DOCLINE ® Page | of 1 *37467612* Request # 37467612 APR 22, 2015 Email (PDF) To: yphowell59@gmail.com Miss yasmin del rosario phowell lima, 135) PERU DOCLINE: Journal Copy _EFTS Participant Title: Human factors Title Abbrev: Hum Factors Citation: 2014 Nov;56(7):1249-61 A Postural variability: an effective way to reduce musculoskel Author: Davis KG;Kotowski SE NUM Unique ID: 0374660 Verify: PubMed PubMed Ut: 25509006 Issi 0018-7208 (Print) 1547-8181 (Electronic) Fill from: Any format Publisher: Human Factors and Ergonomics Society, Santa Monica, Ca : Copyright: Copyright Compliance Guidelines Authorization: Cindy Need By: N/A Maximum Cost: Free Patron Name: del rosario, Miss yasmin Referral Reason: Not owned (title) Library Groups: FreeShare,ICON Phone: 1.402,398-6092 Fax: “ Routing Reason: Routed to MAUNEO in Serial Routing - cell 5 Received: Apr 22, 2015 ( 09:46 AM ET ) enter: New England College of Optometry/ Boston/ MA USA (MAUNEO) This material may be protected by copyright law (TITLE 17,U.S. CODE) Bill to: NEUBRG Creighton University Health Sciences Library 2500 California Plaza OMAHA, NE 68178 hitps://docline.gov/docline/reques receipVreceipt.cfm?Program=Docétype=n&t=0.5810... 4/22/2015NOTICE: This material may be protected by Copyright Law (Title 17, U.S. Code)2014 - Human Factors Jow in the Department of patonal Health Sciences at on in Seattle. He received m the Department of Indus- ring. at the University of 012. research scientist in the mental and Occupational niversity of Washington in MS from the Department University of Washington 1 doctoral student in the and Systems Engineering ington in Seattle. ategie rescarch mans ogram at Hewlett-Packard ssociate professor of envi= jonal health sciences, an a of industrial and systems or of the Ergonomics Pro- ho University of Washing- {his PHD from the Unive cley in 1998, Postural Variability: An Effective Way to Reduce Musculoskeletal Discomfort in Office Work Kermit G. Davis and Susan E. Kotowski, University of Cincinnati, Cincinnati, Ohio ‘Objective: This article investigates whether difer- cent interventions aimed at promoting postural change could Increase body movement throughout the shift and reduce musculoskeletal discomfort. Background: Many researchers have reported high levels of dicomfort for workers that have rela tively low-level demands but whose jobs are sedentary innature. To date, few interventions have been found 10 be effective in reducing worker discomfort Methods: Thirty-seven call center operators were ‘evaluated in four diferent workstation condiions: con- ventional workstation, sivstand workstation, conve tional workstatlon with reminder sofeware, ad stand ‘worketation with bresk reminder software-prompt Famind workers to cake break. The primary outcome ‘arabes consisted of productivity, measured by custom oftware; posture changes, measured by continuous video recording, and cscorfort, measured by simple survey. Each condition was evaluated over a 2-week period Results: infant reductions in short-term discom fort were reported in the shoulders. upper back, and lower back when utiling reminder sofsware, indepen dent of workstation ype, Although not signfcane, many productivity indices were found to increase by about 10% ‘Conchisions: Posture-alering workstation incerven tions, specticaly ststand tables or reminder sofeware ‘with triiconal tables, were effective In introducing pos ture variability, Further. postural varialiey appears to be linked to decreased short-term discomfort atthe end of the day without a negative impact on productivity. ‘Applications: An intervention that can simply induce the worker to move throughout che day, such az a sivstand table or simple software reminder about making a large posture change. can be effecive in reducing discomfort in the worker, while not adversely Impacting productivity Keywords: sedentary, static postures, musculoske! eral discomfore, productiviy, posture ‘Address conespondense to Kemit G, Davis, University of Cincinnati, Low Back Biomechanics and Woekplace Stress sbortory, 3223 Elen Ave, 300 Ketering Lab, Cincinat, (OH 45267-0056, USA; email: Kermitdavis@ue ed HUMAN FACTORS Vol. 56, No. 7, November 2014, pp. 1249-1261 DOI: 16,1177/0018720814528003 Copysight ©2014, Human Factors and Ergonomics Society INTRODUCTION Data entry and long durations of oflice work al a computer terminal are common and often very detrimental to the workers (Jensen, Fin sen, Sogaard, & Chistensen, 2002). Blatter and Bongers (2002) reported that more than Si of secretarial workers indicated they worked continuously for more than 4 hours using a keyboard and mouse. Call center operators have also been documented to remain in their seats more than 95% of the work shift (Rocha, Glina, Marinho, & Nakasato, 2005). Toomingas, Fors- ‘man, Mathiassen, Heiden, and Nilsson (2012) reported that 80% of the work shift was spent seated with 9% of the workers having periods of more than | hour of continuous sitting. The bottom line is that office workers, particularly data entry and call center operators, will work long periods without taking a break. Incidence rates for neck and shoulder discom: fort were found to be between 10% and 60% in individuals who have extensive computer use (Elana, Andersson, Hagberg, & Helim, 2000; Gerr et al., 2002; Korhenon et al, 2003; Rocha al., 2005; Wablstrim, 2005). Prevalence of discomfort in the hand and wrists in call center operators has been reported at similar levels (about 40%) (Rocha et al., 2005). This body dis- comfort has an adverse