Industrial Health 2022, 60, 307 – 318 Original Article

Relationship between using tables, chairs, and

computers and improper postures when doing VDT
work in work from home
Tanghuizi DU1*, Kazuyuki IWAKIRI1, Midori SOTOYAMA1,
Ken TOKIZAWA1 and Fuyuki OYAMA1

1
National Institute of Occupational Safety and Health, Japan

Received October 5, 2021 and accepted January 24, 2022

Published online in J-STAGE February 28, 2022
DOI https://doi.org/10.2486/indhealth.2021-0222

Abstract: This study focused on everyday furniture and computers used in work from home and
aimed to investigate how improper postures increase the risk of musculoskeletal disorders using
different combinations of tables, chairs, and computers. Twenty-one healthy participants were
asked to perform a visual display terminal task for 30 minutes in a laboratory modeled on the
work from home concept. Seven experimental conditions were set up according to the different
combinations of desks, chairs, and computers. Three-dimensional body posture was measured
using a magnetic tracking device. The results showed that when using a low table, floor chair, and
laptop computer, the body posture above the hip was similar to that when using a dining table,
chair, and desktop computer. When using a sofa, and tablet computers, or laptop computer, severe
neck flexion, which is stressful to the neck, was observed. Moreover, excessive low back flexion was
observed when using a floor cushion and laptop computer. We suggest that computer work while
sitting on a sofa or floor cushion without a backrest is harmful to the neck and low back.

Key words: Biomechanics, Neck, Low back, Telework, Occupational health

congestion and improving work-life balance1, 2). Before the

Introduction COVID-19 pandemic, teleworkers addressed work in both
a prepared work environment as well as an office. Howev-
Owing to the COVID-19 pandemic and lockdown in er, an abrupt situational change was experienced during the
many cities and countries, work from home (WFH) has be- COVID-19 pandemic. In the spring of 2020, the govern-
come an important work style worldwide. WFH, as a type ment of Japan declared a state of emergency and set a target
of remote work, is an effective way to avoid the risk of viral of over 70% of the employees to work remotely. Conse-
exposure. Other benefits of WFH include reducing traffic quently, many employees were forced to WFH. A scientific
report on WFH during the COVID-19 pandemic in Japan
*To whom correspondence should be addressed.
showed that over 60% of enterprises introduced WFH2).
E-mail address: [email protected] According to data from the Tokyo Metropolitan Govern-
©️2022 National Institute of Occupational Safety and Health ment of Japan, 56.6% of employees in Tokyo had been
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.
(CC-BY-NC-ND 4.0: https://creativecommons.org/licenses/by-nc-nd/4.0/)
308 T DU et al.

