Work 39 (2011) 455463 DOI 10.

3233/WOR-2011-1195 IOS Press

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Upper extremity musculoskeletal discomfort among occupational notebook personal computer users: Work interference, associations with risk factors and the use of notebook computer stand and docking station
Oguzhan Erdinc
Department of Industrial Engineering, Turkish Air Force Academy, Istanbul, Turkey

Received 27 July 2009 Accepted 30 December 2009

Abstract. Objective: This study explored the prevalence and work interference (WI) of upper extremity musculoskeletal discomfort (UEMSD) and investigated the associations of individual and work-related risk factors and using a notebook stand or docking station with UEMSD among symptomatic occupational notebook personal computer (PC) users. Participants: The participant group included 45 Turkish occupational notebook PC users. Methods: The study used self-reports of participants. The Turkish version of the Cornell Musculoskeletal Discomfort Questionnaire (T-CMDQ) was used to collect symptom data. Results: UEMSD prevailed mostly in the neck, the upper back, and the lower back with prevalence rates of 77.8%, 73.3%, and 60.0% respectively, and with WI rates of 28.9%, 24.4%, and 26.7% respectively. Aggregated results showed that 44% of participants reported WI due to UEMSD in at least one body region. Signicant risk factors were: being female, being aged < 31 years, having computer work experience <10 years, and physical discomfort during computer use. Conclusions: UEMSD prevalence and WI rates were considerable in the neck, the upper back, and the lower back. Signicant associations between certain risk factors and UEMSD were identied, but no association was found between using notebook stand and docking station and UEMSD among participants. Keywords: Cornell Musculoskeletal Discomfort Questionnaire, self-report, neck

1. Introduction Occupational use of notebook personal computers (PCs) has become very common, because of their various advantages, such as portability, compactness, and
Address

for correspondence: O. Erdinc, Hava Harp Okulu Endustri, Muhendisligi Bolum, Baskanligi 34149, Yesilyurt, Istanbul, Turkey. Tel.: +90 212 663 2490/+90 505 849 2420; Fax: +90 212 663 2838; E-mail: o.erdinc@hho.edu.tr.

effective use of time, which enable employers to provide mobility to their work force and allow users to work efciently [13]. Despite their efciency and mobility advantages, notebook PCs introduce substantial musculoskeletal (MS) risks to the users. The foremost MS risk in using notebook PCs is exposure to awkward postures in the upper extremities [310]. Several authors report that exposure to awkward postures, particularly in the neck, upper back, and head, is higher when using notebook PCs, compared to using desktop PCs [59]. Likewise,

1051-9815/11/$27.50 2011 IOS Press and the authors. All rights reserved

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muscular and mechanical loads in the upper extremities, particularly in the neck, were found to be higher when using notebook PCs, compared to using desktop PCs [6,9]. The major factor that causes MS risks in using notebook PCs was proposed to be the design of PC elements. While screens hinged to keyboards were suggested to result in neck exion and neck protraction due to difculties in viewing [2,5,8], smaller keyboards and smaller mice were suggested to result in deviated wrist postures [11], and touch pads were found to cause higher muscular activity in the neck/shoulder region [12]. Owing to their portability and compactness, using notebook PCs allows for more variable positions, compared to using desktop PCs, and variations in the work positions (e.g. typing with the notebook PC on ones lap) introduce differences in the degrees of awkward postures and muscular loadings in the upper extremities [4,7]. One way to mitigate exposure of notebook PC users to awkward postures is using external equipment, such as notebook stations and external keyboards which serve to maintain more neutral postures [9,13]. In an experimental study [13], using a notebook station and an external keyboard culminated in a 24% decrease in neck exion moment, 17% less subjective neck strain, and 17% higher productivity, compared to using notebook PC without a notebook station and an external keyboard. There are different types of external notebook equipment available in the market such as notebook stands and docking stations, which can provide adjustability and serve to improve postural risks while using notebook PCs. However, there is little knowledge regarding the inuence of using these types of external equipment with notebook PCs in natural work environments. The abovementioned studies indicate that using notebook PCs involve noticeable differences compared to using desktop PCs, and authors stress that one possible consequence of exposure to MS risks in using notebook PCs is elevated upper extremity MS discomfort (UEMSD) among notebook PC users [5,6,12]. Whilst the extent of UEMSD among occupational desktop PC users has been extensively studied from different standpoints such as prevalence [1418], associations with individual, work-related, and psychosocial risk factors [1422], and work performance effects [16, 2325], studies on UEMSD among notebook PC users are scarce [1,5,8]. Among occupational desktop PC users, UEMSD was reported to prevail in the neck, shoulders, upper and lower back, hands, and wrists [14 18]. Several risk factors, such as being female [15,17, 19,20], duration of daily/weekly computer work [14,16,

