Mobile touch screen device use and associations with musculoskeletal symptoms and visual health in a nationally representative sample of Singaporean adolescents

This study aimed to describe contemporary technology use, especially smartphones and tablets (mobile touch screen devices), and examine associations with musculoskeletal symptoms and visual health among adolescents in Singapore. A representative sample of 1884 adolescents (50.4% girls) from grades primary 5 to post-secondary (10–18?years old), recruited from 13 schools, completed an online questionnaire in class. Total technology use was high, with smartphone duration being highest (mean?=?264 [SD?=?243] min/day). Patterns of use, including multitasking and bout length, were influenced by gender, school level, type of device and activities. Musculoskeletal discomfort and visual symptoms were commonly reported. After adjusting for potential confounders, more hours/day of smartphone use was associated with increased risk of neck/shoulders, upper back, arms and wrist/hand discomfort (OR?=?1.04[95%CI?=?1.01–1.07] to 1.07[1.03–1.10]) and visual symptoms (OR?=?1.05[1.02–1.08]), but was associated with decreased odds of myopia (OR?=?0.97[0.94–0.99]). No significant associations were found for tablet use.

Practitioner Summary: 1884 adolescents in Singapore completed an in-depth questionnaire regarding their use of technology. The smartphone was the device with the highest usage, and greater smartphone use was associated with increased odds of musculoskeletal and visual symptoms. High use of smartphones has physical health implications for adolescents.     

Analysis of natural finger-press motions for design of trackball buttons

This study analysed natural press motions of the index, middle and ring fingers for ergonomic design of the positions and surface angles of the left, middle and right trackball buttons. Finger motions of 26 male participants for naturally pressing the trackball buttons were recorded after the participants adjusted the trackball buttons to their preferred locations for comfortable pressing. The natural positions of the finger pulps formed a symmetrically rainbow-shaped reach zone for the fingers. The natural press angles of the fingers’ motion trajectories to the vertical reference line ranged from 14.2° to 20.5°, suggesting an 18-degree surface from the horizontal line for the trackball buttons. Regression formulas (adjusted R²?=?0.90?±?0.07 and mean squared error?=?8.55?±?7.52?mm) were established to estimate the natural positions of finger pulps from hand segment lengths and joint angles for a population having different hand sizes from this study.

Relevance to industry     

Naturalistic data collection of head posture during smartphone use

Association between smartphone use and head-down tilt posture has not yet been quantitatively evaluated in natural settings. This study aimed to objectively assess the angle and duration of head-down tilt posture of smartphone users during a typical working day via naturalistic data collection. Thirty-one college students conducted their typical school activities while their head posture and smartphone-app usage records were collected simultaneously for 8?hours. Participants spent 125.9?minutes (median usage duration) on their smartphones with significantly larger head-down tilt (p?<?.05) than when they were not using the phone. Head tilt angle greater than 30° was found to be more common when using the phone, while head tilt less than 20° was more common when they were not using the phone. Study findings provide empirical evidence that supports an association between the duration of smartphone use and the intensity of head-down tilt posture.

Practitioner Summary: Head postures of young smartphone users were quantified for 8?hours continuously during a typical workday using a wearable sensor. Participants spent more time in larger head-down tilt postures (greater than 30°) when they were using their smartphones as compared to when they were not using them.     

A comfort assessment of existing cervical orthoses

Purpose: Identify location and intensity of discomfort experienced by healthy participants wearing cervical orthoses.

Method: Convenience sample of 34 healthy participants wore Stro II, Philadelphia, Headmaster, and AspenVista^® cervical orthoses for four-hour periods. Participants reported discomfort level (scale 0–6) and location.

Results: Participants reported mean discomfort for all orthoses over the four-hour test between ‘a little discomfort’ and ‘very uncomfortable’ (mean discomfort score = 1.64, SD = 1.50). Seven participants prematurely stopped tests due to pain and six reported maximum discomfort scores. Significant linear increase in discomfort with duration of wear was found for all orthoses. Significantly less discomfort was reported with Stro II than Headmaster and Philadelphia. Age correlated with greater perceived discomfort. Orthoses differed in the location discomfort was experienced.

