Ergonomics

ISSN: 0014-0139 (Print) 1366-5847 (Online) Journal homepage: http://www.tandfonline.com/loi/terg20

Two posture analysis approaches and their

application in a modified Rapid Upper Limb
Assessment evaluation

S. Bao , N. Howard , P. Spielholz & B. Silverstein

To cite this article: S. Bao , N. Howard , P. Spielholz & B. Silverstein (2007) Two posture analysis
approaches and their application in a modified Rapid Upper Limb Assessment evaluation,
Ergonomics, 50:12, 2118-2136, DOI: 10.1080/00140130701458230

To link to this article: http://dx.doi.org/10.1080/00140130701458230

Published online: 21 Nov 2007.

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 Ergonomics
Vol. 50, No. 12, December 2007, 2118–2136

Two posture analysis approaches and their

application in a modified Rapid Upper Limb
Assessment evaluation
S. BAO*, N. HOWARD, P. SPIELHOLZ and B. SILVERSTEIN

Safety & Health Assessment & Research for Prevention (SHARP) Program,
Washington State Department of Labor and Industries, P.O. Box 44330, Olympia,
WA 98504, USA
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This paper presents two posture risk quantification methods: first, an event-
based method where the most common and the worst postures are estimated
in a task; second, a time-based method where posture distributions are
calculated from random samples of observed postures in the task. A ‘click-
on-screen’ posture data entry method was developed for the time-based
posture analysis method to make the observation process easier and to reduce
possible posture categorization bias. Both methods were used to quantify
various work posture parameters among a study cohort of 733 subjects from
a prospective epidemiological study of upper extremity musculoskeletal
disorders. Composite posture indices using a modified Rapid Upper Limb
Assessment (RULA) method were also computed using data obtained by the
two posture analysis methods. Results showed that both methods were able
to distinguish jobs with large differences in certain posture measures.
However, they did not produce the same results and could not be used
interchangeably. Risk evaluation criteria should be developed, either for
specific posture parameters or as a composite index, with a well-defined
postural analysis method, so that users can follow exact procedures and
obtain comparable results. The event-based method is easy to use and may
suit practitioners better, while the time-based method adds more information
to the measurement and may suit users who want more detailed information
about posture exposure.

Keywords: Task-based analysis; Event-based analysis; Work-related muscu-

loskeletal disorders

1. Introduction
Awkward working posture has been considered a risk factor related to musculoskeletal
disorders (MSDs) in workplaces. Holmstrom et al. (1992) found that workers working

*Corresponding author. Email: baos235@lni.wa.gov

Ergonomics
ISSN 0014-0139 print/ISSN 1366-5847 online ª 2007 Taylor & Francis
http://www.tandf.co.uk/journals
DOI: 10.1080/00140130701458230
 Posture analysis and application in a RULA evaluation 2119

with their hands above their shoulders for greater than 4 h/d were twice as likely to have
neck MSDs as those working with the same posture for less than 1 h/d. English et al.
(1995) reported that the risk of having a medically diagnosed shoulder condition was
increased by repeated shoulder rotation with an elevated arm (odds ratio ¼ 2.30,
p 5 0.05). Based on currently available epidemiological data (National Institute for
Occupational Safety and Health 1997), there is strong evidence for a positive association
between work that requires extreme postures in combination with other job risk factors
and hand/wrist tendonitis.
There are varied degrees of association between work postures and upper extremity
MSDs, depending on the body part and type of diagnosis. Those studies finding weak
associations may have suffered from difficulty with posture exposure measurement
approaches. Most studies investigating relationships between postural variables and
MSDs have been based on group exposure measurements; that is, taking exposure
measurements on a few so-called ‘representative’ subjects in a job exposure group and
extrapolating the results to the whole group. Silverstein et al. (1987) found in their study
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of carpal tunnel syndrome that among all the postural variables recorded, the variability
between individuals with similar or identical jobs was probably the greatest for wrist
postural variables. This individual variation within jobs was not taken into account in the
analysis, creating a potential for misclassification of individuals by using the variable
‘job category’ in the analysis.
Different posture measurement methods have been used in epidemiological studies of
MSDs. The roughest format is the use of job titles, such as welders vs. office clerks
(Herberts et al. 1981) or dentists vs. pharmacists (Milerad and Ekenvall 1990). Even
though work postures are not measured, job titles give crude descriptions about physical
exposures, including postures associated with jobs. For example, welders might have
more awkward postures than office clerks, and dentists have more awkward postures
than pharmacists. Instead of using job titles, some studies have used descriptive
workplace characteristics, such as workstation height, as a surrogate measure for posture.
For example, Hoekstra et al. (1994) used descriptive differences between workstation
designs at two locations to provide a plausible explanation for finding a high odds ratio
(4.0). At the higher risk location, the workstation surface was too high to serve as a
keyboard support, there were non-adjustable chairs and it was observed that ‘non-
adjustable furniture universally promoted undesirable postures’.
More accurate measurement methods, such as electrogoniometers (Hansson et al.
1996, Wahlstrom et al. 2000) or potentiometers (Aarås et al. 1988) have been used in
occupational studies to measure postural angles and movements. However, these are
often only applied to small population samples. Another weak point of the direct
measurement method is that only postures of a small number of joints can be measured
simultaneously due to technology and/or resource limitations.
In musculoskeletal epidemiological research, the most commonly used posture
exposure measurement methods have been questionnaires and observations. Linton
and Kamwendo (1989) and Bernard et al. (1994) asked workers if bending and twisting
occurred in their jobs. Viikari-Juntura et al. (1994) questioned workers about the amount
of time they worked with their trunk twisted or bent. Tola et al. (1988) collected
information about frequency of task performed and percentage of time spent hanging
duct work. Questionnaire methods are able to reach a large number of subjects, but they
may not be very accurate or precise.
Observational methods of posture measurement have been considered a practical
and reasonably reliable tool in musculoskeletal epidemiological research. Posture
 2120 S. Bao et al.