17,21,22], duration of computer work without taking breaks [14,16], and subjective physical discomfort during computer work [14,15,18], were found to be linked with UEMSD in computer work. Work performance effects of UEMSD such as reduced productivity [23 25] and work interference (WI) [16] among occupational desktop PC users were also documented. On the other hand, few studies examined UEMSD in notebook PC use [1,5,8]. In an experimental study, notebook PC users were found to experience MSD mostly in the neck and thoracic spine [1]. In another study, MSD in notebook PC use was found to be located in the neck, shoulders, elbow, and wrists, and smaller display units were found to be associated with higher MSD rates among notebook PC users [8]. However, these studies were performed in experimental settings, and ndings were restricted to experiment subjects. Furthermore, no study was found to examine the WI of UEMSD and the associations of individual and work-related risk factors and using a notebook stand or docking station with UEMSD among occupational notebook PC users. In this respect, objectives of this cross-sectional study are: a) to explore the prevalence and WI of UEMSD, b) to investigate the associations of individual and work-related risk factors and using a notebook stand or docking station with UEMSD among a group of symptomatic occupational notebook PC users. The main hypotheses of the study are: 1) The highest prevalence and WI of UEMSD was expected to be found in the neck, 2) Being older, being female, having longer computer work experience, longer duration of computer work, longer duration of computer work without a break, visual discomfort and physical discomfort during computer work were expected to be associated with higher prevalence of the UEMSD, whereas using a notebook stand or docking station was expected to be associated with lower prevalence of the UEMSD among participants. 2. Materials and methods 2.1. Data collection instrument The current study was based upon the self-reports of symptomatic occupational notebook PC users. The data was collected using the Turkish version of the Cornell MS Discomfort Questionnaire (T-CMDQ) [26 28], which addresses seven-day frequency,severity, and WI of MSD across 18 body regions on three scales. In the current study, data collected for 11 upper extremity

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regions were used. The responses given on the frequency, the severity, and the WI scales can be given weights [26]. On the frequency scale, the frequency of experiencing MSD in the past work week is rated across the following anchors: Never,12 times last week, 34 times last week, Once every day and Several times every day with weights of 0, 1.5, 3.5, 5, and 10, respectively. On the severity scale, the severity of the experienced MSD is rated across the following anchors: Slightly uncomfortable, Moderately uncomfortable and Very uncomfortable with weights of 1, 2, and 3, respectively. On the WI scale, the interference of experienced MSD with ones working ability is rated across the following anchors: Not at all, Slightly interfered and Substantially interfered with weights of 1, 2 and 3, respectively. The product of the weighted responses given on the three scales gives a weighted score (WS) for each body region [26], which ranges between 0 (Never on the frequency scale) and 90 (10 on the frequency scale 3 on the severity scale 3 on the WI scale). The sum of the WSs across 11 body regions for each person gives a total weighted score (TWS) ranging between 1.5 (1.5 on the frequency scale x 1 on the severity scale 1 on the WI scale for one body region) and 990 (10 on the frequency scale 3 on the severity scale 3 on the WI scale for all 11 body regions), which indicates the persons overall UEMSD status. Data on individual and work-related characteristics of participants and use of a notebook stand or docking station were collected on a separate page that preceded T-CMDQ. 2.2. Participants The participant group was comprised of Turkish occupational notebook PC users working in different companies from various business lines such as manufacturing, service, airlines, and architecture in Turkey. For data collection, the author e-mailed the questionnaires and an explanation of the research to several employees in various companies with whom he had contact. Then, these employees circulated the questionnaires and the explanation of the research within their companies by e-mail. A total of 136 questionnaires were collected. Of the returned questionnaires, 18 of them were invalid due to missing data. Remaining 118 questionnaires were checked against four inclusion criteria: 1) to work on a notebook PC for > 4 hours/day [14,16,20,21], 2) to experience MSD in at least one upper extremity body region, 3) not to have experienced an MS injury, disorder, or operation within

