{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:41:56Z","timestamp":1780544516453,"version":"3.54.1"},"reference-count":40,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100006402","name":"Fasa University of Medical Sciences","doi-asserted-by":"publisher","award":["99233"],"award-info":[{"award-number":["99233"]}],"id":[{"id":"10.13039\/501100006402","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Understanding of students' musculoskeletal health under home\u2010schooling during the COVID\u201019 pandemic is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>(1) To investigate the prevalence and severity of musculoskeletal symptoms in home\u2010schooled adolescents during the COVID\u201019 pandemic. (2) To evaluate the effect of an online exercise + ergonomics advice protocol on symptoms, compared with ergonomics advice alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross\u2010sectional symptom survey identifying eligible participants, followed by a pragmatic randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Online classes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Survey: 354 students (mean 16.6\u2009years). Trial: 188 students with upper body musculoskeletal symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Randomization to three groups (physical therapy exercises + ergonomics postural advice, ergonomics postural advice alone, nonintervention control) stratified by the site of symptoms (neck, shoulder, upper back). Interventions were orally delivered online (via WhatsApp) supplemented with written\/illustrative material. Follow\u2010up occurred at 8\u2009weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome Measures<\/jats:title>\n                    <jats:p>Survey: prevalence of symptoms (Nordic Questionnaire). Trial: primary outcome\u2009=\u2009change in intensity of upper body symptoms (visual analogue scale); secondary outcome\u2009=\u2009number of participants reporting improvement in upper body symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 12\u2010month prevalence of musculoskeletal disorders in the survey was 38% neck, 28% shoulder, and 35% upper back, with mean pain intensity of 3.6, 3.9, and 3.8, respectively, on 0\u201310 visual analogue scale: Two\u2010thirds reported symptoms in multiple anatomical regions. In the trial, there was no statistically significant difference between the exercise + ergonomics group and ergonomics alone group on the primary outcome, yet both groups showed reduced symptom intensity compared with control (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). More participants in the exercise + ergonomics group reported improvement than in the ergonomics advice alone group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The prevalence of musculoskeletal symptoms was relatively high in home\u2010schooled adolescents. Symptoms can be reduced by ergonomics advice with or without exercises, but the effect is enhanced by the addition of physical therapy exercises. The latter approach may be considered for improving schoolchildren's musculoskeletal health in the usual classroom setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.13102","type":"journal-article","created":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T14:25:22Z","timestamp":1699107922000},"page":"723-731","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Home schooling during the\n                    <scp>COVID<\/scp>\n                    \u201019 pandemic: A randomized controlled trial of online exercise and ergonomics advice protocols on upper body symptoms"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9347-2434","authenticated-orcid":false,"given":"Razieh","family":"Karimian","sequence":"first","affiliation":[{"name":"Department of Public Health Fasa University of Medical Sciences and Healthcare Services  Fasa 7461686688 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