Conclusion: Existing cervical orthoses cause discomfort influenced by design and duration of wear with orthoses’ design the more significant factor. This work informed the design of a new orthosis and future orthoses developments.

Practitioner Summary: The purpose of this study was to gain greater knowledge about the discomfort caused by wearing of existing neck orthoses in order to inform the design and development of a new neck orthosis. This study gathers empirical data from a surrogate population and concludes that orthosis design is more influential than the duration of wear.     

Frequency-dependence of discomfort caused by vibration and mechanical shocks

The frequency content of a mechanical shock is not confined to its fundamental frequency, so it was hypothesised that the frequency-dependence of discomfort caused by shocks with defined fundamental frequencies will differ from the frequency-dependence of sinusoidal vibration. Subjects experienced vertical vibration and vertical shocks with fundamental frequencies from 0.5 to 16 Hz and magnitudes from ±0.7 to ±9.5 ms^–2. The rate of growth of discomfort with increasing magnitude of motion decreased with increasing frequency of both motions, so the frequency-dependence of discomfort varied with the magnitudes of both motions and no single frequency weighting will be ideal for all magnitudes. At the frequencies of sinusoidal vibration producing greatest discomfort (4–16 Hz), shocks produced less discomfort than vibration with same peak acceleration or unweighted vibration dose value. Frequency-weighted vibration dose values provided the best predictions of the discomfort caused by different frequencies and magnitudes of vibration and shock.

Practitioner Summary: Human responses to vibration and shock vary according to the frequency content of the motion. The ideal frequency weighting depends on the magnitude of the motion. Standardised frequency-weighted vibration dose values estimate discomfort caused by vibration and shock but for motions containing very low frequencies the filtering is not optimum.     

A detailed description of the short-term musculoskeletal and cognitive effects of prolonged standing for office computer work

Due to concerns about excessive sedentary exposure for office workers, alternate work positions such as standing are being trialled. However, prolonged standing may have health and productivity impacts, which this study assessed. Twenty adult participants undertook two hours of laboratory-based standing computer work to investigate changes in discomfort and cognitive function, along with muscle fatigue, movement, lower limb swelling and mental state. Over time, discomfort increased in all body areas (total body IRR [95% confidence interval]: 1.47[1.36–1.59]). Sustained attention reaction time (β = 18.25[8.00–28.51]) deteriorated, while creative problem solving improved (β = 0.89[0.29–1.49]). There was no change in erector spinae, rectus femoris, biceps femoris or tibialis anterior muscle fatigue; low back angle changed towards less lordosis, pelvis movement increased, lower limb swelling increased and mental state decreased. Body discomfort was positively correlated with mental state. The observed changes suggest replacing office work sitting with standing should be done with caution.

Practitioner Summary: Standing is being used to replace sitting by office workers; however, there are health risks associated with prolonged standing. In a laboratory study involving 2 h prolonged standing discomfort increased (all body areas), reaction time and mental state deteriorated while creative problem-solving improved. Prolonged standing should be undertaken with caution.     

Integrating a hip belt with body armour reduces the magnitude and changes the location of shoulder pressure and perceived discomfort in soldiers*

Soldiers carry heavy loads that may cause general discomfort, shoulder pain and injury. This study assessed if new body armour designs that incorporated a hip belt reduced shoulder pressures and improved comfort. Twenty-one Australian soldiers completed treadmill walking trials wearing six different body armours with two different loads (15 and 30 kg). Contact pressures applied to the shoulders were measured using pressure pads, and qualitative assessment of comfort and usability were acquired from questionnaires administered after walking trials. Walking with hip belt compared to no hip belt armour resulted in decreased mean and maximum shoulder pressures (p < 0.005), and 30% fewer participants experiencing shoulder discomfort (p < 0.005) in best designs, although hip discomfort did increase. Laterally concentrated shoulder pressures were associated with 1.34-times greater likelihood of discomfort (p = 0.026). Results indicate body armour and backpack designs should integrate a hip belt and distribute load closer to shoulder midline to reduce load carriage discomfort and, potentially, injury risk.

