The state of ergonomics for mobile computing technology

The impact of remote work using mobile information and communication technologies on physical health: a systematic review

Remote e-working with information and communication technology (ICT) has long been on the rise, with its implementation accelerated by mandatory working from home regulations during the COVID-19 pandemic. This systematic literature review summarises the influencing factors of ICT-based remote e-working (device types, duration of use, user interfaces, etc.) on the physical health (musculoskeletal system and eyes) of knowledge workers. A search in four electronic databases and a manual search in four German journals resulted in 21 articles being included in this review. A bias analysis was conducted for all articles. Unfavourable postures, inappropriate working devices and certain environmental factors may cause a range of physical complaints, even after comparably short periods of time. Mostly, these complaints are greater compared to those experienced when working on a fully equipped stationary computer. Therefore, remote e-working requires careful planning, awareness, and the willingness to embrace working situations that counteract these problems.

The Onset of Musculoskeletal Pain in the COVID-19 Era: A Survey of Physiotherapy Students in Sicily

Online teaching has resulted in university students adopting a sedentary lifestyle. Prolonged sitting and reduced physical activity due to pandemic restrictions have led to musculoskeletal pain in various body areas, significantly impacting students' quality of life. This study aims to investigate the effects of remote learning on Sicilian physiotherapy students during the COVID-19 pandemic, specifically focusing on the occurrence of musculoskeletal pain. An observational study was conducted using an online survey administered through Google Forms. The survey consisted of 26 multiple-choice questions and was distributed to students enrolled in physiotherapy programs at the universities of Catania, Messina, and Palermo. Participants were contacted via social channels or email, and data collection spanned 5 weeks. The collected data were analyzed using R software. A total of 128 questionnaires were collected. At the time of compilation, most respondents (n = 103/201, 51.2%) were enrolled in the third year of the course of study in physiotherapy at the universities of Catania, Messina, and Palermo. Their ages ranged between 22 and 25 years (43.3%), and most were female (n = 104/201, 51.7%). More than half of the students (51.6%) reported dedicating 15-22 h per week to distance learning for a duration of 6-12 months (50%). Regarding study location, most students preferred studying at a desk (82.8%), and slightly over half (57.8%) adopted a backrest while studying remotely. Analysis of the students' posture during study hours revealed common positions, including tilting the head forward by more than 20 degrees (47.8%), leaning the trunk forward by more than 20 degrees (71.9%), hunching both shoulders forward (57.0%), wrists positioned above the level of the elbows (46.1%), thighs pointing upwards (41.4%), and one or both feet in a downward or dorsiflexed position (69.5%). In conclusion the questionnaire responses indicate that the lifestyle of university students, influenced by online teaching, has deteriorated, leading to musculoskeletal pain, including myofascial pain. These results are primarily influenced by the adopted posture and the duration of time spent in these positions. Additionally, research is needed to identify the most effective therapeutic approaches for managing musculoskeletal pain.

The effect of tablet tilt angles and time on posture, muscle activity, and discomfort at the neck and shoulder in healthy young adults

BACKGROUND

Although young adults regularly perform tablet writing, biomechanics during the tablet writing with different tilt angles has not been studied. The objective of this study was to compare posture, muscle activity, and discomfort at the neck and shoulder between tablet writing with 0° (horizontal) and 30° tablet tilt angles over 40 minutes in healthy young adults.

METHODS

Twenty participants wrote continuously for 40 minutes on a tablet with both tilt angles in a randomized order. Between conditions, there was a 5-minute activity break. Differences in neck and shoulder posture, muscle activity, and discomfort between both tablet tilt angles and changes in the outcomes every 10 minutes over 40 minutes were investigated.

RESULTS

With the tilted tablet, there were lower neck flexion (Z = -4.637, P<0.001), lower shoulder extension (Z = -3.734, P<0.001), and lower neck Visual Analogue Scale (VAS) (left; Z = -4.699, P<0.001 and right; Z = -3.874, P<0.001) as compared to the no tilt condition. However, the right upper trapezius muscle activity was higher in the tilted condition as compared to the no tilt one. Over 40 minutes, the neck VAS (left; χ2(4) = 30.235, P<0.001 and right; χ2(4) = 32.560, P<0.001) and heart rate variability (χ2(4) = 12.906, P = 0.012) showed notable increases after 20 minutes compared to baseline.