impact on productivity of the office workers, as reported by Wahlstrim Hagberg, Toomingas, and Tomgvist (2004 Another group of researchers have reported about 12% of the computer users indicated pro- ductivity reductions due to discomfort, which resulted in 10% to 20% decreases in perceived productivity (Hagberg, Tomgvist, & Toomingas, 2002). Thus, the oppor fort in workers may result in inereased produc- tivity and reduce presente Although there are many factors that contrib- ute to the discomfort in the shoulders and upper extromities of office workers, one factor that has nity to reduce discom-1250 been strongly related to these adverse factors was sitting for long durations without a break (Ariens et al., 2001; Rocha ef al., 2005). Rocha tal. (2005) found a strong relationship between symptoms in the neck/shoulder and lack of rest breaks (odds ratio [OR] = 3.17 95%; CI= 1.11 8.97), Some evidence of a dose response effect for prolonged durations of static postu neck/shoulder discomfort was presented by Blatter and Bongers (2002), who found signifi- cant ORs for 4 10 6 ars (ORag = 1.50; 95% C 1.11-2.02) and 6 to 8 hrs (ORay = 2.03; 95% CI = 1.44-2.85) as compared to 0 to 1 hrs of exposure. Jensen etal, (2002) also found a simi lar dose-response relationship with hours of computer work. Other factors relating to body discomfort and injuries in office workers include ‘mouse activation, low static muscle effort due to lack of postural relief of the arms and keyboard ‘mouse activation, mental stress, and nonneutral postures of the body while sitting in the chair (Wahistrom, 2005), Although there investigating changes in the work environm: that tar neutral joint postures, the results are mixed and fe been several studies it proper ergonomic position such as regarding the impact on discomfort and injuries (Cook, Burgess-Limerick, & Chang, 2000; Gerr et al., 2002, 2005; Ketola et al., 2002; Lewis, Krawiec, Confer, Agopsowicz, & Crandall, 2002; Rempel et al, 2006). Gerr, Marcus, and Monteith (2004) provided extensive literature review that concluded the results linking posture to office worker discomfort a further supporting the notion ¢ interventions designed to promote neutral work ing postures may be helpful but might be pat tially the entire solution. One reason why thes types of en effective in reducing discomfort, injuries, and compensation costs might be that although the workers are in better postures, they still remain in fixed postures for long durations (e.g, no breaks). Thus, additional interventions need to be explor The premise for the interventions evaluated in the current study was that routinely en in postural changes during the work shift will reduce the discomfort and improve productivity The sit-stand adjustable table may be one option not consistent t ergonomics onomic interventions may not be November 2014 - Human Factors to introduce postural variability without havin to leave the actual work area. The premise of tl sit-stand workstation is to promot movement by allowing the worker to switeh between a sitting and standing work posture throughout the day. In a simulated data entry study, Husemann, Von Mach, Borsotto, Zepf and Schambacher (2009) reported that musculo- skeletal complaints were lower without a detriment to productivity for the sit-stand work: station as compared to a traditional sitting work station, Alkhajah et al. (2012) found sit-stand workstations reduced sitting time by about 140 minutes per day. However, previous research into sit-stand workstations has shown low levels of usag work crs stop adjusting the tables after a few weeks, indicating any benefits could be lost over time (Wilks, Mortimer, & Nylen, 2006). ‘Another type of postural change intervention isto remind workers to take more routine breaks, A study conducted by Galinsky, Swanson, Sau Hurrell, and Schleifer (2000) showed tha frequent (5 min break/hour) breaks significantly decreased discomfort for data entry workers ‘compared to a conventional break schedule (two 15 min breaks/day). A follow-up study from this ‘group evaluated routine breaks with stretching (Galinsky et al., 2007). The results indicated that the breaks, but not stretching, had an impact on the discomfort of the workers, possibl noncompliance of stretching. Furthermore, the cffeetiveness of stretching is compounded by ssues and appropriateness of the stretching for specific work conditions. A review by Goodman et al. (2012) reported that the few studies investigating rest breaks as an interve tion found positive results decreased pain and static awkward postures. Bernards, Ariéns, Simons, Knol, and Hildebrandt (2008) reported that re s effectiv ‘aging the use of breaks. However, two additional eviews (Hoe, Urquhart, Kelsall, & Sim, 2012; Kennedy et al., 2010) reported limited positive results for rest breaks being effective in control ling musculoskele shoulder for computer work. The current study investigated whether inte ventions aimed at postural change could encour sdoption of routine dynamic movement o} compliance due to compliance minder software in encour- | disorders of the neck and2014 - Human Factors Tr Posrurat Vaniasiury Reouces MSD Discomront 1251 variability without having k area. The premise of the is to promote a dynamic ng the worker to switch i standing work posture na simulated data entry n Mach, Borsotto, Zepf, )9) reported that musculo- were lower without a ity for the sit-stand work. ‘traditional sitting work= Alkhajah et al. (2012) stations reduced siting imutes per