Practitioner Summary: Soldiers carry heavy loads that increase their risk of discomfort and injury. New body armour designs are thought to ease this burden by transferring the load to the hips. This study demonstrated that designs incorporating a hip belt reduced shoulder pressure and shoulder discomfort compared to the current armour design.     

Three-dimensional finger joint angles by hand posture and object properties

The objective of this study was to identify three-dimensional finger joint angles for various hand postures and object properties. Finger joint angles were measured using a VICON system for 10 participants while they pinched objects with two, three, four and five fingers and grasped them with five fingers. The objects were cylinders and square pillars with diameters of 2, 4, 6 and 8 cm and weights of 400, 800, 1400 and 1800 g. Hand posture and object size more significantly affected the joint flexion angles than did object shape and weight. Object shape affected only the metacarpophalangeal (MCP) joint angle of the index finger and the flexion angle of the MCP joint of the little finger. Larger flexion angles resulted when the hand posture was grasping with five fingers. The joint angle increased linearly as the object size decreased. This report provides fundamental information about the specific joint angles of the thumb and fingers.

Practitioner Summary: Three-dimensional finger joint angles are of special interest in ergonomics because of their importance in handheld devices and musculoskeletal hand disorders. In this study, the finger joint angles corresponding to various hand postures and objects with different properties were determined.     

A statistical model including age to predict passenger postures in the rear seats of automobiles

Few statistical models of rear seat passenger posture have been published, and none has taken into account the effects of occupant age. This study developed new statistical models for predicting passenger postures in the rear seats of automobiles. Postures of 89 adults with a wide range of age and body size were measured in a laboratory mock-up in seven seat configurations. Posture-prediction models for female and male passengers were separately developed by stepwise regression using age, body dimensions, seat configurations and two-way interactions as potential predictors. Passenger posture was significantly associated with age and the effects of other two-way interaction variables depended on age. A set of posture-prediction models are presented for women and men, and the prediction results are compared with previously published models. This study is the first study of passenger posture to include a large cohort of older passengers and the first to report a significant effect of age for adults. The presented models can be used to position computational and physical human models for vehicle design and assessment.

Practitioner Summary:

The significant effects of age, body dimensions and seat configuration on rear seat passenger posture were identified. The models can be used to accurately position computational human models or crash test dummies for older passengers in known rear seat configurations.     

Push Notifications in Diet Apps: Influencing Engagement Times and Tasks

Background: Smartphones have reached levels of popularity and penetration where they are now suitable for use in population health interventions. A key feature of smartphones is push notification or in app messaging service, which can be used to alert users to messages or instructions pertaining to an installed app. Little evidence exists as to the persuasive power of these messages.

Method: We conducted a 24-week live user evaluation of push notifications used in a behavior-based mobile app for a meal replacement program to understand the role of push notifications in persuading users to engage with self-monitoring tasks.

Results: User perception of the prompts were verified through questionnaires, which in conjunction with the interaction logs show that users were tolerant of multiple daily prompts. The decline in compliance to the tasks set, however, shows that while the participants did not object to receiving prompts, they were less likely to respond to them as the study progressed.

Conclusions: Push notifications and user tasks are appropriate mechanisms to engage users with mobile technology in the short term.     