WFH in April 20213). This situation forced people to make devices, and the risk of neck problems, as well as other
use of their daily life furniture for work purposes, for exam- MSDs, can develop.
ple, the dining table and chair, sofa, or Japanese traditional No study has evaluated the risk of MSDs in teleworker
low table (kotatsu) and floor chair. postures when using daily life furniture and various types
The main task of WFH is visual display terminal (VDT) of computers. Therefore, the present study focused on the
work, such as typing and reading documents on a laptop daily life furniture and computers used in WFH scenarios
computer, tablet computer, or desktop computer. Musculo- and aimed to investigate improper postures that increase
skeletal disorders (MSDs), especially neck/shoulder pain the risk of MSDs using different combinations of tables,
and low back pain, are the most common complaints among chairs, and computers. As WFH is increasing, investigating
VDT workers, with a prevalence of over 40%4–6). Improper the problem of work postures when using daily life furni-
postures, which generate significant load on joints, have ture and various types of computers has become important
been suggested as the main cause of MSDs among VDT in occupational health.
workers7, 8). The sitting postures were reported to be affect-
ed by the design of the furniture and computers used in Sample and Methods
VDT work, such as the height of the display monitor, arm
support of the chair, and angle of the backrest9). There is a Sample
guideline for VDT work published by the Ministry of This study included 21 healthy participants, 10 men and
Health, Labour and Welfare, Japan10, 11). The height of the 11 women (height: 166.4 ± 7.5 cm, body mass: 59.8 ± 9.0
desk and chair, brightness in the room, distance from the kg, age: 26.0 ± 4.9 yrs., presented in mean value ± standard
display to the eyes, and other environmental details are de- deviation). The inclusion criterion was healthy people aged
scribed in the guidelines for preventing occupational health 20–39 years who were familiar with VDT work. Patients
degradation related to VDT work. These guidelines con- with MSDs were excluded from this study, and all partici-
tribute to staying healthy in the office but is not suitable for pants were right-handed. This study was approved by the
WFH using daily life furniture, such as a low table, floor Ethics Committee of the National Institute of Occupational
chair, sofa, or floor cushion. However, no study has exam- Safety and Health in Japan (approval number: 2020N11).
ined body postures during VDT work using daily life furni- All participants provided written informed consent prior to
ture. Whether the daily life furniture used in WFH leads to participating.
an improper posture, which joints are at risk of MSDs, and
how to prevent these risks are still unknown. Therefore, a Experimental conditions
biomechanical study that investigates the problem of body Seven experimental conditions were set up according to
posture and discusses the risk of MSDs in VDT work using different combinations of desks, chairs, and computers,
daily life furniture is required. which were grouped into three categories (Fig. 1). Three of
Recently, as information technology is growing rapidly, the seven conditions were replicated in each category. The
various types of electronic devices have been developed. In first category (Category 1) included three conditions that
addition to desktop computers, laptop computers, tablet are common in WFH in Japan: (A1) a dining table, chair,
computers, and even smartphones are widely used in VDT and desktop computer; (A2) a low table, floor chair, and
work, as well as in daily life. Computer design can also be laptop computer; and (A3) a sofa and tablet computer.
a risk factor for improper postures. Text neck syndrome, Among these three conditions, condition A1 was deemed to
which has become a prevalent problem, is an example. Text be similar to an office environment and consequently de-
neck syndrome is a series of problems associated with ex- fined as the control condition. The second category (Cate-
cessive use of personal computers, smartphones, or tablet gory 2) included the same furniture of the dining table and
computers. Symptoms include neck pain, alteration of cer- chair, but different types of computers, such as (B1) desk-
vical spine alignment, headache, and reduced mobility of top computers, (B2) laptop computers, and (B3) tablet
the head and shoulder12). With such a large load on the neck computers. The third category (Category 3) included the
lasting for a long time during the use of personal comput- same laptop computers, but different furniture frequently
ers, tablet computers, and smartphones, MSDs have conse- used in WFH instances: (C1) dining table and chair, (C2)
quently been prevalent. In regard to WFH, laptops and tab- low table and floor chair, (C3) sofa without a table, and
let computers are commonly utilized devices, and it is (C4) floor cushion without a table. A1 and B1, B2 and C1,
possible that improper postures occur with the use of these and A2 and C2 were subjected to the same conditions.

Industrial Health 2022, 60, 307 – 318

FURNITURE, IMPROPER POSTURES, AND VDT WORK FROM HOME 309

Fig. 1. Images of experimental conditions.

(A1) a dining table, chair, and desktop computer; (A2) a low table, floor chair, and laptop computer; and (A3) a sofa
and tablet computer; (B1) a dining table, chair, and desktop computer, (B2) a dining table, chair, and laptop computer,
(B3) a dining table, chair, and tablet computers; (C1) a dining table, chair, and laptop computer (C2) a low table, floor
chair, and laptop computer (C3) a sofa and laptop computer, (C4) a floor cushion and laptop computer. A1 and B1, B2
and C1, and A2 and C2 had the same conditions.

Body posture measurement where there was a lack of muscle and fat between the skin
The three-dimensional body posture of each participant and bone. For the head and the left and right upper arms, a
was measured using a magnetic tracking device (LIBER- handmade elastic headband and plastic plates were used to
TY, Polhemus, VT, USA). The device can track the sen- attach the sensors (Fig. 2).
sor’s location and orientation in six degrees of freedom Subsequently, a pen-shaped stylus sensor was used to
within the magnetic field generated by a source at 240 Hz. pinpoint and record the coordinates of the body landmarks
This device is widely used in the medical and sports relative to the sensors for each segment. Body landmarks
fields13–15). Given that it is easily operated and can be used for the thorax, scapulae, humeri, and joint coordinate sys-
without visual information, when the participant leans on tems for the shoulder were defined according to ISB recom-
the backrest of a chair or sofa, sensors hidden on the back- mendations16). Body landmarks for the pelvis and joint co-
side of the body can be tracked efficiently. Seven sensors ordinate systems for the low back were defined according
were attached to the backside of the head, mid-sternum, left to a previous study17). Body landmarks for the head were
and right acromion, distal side of the left and right upper chosen as the vertex of the head and the left and right tra-
arms, and central sacrum, to record the three-dimensional gions. For the head reference system, the transverse axis
segment movements of the head, thorax, left and right scap- was defined as a unit vector pointing from the left to right
ulae, left and right humeri, and pelvis. Sensors were fixed tragion. The sagittal axis was defined as a unit vector per-
using double-sided kinesiology tape on the body sites pendicular to the plane defined by the vertex of the head
310 T DU et al.