day. However, it-stand workstations has sage compliance—work- tables after a few weeks, s could be lost over time iylen, 2006), sural change intervention e more routine breaks, Galinsky, Swanson, Sau: cifer (2000) showed that hour) breaks significantly for data entry workers 3 jonal break schedule (two follow-up study from this ne breaks with stretching The results indicated that “ching, had an impact on workers, possibly due to hing. Furthermore, the ing is compounded by {appropriateness of the vork conditions. A review 12) reported that the few est breaks as an interven Its decreased pain and ures. Bemaards, Ariéns, debrandt (2008) reported vas effective in encour However, two additional r, Kelsall, & Sim, 2012; reported limited positive reing effective in control- lisorders of the neck and work. estigated whether int wral change could er ‘TABLE 1; Demographic and Anthropometric Data for the Participants Who Enrolled and Completed the Study (Mean and Standard Deviation) Standing Height Body Weight Body Mass_ Hours Worked Age (Year) (em) kg) Index (kg/cm?) _(Hours/Week) Fulltime Male (5) 338 1812 95.4 292 443 5) 2) (23.0) (6.2) (13.8) Female (13) 390 165.1 714 26.1 33. (12.9) 6.0) (156) 5.6) 7.9) al (18 373 1704 79.4 272 35.9 as) (10.2) ay 6.4) 10.9) Part-time Male (3) 385 1808 89.0 23 193 205) (124) a) 23) (10.0) Female (16) 32.5 17 258 139 66) 140) 6.4) oy All(a9) 335 710 261 148 es) (15.2) 60) 2) the body, resulting in decreasing musculoske! tal discomfort and increased productivity. Four different office workstation conditions were d including a conventional workstation, sit-stand workstation, conventional workstation with reminders to take breaks, workstation with reminders to switch table heights and adopt postural changes. evalu and sit-stand METHODS Participants Thirty-seven (29 females and 8 males) call center employees were recruited fiom a local {drug and poison information center that is open 24 hours a day, 7 days a week, and handles onal emergency calls that deal with drug overdose and poison ingestion. The gender mix was representative of the gender ratio in the call center. The participants were full-time (18 employees) and part-time (19 employees) employees at the call center, All participants hhad worked at the f . The participation rate was 7. worker being lost to follow-up due to leaving the place of employment (the partial data were not ana- lyzed in the results). Complete demographic and anthropometric data can be found in Table Experimental Design and Approach A. quasi-experimental design study adopted with each workstation evaluated fo I-month period (2-week break-in period and 2-week observation period) (see Figure 1 ‘or timeline of conditions). During the entire period, video cameras remained up with appe ance of being active. There were four different ‘workstation conditions: (1) conventional work station/exising workstation, (2) conventional workstation with reminder software, (3) sit stand workstation, and (4) sit-stand workstation with reminders. For all conditions, the worksta tion consisted of a comer unit (see Figure 2 with a flat sereen monitor, keyboard, mouse, phone, and reference materials (e.g., books and notes). The outcome variables included the following: productivity handling calls and computer usage, body discomfort, and postural changes (see Outcome Variables section for I definition). Workstation conditions. The conventional workstation had a fixed height at 71.1 om from the floor Although the sit-stand adjustment con- troller was functional, the participants were instructed not to use the function when complet- ing the conventional workstation condition act1252 November 2014 - Human Factors Figure 1, Timeline For evaluation of the conditions: Half ofthe participants started in normal and halfstarted in sit-stand; the participants switched to other nonsoftware reminder condition; reminder software was activated and half of each group wa conditions; and each participant then switched to the last remin randomly placed in reminder software and sit-stand with reminder software software condition Figure 2, Pasticipant siting height work su (compliance was validated throu vation). For the sit-stand workstation condition, participants were instructed how to use the adjustment controller. All participants wei encouraged to change the workstation height during the day as they pleased. However, instru tions were provided at the beginning of the con- dition with no reminders after the interaction, ‘The height of the workstation could gh video obser: the conventional-height work surface (a) and stan gat the high= be adjusted between 61.0 om and 130.8 em, However, the actual height of the workstation during sit-stand conditions was self-selected and ‘was then specifically measured. The conven- tional workstation with software reminders uti- lized the fixed workstation height, but software was loaded on to the computers to track com puter activity and request participants to make a postural change at 30-minute intervals, Similarly,-2014 - Human Factors Fr. Posturat Variasiury Repuces MSD Discomrort 1253 in normal and half started in nder software was activated nd with reminder software standing atthe high 51.0 em and 130.8 em. eight of the workstation ons was self-selected and measured. The conven- software reminders uti ion height, but software computers to track com- st participants to make a inute intervals. Similarly, WorkPace Break Posture: ‘Change you postre by ether austin abe height {rn oo lower standing and mesg around tlpending