Predictive discomfort of supine humans in whole-body vibration and shock environments

This work presents a predictive model to evaluate discomfort associated with supine humans during transportation, where whole-body vibration and repeated shock are predominant. The proposed model consists of two parts: (i) static discomfort resulting from body posture, joint limits and ambient discomfort; and (ii) dynamic discomfort resulting from the relative motion between the body segments as a result of transmitted vibration. Twelve supine subjects were exposed to single and 3D random vibrations and 3D shocks mixed with vibrations. The subjects’ reported discomfort and biodynamic response were analysed under different support conditions, including a rigid surface, a stretcher and a stretcher with a spinal backboard. The results demonstrated good correlations between the predictive discomfort and the reported discomfort for the different conditions under consideration, with R² = 0.69–0.94 for individual subjects and R² = 0.94 for the group mean. The results also indicated a strong relationship between the head-neck and trunk angular velocities and discomfort during supine transportation.

Practitioner Summary: The quantification of discomfort of supine humans under vibration and shocks by using a predictive model is an important contribution to this field, whereby the efficacy of different transport systems can be compared. The predictive discomfort model can be used as design criteria for ergonomic enhancement in supine transportation of humans.     

Biomechanical investigation of prolonged driving in an ergonomically designed truck seat prototype

A postural evaluation during a prolonged driving task was conducted to determine the ergonomic validity of a new freely adjustable truck seat prototype. Twenty participants were recruited to perform two 2-h simulated driving sessions. Postures were assessed using motion capture, accelerometers and pressure pads. Subjective discomfort was also monitored in 15-min increments using ratings of perceived discomfort (RPD) and the Automotive Seating Discomfort Questionnaire. Participants had a more neutral spine posture during the first hour of the drive and reported lower RPDs while sitting in the prototype. Pairing the gluteal backrest panel with the adjustable seat pan helped reduce the average sitting pressure. The industry-standard truck seat may lead to the development of poor whole body posture, and the proposed ergonomic redesign of a new truck seat helped improve sitting posture and reduce perceived discomfort.

Practitioner Summary: A new freely adjustable truck seat prototype was compared to an Industry standard seat to assess hypothesised improvements to sitting posture and discomfort for long haul driving. It was found that the adjustable panels in the prototype helped promote spine posture, reduce sitting pressure and improved discomfort ratings.     

Lift performance and lumbar loading in standing and seated lifts

This study investigated the effect of posture on lifting performance. Twenty-three male soldiers lifted a loaded box onto a platform in standing and seated postures to determine their maximum lift capacity and maximum acceptable lift. Lift performance, trunk kinematics, lumbar loads, anthropometric and strength data were recorded. There was a significant main effect for lift effort but not for posture or the interaction. Effect sizes showed that lumbar compression forces did not differ between postures at lift initiation (Standing 5566.2?±?627.8 N; Seated 5584.0?±?16.0) but were higher in the standing posture (4045.7?±?408.3 N) when compared with the seated posture (3655.8?±?225.7 N) at lift completion. Anterior shear forces were higher in the standing posture at both lift initiation (Standing 519.4?±?104.4 N; Seated 224.2?±?9.4 N) and completion (Standing 183.3?±?62.5 N; Seated 71.0?±?24.2 N) and may have been a result of increased trunk flexion and a larger horizontal distance of the mass from the L5-S1 joint.

Practitioner Summary: Differences between lift performance and lumbar forces in standing and seated lifts are unclear. Using a with-in subjects repeated measures design, we found no difference in lifted mass or lumbar compression force at lift initiation between standing and seated lifts.     

The impact of different seats and whole-body vibration exposures on truck driver vigilance and discomfort

Laboratory studies have shown that exposure to whole-body vibration (WBV) increases physical and mental fatigue, which are common issues professional drivers face. The objective of this study was to determine whether altering WBV exposures had any effect on driver vigilance and discomfort. A repeated measures crossover design of five truck drivers with regular 10-h routes was used. Active and passive suspension truck seats were evaluated. For each seat, WBV exposures were measured. Participants completed a discomfort questionnaire and a reaction time task before and after their shift for two weeks, one week per seat. Compared with the passive seat, the active seat significantly reduced WBV exposures, decrements in the optimal and mean reaction times (p = 0.02, 0.047, respectively), and discomfort in the lower back and wrist(s)/forearm(s) (p < 0.01, 0.01, respectively). Study results indicated that reducing WBV helps reduce discomfort and maintain vigilance, which may improve drivers’ health and reduce the risk of truck collisions.

