Musculoskeletal Disorders in Primary School Teachers

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Paper Title: Musculoskeletal disorders in school teachers in the cities of Coca and Nueva Loja - Ecuador

 The present research studies the musculoskeletal disorders (MSD) prevailing in school teachers due to the working conditions in schools in Coca and Nueva Loja, Ecuador. They collected the anthropometric and working condition data of 134 teachers using calibrated measuring instruments such as the measuring ruler, tape measure, and anthropometric box. They administered the Kuorinka Nordic Questionnaire to determine the pains experienced by teachers and their subsequent attribution to these pains. Furthermore, they carried out an ergonomic assessment using ERGO/IBV software to determine the level of risk. The results revealed that the teachers are suffering from low back pain and neck pain due to postures and repetitive tasks. They also concluded that the low back pain was associated with an increase in body mass index (BMI), whereas the cervical pain was linked to posture.

  General comments:

 1)      Please refer to line 30: “…the specific working conditions of the profession, especially in developing countries (Ehsani et al., 2018; Naima Malik Akhtar, 2018).’ Authors may clarify the “specific condition in developing countries.”

2)      Please refer to line 44: “… postures that accumulate affectation in workers' health.”  Worker may be replaced by teacher

3)      Similarly pathologies in these workers,”..may be changed as well

4)      Please refer to line 44: “Significant relationships … teacher level, .. of MSDs. The teacher level may be clarified

5)      The introduction may be fine-tuned to justify the significance of this study. The para “Regarding the muscle mass … (Centers for Disease Control and Prevention, 2021).’ It is well-known and looks out of place.

6)      Please refer to “The sample size was determined according to equation 1,…” stating equation doesn't add any value..the calculation will help to add value.

7)      Please refer to the line: “Various measurements were recorded, including anatomical points, body circumferences, dimensions, extensions, heights, mass, and height Table 1.” Table 1 does not provide any measured data except nomenclature.

8)      Rapid Entire Body Assessment (REBA) and body mass index (BMI)  may be added.

9)      The title of “Figure 2. Parts of the human body in which you have felt discomfort due to work.” May be changed to “Figure 2. Human body parts experiencing work-based discomfort” or similar, remove you. “Place of trouble” may be changed to “Body parts experiencing discomfort”

10)  Please refer to line:215: Table 5. Measurements obtained from working conditions in educational centers. The unit of “cm” may be added as  Chair height (in cm)…for all measurements.

11)  Please refer to “Figure 4. Relationship between back/lumbar pain and BMI” The figure does not show back/lumbar pain.

12)  Please refer to “This makes workers in educational institutions ...” The worker may be replaced by a teacher.

(13) The questionnaire used in the study may be supplied as a secondary file to verify the results of various tables.

Comments on the Quality of English Language

The manuscript has several typos and grammatical mistakes, hence careful editing is needed. 

1)         Please refer to line no. 13: “…and the associated risk factors with this occupational disease” should be “…and the associated risk factors for this occupational disease”

2)         Please refer to line no. 29: “…known as musculoskeletal disorders, are a frequent problem among these” should be “known as musculoskeletal disorders, is a frequent problem among these”

3)         Please refer to line no. 33: “… “In relation to Musculoskeletal disorders (MSDs),’ should be In relation to musculoskeletal disorders (MSDs),

4)         Please refer to line no. 74: “Various measurements were recorded, including anatomical points, body circumferences, dimensions, extensions, heights, mass, and height Table 1.’ statement may be changed to as per Table 1 content. Height is repeated twice.

5)         Please refer to line no. 129: “REBA: the module…” should be “REBA: The module…”

6)         Please refer to line no. 355: "It has been established that training protocols of the cervical..." should be ""It has been established that training protocols for the cervical..."

7)         “In the case of group A, the posture of the trunk, neck, legs and the applied load are meticulously evaluated. Group B, on the other hand,’ should be “In the case of group A, the posture of the trunk, neck, and legs the applied load are meticulously evaluated. Group B, on the other hand,”

 

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

We commend the effort put into your manuscript. Here are some key recommendations for each section:

Introduction:

Add specific data on the impact of the increase in body mass index (BMI) on the physical health of teachers, highlighting the potential risks associated with this phenomenon.

Provide a clearer insight into how specific health issues, such as lower back and cervical pain, affect teachers' work performance and overall quality of life.

Literature Review:

 Review and add additional studies that provide specific solutions and recommendations to address the identified health issues, thus supporting the strategies proposed in the manuscript.

Methods:

 Provide a more detailed description of participant selection criteria, including specific details on how teachers were selected for the study and how potential confounding variables were controlled.

Detail the measurement instruments used and specific data collection procedures to ensure the validity and reliability of the presented results.

Results:

Highlight the most relevant findings and provide a more detailed explanation of their significance in the context of the study.

Discussion:

Ensure that each finding is clearly linked to the reviewed literature and supported by specific examples from the study, which will strengthen the credibility and robustness of the presented arguments.

Explore more deeply the practical and theoretical implications of the findings, especially in terms of how health issues affect teachers' work performance and potential strategies to mitigate these effects.

Conclusions and Recommendations:

Ensure that the conclusions are fully supported by the results presented in the article and closely related to the reviewed literature, thus reinforcing the validity of the claims made.

 

Provide clear and practical recommendations to address the identified health issues, along with specific examples of effective interventions that could be implemented in educational settings, contributing to the applicability and relevance of the findings.