upon your sesgned conden Leow) e Figure 3. Software reminder that is displayed at the appropriate time (every 30 minutes) to remind the participant toadjust their posture and/or height of the table. The prompt had a simple message with a soft lock on the seroen—ignore button. The WorkPace software displayed a status bar for break timefidle time on computer (example, 52 s) and how long computer was used continuously (example, 1.43 hrs). the sit-stand workstation with software remind- cts utilized the adjustable workstation along with tracking software, The reminder software, which was provided by WorkPace prompted the participants to stand up and move around or adjust the sit-stand table with a simple message (see Figure 3). The prompt would pop up on the sereen every 30 minutes but did not require them to stop imme- diately given the potential for handling calls with life and death consequences. Instructions given to each of the participants at the start of every condition stated thatthe participant should use discretion when taking a break but were encouraged to follow the prompts as much as possible. One suggestion was to continue work- ing, but to stand (or adjust table height) until time permitted a posture change. WorkPace soft- ware monitored the activity including key strokes and mouse movements, total computer usage, and compliance to postural change (e.g, 1no keyboard or mouse activity). Each participant selected a chair that was uti- lized throughout the study. Numbers were placed ‘on the back of the chairs for identification by the participants as well as allowing the research team {o verify chair number through video capture. Condition Assignment and Assessment During the first 2 weeks for each condition, participants became familiar with the work con- ditions without any assessments. The break-in period also allowed the participants to establish everyday routines and minimize changes result- ing purely from awareness of being observed (eg., workers return to routines and habits). TThe 2-week break-in period was followed by 2-week assessment period, During the 2-week assessment period, each participant was evalu- ated for productivity levels, presence of body discomfort, and any postural changes during the work shift (see dependent variables for more description of these variables). The participants ‘were aware when the assessment period was underway, as they were required to complete the discomfort survey at the end of each shift Figure 1 provides the timeline of the conditions. ‘The order of workstation conditions was counterbalanced with participants who were randomly assigned to workstation condition. At the start of the study, participants were randomly assigned to two groups: half into current work- station condition (e.g., fixed height) and half assigned to sit-stand workstation (e.g., adjust- able height). After the first assessment, the groups switched workstation conditions (e.g., conventional condition switched to sit-stand condition and vice versa). At the midpoint of the study (upon completion of the first two condi- tions), software reminders were activated. Half of each of the original groups was randomly selected to start the conventional workstation with reminder software, whereas the other half were assigned to the sit-stand with reminder software, After the assessment period, the groups switched conditions for the final assessment. ‘The block assessments on reminder software were necessitated by having multiple users on the same computer throughout the assessment period with no way to control the sofiware pop- ups for nonsoftware conditions. Given the work environment with a 24/7 ser- vice requirement and cubicle layout (two four- cubicle workstations), webcam cameras were set up to monitor each workstation continuously over the 2-week follow-up period. The webcam cameras recorded at a 50 Hz. frame rate, Web- ccam cameras were present and visible during the1254 November 2014 - Human Factors entire study, Videos were digitally stored on lap- tops connected to the webcam cameras and then downloaded to adata server where they remained until they were viewed and analyzed by a mem- ber of the research team who documented pos~ ture changes and postural change compliance Recruitment of Participants Recruitment consisted of an email announce iment from the research group, which obtained email addresses of all current employees from wgement, The email provided study details and asked for volunteers. Once an email response was returned to the research team, one member of the research team met the individual to com: plete the consent process and obtain a signature fon the consent form. The consent form and protocol was approved by the University of Cin. cinnati’s Institutional Review Board. Once a par- ticipant agreed to participate, the individual was assigned an identification number and assigned to an initial workstation group. Although com- plete confidentiality was not achieved because it {was impossible to blind study participants from nonparticipants in the call center participant-specifie data were coded and kept confidential. Management remained out of the avironment, recruitment process and had limited information about who participated. Outcome Variables Body Body discomfort was sessed at the end of each shift during each assessment period. A short questionnaire uti lized an 11-point ordinal scale of discomfort ( no discomfort to 10 = unbearal document discomfort in the following regions: lower legs and feet, hips, knees, low