Head sensor

Left scapular sensor

Right scapular sensor

Right upper arm sensor

Left upper arm sensor

Pelvis sensor

Fig. 2. Image of sensor attachment.

and the left and right tragions pointing in the anterior direc- puter with a 23.8-inch height-adjustable monitor, standard
tion. The long axis was defined as the cross product of the keyboard, and mouse; a laptop computer with a 14.1-inch
transverse and sagittal axes. The orientation of the head monitor and 1.61 kg weight; and a tablet computer with an
reference system relative to the thorax was determined by 11-inch monitor and 0.466 kg weight (participants typed
the joint motion of the neck. Anatomical posture was de- with the screen keyboard: a QWERTY keyboard or a Japa-
fined as the “zero position,” which is 0° of each joint angle. nese Kana keyboard, as their preference). Seven work con-
ditions with different combinations of furniture and com-
Procedure puters were randomly assigned to each participant. To
The measurements were performed in a 30 m2 room. A reduce the effect of the magnetic field distortion caused by
standard dining table (height: 70 cm) and chair (height: 42 computers, the source of the electromagnetic device was
cm, backrest-seat angle: 102°), a low table (height: 38 cm) placed beside the sensors attached to the participants. Ac-
and floor chair (height: 8 cm, backrest-seat angle: 92°), cording to the manual of the device, a short distance be-
three-seater sofa (height: 35 cm, backrest-seat angle: 115°), tween the source and sensor helps to reduce measurement
and a floor cushion (height: 8 cm) were placed in the room. errors owing to the distortion conductor in the field. The
Three types of computers were prepared: a desktop com- accuracy of the electromagnetic tracking device in the mea-