Practitioner Summary: The active suspension seat used in this study reduced truck drivers’ exposure to whole-body vibration (WBV) by over 33% in relation to their current industry standard passive suspension seat. This study demonstrated that reducing truck drivers’ exposure to WBV reduced fatigue and discomfort development over a workday.     

Multi-modal demands of a smartphone used to place calls and enter addresses during highway driving relative to two embedded systems

There is limited research on trade-offs in demand between manual and voice interfaces of embedded and portable technologies. Mehler et al. identified differences in driving performance, visual engagement and workload between two contrasting embedded vehicle system designs (Chevrolet MyLink and Volvo Sensus). The current study extends this work by comparing these embedded systems with a smartphone (Samsung Galaxy S4). None of the voice interfaces eliminated visual demand. Relative to placing calls manually, both embedded voice interfaces resulted in less eyes-off-road time than the smartphone. Errors were most frequent when calling contacts using the smartphone. The smartphone and MyLink allowed addresses to be entered using compound voice commands resulting in shorter eyes-off-road time compared with the menu-based Sensus but with many more errors. Driving performance and physiological measures indicated increased demand when performing secondary tasks relative to ‘just driving’, but were not significantly different between the smartphone and embedded systems.

Practitioner Summary: The findings show that embedded system and portable device voice interfaces place fewer visual demands on the driver than manual interfaces, but they also underscore how differences in system designs can significantly affect not only the demands placed on drivers, but also the successful completion of tasks.     

The effect of age on in-vivo spine stiffness,postures and discomfort responses during prolonged sitting exposures

Many industrialised working populations are ageing and prolonged sitting exposures are prevalent across occupational sectors. The purpose of this work was to determine the effect of age and sex on passive spine stiffness, postures and discomfort in response to seated work. A total of 34 participants were recruited, with 17 older adults with an average age of (standard deviation) 63.7 (±3.9) years and 17 younger adults aged 23.8 (±5.0) years. Participants were asked to sit continuously for 90?min while typing. Baseline passive spine stiffness was higher in older adults at 40% flexion compared to younger adults (p?=?.0233). Older adults sat in less normalised flexion, at 33.4% (±16.4) compared to 60.9% (±20.2) in the younger group (p?=?.0003). Discomfort was higher among older adults in the neck, right shoulder and middle back regions (p?<?.0086). An understanding of age-specific responses to workplace exposures is essential to determine whether age-specific interventions are warranted.

 

Practitioner summary: Older adults had higher passive spine stiffness and sat with less flexion during prolonged sitting. Discomfort was higher among older adults and occurred earlier in the simulation compared to younger participants, indicating that interventions, such as walking breaks may need to be implemented earlier during sitting for aged workers.     

Effects of mouse slant and desktop position on muscular and postural stresses,subject preference and performance in women aged 18–40 years

This study compared muscular and postural stresses, performance and subject preference in women aged 18–40 years using a standard mouse, a vertical mouse and a slanted mouse in three different computer workstation positions. Four tasks were analysed: pointing, pointing-clicking, pointing-clicking-dragging and grasping-pointing the mouse after typing. Flexor digitorum superficialis (FDS) and extensor carpi radialis (ECR) activities were greater using the standard mouse compared to the vertical or slanted mouse. In all cases, the wrist position remained in the comfort zone recommended by standard ISO 11228-3. The vertical mouse was less comfortable and more difficult to use than the other two mice. FDS and ECR activities, shoulder abduction and wrist extension were greater when the mouse was placed next to the keyboard. Performance and subject preference were better with the unrestricted mouse positioning on the desktop. Grasping the mouse after typing was the task that caused the greatest stress.