back, upper back, neck, shoulders, and arms and wrists. Postural variability. The posture variability included multiple variables that were defined through video analyses, These variables were measured for each participant during every shift during the assessment periods. Each of the digi- tized videos was reviewed by a member of the research team, The following were the posture variables assessed (all measured in minutes): total time on shif, time without postural chang total time sitting, total time standing, total time discomfort. discomfort) to siting at lowered height, total time sitting at raised height, total time standing at lowered height, total time standing at raised height, num- ber of times switching between standing/sitting, number of times switching between lower raised, total time at lowered height, total time at raised. height, and total number of postural changes per hour, A postural change was defined as a major change of the entire body posture such as standing up/sitting down, turning in chair to communicate to coworkers, or walking. away from the workstation. The following were not included as a postural chang posture or movements of the upper extremities only, movement in the body while in the chair (e.g, moving leg under body), and reaching for the phone or other documents. Postural changes concentrated on large movements that were eas- ily distinguishable on the video. ‘The research nber would identify key events (e.g and sitting intervals, postural changes) along with the corresponding times using the team mi standing time stamp on the video and recording them into a database for further calculations. ‘Times between events along with frequency of events ‘were then computed. Productivity and computer usage. Productiv- ity was tracked by the call center through cu tom software, The research team ¥ data by the management of the call center, The call center reports provided productivity indices relating to average number of calls per hour, average number of calls picked up per hour, average hold time—amount of time placed on hold waiting for call center representative, and percentage of time not available for calls—rela- tive amount of time spent on a call or entering data into computer from previous case. In addi- tion, WorkPace software provided productivity variables that related to input devices and com: puter usage: total number of Keystrokes, total number of mouse clicks, and total time using computer, The WorkPace software was installed onall the computers during the entire study and tracked the number of clicks on the keyboard, number of clicks of the mouse (right and left buttons), and time actively using the computer (e.g, when keyboard was being typed on, the ‘mouse was clicked or being moved around the The software is given the sereen) provides an accurate2014 - Human Factors ght, total time sitting at me standing at lowered ing at raised height, num- between standing/sitin itching between lover vered height, total time at tal number of post tural change was defined the entire body posture iting down, tuning in to coworkers, or walking tion. The following we rural change: changes in of the upper & body while in the chair r body), and reaching for uments. Postural changes novements that were eas- the video. The research dentify key events (c.g ervals, postural change ponding times using the ) and recording them into et calculations. Times with frequency of events remities mputer usage. Produetiv- call center through cus- arch team was given the nt of the call center: The ided productivity indices mber of calls per hour, lls picked up per hour, nount of time placed on enter representative, and available for calls—rela- ent on a call or entering n previous case, In addi- provided productivity input devices and com ber of keystrokes, total ks, and total time using ve software was installed ring the entire study and licks on the keyboard, mouse (right and left vely using the computer vas being typed on, the being moved around the - provides an accurate rT Posturat Vanasiury Reouces MSD Discomrort sessment of these outcomes b quantitative oon the exact time that the keyboard or mouse twas being clicked or moved, with the total time ‘on computer being the summary of keyboard and mouse usage time. Overall, the software provides an accurate measure of computer usage. Douwes, de Kraker, and Blatter (2007 estimated that WorkPace overestimates cor puter usage by 9%, whereas Blangsted, Hansen, and Jensen (2004) reported underestimates of 2% to 8% for computer usage, Descriptive statistics were computed for all the variables as a function of workstation condi- tion, A Kruskal-Wallis one-way analysis of vari- ance by ranks procedure was utilized to dete mine significant differences for the discomfort variables. Follow-up post hoc comparisons were computed for significant effects in the form of 1a Wilcoxon signed rank test with a Bonferroni correction to determine the source of the signi cant differences. For the continuous variables (productivity and video outcomes), a repeated measures analysis of variance (ANOVA) was conducted with studentized Tukey post hoc tests, For all statistical analyses, an alpha of 0.05 ‘was utilized to determine significance. RESULTS The results for the productivity and exposure outcomes are displayed in Table 2. The time worked during all four conditions was. very consistent and not significantly different. This indicates that all workstation conditions had equal amounts of exposure to the office work In general, participants