Industrial Health 2022, 60, 307 – 318

FURNITURE, IMPROPER POSTURES, AND VDT WORK FROM HOME 311

surement area was tested using two sensors fixed at certain (MathWorks, USA).
distances and orientations. The error was found to be less
than 3° in orientation and 10 mm in proximity. After the Results
sensors were attached, the participants were asked to per-
form a 30 minute reading and typing task on the computer Category 1: comparison of common WFH conditions
for each condition. The electronic document used in the Table 1 shows the comparison results of body postures
task was part of a Japanese novel. For each page of the and variation across time under three conditions: (A1) din-
material, participants were asked to read the page first and ing table, chair, and desktop computer; (A2) low table,
subsequently type the words on the page into a blank docu- floor chair, and laptop computer; and (A3) sofa and tablet
ment. During the task, the participants were instructed to computer. A significantly larger neck flexion (p<0.001) and
relax as if at home and were allowed to change their pos- %ROM of neck flexion (p<0.001) were observed in condi-
tures as they felt comfortable, but they were not allowed to tion A3 than in conditions A1 and A2. Condition A2 had the
talk, drink, eat, stand, or lie down. In addition, a medical largest shoulder abduction angle, while condition A3 had
check for active range of motion (ROM) of the neck, shoul- the smallest angle (p<0.001). Condition A3 showed a sig-
der, and low back was performed for each participant. nificantly larger right tilt angle of the shoulder girdle
Three-dimensional joint angles were calculated for the (p<0.001) than conditions A1 and A2. There were no differ-
neck, shoulder (glenohumeral joint), and low back during ences in the conditions for the low back angles (p=0.586
the entirety of measurements. The flexion-extension angle for flexion and p=0.162 for tilt angle). The motion-varia-
of the neck (forward-backward bending of the head), shoul- tion index of the low back was different among the furni-
der abduction angle (elevation of the upper arm), tilt angle ture-computer conditions (p=0.001) and time sessions
of the shoulder girdle (the tilt of the left-right shoulder (p=0.024). The index increased as work time increased. No
line), and flexion-extension and lateral tilt angles of the low interaction effect of the furniture-computer conditions or
back were utilized to describe the work posture. To evalu- time sessions was observed. The word count results were
ate the extent of spinal motion, the percentages of the neck 2301 ± 940 Japanese characters in condition A1, 2216 ±
and low back angles to their active ROM were calculated 837 Japanese characters in condition A2, and 1364 ± 478
and represented as %ROM. The mean and standard devia- Japanese characters in condition A3. The typed characters
tion for the above variables were calculated every 10 min- in condition A3 were significantly less than those in condi-
utes during the task and were represented as the mean ± tions A1 and A2 (p<0.001).
standard deviation. In addition, to evaluate the variation in
neck and low back motion within participants, an original Category 2: comparison of types of computers
variable, the motion-variation index, was defined. It calcu- Table 2 shows body postures and variation across time
lated for each participant as the integration of the difference by using the same furniture of a dining table and chair in all
between joint angles and the mean value for each 10 minute conditions, while using different computers: (B1) desktop
session. If the mean joint angles were different from the computer, (B2) laptop computer, and (B3) tablet computer.
control condition and fell into the ranges of “large stress,” Condition B3 showed a significantly larger neck flexion
as reported within the literature, the posture in the condi- (11.5° ± 15.4°, p<0.001) and %ROM of neck flexion (25.4
tion was defined as an improper posture. ± 20.3%, p<0.001) than conditions B1 and B2. The shoul-
der abduction angle was different between the furni-
Statistics ture-computer conditions (p=0.002), and a significantly
A two-way ANOVA (conditions × time sessions) of re- larger value was observed in condition B2 compared to
peated measures was used to compare the variables of pos- condition B3 (p=0.001). No difference was found among
tures among the furniture-computer conditions and time conditions for the shoulder gilder tilt angle (p=0.767) and
sessions in each category. Post hoc Bonferroni tests were low back angles (p=0.894 for flexion and p=0.887 for tilt
conducted to evaluate the significant effect of the furni- angle). The motion-variation index of the neck was signifi-
ture-computer conditions, time sessions, and interactions. cantly higher in condition B3 than in condition B2
In addition, the word counts for each condition were re- (p=0.007), and the motion-variation index of the low back
corded and compared using a one-way repeated measures was significantly higher in condition B3 than in condition
ANOVA. Statistical significance was set at p<0.05. Statisti- B1 (p=0.003). The motion-variation index of the low back
cal analyses were conducted using MATLAB R2016a ver. increased as work time increased (p=0.033). No interaction
 312

Table 1. Work postures and variation across time in typical WFH conditions
Table 1. Work postures and variation across time in typical WFH conditions

(A1) dining table, chair, desktop computer (A2) low table, floor chair, laptop computer (A3) sofa, tablet computer

0–10min 10–20min 20–30min 0–10min 10–20min 20–30min 0–10min 10–20min 20–30min ANOVA Post hoc (condition) Post hoc (time)

pc<0.001
flexion (°) −5.4±11.5 −4.6±11.9 −5.3±11.8 −2.5±16.5 −1.0±15.2 −1.1±15.8 23.3±16.1 24.8±12.6 22.5±17.2 (A1)(A3), (A2)(A3)
pt=0.867
pc<0.001
neck %ROM of flexion 15% 15% 14% 22% 20% 21% 43% 42% 43% (A1)(A3), (A2)(A3)
pt=0.849
pc=0.042
motion-variation index 1,908 2,235 2,376 1,334 2,214 1,528 2,042 2,912 2,623 (A2)(A3)
pt=0.107
pc<0.001 (A1)(A2), (A1)(A3),
abduction (°) 32.2±14.7 32.6±13.4 32.4±12.3 49.2±17.4 49.0±16.1 49.5±16.5 11.3±9.2 11.5±8.3 14.3±11.7
pt=0.864 (A2)(A3)
shoulder
pc<0.001
right tilt (°) 2.0±2.5 2.0±2.7 2.0±2.7 2.9±2.3 2.9±2.3 3.0±2.4 6.1±1.8 6.0±2.0 5.8±2.1 (A1)(A3), (A2)(A3)
pt=0.983
pc=0.586
flexion (°) 43.4±15.5 43.5±14.3 32.4±12.3 46.6±15.0 46.8±14.9 47.2±14.1 43.8±9.2 45.6±10.0 45.8±12.4
pt=0.927
pc=0.604
%ROM of flexion 78% 79% 78% 84% 84% 85% 79% 82% 81%
pt=0.947
pc=0.162
low back right tilt (°) 0.9±3.8 0.9±4.0 0.5±4.5 2.0±4.5 2.0±4.2 1.2±4.8 2.5±4.3 2.4±4.9 2.2±5.0
pt=0.825
pc=0.102
%ROM of tilt 8% 8% 9% 11% 10% 10% 9% 9% 8%
pt=0.994
pc=0.001
motion-variation index 1,132 1,971 2,200 984 1,239 1,063 1,077 1,236 1,734 (A1)(A2), (A1)(A3) (A1)(A3)
pt=0.024