Table 1 Individual and work-related characteristics of participants Gender Females Males Age Range Median Education High school University Graduate Computer work experience Range Median Occupational Notebook PC use experience < 5 years 5 years Duration of computer work < 8 h/day > 8 h/day Duration of computer work without a break < 2 h/day > 2 h/day Visual discomfort during computer work Yes No Physical discomfort during computer work Yes No Use of notebook stand and docking station Docking station-mouse Notebook stand-mouse Docking station Notebook stand Mouse No ext. equipment n (%) 29 (64.4) 16 (35.6) 2352 years 31 years n (%) 2 (4.4) 21 (46.7) 22 (48.9) 226 years 10 years n (%) 23 (51.1) 22 (48.9) n (%) 18 (40.0) 27 (60.0) n (%) 15 (33.3) 30 (66.7) n (%) 10 (22.2) 35 (77.8) n (%) 25 (55.6) 20 (44.4) n (%) 3 (6.7) 8 (17.8) 3 (6.7) 3 (6.7) 17 (37.8) 11 (24.4)

the past year before the study [6,13,15], and 4) not to have received medical treatment due to an MS problem within the past three months before the study [5,6,12]. In total, 73 (61.9%) of respondents were excluded due to these criteria, and the nal participant group included 45 (38.1%) symptomatic occupational notebook PC users (Table 1). 2.3. Individual and work-related risk factors The study investigated the associations between two individual and six work-related risk factors and UEMSD among participants. Factors with more than two options were dichotomized for statistical analysis, due to the low number of participants. Individual risk factors were: Age (dichotomized into < 31 years and years) Gender Work-related risk factors were: 31

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Computer work experience (dichomotized into < 10 and 10 years), Occupational Notebook PC use experience (< 5 and 5 years) Duration of computer work (46, 68, and > 8 hours/day; dichomotized into < 8 and > 8 hours/day) Duration of computer work without a break (< 1, 12, 24, and > 4 hours/day; dichomotized into < 2 and > 2 hours/day) Visual discomfort, discerned with the question, Do you experience visual discomfort during computer work? (Yes No) Physical discomfort, discerned with the question, Do you experience physical discomfort during computer work? (Yes No) 2.4. Use of a notebook stand or docking station The use of a notebook stand or docking station was explored with the following question: Do you use external equipment during computer work? The following anchors were possible in response to the above question: I do not use any external equipment, I use a mouse, I use a notebook stand, and I use a docking station. No anchor was provided for other external equipment such as external keyboards. Multiple selections of anchors were allowed, and an open-ended answer section was also provided for participants to explain their equipment use in any other way. Due to the low number of participants, two groups were formed among the six groups of responses displayed in Table 1. While the participants who used notebook stand or docking station with or without mouse formed the Notebook stand and docking station group, other participants who used only mouse or no external equipment at all formed the No external equipment group. No participant reported equipment use in any other way in the open-ended answer section. 3. Results 3.1. Prevalence and WI of UEMSD The prevalence and WI of UEMSD among participants were investigated using the percentages of responses given on the frequency, the severity, and the WI scales. Table 2 displays the frequency distribution of responses and the mean WS across body regions. The three body regions mostly affected by UEMSD

were the neck, the upper back, and the lower back, with prevalence rates of 77.8%, 73.3% and 60.0% respectively. These three body regions also involved the highest WI with rates of 28.9%, 24.4%, and 26.7% respectively, and highest mean WSs of 8.28, 9.57, and 5.89 respectively. Thus, further investigations involved these three body regions. 3.2. Associations between individual and work-related risk factors and UEMSD The associations between individual and workrelated risk factors and UEMSD were explored in two aspects: the occurrence of UEMSD and the overall UEMSD status. The associations between individual and workrelated risk factors and the occurrence of UEMSD in the neck, the upper back, and the lower back were computed as prevalence ratios (PR), and 95% condence intervals (CI) which did not include one were accepted as statistically signicant [29] (Table 3). The signicant risk factors were as follows: being female for the neck, and being aged of < 31 years and having < 10 years of computer work experience for the upper back. None of the risk factors were signicantly associated with the occurrence of MSD for the lower back region. Additionally, being female and experiencing physical discomfort during computer work were insignicant but noticeable risk factors for the upper back and the neck, respectively. The associations between individual and workrelated risk factors with the overall UEMSD statuses of participants were explored by comparing the mean TWS of the groups. The non-parametric MannWhitney U test was performed to compare the mean TWSs, and two-sided p values < 0.05 were accepted as statistically signicant (Table 4). Being female and experiencing physical discomfort during computer work were signicantly associated with the overall UEMSD status. In addition, occupational notebook PC use experience of < 5 years was an insignicant but notable risk factor. 3.3. Associations between using a notebook stand or docking station and UEMSD The associations between using external equipment and the occurrence of UEMSD and the overall UEMSD status were explored with the abovementioned methods used for risk factors. Based upon previous literature ndings which suggest that using external equipment

