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Scott Haynes, MBME

ABSTRACT

Problems with low back pain (LBP) impact the lives of many working age adults, leaving them frustrated when their desire to work conflicts with their need to relieve the chronic discomfort. Alternative computer workstations have been designed to allow people to access the computer from a significantly reclined or supine position, which has been shown to relieve some forms of chronic LBP. A comparison of twenty-four such workstations reveals that almost half (46%) will not support full-size monitor and keyboard. Only 33% allowed access to a full-size computer from both a reclined and a supine position. Furthermore, difficulties with component adjustment and egress make these systems less than optimal for accommodating people with LBP in a typical computer workplace environment.

KEYWORDS: Low Back Pain; Supine Computer Workstation; Product Review

BACKGROUND

Computer workstations have become prevalent in today’s workplace. Although laptop computers abound, many offices are equipped with full size computer components. For people in fields such as graphic design, customer service, computer programming, or data entry much of the employee’s time is spent at a computer workstation. Traditionally, these computer workstations require the operator to sit in an upright or slightly reclined position. However, a person with chronic low back pain (LBP) may find it difficult or impossible to work in such a position for the amount of time necessary to maintain employment. Twisted trunk positions, prolonged static work postures, inadequate backrest use, and positions that cause excessive seat pan pressure may each contribute to LBP (1-3).

LBP is the most common work-related disability in people under 45 years of age, and the most expensive workers compensation claim (4). The Centers for Disease Control estimates the cost of LBP in the US to be between $50-$100 billion annually. For many individuals with chronic LBP, the ability to relieve the pressure from the lower spine by standing flat against a wall or lying supine on a regular basis is key to their ability to function in the workplace (5, 6). Unfortunately, time away from the workstation can significantly limit an employee’s productivity in a job where output is measured primarily by computer work generated. Therefore, it is important to identify a safe and efficient means to allow a person with LBP to continue to access their computer workstation while relieving the stress on their lower back (7). The purpose of this review is to compare existing computer workstations, designed specifically for use in a reclining or supine position, and to discuss their application as an office accommodation for people with chronic LBP.

METHODS

The methods used to identify potential products for review included Internet searches, contact with rehabilitation professionals, and an investigation of published literature. Products for this research were selected based on their claim of being designed for use as a computer workstation by people who choose to work in a reclined or supine position.

RESULTS

Twenty-four workstations were identified through the methods described above. The variety in the design of these workstations reflects the desire to develop systems that can meet a variety of user needs and accommodate standard computer components for a reasonable cost. In this product review, three aspects of the workstations are considered for comparison: type of design, compatibility with standard computer components, and cost.

Type of Design:

The products identified by this research were designed to allow computer access from either an independent support surface (i.e. the surface upon which the user is supported), or from an integrated support surface. The following four major types were identified.

Laptray: Laptray systems are designed for use when sitting on a flat surface with legs outstretched, as in a bed or on the floor. They consists of a flat surface (tray) supported over the user’s lower body by two sets of legs, which rest on the support surface.

Boom Support: This type consists of a broad or weighted base, resting on the floor, and a vertical support column from which one or more booms (i.e. beam or pole projecting from a vertical support) extend. Upon each boom is a tray or a mounting bracket designed to support one or more computer components. Added height adjustability and angular adjustment make the boom support systems useful for people in beds or reclining chairs. This was the most common type identified in the product review.

Crossbar Support: The system is termed “crossbar” because its main structural component crosses over the user and their support surface. The crossbar is supported by vertical members reaching to the floor on each side of the user’s support surface, forming an inverted “U-shape.” The increased base of support provides greater strength and stability, allowing the product to hold larger computer equipment.

Integrated Chair: As its name implies, these are systems in which the chair is an integral part of the workstation. Designs varied as to the amount of adjustment permitted with respect to the support surface and the computer components.