averaged about per week and roughly 8 hrs per shift, indicat- ing a mixture of full-time and part-time work- ers, Furthermore, computer-based productivity indices were also not impacted by the four dif ferent conditions, although a slight increase in keystrokes and mouse clicks was seen for the conditions with reminder software (Table Over the 2-week evaluation period, the workers utilized the computer keyboard for about 16 brs ‘and the mouse for about 10 hrs. The number keystrokes ranged between 40,000 and 45,000 keys with about 12,000 clicks of the mouse 1255 (single and double clicks), independent of inter- 9 condition, Productivity data provided by the call cen- ters’ productivity reports indicated that most of the productivity indices were not affected by ‘workstation condition, including average num- ber of calls picked up per hour, average hold time, and percentage of time not available for calls (Table 2). A couple of variables relating to productivity were found to be significantly impacted by workstation condition. First, although the number of phone calls answered per hour inereased with the reminder sofware, fhe change was only significant among. those using sit-stand workstations. Second, the num- ber of calls completed was not different between conventional and sit-stand. Differences in ealls completed were documented for the reminder software (increase of 10%) and sit-stand with reminder software (decrease of $%) as com- pared to conventional condition. The video analyses evaluated the time spent sitting, standing, and away from the desk as well as the number of times workers transitioned between sit-stand and low-high worksta (see Table 2), Figure 4 provides a summary of how the different conditions influenced the amount of sitting, During the conventional workstation (with and without reminder soft- ware), the percentage of time standing was vit tually nothing, whereas siting approached 90° The reminder software did reduce the percent- age of time sitting by 8%. The sitstand condi- tion increased the amount of time standing by approximately 10% to 15%, with and without reminder software, respectively. The amount of time sitting was also significantly reduced by about 20% (for both with and without reminder software), The percentages of time for using the low and high workstations were mirror images of the sitting and standing percentages, potentially indicating an influence of the sit-stand interven- tion, The remaining time was spent away from th work area, which actually increased with the reminder software. The conventional worksta- tion resulted in about 10% of the time away fro the desk, whereas the sit-stand and reminder software conditions resulted in 15% of the time rot using the computer. 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Ae B+ C ters indicate signi 3 Percentage of time workstation at high height? (%) Percentage of time away from workstation? (%) Percentage of time workstation at low height! (%) ‘Baced on WorkPace software, Posturat Vamwsurry ReDuces MSD Discomrort 8 Pemoen tage of Tie) ao 1257 Figure 4. Percentage of tim: stand with reminder software. stand with reminder software (about 21% of the time). This time away allowed for breaks and completion of other activities outside the work AAS expected, the conditions with sit-stand tables had more times transitioning between si ting and standing (about four times per shif) The addition of the reminder software resulted in an increase of approximately one switch per shift more. The number of postural changes per shift was impacted (p < 0.05) by condition, with the conventional condition having the least about seven per 8-hr shift. Both of the sit-stand conditions (with and without reminder software) had approximately eight postural changes per S-hr shift, whereas the reminder software with conventional workstation had nine postural changes per 8-hr shift. The reminder software appeared tobe effective in encouraging postural changes throughout the shift. However, the data from the WorkPace tracking software indicated 2.62% compliance of the break prompts (e.., computer was idle). The body discomfort (measured at end of shift) across the 2-week intervention period was significantly lower for the shoulders, lower back, and upper back generally in the direction of sitstand compared to conventional and Time standing Time Siting Time Away From Workstation Workstation Condition ‘Bconveitions! msitStand CComentionalwithReminderSoftware mS#-Stnd withReminderSoftware and away from workstation for the Fou ‘conditions: (1) conventional, (2) sit-stand, (3) conventional with reminder software, and (4) sit- reminder software compared to no reminder software (see Table 3). The decrease in diseom- fort levels ranged between 22% and 46° (Figure 5). There was no difference (p > 0.08) among the workstation conditions for discon fort in the neck, elbows, hands and wrists hips, knees, and lower legs and fect. DISCUSSION Although the study population was rela tively small and the observation periods short, the results indicated sitstand tables and break rominder software produce routine postural changes that could impact the discomfort of sedentary office workers. The effect of sit-stand or break reminders appeared to be independent as the synergistic impact on the outcome vari- ables was not significantly different from the individual effects. The breaks/postural changes included in the current study were different than previously investigated by Galinsky et a (2000, 2007) (e.g,, 