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Musculoskeletal symptoms among teleworkers assessed using validated tools: a systematic review and single-arm
Monika Zawadka-Kunikowska1, Mateusz Tomanek2, Anna Skarpańska-Stejnborn3
1Department of Human Physiology, Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
Background:
Work-related musculoskeletal disorders are common in teleworkers, but reported prevalence rates are inconsistent. This study aimed to estimate the pooled prevalence of musculoskeletal symptoms and to quantify ergonomic risk in teleworkers through single-arm meta-analysis.
Methods:
Two reviewers searched PubMed, Scopus, Web of Science, and EBSCO from database inception to March 19, 2026 for observational studies reporting musculoskeletal symptoms or ergonomic risk in teleworkers assessed using validated instruments. A random-effects single-arm meta-analysis was performed to calculate pooled prevalence estimates and pooled mean scores with 95% confidence intervals (CI) and prediction intervals (PI).
Results:
Twenty-one studies were included. Nordic-based questionnaires (n = 13) were the most frequently used instruments for assessing musculoskeletal symptoms, while the Rapid Office Strain Assessment (ROSA; n = 6) and Maastricht Upper Extremity Questionnaire (n = 4) were the most commonly used ergonomic assessment tools. Most studies were rated as moderate quality based on the Newcastle-Ottawa Scale. Pooled prevalence analysis (5 studies, n = 2,215 teleworkers) showed the highest prevalence for neck symptoms (54.9%; 95%CI 20.8-85.0%), followed by shoulder symptoms (52.8%; 95%CI 34.1-70.7%) and low back symptoms (49.0%; 95%CI 25.4-73.1%), with substantial between-study heterogeneity. Pooled ROSA total scores (6 studies, n = 1,086 teleworkers) indicated moderate-to-high ergonomic risk (mean score, 4.27; PI 2.58-5.95). Regarding ROSA components (5 studies, A-C), section A (chair) yielded the highest mean score (4.07; 95% CI 2.98-5.16), followed by section C (monitor and telephone: 3.04; 95% CI 2.69-3.40) and section B (keyboard and mouse: 2.18; 95% CI 1.80-2.56).
Conclusion:
Very low-certainty evidence suggests that neck, shoulder, and low back symptoms are prevalent among teleworkers. Pooled ROSA estimates indicated moderate ergonomic risk, supporting the need for preventive ergonomic strategies and standardized assessment methods in teleworking populations.
Systematic Review Registration:
https://doi.org/10.17605/OSF.IO/EMVYG.