Note: pc: p-value of the main effect in work conditions; pt: p-value of the main effect of time sessions
%ROM: percentages of joint angles to their active range of motion
Motion-variation index: integration of the difference between joint angles and the mean value
T DU et al.

Industrial Health 2022, 60, 307 – 318

Table 2. Work postures and variation across time using the same furniture but different computers
Table 2. Work postures and variation across time using the same furniture but different computers

(B1) desktop computer (B2) laptop computer (B3) tablet computer

0–10min 10–20min 20–30min 0–10min 10–20min 20–30min 0–10min 10–20min 20–30min ANOVA Post hoc (condition) Post hoc (time)

pc<0.001
flexion (°) −5.4±11.5 −4.6±11.9 −5.3±11.8 −1.1±14.0 −0.2±13.2 −1.4±11.9 10.0±16.1 12±15.4 12.5±15.2 (B1)(B3), (B2)(B3)
pt=0.879
pc<0.001
neck %ROM of flexion 15% 15% 14% 15% 14% 13% 24% 25% 27% (B1)(B3), (B2)(B3)
pt=0.981
pc=0.009
motion-variation index 1,908 2,235 2,376 1,442 1,700 1,978 2,098 2,591 2,694 (B2)(B3)
pt=0.103
pc=0.002
abduction (°) 32.2±14.7 32.6±13.4 32.4±12.3 38.4±14.9 37.4±14.6 37.4±13.5 28.4±14.9 27.7±19.5 27.5±18.1 (B2)(B3)
pt=0.975
shoulder
pc=0.767
right tilt (°) 2.0±2.5 2.0±2.7 2.0±2.7 2.2±3.0 2.2±2.7 2.6±2.7 2.3±2.8 1.8±2.6 1.9±2.4
pt=0.899
pc=0.894
flexion (°) 43.4±15.5 43.5±14.3 32.4±12.3 42.6±16.5 41.4±17.6 42.3±15.0 44.6±17.7 40.4±19.7 44.2±17.8
pt=0.810
pc=0.889
%ROM of flexion 78% 79% 78% 77% 76% 76% 82% 74% 81%
pt=0.876
FURNITURE, IMPROPER POSTURES, AND VDT WORK FROM HOME

pc=0.887
low back right tilt (°) 0.9±3.8 0.9±4.0 0.5±4.5 0.4±4.5 0.9±3.9 0.2±3.9 1.4±5.0 0.5±4.9 0.8±4.9
pt=0.882
pc=0.831
%ROM of tilt 8% 8% 9% 8% 7% 8% 8% 8% 9%
pt=0.878
pc=0.004
motion-variation index 1,132 1,971 2,200 1,705 2,492 3,008 2,413 3,798 4,226 (B1)(B3) (B1)(B3)
pt=0.033

Note: pc: p-value of the main effect in work conditions; pt: p-value of the main effect of time sessions
%ROM: percentages of joint angles to their active range of motion
Motion-variation index: integration of the difference between joint angles and the mean value
313
314 T DU et al.