CONCLUSION

In conclusion, adjusting the tablet tilt to 30° and limiting time spent to 20 minutes are recommended for young adults during the tablet writing to prevent neck problems.

Examination of muscular pain when using an innovative smartphone app for adults

BACKGROUND: Smartphones are very convenient and accessible communication devices. Smartphone usage over long durations with poor posture can lead to musculoskeletal pain in adult users. OBJECTIVE: To compare pain in the neck, shoulder, upper back, lower back, arm, hand, and eye regions. METHODS: Thirty-five asymptomatic adults aged 18-25 years were divided into two groups: 1. use of an innovative smartphone app for the promotion of ergonomic behaviour (app use) and 2. no use of the innovative smartphone app (no app use). Participants sat upright, holding a smartphone with two hands, eyes 30-40 cm away from the screen, with frequent breaks consisting of stretching the neck and hand muscles while resting the eyes. The task involved taking part in online social networking for a duration of 45 minutes. A body pain chart and the visual analog scale (VAS) were used to evaluate the location and severity of pain. RESULTS: Pain in the neck, shoulder, upper back, arm, and hand regions in the “app use” condition were significantly lower than in the “no app use” condition at 15, 30, and 45 min (p-value<0.05). However, there were negligible differences between the two groups for eye pain, and lower back pain. CONCLUSION: Pain in the neck, shoulder, upper back, and arm regions in adult users in the “app use” condition was less than in the “no app use” condition. We would recommend that adults use the innovative smartphone app to prevent the risk of musculoskeletal pain potentially caused by smartphone usage.

Effects of Biopsychosocial Interventions on Non-specific Chronic Low Back Pain and Its Related Disabilities among Students

BACKGROUND

This study aimed to investigate the effects of biopsychosocial interventions on non-specific chronic low back pain (NSCLBP) and disabilities caused by it among Students.

STUDY DESIGN

A two-group pretest-posttest randomized clinical trial.

METHODS

The statistical population of the study was female students enrolled at the first-stage secondary school in Hamadan, Iran. A total of 200 students were selected through cluster sampling and randomized into two groups of intervention and control. The primary evaluation was performed by the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), the Health-Related Quality of Life (SF-36), the International Physical Activity Questionnaire-Short Form (IPAQ-S), the World Health Organization Disability Assessment Schedule (WHODAS), and the visual analogue scale (VAS). Upon developing and implementing the biopsychosocial model-based interventions for ten weekly two-hour sessions, the secondary evaluation was fulfilled, and the extracted data were analyzed using the IBM SPSS version 21.

RESULTS

The independent-group t-test results revealed that the mean scores of quality of life (QOL) and physical activity significantly elevated in the intervention group, compared to the control. In addition, the mean value of disabilities, the amount of disorder in the lumbar region, and the VAS scores in the intervention group substantially declined compared to the control group.

CONCLUSION

The significant variations in the biopsychosocial factors demonstrated that the development of some interventions based on the bio-psychosocial model (BPSM) could help manage the NSCLBP and its ensuing disabilities. Therefore, the BPSM-based interventions could be exploited to minimize musculoskeletal disorders (MSDs) in students.

The role of at home workstation ergonomics and gender on musculoskeletal pain

BACKGROUND

The recent mandate for university faculty and staff to work-from-home (WFH) during the COVID-19 pandemic has forced employees to work with sub-optimal ergonomic workstations that may change their musculoskeletal discomfort and pain. As women report more work-related musculoskeletal discomfort (WMSD), this effect may be exacerbated in women.

OBJECTIVE

The purpose of this study was to describe university employee at-home office workstations, and explore if at-home workstation design mediates the effect of gender on musculoskeletal pain.

