How Can Teleworkers Stay Mentally and Physically Healthy?

Javier Cotelo, MD

June 20, 2022

MADRID — The COVID pandemic has had countless consequences. One of the most significant can be seen in any number of companies: the introduction of the telework model into work routines. There has been such a clear push toward this way of working that it's quite likely that employees will regularly carry out their tasks from home in the future.

This topic was brought to light at the 1st International Congress and 12th Spanish Congress of Occupational Medicine and Nursing in Madrid, Spain. At the event, which was organized by the Spanish Association of Occupational Medicine Specialists (AEEMT), participants discussed telework's impact on musculoskeletal disorders and the resulting psychosocial burden, the mental health of teleworkers, and how to approach insurance coverage for incidents that occur when teleworking. Fortunately, there are effective preventive measures that can be implemented.

People have been working remotely since the 1970s. However, when Spanish Royal Decree–Law 8/2020 came into effect, this practice was transformed into an extraordinary emergency measure aimed at mitigating the economic and social impact of COVID. In Spain, the percentage of teleworkers shot up, going from 4.8% before the pandemic to 34%. María Teófila Vicente, MD, PhD, coordinator of various working groups within AEEMT, reported that if there is no option to work from home, over 50% of companies may lose employees.

Risks, Resilience, and Flexibility

Vicente explored the theme of remote workers' mental health. She began by reminding the audience that during the pandemic, telework went from being an option to being almost an obligation. The move had not been planned and, therefore, was not organized. The systems were not adequate, there was a lack of information, and employees had to bear the costs not covered by their companies.

Vicente stressed the psychosocial risks faced by teleworkers, citing several articles on the topic. In addition, she highlighted the negative effects of "marathon workdays and being connected to work all the time, workers feeling invisible, loneliness, and the sense of isolation and being cut off from communication with others. These workers also face difficulties in finding a balance between family life and work life. That said, we should keep in mind that there are some notable advantages as well."

She then explained that telework plays a key role in the ongoing fight to be resilient and flexible, with businesses trying to stay viable in what the pandemic has made one of the most difficult environments for all industries around the world.

Vicente outlined where we are headed in terms of telework. She highlighted the positive aspects that emerged from a far-reaching review of literature published over the past 2 decades. More than 40 articles have been published in that time. "Telework may facilitate the inclusion of certain groups into the labor force. It contributes to employees' job satisfaction and has an impact on work-life balance, employee productivity, and career growth. In addition, flexible work practices, such as telework, are expected to proliferate," researchers wrote in the journal Heliyon.

Improving Teleworkers' Health

Regarding proposals for improving teleworkers' general health and, specifically, lowering their psychosocial risks, Vicente began by pointing out the need for strict compliance with Spain's Royal Decree–Law 28/2020. These efforts should bring about better states of mental and physical health.

"Telework will be voluntary for the worker and for the employer. The company, as it deems appropriate to verify compliance with obligations and duties, may keep a record of the time spent on work activity. Teleworkers have rights with respect to digitally disconnecting outside of work hours, being discriminated against based on their working remotely or based on sex, and being treated detrimentally with respect to any of their working conditions. Above all, teleworkers have rights regarding the prevention of occupational risks, with special attention placed on psychosocial, ergonomic, and organizational factors," Vicente emphasized.

Training and Recommendations

It is important to conduct theoretical and practical training in areas relevant to staff whose jobs involve providing services via telework, such as "applying cybersecurity, operation of the information and communication technologies (ICTs) tools and devices that they're going to work with, data protection of the documentation they use, and knowing the health risks associated with telework," Vicente added.

Lastly, she specified important preventive recommendations that address psychophysical concerns. She recommended the avoidance of being connected to work at all times and thus facing the attendant problems of techno-stress, techno-addiction, techno-anxiety, and techno-fatigue.

"Set clear boundaries on work time, avoiding long days, and factor in work-life balance," said Vicente. "Avoid situations that can bring about feelings of loneliness and the sense of being cut off from communication with others or situations where you aren't involved in the usual amount of work. Don't let yourself get into those kinds of slowdowns that sometimes set in as a result of not having a team there providing positive feedback. If there's not the usual flow of projects, take actions to prevent negative feelings from taking hold: that uncertainty and doubt and the mood changes, anxiety, stress, lack of motivation, et cetera, that come with them."