Table 2 The prevalence and work interference of upper extremity musculoskeletal discomfort Severity Slightly Moderately Severely n (%) n (%) n (%) 24 (53.3) 11 (24.4) 13 (28.9) 5 (11.1) 1 (2.2) 16 (35.6) 3 (6.7) 20 (44.4) 12 (26.7) 1 (2.2) 5 (11.1) 3 (6.7) 3 (6.7) 1 (2.2) 17 (37.8) 10 (22.2) 6 (13.3) 2 (4.4) 2 (4.5) 2 (4.5) 16 (35.6) 4 (8.9) 1 (2.2) 5 (11.1) 2 (4.4) Work interference Weighted scores Not at all Slightly Substantially Mean (SD) n (%) n (%) n (%) 22 (48.9) 13 (28.9) 8.28 (12.33) 12 (26.7) 7 (15.6) 5.68 (1.84) 15 (33.3) 4 (8.9) 2.48 (4.81) 22 (48.9) 9 (20.0) 2 (4.4) 9.57 (17.81) 3 (6.7) 5 (11.1) 2.40 (7.33) 3 (6.7) 1 (2.2) 0.56 (0.32) 15 (33.3) 12 (26.7) 5.89 (9.28) 3 (6.7) 5 (11.1) 1.99 (6.56) 2 (4.4) 1 (2.2) 0.38 (1.64) 15 (33.3) 5 (11.1) 1 (2.2) 5.00 (14.84) 4 (8.9) 3 (6.7) 1.64 (6.40)

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Frequency Never 12 times last 34 times last Once every Several times every n (%) week n (%) week n (%) day n (%) day n (%) Neck 10 (22.2) 13 (28.9) 9 (20.0) 4 (8.9) 9 (20.0) Right shoulder 26 (57.8) 5 (11.1) 5 (11.1) 2 (4.4.) 7 (15.6) Left shoulder 26 (57.8) 9 (20.0) 5 (11.1) 2 (4.4) 3 (6.7) Upper Back 12 (26.7) 11 (24.4) 9 (20.0) 5 (11.1) 8 (17.8) Right upper arm 37 (82.2) 2 (4.4) 1 (2.2) 3 (6.7) 2 (4.4) Left upper arm 41 (91.1) 1 (2.2) 1 (2.2) 2 (4.4) Lower back 18 (40.0) 8 (17.8) 7 (15.6) 9 (20.0) 3 (6.7) Right forearm 37 (82.2) 1 (2.2) 4 (8.9) 2 (4.4) 1 (2.2) Left forearm 42 (93.3) 2 (4.4) 1 (2.2) Right wrist 24 (53.3) 12 (26.7) 2 (4.4) 4 (8.9) 3 (6.7) Left wrist 38 (84.4) 2 (4.4) 3 (6.7) 1 (2.2) 1 (2.2)