effect of the furniture-computer conditions and time ses- and laptop computer. The participants used an altered pos-
sions was observed. Typed characters in condition B3 ture when working with a sofa and a tablet computer. Com-
(1351 ± 423) were significantly less than those in condi- pared with condition (A1), a dining table, and condition
tions B1 (2301 ± 940 Japanese characters) and B2 (2242 ± (A2), a low table, condition (A3), a sofa, had no table to
835 Japanese characters) (p<0.001). support the participant’s arms and computer. Most partici-
pants conducted VDT work by holding a 466g tablet com-
Category 3: comparison of the furniture puter with one hand and typing with the other hand. Al-
Table 3 shows body postures and variation across time though the tablet is not heavy, holding it without any
by using the same laptop computer and different furniture: support for 30 minutes is not an easy task. A small angle of
(C1) dining table and chair, (C2) low table and floor chair, shoulder abduction was necessary to hold the computer
(C3) sofa, and (C4) floor cushion. All variables showed a steady and comfortably. This posture leaves the deltoid and
significant main effect of the furniture-computer condi- supraspinatus muscles in a relatively relaxed position and
tions. No main effect or interaction effect of time sessions provides steady support to the forearm and hand. However,
was observed. Condition C3 showed significantly larger this restricts the direction and location of the tablet comput-
neck flexion (p<0.001) and %ROM (p<0.001) than other er, which may require the neck to flex more to achieve a
conditions. In addition, condition C3 showed a smaller comfortable position for looking at the display monitor.
shoulder abduction angle (p<0.001) and low back flexion The neck flexion when using a sofa and tablet was 23°,
(p<0.001) than other conditions. Condition C4 had the larg- which is within, but near the limit of the acceptable range
est low back flexion among the four conditions (p<0.001). (0°–25° of neck flexion/extension) according to ISO 11226
Condition C1 showed a significantly higher motion-varia- ergonomics evaluation of static working postures18). The
tion index of the low back than other conditions (p<0.001). neck flexion angle when using a sofa and tablet accounted
Typed Japanese characters were 2242 ± 835 in condition for 43% of the active ROM. In a previous study, a range of
C1, 2216 ± 837 in condition C2, 2265 ± 703 in condition over 39.8% flexion of the whole cervical spine was sug-
C3, and 2103 ± 766 in condition C4. There was no statisti- gested to develop a large internal force, stretching the liga-
cal significance among conditions (p=0.955). ments and muscles around the neck19). Improper neck flex-
ion posture is suggested to generate a large load on the
Discussion cervical spine and is the main reason for text neck syn-
drome12, 20). Barret et al.21) calculated the shear force and
The present study focused on the furniture and types of compression in the cervical spine and found that the forces
computers used in WFH context and aimed to investigate in the cervical spine at 45° of neck flexion were two to four
improper postures that may develop the risk of MSDs. Sev- times that of the neutral position. Working in such a stress-
en experimental conditions were selected and grouped into ful neck flexion posture for an extended period of time may
three categories. In Category 1, the conditions of using a lead to the development of MSDs of the neck, such as text
low table, floor chair, and laptop computer had a similar neck syndrome22, 23). In addition, when using a sofa and tab-
neck and low back posture to the control condition of using let, the shoulder girdle tilted significantly to the right, indi-
a dining table, chair, and desktop computer. Significantly cating an imbalance in body posture as well as an asymmet-
large neck flexion and small shoulder abduction angles ric load on the spine. The reason may be that all participants
were observed when using a sofa and a tablet computer were right-handed and typed on the screen keyboard of the
without a table. In addition, when using a sofa and tablet tablet with their right hand, while in other conditions, they
computer, the right shoulder tilt angle was large. Postures used both hands to type on the keyboard. Moreover, arm
did not change considerably throughout the 30 minute VDT elevation ranging from 0° to 60° without full arm support is
work duration; however, the motion-variation index of the an unacceptable posture with health risks according to ISO
low back increased in the last 10 minute session. Work per- 1122618).
formance, represented by the number of typed characters, A second comparison was made between the conditions
was however, much lower when using a sofa and tablet of using the same furniture of a dining table and chair, but
computer than in the other conditions. different types of computers, such as (B1) desktop comput-
These results indicate a similar above-hip posture for er, (B2) laptop computer, and (B3) tablet computer . The
the condition of using a dining table, chair, and desktop results revealed that neck flexion was significantly greater
computer to the condition of using a low table, floor chair, when using a tablet computer than when using other com-

Industrial Health 2022, 60, 307 – 318

Table 3. Work postures and variation across time when using a laptop computer and different furniture
Table 3. Work postures and variation across time when using a laptop computer and different furniture

(C1) dining table and chair (C2) low table and floor chair (C3) sofa (C4) floor cushion