Programs for Preventing Pain

Marta Aparicio, MD, an occupational medicine specialist at the external prevention service Cualtis, addressed the impact that telework has had on bone and joint disorders during the COVID pandemic. She reviewed several recent publications that, in general, suggest "a significant increase in pain located mainly in the lumbar spine and cervical spine, which then affects the shoulders and hands due to movements and postures particular to telework."

The study authors also mentioned the advantages of regularly engaging in physical activity four times a week; workers who did so had fewer musculoskeletal problems. By contrast, workers with overweight and, above all, workers with obesity (BMI >30) were at higher risk for spinal pain and joint pain; the incidence was higher in women. Other risk factors were age (being between 35 and 49 years) and remaining in a static posture for prolonged periods.

Aparicio also highlighted the results of a study of a 12-week multimodal digital care program that incorporated education, sensor-guided exercise therapy, and behavioral health support with one-on-one remote health coaching. The researchers assessed engagement and subject-reported outcomes of over 10,000 participants with either chronic knee pain or low back pain. The findings were quite remarkable: the estimated mean reduction in pain by week 12 was 68.45%, and minimally important change from baseline pain (defined as either a visual analogue scale pain score reduction of 20 points or 30% with respect to baseline) was achieved by 78.6% of those who completed the program. Secondary outcomes included decreases of 57.9% and 58.3% in depression and anxiety scores, respectively. There was also a 61.5% improvement in work productivity.

"That led us to conclude that there was a need to set up these types of programs to discourage a sedentary lifestyle and to promote activity, with aerobic and strengthening exercises, as well as yoga, as preventive measures to implement for these teleworkers," said Aparicio.

Incidents During Telework

A presentation was delivered by Juan Antonio Martínez, deputy director-general of the Medical Units Directorate at Spain's National Institute of Social Security. He focused on the topic of insurance coverage for incidents that occur when teleworking remotely. Martínez began by noting that no regulations specifically address this issue.

"It's essential to demonstrate a presumption of employment, stipulated in the employment contract, that clearly defines time-related aspects (duration of the workday, schedule, and hours) and the workplace, chosen by the individual, where this remote work will be carried out. Submitted doctors' reports should also be considered, and it'd be worth having a statement of compliance from the worker — fundamental aspects for determining whether there's been this kind of incident," he emphasized.

Martínez cited some situations that constitute such an incident: the inclusion of "unexpected incidents in the workplace that are related to workplace elements (chair, desk, accessories, cables, et cetera) and unexpected incidents in the workplace environment, ordinarily the domicile itself, with or without connection to the work performed."

He listed various situations that may fall under the definition of an incident that occurs when teleworking. These include "acute cardiovascular and cerebrovascular syndromes that occur unexpectedly when the affected party is on the clock and at the workplace, a legal principle accepted by the Labor Chamber of the Spanish Supreme Court, unless the action of the work is ruled out or excluded as a determining or triggering factor or there are facts that undermine the causal nexus with the work."

This principle is in addition to the occupational disorders already included in the current framework, such as those caused by repeated motions, restricted postures, tendon sheath irritation, and inflammation and nerve paralysis due to strain or pressure. Not to be forgotten, Martínez added, are "the psychosocial conditions arising from the constant use of new technologies, such as ICT addiction, social isolation, or vision problems."

Awaiting Legal Regulations

In this regard, also relevant are accidents that happen on the way to or from work — eg, those that happen when staying overnight at a second home and commuting to the telework site or that concern mobile teleworkers who determine where they will carry out their work — as well as accidents that happen in the course of attending training sessions required by work, acquiring some device necessary for one's job, or visiting special clients.

Martínez concluded by saying that "there's a need to draw up regulations specific to remote working. In the meantime, we must abide by case law. So, the assessments made by the evaluation teams and disability commissions will be, for the most part, of a legal nature. Analyzing the files and seeing how the type of incident was determined will lead to having a greater consensus or the establishment of qualifying criteria."

Vicente, Aparicio, and Martínez have disclosed no relevant financial relationships.

Follow Javier Cotelo, MD, of Medscape Spanish Edition on Twitter @ Drjavico.

This article was translated from the Medscape Spanish edition.


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