Body regions

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O. Erdinc / UEMSD among occupational notebook PC users Table 3 Associations of individual and work related risk factors, and use of notebook stand and docking station with the occurrence of upper extremity musculoskeletal discomfort Individual and work-related factors n Age < 31 years 31 years Gender Females Males Computer work experience < 10 years 10 years Occupational Notebook PC use experience < 5 years 5 years Duration of computer work < 8 h/day > 8 h/day Duration of computer work without a break < 2 h/day > 2 h/day Visual discomfort during computer work Yes No Physical discomfort during computer work Yes No Use of notebook stand and docking station Notebook stand and docking station No external equipment 20 25 29 16 19 26 23 22 18 27 15 30 10 35 25 20 17 28 Neck PR (95 % CI) 1.18 (0.871.60) Ref. 1.59 (1.022.49) Ref. 1.15 (0.851.56) Ref. 1.14 (0.831.56) Ref. Ref. 1.13 (0.801.58) Ref. 1.09 (0.771.55) 1.04 (0.721.48) Ref. 1.36 (0.951.93) Ref. Ref. 1.03 (0.741.42) Upper back PR (95 % CI) 1.50 (1.062.13) Ref. 1.47 (0.932.34) Ref. 1.45 (1.032.04) Ref. 1.15 (0.801.64) Ref. Ref. 1.33 (0.88-2.01) Ref. 1.15 (0.761.73) 0.94 (0.601.48) Ref. 1.23 (0.841.79) Ref. Ref. 0.93 (0.661.33) Lower back PR (95 % CI) 1.16 (0.721.86) Ref. 1.58 (0.862.89) Ref. 1.27 (0.792.03) Ref. 1.39 (0.852.29) Ref. Ref. 0.83 (0.52-1.33) Ref. 0.63 (0.400.97) 1.23 (0.752.01) Ref. 1.36 (0.812.27) Ref. Ref. 1.21 (0.72-2.06)

such as notebook stations or external keyboards [9,13] would decrease exposure to awkward postures, using external equipment was taken as the reference for PR computation. No signicant association was found between using a notebook stand or docking station and either the occurrence of UEMSD in the three investigated body regions (Table 3) or the overall UEMSD status (Table 4). 4. Discussion 4.1. Main ndings The current study explored the prevalence and WI of UEMSD and investigated the associations of individual and work-related risk factors and using a notebook stand or docking station with UEMSD among a group of symptomatic Turkish occupational notebook PC users. The study highlighted that the three body regions with the highest MSD prevalence rate, WI rate, and mean WS were the neck, the upper back, and the lower back. Aggregated results showed that 44% of partici-

pants reported interference of MSD they experienced in at least one body region with their working ability. This result extended previous research [16,2325] by showing that UEMSD leads to not only health outcomes, but also work performance outcomes in computer work. Being female was found to be signicantly associated with MSD in the neck and with the overall UEMSD status. Furthermore, an insignicant but notable association was found between being female and MSD in the upper back. Ample evidence has suggested that females form a higher MSD risk group compared to males within the computer work force [15,17,19,20]. This study showed that female occupational notebook PC users also have a higher risk of experiencing UEMSD, compared to their male counterparts. Previous literature did not present conclusive ndings about the association between age and UEMSD among computer workers [15,16,18,20,30]. The current study identied signicant association between being aged < 31 years and MSD in the upper back. This nding could be attributed to the computer use habits of young people, who are likely to spend a substantial portion of their leisure times using computers. Moreover, there is evidence pointing to the consider-

O. Erdinc / UEMSD among occupational notebook PC users Table 4 Associations of individual and work related risk factors, and use of notebook stand and docking station with overall upper extremity musculoskeletal discomfort status Individual and work-related factors n Age < 31 years 31 years Gender Females Males Computer work experience < 10 years 10 years Occupational Notebook PC use experience < 5 years 5 years Duration of computer work < 8 h/day > 8 h/day Duration of computer work without a break < 2 h/day > 2 h/day Visual discomfort during computer work Yes No Physical discomfort during computer work Yes No Use of notebook stand and docking station Notebook stand and docking station No external equipment 20 25 29 16 19 26 23 22 18 27 15 30 10 35 25 20 17 28 Total weighted score Mean (SD) p 47.00 (59.99) 41.34 (50.39) 53.41 (53.78) 26.53 (52.47) 61.11 (69.13) 31.25 (36.81) 60.20 (61.67) 26.77 (39.92) 56.53 (70.92) 35.41 (38.92) 38.80 (38.24) 46.38 (61.19) 38.60 (35.59) 45.36 (58.89) 47.36 (44.60) 39.48 (65.39) 47.82 (48.09) 41.45 (58.45) 0.486 0.007 0.171 0.052 0.982 0.547 0.619 0.024 0.447