0–10min 10–20min 20–30min 0–10min 10–20min 20–30min 0–10min 10–20min 20–30min 0–10min 10–20min 20–30min ANOVA Post hoc (condition)

−1.1 −0.2 −1.4 −2.5 −1.0 −1.1 26.8 27.4 28.3 12.1 11.7 12.0 pc<0.001 (C1)(C3), (C1)(C4),
flexion (°)
±14.0 ±13.2 ±11.9 ±16.5 ±15.2 ±15.8 ±8.4 ±8.4 ±7.6 ±9.7 ±9.1 ±9.1 pt=0.936 (C2)(C3), (C2)(C4), (C3)(C4)
%ROM of pc<0.001 (C1)(C2), (C1)(C3),
neck 15% 14% 13% 22% 20% 21% 45% 46% 47% 22% 21% 21%
flexion pt=0.910 (C1)(C4), (C2)(C3), (C3)(C4)
motion- pc=0.024
1,442 1,700 1,978 1,334 2,214 1,528 1,313 1,238 1,707 1,894 2,271 2,377 (C3)(C4)
variation index pt=0.139
(C1)(C2), (C1)(C3),
38.4 37.4 37.4 49.2 49.0 49.5 9.3 9.0 9.4 21.1 20.4 20.4 pc<0.001
abduction (°) (C1)(C4), (C2)(C3),
±14.9 ±14.6 ±13.5 ±17.4 ±16.1 ±16.5 ±4.8 ±4.0 ±4.9 ±14.5 ±12.4 ±12.7 pt=0.970
shoulder (C2)(C4), (C3)(C4)
pc<0.001
right tilt (°) 2.2±3.0 2.2±2.7 2.6±2.7 2.9±2.3 2.9±2.3 3.0±2.4 4.7±6.3 5.9±3.1 6.1±3.3 1.4±2.0 1.8±2.0 1.7±2.4 (C1)(C3), (C2)(C3), (C3)(C4)
pt=0.292
42.6 41.4 42.3 46.6 46.8 47.2 28.6 27.3 27.7 58.1 59.2 59.3 p<0.001 (C1)(C3), (C1)(C4),
flexion (°)
±16.5 ±17.6 ±15.0 ±15.0 ±14.9 ±14.1 ±24.1 ±30.1 ±31.2 ±10.0 ±10.6 ±10.4 pt=0.988 (C2)(C3), (C2)(C4), (C3)(C4)
%ROM of pc<0.001 (C1)(C3), (C1)(C4),
77% 76% 76% 84% 84% 85% 62% 62% 64% 106% 108% 108%
flexion pt=0.976 (C2)(C3), (C2)(C4), (C3)(C4)
FURNITURE, IMPROPER POSTURES, AND VDT WORK FROM HOME

pc=0.017
low back right tilt (°) 0.4±4.5 0.9±3.9 0.2±3.9 2.0±4.5 2.0±4.2 1.2±4.8 1.6±6.4 1.7±6.0 1.6±5.8 0.5±4.3 0.6±3.7 0.5±3.9 (C2)(C4)
pt=0.879
pc=0.028
%ROM of tilt 8% 7% 8% 11% 10% 10% 9% 10% 10% 7% 7% 7% (C2)(C4)
pt=0.964
motion- pc<0.001
1,705 2,492 3,008 984 1,239 1,063 704 916 1,031 1,166 1,798 1,793 (C1)(C2), (C1)(C3)
variation index pt=0.085

Note: pc: p-value of the main effect in work conditions; pt: p-value of the main effect of time sessions
%ROM: percentages of joint angles to their active range of motion
Motion-variation index: integration of the difference between joint angles and the mean value
315
316 T DU et al.