METHODS

University employees completed a survey that focused on the WFH environment, at home workstation design and musculoskeletal pain. Descriptive statistics and regression analysis were used to analyze the responses.

RESULTS

61% of respondents reported an increase in musculoskeletal pain, with the neck, shoulders and lower back being reported most frequently. Women reported significantly greater musculoskeletal pain, but this relationship was significantly mediated by poor ergonomic design of the home workstation. Improper seat-height and monitor distance were statistically associated with total-body WMSD.

CONCLUSIONS

WFH has worsened employee musculoskeletal health and the ergonomic gap between women and men in the workspace has persisted in the WFH environment, with seat height and monitor distance being identified as significant predictors of discomfort/pain.

Ergonomics in the operating room: it doesn't hurt to think about it, but it may hurt not to!

Ergonomics has gained increasing recognition as an integral component of career longevity in ophthalmology. Residents and fellows may encounter unique ergonomic challenges when learning surgical techniques. A systematic review of the literature, specifically looking for recommendations on optimizing ergonomics in the operating room (OR) and articles that explicitly mentioned suggestions for trainees, was conducted. Of the identified 41 pieces of literature, 31 specifically mentioned ergonomics in the OR, 10 discussed vitreoretinal surgery, 2 mentioned strabismus surgery, and 2 described ergonomics in oculoplastics surgeries. Only 9 of the 41 articles explicitly mentioned either residents or fellows. Based on this review, as well as anecdotal experience, recommendations for residents, fellows, and staff ophthalmologists while working in the OR were compiled. To help offset risk for musculoskeletal injury, recommendations related to relaxation, movement, and maintenance of ergonomic focus are proposed. In addition, methods to optimize ergonomics for the patient, surgeon, surgical bed, foot pedals, surgeon's chair, and the microscope are identified. Trainees may be at particular risk for injury owing to their placement at the surgical bed, and the fact that they may be less likely to get set up ergonomically either owing to a lack of awareness and teaching on the subject, or secondary to perceived time pressures in the OR. Ergonomics should ideally be considered across all domains of life, including in the OR, clinic, and office and at home. The earlier proper positioning is adopted and becomes habitual, the less likely potentially career-threatening musculoskeletal disorders will develop.

Changes in the Sagittal Cranio-Cervical Posture Following a 12-Week Intervention Using a Simple Spinal Traction Device

STUDY DESIGN

Non-controlled clinical trial.

OBJECTIVE

To assess the efficacy of a simple home spinal traction device on sagittal cranio-cervical posture and related symptoms.

SUMMARY OF BACKGROUND DATA

Forward head protraction (FHP) and cranio-cervical malalignment were shown to be consequential in the development adverse musculoskeletal radiographic findings and symptoms in that region.

METHODS

Participants (n = 13, 18-36-year-old) were drawn from a mildly symptomatic population, all presented with cranio-cervical malalignment and considerable FHP. Participants used a simple home spinal traction device for 12 weeks, 10 min/d. Sagittal cervical radiographs and the SF36 health survey were obtained pre/post intervention and guideline compliance was recorded. Radiographic evaluation included typical measurements of sagittal cranio-cervical alignment and FHP (e.g., atlas plane line, vertical axis line, sagittal cranial angle, absolute rotation angle). Standard paired samples t tests, chi-squared, and effect size analyses were used to assess pre- and post-intervention changes.

RESULTS

Each of the key radiographic variables recorded significant moderate to very large positive changes as a result of the intervention. Similarly, Chi-squared analyses indicated that saggital cervical spine configuration tended to become more lordotic (P = 0.007), with four participants shifting from a kyphotic to a lordotic presentation. SF36 health survey data demonstrated mostly significant positive changes throughout all tested domains, and moderate positive changes were recorded across all radiographic cranio-cervical mesured paramenters (e.g., decreased FHP, increased cervical lordosis, and cranial extention). Participants indicated high level of protocol compliance.

