 2002.

Eubank BH, Mohtadi NG, Lafave MR, Wiley JP, Bois AJ, Boorman RS, et al. Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology. BMC Med Res Methodol. 2016;16(1):56. doi: 10.1186/s12874-016-0165-8.

van Houwelingen CTM, Moerman AH, Ettema RGA, Kort HSM, ten Cate O. Competencies required for nursing telehealth activities: A Delphi-study. Nurse Educ Today. 2016;39:50–62.

David Magee, Robert Manske. Orthopedic Physical Assessment. 7th ed. Saunders; 2018.

Sluiter JK, Rest KM, Frings-Dresen MHW. Criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders. Scand J Work Environ Health. 2001;27(SUPPL. 1):1–102.

Schneider P, Evaniew N, Rendon JS, Mckay P, Randall RL, Turcotte R, et al. Moving forward through consensus: protocol for a modified Delphi approach to determine the top research priorities in the field of orthopaedic oncology. Clin Orthop Relat Resv. 2017;475(12):3044–55.

Preston CC, Colman AM. Optimal number of response categories in rating scales: reliability, validity, discriminating power, and respondent preferences. Acta Psychol. 2000;104(1):1–15.

Finstad K. Response interpolation and scale sensitivity: evidence against 5-point scales. J Usability Stud. 2010;5:104–10.

Meesil N. Delphi technique : avoidance of misconception. Veridian E-journal Silpakorn Univ. 2016;9(1):1256-67.

Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;4(1). doi: 10.1186/1471-2474-4-11.

Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409–15.

McKenzie R. May S. The cervical and thoracic spine: mechanical diagnosis and therapy. Orthopedic Physical Therapy Products; 2006.

Byng J. Overuse syndromes of the upper limb and the upper limb tension test: a comparison between patients, asymptomatic keyboard workers and asymptomatic non-keyboard workers. Man Ther. 1997;2(3):157–64.

Butler DS, Matheson J. The sensitive nervous system. Noigroup Publications; 2000.

Shacklock M. Chapter 8 - Method of treatment: systematic progression. In: Shacklock M, editor. Clinical neurodynamics. Edinburgh: Butterworth-Heinemann; 2005. p. 153–8.

Opdenakker R. Advantages and disadvantages of four interview techniques in qualitative research. Qual Soc Res. 2006;7(4). doi:

Burton C, Chesterton LS, Davenport G. Diagnosing and managing carpal tunnel syndrome in primary care. Br J Gen Pr. 2014;64(622):262–3.

De Marco F, Ricci MG, Bonaiuti D. Clinical trials among worker populations: The value and significance of anamnestic findings and clinical and instrumental tests for diagnosing work-related musculoskeletal disorders of the upper limbs (WMSDs). Ergonomics. 1998;41(9):1322–39.

Krausch-Hofmann S, Palmers E, Declerck D, Duyck J. Development of practice guidelines for daily oral care in care-dependent older adults to complement the InterRAI suite of instruments using a modified Delphi approach. Int J Older People Nurs. 2021;16(1):e12351.

George SZ, Beneciuk JM, Bialosky JE, Lentz TA, Zeppieri G, Pei Q, et al. Development of a review-of-systems screening tool for orthopaedic physical therapists: results from the optimal screening for prediction of referral and outcome (ospro) cohort. J Orthop Sport Phys Ther. 2015;512(7):512–26.

Çalıs M, Akgün K, Birtane M, Karacan I, Çalıs H, Tüzün F, et al. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis. 2000;59:44–7.

Boettcher CE, Ginn KA, Cathers I. The ‘empty can’ and ‘full can’ tests do not selectively activate supraspinatus. J Sci Med Sport. 2009;12(4):435-9.

Wiesman IM, Novak CB, Mackinnon SE, Winograd JM. Sensitivity and specificity of Phalen’s test and Tinel’s test in patients with Carpal Tunnel Syndrome. Can J Plast Surg. 2013;11(2):70–2.

Novak CB, Mackinnon SE. Multilevel nerve compression and muscle imbalance in work-related neuromuscular disorders. Am J Ind Med. 2002;41(5):343–52.

Boonstra AM, Preuper HRS, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155(12):2545–50.

Castelli L, Torta DME, Hirschfeld G, Boonstra AM, Am B, Re S, et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front Psychol. 2016;7:1466. doi: 10.3389/fpsyg.2016.01466.