5 minv/hr) and were gener- ally designated (Soft break every 30 min) due to the critical nature of the work. This type of break patter allowed the user to have control of the breaks and to focus on making a large body movement—change in position of the entire body such as standing up, walking away1258 TABLE 3: Summary of the Body Di Conditions (Mean and Standard Deviation) November 2014 - Human Factors Lomfort at the End of the Shift During Each of the Workstation Conventional conditions: (I) conventional, 2) s reminder softwat from the workstation, and turning away from the workstation to communicate with other coworkers. The purpose of the break was 10 ange body posture by altering the sit-stand height or completing productive tasks, which ‘may have load to the lack of adverse impact on the productivity indices. ‘AS seen by others (Galinsky et al., 2000, 2007; Husemann et al,, 2009), breaks and using, and, (3) conventios SitStand With With Reminder Reminder Outcome Variable Conventional _SitStand __ Software Software P Neck TI —-A9(NSO «TATE —-1.85@1 0.10 Shoulders zig 2or 1428 (156) 1.16°(1.52) 1.208166) 0.02 Elbows 055(1.05) 024/060) 0430092) O49) 0.33 Hands and wrists 49(182) 0.98 (149) 0.89(1.28 ——1.00(1.52) 11 Upper back 2.28°(2.08 1.338(159) —1448(1.61) 1.37.07) 0.004 Lower back 218231) 1372.11) 170E(177)—1ATP(A. 73) 0.04 Hips 051 (1.06) 11425) O80(i.18) 0631.29) 0.17 Knees 0.78132) 0.7111.20) 083(13t) —0.83(1.75) 8 Lowerlegs andfeet 1.01(1.40) _0.99(7.80) 0881.14) 0931.58) 0.63 ‘Note. Different alpha characters indicate significant difference. A+ B+ C. 2 z sé 38 Es ° # aa, $2 5 | g 0 Shoulders Upper Back Lower Bock Workstation Conation {@Convertonat esisend Convertionalwith Reminder Sofware Sit-Standwith Reminder Software Figure 5, Discomfort atthe end ofthe shift forthe shoulder, upper back, and lower back forthe four intervention I with reminder software, and (4) sit-stand with ‘an adjustable-height table had no impact on pro- ductivity of the workers. Actually, in the current study, the indices of productivity improved in most eases by about 10% (not statistically nificant). It appeared that the postural cl resulted in the worker feeling better without any negative impact on productivity. One potential explanation might be that when workers felt bet- ter, they were more productive, even though2014 - Human Factors fh of the Workstation Stand V - Remindor Software P 155210) 0.10 205 (1.66) 0.02 0.44 (0.91 0.33 1.00 (1.52) on 374 (2.07) 0.004 4181.73) 0.08 0:63 (1.29) 0.17 0.83 (1.75) 059 093 (1.58) 063 1 ower Back jr Software 1c forthe four intervention are, and (8) si estand with le had no impact on pro: . Actually, in the current roductivity improved in %o (not statistical pat the postural changes eeling better without any xduetivity. One potential at when workers felt bet- roduetive, even though > posrna Vatabu Rebus MSD Dsconso they were away from their workstations more or paused routinely throughout the shift. Future tvork needs to better understand how postural changes impact productivity. The impact of sit-stand on time sitting wa slightly lower than what was reported by Alkha- jah etal. (2012), where they reported a decrease of about 140 min (or 29%) in sitting time, The current study found reductions in sitting to be between 15% and 18%. However, the number of postural changes was increased by 40% for the sit-stand conditions, indicating they did more major body changes within their chair rather than standing up entirely. It appears the frequency of switches inthe cur- rent study between sit and stand postures were found to be lower than previous work of Toomin- gas tal. 2012). Toomingas et al. (2012) found approximately 10 changes, whereas sit-stand conditions resulted in four to five per shift and reminder software alone was 1.25 per shift n the current study. These lower numbers of switches also point to dynamic posture changes while seated. For the conventional condition, the aver- ‘age numberof switches was less than 0.5 per shi, indicating long durations of siting. So although there was an inerease in the number of times that the workers changed between sit and stand forthe intervention stadies as compared to the conven- tional workstation, the increases did not equal an average of 2/hr or close to the 10/hr found by ‘Toomingas et al, (2012). The culture, type of emergency situation, and relatively short break-in petiod(eg,,2 weeks foreach condition) may have contributed tothe lower number of actual changes between siting and standing, Although it appeared fram the video analyses thatthe workers complied With the protacols, more rigid breaks could have had more promising results ‘To provide adequate context ofthe results, the following considerations and limitations need to be discussed. First, the participant population was a sample of convenience that was no selected randomly and was selected from one facility with a given culture and work demands The simple of convenience was a result of fund- ing considerations and the intensive evaluation of the workers (e.g, monitoring for 2 weeks, 24 hus and 7 days a'week for each condition). Although the sample came from one call center, 1259 the specific one selected offered some unique ‘opportunities such as monitoring continuously for long periods of time (e.g observation period), observing more than one person at a time (e.g, multiple users in multiple cubicle arrangement), and observing workers who were well-educated individuals (eal had a college degree in order to provide the emer- gency services). Although the study was eom- pletely voluntary with limited encourage from management, there were some confide: ity issues (eg, some did not complete confidenti- ality of panicipation) that may have influenced or biased who volunteered for the study. How ever, the potential bias ofa small participant pool and nonparticipation was low, given the overall response from the workers was high (e.g than 75% participation). Furthermore, the work environment was relatively unigue to this call center in that the calls carried some level of urgency and potential life-threatening risk. AS a result, the operators were notable to take breaks immediately on soveral occasions. 