CONCLUSION

This study has demonstrated that the unsupervised daily use of a simple home spinal traction device (Thoracic Pillow) proved effective in bringing positive plastic changes to the sagittal cranio-cervical alignment and reduction in symptoms in the tested population during a short intervention period.

LEVEL OF EVIDENCE

3.

Musculoskeletal pain and musculoskeletal syndromes in adolescents are related to electronic devices

OBJECTIVE

To evaluate television and simultaneous electronic devices use in adolescents with musculoskeletal pain and musculoskeletal pain syndromes.

METHODS

A cross-sectional study was performed in 299 healthy adolescents of a private school. All students completed a self-administered questionnaire, including: demographic data, physical activities, musculoskeletal pain symptoms, and use of simultaneous television/electronic devices (computer, internet, electronic games, and cell phones). Seven musculoskeletal pain syndromes were also evaluated: juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, tendinitis, bursitis, epicondylitis, and complex regional pain syndrome.

RESULTS

Inter-rater agreement between pretest and retest was 0.83. Musculoskeletal pain and musculoskeletal pain syndrome were found in 183/299 (61%) and 60/183 (33%), respectively. The median age (15 [10-18] vs. 14 [10-18] years, p=0.032) and years of education (10 [5-12] vs. 9 [5-12] years, p=0.011) were significantly higher in adolescents with musculoskeletal pain when compared with those without this condition. The frequencies of female gender (59% vs. 47%, p=0.019), cell phone use (93% vs. 81%, p=0.003), and simultaneous use of at least two electronic devices (80% vs. 67%, p=0.011) were significantly higher in the former group. Further comparisons between adolescents with and without musculoskeletal pain syndromes revealed that the frequency of female gender was significantly higher in the former group (75% vs. 25%, p=0.002), and with a significantly reduced median of weekends/holidays electronic games use (1.5 [0-10] vs. 3 [0-17]h/day, p=0.006).

CONCLUSIONS

A high prevalence of musculoskeletal pain/syndromes was observed in female adolescents. Musculoskeletal pain was mostly reported at a median age of 15 years, and students used at least two electronic devices. Reduced use of electronic games was associated with musculoskeletal pain syndromes.

Ergonomic risk assessment of smartphone users using the Rapid Upper Limb Assessment (RULA) tool

The number of smartphone users globally is rapidly increasing. This study aimed to assess the level of ergonomic risk to smartphone users, and to evaluate the correlation between any self-reported musculoskeletal disorders and the level of ergonomic risk. Thirty participants completed a questionnaire, tailored specifically for smartphone users, to determine any musculoskeletal disorders. Participants were given a seated smartphone texting task and their postures were video recorded during the task. The video scenarios were evaluated by three independent researchers to determine the level of ergonomic risk using the Rapid Upper Limb Assessment (RULA) tool. RULA is an observation-based screening tool which has been widely used to assess the postural risk of IT device users. However, it has not yet been specifically utilized with smartphone users. The RULA tool scores identified ergonomics risks from using smartphones to text. Most smartphone users had a total RULA Grand Score of 6 for both sides (left side: 80.00%, right side: 90.00%), indicating the need for further investigation and changes (Action Level 3). Notably, no participants had acceptable RULA Grand Scores of 1 or 2. The correlation between musculoskeletal disorders and the ergonomic risk among smartphone users was determined using the Chi-Square test and Fisher's exact test; p<0.05 was considered statistically significant. There was a significant correlation between right RULA Grand Score and neck musculoskeletal disorder (χ2 = 9.424 at p value = 0.009) and right RULA Grand Score and upper back musculoskeletal disorder (χ2 = 31.717 at p value <0.001). RULA Score B (combination of neck, trunk and leg postures) and RULA Score D (combination of Score B, muscle use and force scores for group B) were also significantly correlated with neck musculoskeletal disorders (χ2 = 19.286 at p value<0.001 and χ2 = 9.310 at p value = 0.002 respectively). The RULA results identified the high ergonomics risk of smartphone users, this resulted from two key risk factors: posture and muscle use. The neck, trunk and leg postures had a combined effect on neck musculoskeletal disorders. Future investigations should consider these factors when designing ergonomic interventions for smartphone users.