Compatibility with Standard Computer Components: The components of computer systems typically consist of a keyboard, monitor, pointing device, and central processing unit (CPU). Based on the workstation design type, there are limitations as to the compatibility of the computer hardware that can be used with each system. Of the products reviewed, 75% are compatible with a laptop keyboard and monitor. The larger systems have sufficient structural integrity to allow for the installation of a full-size keyboard (54%), and either a flat screen (46%) or CRT (33%) monitor. Static pointing devices (e.g. secured trackball or track pad) are supported by 75% of the products. Compatibility with the dynamic pointing device (e.g. cabled or wireless mouse) requires that the space be sufficiently large and level. For this reason only 46% of the products were compatible with dynamic pointing devices.

Figure 1: Number of computer workstations according to cost. (Click image for larger view)

Cost:

The cost of these computer workstations ranges from about $40-$4,000 as shown in Figure 1. Of the twenty-four systems reviewed, nearly two-thirds (63%) were $1,000 or less. This includes all of the Laptray designs and the majority of the Boom Support systems. Four out of the five Integrated Chair systems reviewed were in the range of $2001-$3000. However, it is important to note that this increased cost is due in part to the fact that these systems include the cost of the support surface.

DISCUSSION

In order to meet the physical needs of the user with chronic LBP seeking employment as a computer operator in an office environment, the workstation should 1) allow the user to assume a supine position, 2) allow the user to access the computer from various degrees of recline, 3) allow the user to get on and off of the support surface without having to twist or assume an awkward posture, and 4) support full-size computer equipment, typically found in an office environment. Just over half (54%) of the products reviewed allow the user to access the computer system from a fully supine position. However, less than half (42%) allow the user to choose between a range of reclined or supine postures. With regard to support surface access, three of the Integrated Chair types require the user to maneuver into the support surface either from an awkward stance (i.e. straddling over some large component) or by sitting askew from the workstation then pivoting into position. The other two Integrated Chair units provided a pivoting chair mechanism so that the user could easily sit then rotate into position, without the need to twist their upper body. Unfortunately, neither of these two workstations allowed the user to assume a fully supine orientation. Other types would presumably be purchased for use with the preferred support surface suitable to the user’s needs. However, because the workstation is independent of the support surface, this may require extended reaches or assistance from another person in order to position the workstation once the user is seated. As was pointed out earlier, 54% of the units reviewed are compatible with full-size keyboard and monitor (flat screen or CRT). However, only 33% allow access to full-size computer components from both a reclined and supine position.

CONCLUSIONS

Development efforts for future alternative computer workstations should be focused on systems that allow for ease of egress, compatibility with full-size computer components, and the ability to adjust independently between reclined and fully supine positions.

REFERENCES

1. Herman-Miller. (2002, 2002). Body support in the office: sitting, seating, and low back pain. Herman Miller, from http://www.hermanmiller.com/hm/content/research_summaries/wp_Body_Support.pdf
2. Bergqvist, U., Wolgast, E., Nilsson, B., & Voss, M. (1995). Musculoskeletal disorders among visual display terminal workers: individual, ergonomic, and work organizational factors. Ergonomics, 38(4), 763-776.
3. Aissaoui, R., Lacoste, M., & Dansereau, J. (2001). Analysis of sliding and pressure distribution during a repositioning of persons in a simulator chair. IEEE transactions on neural systems and rehabilitation engineering, 9(2), 215-224.
4. Deyo, R. A., Weinstein, J N. (2001). Low back pain. New England journal of medicine, 344(5), 363-370.
5. Borenstein, D. G. (1996). Chronic low back pain. Rheumatic diseases clinics of North America, 22(3), 439-456.
6. Fujimaki, G., & Mitsuya, R. (2002). Study of the seated posture for VDT work. Displays, 23(1-2), 17-24.
7. Grott, R., MA, ATP. (2001). Lying Down on the Job: Case Studies in Working While Reclined. Paper presented at the RESNA 2001 Annual Conference Proceedings: The AT Odyssey Continues, Reno, Nevada.

ACKNOWLEDGEMENTS

This paper supported by NIDRR through the Workplace Accommodations RERC, Grant # H133E020720.

Author Contact Information

Scott Haynes, MBME
Center for Assistive Technology and Environmental Access
Georgia Institute of Technology
490 10 th Street, NW
Atlanta, GA 30332-0156