puters. However, the magnitude of the flexion was approx- floor cushion showed the largest low back flexion com-
imately 11° and accounted for 25% of the active ROM of pared to the other conditions, which was approximately 59°
neck flexion, which was suggested to be a posture with lit- and approached the limit of the active ROM of the low
tle internal force in the cervical spine20). This neck posture back. However, neck flexion was not as critical to internal
is also an acceptable posture according to ISO 1122618), stress as in condition C3, in which the participants sat on a
which is suggested to be without any or with minimal ex- sofa. The sofa and floor cushion conditions had no tables to
ternal stress. A third comparison was made between the support the upper limbs and computer. Most participants
conditions of using the same laptop computer but different worked with a computer on their thighs and moved their
furniture, such as (C1) a dining table and chair, (C2) a low heads close to the display monitor. In the sofa condition,
table and floor chair, (C3) a sofa, and (C4) a floor cushion. the backrest restrained the low back angles, and a large
In condition C3, sitting on a sofa, the largest neck flexion, neck flexion was required for the head to achieve a com-
smallest shoulder abduction angle, and smallest low back fortable distance from the display monitor. In the floor
flexion was observed. The neck flexion in condition C3 was cushion condition, because no backrest was used, the head
27° and 45% ROM, which was within the stressful range of position seemed to be achieved by a large low back flexion
neck flexion according to the literature18, 19). These results and moderate neck flexion. Therefore, the stress on the
indicate that improper postures in VDT work using a sofa neck should be low when working with a floor cushion.
and tablet computer should be a combined effect of the type However, without a backrest to reduce the low back load in
of computer and furniture, and furniture has the main ef- the sitting postures9, 18), excessively large flexion of the low
fect. Using a tablet computer can contribute to severe neck back in the floor cushion condition may increase the risk of
flexion and sitting on a sofa without the support of a table MSDs of the low back.
can significantly affect the joint angles of the neck, shoul- The present study has some limitations. First, the body
der, and low back. Furthermore, work performance, repre- postures of VDT workers were measured in each condition
sented by the number of typed characters, was similar for only a 30 min duration, which may not represent the full
among the conditions in the third comparison. This indi- period of WFH (generally 5 to 8 hours per day). Given that
cates that work performance is affected by the type of com- no main effect of time session was observed for the joint
puter used, rather than furniture. angles in our study, having a short break every 30 min is a
The Japan Human Factor and Ergonomics Society has valuable method of maintaining good posture. Further
published instructions for teleworking using tablet/smart- studies are required to evaluate posture variation and the
phone devices24). They recommend using a stand for a tab- prevalence of MSDs over an extended period of WFH. Sec-
let and raising its height to eye level to reduce neck flexion, ond, the amount of furniture used in this study was limited.
risk of text neck syndrome, and other MSDs of the neck. Various pieces of furniture are used in WFH context, such
Moreover, they recommend using a separate keyboard for as a soft or hard chair, backrest with different inclination
typing, to reduce MSDs in the upper limb and neck. Ac- angles, chair or sofa with arm support, and rotatable chair.
cording to the results of our study, the above suggestions The ergonomic characteristics of furniture can alter body
can be helpful when working from home and utilizing a posture to reduce or increase the risk of developing MSDs.
sofa and tablet computer because they can make workers For example, arm support on a chair is reported to alter the
more comfortable and work more efficiently. However, if shoulder posture and reduce the low back load in sitting
there was a suitable table to support the arms during VDT postures because the weight of the upper limbs and upper
work, according to the results of the comparison of Catego- torso is carried by the arm support9). Further studies should
ry 2, using a tablet would not result in a stressful shoulder be conducted to discuss the effect of various furniture used
posture and neck posture during the 30 minutes of VDT in WFH contexts on teleworkers’ health. In addition, cohort
work. In addition, the Japan Human Factor and Ergonomics studies are expected to examine the relationship between
Society suggests taking a break every 20 minutes. Our re- the incidence of MSDs and posture in WFH patients.
sults show that during the 20 to 30 minute session of work, In conclusion, the body posture above the hip when us-
the motion-variation index increased significantly com- ing a low table, floor chair, and laptop computer is similar
pared to the 0 to 10 minute session of work. This may be an to that when using a dining table, chair, and desktop com-
indication of fatigue. Therefore, taking a break every 20 puter, and both postures cause minor stress on body joints.
minutes is an effective way to maintain a healthy posture. However, there is a significantly large neck flexion angle
The posture of working in condition C4 of sitting on a when using a sofa and tablet computer or a sofa and laptop

Industrial Health 2022, 60, 307 – 318

FURNITURE, IMPROPER POSTURES, AND VDT WORK FROM HOME 317

computer, which may be harmful to the neck and develop studies. J Manipulative Physiol Ther 35, 568–77.
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Jersey.
a floor cushion generates excessive low back flexion, which 10) Japan Ministry of Health, Labour and Welfare. [Guildlines
indicate a stressful posture. Hence, VDT work using a sofa for proper introduction and promotion of telework.] 2021.
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