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able prevalence of UEMSD associated with notebook PC use among undergraduate students, who comprise a signicant portion of the prospective computer work force [31,32]. Early development of UEMSD prior to job entry could turn young occupational notebook PC users into a higher risk group, compared to older users. Therefore, measures addressing UEMSD among occupational notebook PC users (e.g. ofce ergonomics training) should primarily target the young work force, and such measures should be taken even prior to job entry, during the undergraduate years, when these individuals begin to use notebook PCs extensively both for educational and personal activities. Computer work experience of < 10 years was found to be signicantly associated with MSD in the upper back, and occupational notebook PC use experience of < 5 years was found to be insignicantly but notably associated with the overall MSD status. The users with longer computer work experience and longer occupational notebook PC use experience could be expected to have higher UEMSD prevalence, compared to users with shorter work experience lengths. However, the results of the current study contradicted these expecta-

tions. Older users with longer length of computer work experience could have adopted measures against MSD risks, such as taking frequent breaks or maintaining neutral postures during computer work. Another factor could be task content, which was suggested to be associated with reduced productivity due to MSD among computer workers [24]. Whilst older users with longer work experience could perform tasks involving more creativity and decision-making responsibilities due to seniority, younger computer workers with shorter work experience are more likely to perform data-entry or typing tasks of a static and repetitive nature, leading to the higher risk of developing UEMSD symptoms. Physical discomfort during computer work was suggested to indicate the presence of ergonomic problems in the workstations used [18]. Previous studies identied subjective physical discomfort as a risk factor for neck pain among occupational desktop PC users [14, 15]. The current study identied a signicant association between physical discomfort and the overall MSD status. Moreover, an insignicant but notable association was found between physical discomfort and MSD in the neck. Thus, the current study extends previ-

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ous research showing that physical discomfort is a risk factor for MSD in the neck not only among occupational desktop PC users, but also among occupational notebook PC users. Using external equipment, particularly a notebook station and external keyboard was reported to decrease exposure to awkward postures and thus was suggested to reduce UEMSD risk in using notebook PCs [9,13]. Therefore, using notebook stand and docking station was expected to be associated with lower prevalence of UEMSD among participants. However, the current study did not identify an association between using a notebook stand and docking station and either the occurrence of UEMSD or the overall MSD status. In addition, physical discomfort was not more common among those who did not use a notebook stand and docking station (2 = 0.34, p: 0.559). 4.2. Limitations and future work The current study was based solely on the self-report of risk factors, use of a notebook stand or docking station, and the prevalence and the WI of UEMSD among participants. The cross-sectional design of the study did not involve causality between the investigated risk factors and UEMSD in occupational notebook PC use. The number of participants was low, and future studies involving larger groups would allow for more elaborate investigations on risk factors and the use of notebook stand and docking station. Due to the low number of participants, information regarding the use of notebook stand and docking station could not be expanded; participants were grouped in two: those who use notebook stand or docking station and the remaining participants who use only mouse or no equipment at all. Future studies can explore the potential associations between using notebook stand and docking station and UEMSD separately. Moreover, use of different external equipment which can improve the posture and inuence the occurrence of UEMSD such as external keyboards or cooling pads was not explored in the current study. No data was collected regarding the use of pointing devices (e.g. mouse) and external keyboards which could affect UEMSD outcomes in occupational notebook PC use. This limitation introduced a confounding effect on the ndings of the study. Future studies can further investigate the potential associations between using other types of external equipment (e.g. external keyboards) and the extent of UEMSD among occupational notebook PC users. Although not explored in the current study, notebook PCs can be used in various set-

tings. Future studies could investigate the association between the various settings of use, the use of external equipment, physical discomfort, and UEMSD among occupational notebook PC users. The current study indicates that younger notebook PC users comprise a high risk group for MSD in the upper back. Future studies can investigate the association between UEMSD status during undergraduate years and during work among young occupational notebook PC users. Job seniority and task content, which were not explored in the current study, are also considered to affect developing UEMSD in computer work. Future studies can explore the association between job seniority, task content, and UEMSD among occupational notebook PC users. 5. Conclusions The current study showed that UEMSD mostly prevailed in the neck, the upper back, and the lower back among occupational notebook PC users. Experienced MSD in these body regions considerably interfered with ones working ability. Signicant risk factors for UEMSD were: being female for the neck and the overall UEMSD status, being aged of < 31 years and having computer work experience of < 10 years for the upper back, and physical discomfort for the overall UEMSD status. Insignicant but notable risk factors for UEMSD were: being female for the upper back, physical discomfort for the neck, and occupational notebook PC use experience of < 5 years for the overall UEMSD status. No association was found between using notebook stand and docking station and either the occurrence of UEMSD or the overall UEMSD status among participants. Acknowledgements The author is grateful to Professor Alan Hedge for his support to use CMDQ. The author thanks Kubilay Hot for his valuable support in data collection. References
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