Practitioner Summary: In women, the slanted mouse and the unrestricted mouse positioning on the desktop provide a good blend of stresses, performance and preference. Unrestricted mouse positioning requires no keyboard, which is rare in practice. Placing the mouse in front of the keyboard, rather than next to it, reduced the physical load.     

Subjective discomfort caused by vertical whole-body vibration in the frequency range 2–100 Hz

Current standards assume the same frequency weightings for discomfort at all magnitudes of vibration, whereas biodynamic and psychological studies show that the frequency-dependence of objective and subjective responses of the human body depends on the magnitude of vibration. This study investigated the discomfort of seated human body caused by vertical whole-body vibration over the frequency range 2–100?Hz at relatively high magnitudes from 1.0 to 2.5?ms^?2 r.m.s. Twenty-eight subjects (15 males and 13 females) judged the discomfort using the absolute magnitude estimation method. The rate of growth of discomfort with increasing vibration magnitude was highly dependent on the frequency, so the shapes of the equivalent comfort contours depended on the magnitude of vibration and no single frequency weighting would be appropriate for all magnitudes. The equivalent comfort contours indicated that the standards and previous relevant studies underestimated the vibration discomfort at frequencies greater than about 30?Hz.

Practitioner Summary: The discomfort caused by vertical vibration at relatively high frequencies can be severe, particularly at relatively great magnitudes in transport. This study provides the frequency-dependence of vibration discomfort at 2–100?Hz, and shows how the frequency weightings in the current standards can be improved at relatively high frequencies.     

A parametric investigation on seat/occupant contact forces and their relationship with initially perceived discomfort using a configurable seat

The present work investigates the contact forces between sitters and seat as well as their correlations with perceived discomfort. Twelve different economy class aeroplane seat configurations were simulated using a multi-adjustable experimental seat by varying seat pan and backrest angles, as well as seat pan compressed surface. Eighteen males and 18 females, selected by their body mass index and stature, tested these configurations for two sitting postures. Perceived discomfort was significantly affected by seat parameters and posture and correlated both with normal force distribution on the seat-pan surface and with normal forces at the lumbar and head supports. Lower discomfort ratings were obtained for more evenly distributed normal forces on the seat pan. Shear force at the seat pan surface was at its lowest when sitters were allowed to self-select their seat-pan angle, supporting that a shear force should be reduced but not zeroed to improve seating comfort.

Practitioner Summary: The effects of seat-pan and backrest angle, anthropometric dimensions and sitting posture on contact forces and perceived discomfort were investigated using a multi-adjustable experimental seat. In addition to preferred seat profile parameters, the present work provides quantitative guidelines on contact force requirement for improving seating comfort.     

Driving comfort,enjoyment and acceptance of automated driving – effects of drivers’ age and driving style familiarity

Automated driving has the potential to improve the safety and efficiency of future traffic and to extend elderly peoples’ driving life, provided it is perceived as comfortable and joyful and is accepted by drivers. Driving comfort could be enhanced by familiar automated driving styles based on drivers’ manual driving styles. In a two-stage driving simulator study, effects of driving automation and driving style familiarity on driving comfort, enjoyment and system acceptance were examined. Twenty younger and 20 older drivers performed a manual and four automated drives of different driving style familiarity. Acceptance, comfort and enjoyment were assessed after driving with standardised questionnaires, discomfort during driving via handset control. Automation increased both age groups’ comfort, but decreased younger drivers’ enjoyment. Younger drivers showed higher comfort, enjoyment and acceptance with familiar automated driving styles, whereas older drivers preferred unfamiliar, automated driving styles tending to be faster than their age-affected manual driving styles.

Practitioner Summary: Automated driving needs to be comfortable and enjoyable to be accepted by drivers, which could be enhanced by driving style individualisation. This approach was evaluated in a two-stage driving simulator study for different age groups. Younger drivers preferred familiar driving styles, whereas older drivers preferred driving styles unaffected by age.