2 works for each second, the evaluation was a relatively short- term assessment with only a 2-we kein period and a 2-week follow-up assessment period, As a result, the health outcomes were limited t© «discomfort responses rather than actual workplace injuries (eg., reportable back discomfort, hand! wrist problems, and shoulder problems). The long-term ramifications of postural. variability through sit-stand and reminder software remain unexplored. The results provide a more immediate impact of the interventions without any perspee- tive to more long-term impact. ‘Third, the postural assessment was limited to global movements such as moving away from the computer, transitioning between sitting and standing, and leaving the work area, With the focus on large dynamic move the postural changes did not account for microbreaks or small extremity breaks, which could have had some impact on the results. With the length of assessment and time-consuming nature of the video analyses, it was not feasible to quantify the small movement level Fourth, the study design was not able to utilize ‘4 completely randomized control design due 10 ‘multiple users sharing a limited number of work- stations and cross-contamination concems. The1260 logistics of having reminder software for some participants while others were not to have reminder software was not feasible, so the study was broken into two phases: no reminder software and reminder software. Although not ideal, par pants were randomized within these groups, mini- mizing the bias associated with condition ordering effects, Anecdotal data confirmed the issue as nonparticipants complained about the software popping up on the screen, which was resolved by show them how to ignore the reminders. Overall, the limitations discussed provide some context when interpreting the resus ofthe current study. However, none of them were felt to provide significant issues with respect to the validity and eneralizability of the results. However, the con- ccems above do indicate additional work is needed ‘0 better understand the underlying mechanisms of postural changing interventions such as investi- gating (1) museular responses and changes in these regions, and (3) more detailed information bout postural changes through the use of quanti- tative tools such as goniometers. Future work also needs to expand these results fo a long. erm pro- skeletal injuries rather than discomfort, CONCLUSION The study results have practical tions for sedentary office workers who take limited breaks. Based on the overall results the implementation of sit-stand workstations and/or break reminder software influenced the ‘number of gross postural changes and/or move- ments of the body that a worker will take throughout the shift. A result of the large body changes was a decreased level of discomfort at the end of the day without having any adverse impact on the productivity indices. However, the results should be viewed as preliminary as the long-term impact of these interventions is not fully understood. The study shows promise that reminders and sit-stand workstations leads {to short-term reduction of body discomfort implica without adverse impact on productivity ACKNOWLEDGMENTS We would like to thank Balaji Sharma, Donald Herrmann and Anita P. Krishnan for their contsbtion November 2014 - Human Factors the vider and hard work in analyz and processing data, Also, we would like o thank the Office Erge nomics Research Committee for partially funding the project. KEY POINTS * The adoption of sit-stand workstations or reminder software produced significant changes in the pos tural response during the shift workstations or the discomfort in the shoulders back, and lower back thatthe individuals suffered at the end ofthe shifts. ‘+ Introduction of postural changing modalities didnot udversely impact the productivity of the workers © Sitstand reminder software duces upper REFERENCES Akh 7 Ay Revs, M My Eakin, EG, Winky, ir Wa Bove, Ls an Macnee U0 skool dns o Cook, C., Bugs Limerick, R, Chang, S (200), The pow Tene of eck and upper extremity mi simp 9 mths oases copter ase: Sept by queton lmao, A. Anderson, A. Haghere. M. & Helin, BW. 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Davis is an associate pro versity of Cincinnati in the Coll partment of Environmental He ergonomics from the Ohio State University College of Engineering, Department of Industrial and Systems E sional ergonomist c is a certified profes Susan B, Kotowski is an assistant professor University of Cincinnati in the College of Allied Health Sciences. She is also director of the Gait and Movement Analysis Lab, She received her PhD in occupational ergonomics and sa from the Uni versity of Cincinnati, College of Medicine. She is also a certified professional ergonomist. Date received: May 31, 2013 Date accepted: February 11, 2014