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

In the submitted manuscript, the authors have analyzed musculoskeletal disorders (MSD) in schoolteachers in the cities of Coca and Nueva Loja - Ecuador. The study aimed to assess the occurrence of MSD among teachers and identify the occupational risk factors associated with them. A total of 134 teachers took part in this research, and the findings revealed that low back pain and neck pain were the primary issues affecting teachers. These problems were predominantly attributed to poor postures and repetitive tasks. Furthermore, it was observed that low back pain was correlated with higher BMI, while cervical pain was linked to posture-related factors.

Overall, the manuscript is well-written. The conclusions are well-supported by the data, and the discussion addresses certain limitations of the study, as well as related work in the field, emphasizing the significance of the findings. The figures are clear and informative. However, I would advise the authors to review the axis label for Figure 2 and the legends for Figures 7 and 8. I have no further suggestions for improvement.

Author Response

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Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

Dear colleagues!

 

Your post is interesting, but I think you're being overly specific in the title.

Based on the fact that specific cities are indicated, I immediately have a question - how are they so different from others in your country, since the emphasis is on them.

The abstract is written carelessly, there is no specificity in the results and conclusions sections. it is necessary to rewrite taking into account the standard procedure for filling out the section adopted in the MDPI.

Your null hypothesis is missing or unclear, so the goal does not follow logically from the introduction.

 

The need for Table 1 is doubtful; it can be written in the text.

 

Table 4 needs to be moved to one page entirely, without a break, and the hierarchy inside must be thought out more carefully, because the logic of data presentation is not traceable

In the conclusion section, I would like to see detailed recommendations on the results obtained

The list of references, in general, corresponds to the topic, but, of course, moderate updating of references, which are more than 15 years old, is necessary

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Version:2

The following comments are pending:

 (a)   Comment 9: Comments 9:  The title of “Figure 2. Parts of the human body in which you have felt discomfort…..Similarly, remove you. “Place of trouble” may be changed to “Body parts experiencing discomfort”

[Response 9: I agree with your comment. We´ve modified the title of Figure 2 to “Human body parts experiencing work-based discomfort”.

We've also changed the label “Place of trouble” to “Body parts experiencing discomfort”. ]

 New Comment: The authors agreed to modify but it still appears below the bar chart shown in Figure 2

 (b)   Comments 13:  The questionnaire used in the study may be supplied as a secondary file to verify the results of various tables

Response 13: 

I agree, consequently, we attach the Excel file with all the information analyzed for the investigation and its results.

 New Comment: Both questionnaires are required to be verified. The Excel sheet provided as a supplementary file shows the collection of data, which does not help to evaluate the “The results of these perceptions are presented in Figure 3.” as mentioned and shown in the Fish bone diagram.

(c)Please refer to Figure 3. 'Workers' perception of pain attribution. 'Workers'  may be replaced with 'Teacher'.

New Comment: Please refer to my earlier comment to change Worker to Teacher, There are several places where the Worker needs to be replaced to suit the present work. For instances: 

Figure 3. Workers' perception of pain attribution

Figure 5. Relationship of cervical pain manifested by workers in comparison with height and the measurement of the lower height of the blackboard.

Figure 6. Relationship of cervical pain manifested by workers in comparison with height and the measurement of the upper height of the blackboard.

Figure 7. Relationship of cervical pain manifested by workers in comparison with sitting eye height and chair height measurement.

 

Figure 8. The relationship of shoulder pain manifested by workers in comparison with the height of the sitting elbows and the measurement of the lower blackboard.

Comments on the Quality of English Language

Earlier comments have been implemented. Thank you

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for addressing the revisions suggested for the manuscript. The changes made have significantly strengthened the overall content, particularly in the results and discussions, making the connections with previous studies more explicit. The additional data provided in various sections has notably enhanced the comprehensiveness of the research. The detailed description of the methods and the clear linkage of findings to the existing literature have significantly improved the manuscript's coherence and credibility. The refined conclusions, supported by practical recommendations, further underscore the significance of the study.

Best regards,

 

Reviewer 2

Author Response

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Author Response File: Author Response.docx

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

Paper Title: Musculoskeletal disorders in school teachers in the cities of Coca and Nueva Loja - Ecuador

1)      The paper is based on the "Teachers' perception of pain attribution, as depicted in Figure 3. Some of the factors mentioned look arbitrary. Several researchers suggest that  “Cause and effect of inferences cannot be ascertained” Hence, to verify the factor, I requested authors to include questionnaires, instead they included an Excel sheet which does not serve the purpose.

·         Figure 3. Shows one of the factors" Inadequate office furniture' under shoulder pain which should appear for resting elbow or arm it is very common to understand. Most of the chair design does include forearm support, which is missing here.

o   Henshaw, R.G. and Reubens, A., 2014. Evaluating design enhancements to the tablet-arm chair in language instruction classes. Journal of Learning Spaces, 2(2).

·         ‘Concerns’ is unclear

·         ‘Lack of knowledge of ergonomics’ may be common to all various categories.

·         “ Back pain or Lumber” factor. Generally, Lower back pain (LBP) is reported in school teacher studies by several researchers.

Yue, P., Liu, F. and Li, L., 2012. Neck/shoulder pain and low back pain among school teachers in China, prevalence and risk factors. BMC public health, 12(1), pp.1-8.

 The perception of pain is concluded using a questionnaire. The questionnaire-based study is under the influence of the ‘self-reporting method ‘,’ questions asked’, ‘recall bias’,

 2)   Authors may provide some limitations based on the above arguments.

3)Similar work has been carried out by several researchers, hence authors may justify the novelty by highlighting the research contributions.

 

Comments on the Quality of English Language

The authors have implemented the given suggestions.

Author Response

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Author Response File: Author Response.pdf