Keyboards types of selected electronic devices and the occurrence of pain in the shoulder girdle and upper limb - a review of literature

Introduction: Nowadays, computers, personal telephones (smartphones) and other electronic devices are widely used in many areas of everyday life, making them indispensable tools in the workplace, as well as other environments, e.g. at home. Studies from recent years have shown that the mere use of a computer keyboard for many hours carries the risk of pain in the hand, forearm, arm, shoulder girdle, neck and other parts of the motor organs. Aim: The aim of the literature review carried out in this work was to determine what potential threats are posed by standard keyboards and smartphone touch keypads, as well as the comparison of standard and ergonomic keyboards. Material and methods: The following databases were searched: PubMed, ResearchGate and Cochrane Library, in which 13 articles meeting the inclusion and exclusion criteria were found (6 regarding standard keyboards, 3 concerning ergonomic keyboards and 4 related to smartphone keypads). Results: The results of these studies indicate exposure to dysfunctions of the musculoskeletal system associated with typing on keyboards, especially when writing fast, with high pressure, in unnatural positions of the wrists and forearms and during long-term writing. Ergonomic keyboards can be a good alternative to standard keyboards, especially for those who use one for more than four hours a day. This literature review indicates the need for more research, especially randomized clinical trials among a large population. Conclusions: 1. The use of keyboards of selected electronic devices with different ergonomic characteristics has an adverse effect on the functionality of the shoulder girdle and upper limb, mainly generating painful symptoms with different clinical characteristics. 2. The most important influence on the occurrence of functional disorders and pain complaints concerning the shoulder girdle and upper limb when using a keyboard with different ergonomic characteristics regards the strength of pressure on the keys, speed of typing as well as long-lasting and forced positioning of the wrists and forearms. Keyboards, ergonomics, pain

Fingertip forces and completion time for index finger and thumb touchscreen gestures

Users actuate touchscreen computers by applying forces with their fingers to the touchscreen, although the amount and direction of the force is unknown. Our aim was to characterize the magnitude, direction and impulse of the force applied during single finger (tapping and sliding in four directions) and two finger gestures (stretch and pinch). Thirteen subjects performed repeated trials of each gesture. Mean(±SD) resultant force was 0.50(0.09)N for tap, 0.79(0.32)N to 1.18(0.47)N for sliding gestures, 1.47(0.63)N for pinch and 2.05(1.13)N for stretch. Mean resultant force was significantly less (p<0.04) for tap than for all gestures except slide right. The direction of force application was more vertical for the two-finger gestures as compared to the single- finger gestures. Tap was the fastest gesture to complete at 133(83)ms, followed by slide right at 421(181)ms. On average, participants took the longest to complete the stretch gesture at 920(398)ms. Overall, there are differences in forces, force direction, and completion times among touchscreen gestures that could be used to estimate musculoskeletal exposure and help forge guidelines to reduce risk of musculoskeletal injury.

Index finger and thumb kinematics and performance measurements for common touchscreen gestures

This study aimed to quantify differences in 7 touchscreen gestures. Eighteen participants performed index finger tapping, sliding in 4 orthogonal directions, and index finger and thumb pinch and stretch gestures on a touchscreen tablet computer. We hypothesized that two finger gestures would require longer task completion time and greater finger joint excursions than sliding gestures using only the index finger. We measured task completion times and finger joint kinematics. Tapping showed the fastest average (±SD) task completion time, 567(190) ms, of all gestures (p < 0.001). Pinch had faster task completion time, 765(277) ms, than all single-finger sliding gestures (p < 0.001). Stretch was faster to complete at 843(317) ms (p < 0.001) than all sliding gestures except slide right. Stretch demonstrated greater mean index finger metacarpophalangeal flexion/extension joint excursions, 63(16)°, compared to sliding gestures, 34(10)°, and tapping, 27(13)° (p < 0.01). Overall, two-finger gestures were faster to complete and showed greater joint excursions than single-finger sliding gestures.