observations can be made on site or from video recordings. Burdorf et al. (1992), for
example, observed trunk bending through direct observations on site. Due to
the limitation of selective attention, the number of body joints and number of
posture categories that can be observed simultaneously are limited when real-time
posture categorization decisions are required. Video analysis allows the analyst to review
the video tapes repeatedly if multiple postural parameters need to be processed (Kilbom
et al. 1986b, Kilbom and Persson 1987, Jonsson et al. 1988). It is also possible to play the
tape in slow motion for fast movement operations, so that the analyst has enough time to
make his/her posture evaluation decisions. A limitation of this approach is that recorded
images may sometimes be obstructed by other objects, hence making a posture
categorization judgement difficult.
It is a common practice in posture risk evaluations to use a pre-defined posture
categorization system (e.g. McAtamney and Corlett 1993), so that an analyst only
needs to decide which category a joint angle is in. Making a pre-defined posture
categorization system is somewhat arbitrary, although some researchers might argue
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that their selections of the various cut-off points were based on previous findings.
However, a number of such studies had little physiological justification when making
their pre-defined posture category selections. Differences in categorization sometimes
make comparisons between studies difficult (Juul-Kristensen et al. 1997). Another
weakness with a pre-defined posture categorization system is that possible classification
bias may occur if the analyst has some advanced knowledge about the working
condition or health condition of the subject observed. When a work posture is close to
a boundary line between two angular sectors, the posture may be placed in the higher
risk posture category if the analyst knows the work condition is poor or the worker had
a MSD complaint.
Although individual work postures have been used in combination as exposure
parameters in determining job risk levels, such as upper arm flexion/extension and
neck lateral flexion, the use of multiple posture parameters simultaneously in
epidemiological modelling can be overwhelming and confusing. Consequently, simple
composite indices have been developed. These indices consider multiple posture
parameters and some exposure parameters, such as force, repetition and vibration.
Using different weighting systems and formulae, a single index is calculated to
quantify job risk levels. For example, the Rapid Upper Limb Assessment (RULA)
method (McAtamney and Corlett 1993) takes various body postures combined with
force and repetition estimates to calculate several scores for the upper arm, hand/wrist
and lower extremity. Combining these scores, a final RULA score is obtained and
used as a job risk level measure. The original RULA method was developed, based on
a group of visual display terminal operators, whose working postures were relatively
constant.
For jobs in general industry, working postures are changed frequently. Various
methods have been used by ergonomics practitioners to collect the posture data. Some
may use the so-called ‘most commonly’ occurring postures and/or the ‘worst’ postures
in a task or job (event-based approach) and calculate the corresponding RULA
scores. Others may use a work sampling strategy to collect posture samples (time-
based approach). RULA scores are computed for these posture samples and a single
score is then calculated using some sort of data reduction method (e.g. the average
score).
The present study is part of a prospective study of upper extremity MSDs, where
individual exposure and health outcome measures were collected, in order to establish
 Posture analysis and application in a RULA evaluation 2121

relationships between these parameters. This paper addresses two postural risk
quantification methods with the following specific purposes:

. To describe in detail two postural risk quantification methods used in a large

prospective upper extremity MSD study: event-based and time-based posture
analysis.
. To introduce a posture estimation method for the time-based posture analysis method
that might reduce analyst categorization bias.
. To examine the relationships between event-based and time-based posture analysis
methods.
. To describe a modified RULA method using the event-based and time-based posture
analysis methods.
. To quantify posture exposure of individual workers in the large epidemio-
logical cohort using the two posture analysis methods and the modified RULA
method.
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2. Subjects and methods

2.1. Subjects
Postural exposure parameters used for the two posture analysis methods were collected
from the 733 eligible participants in the study. These participants were from the baseline
worksite visits of the study at 12 different worksites in manufacturing (n ¼ 634 or 86.5%
of the study population coming from nine sites) and health care (n ¼ 99 or 13.5% of the
study population coming from three sites). A total of 350 females (median age 42.0 years,
range 18.1–64.1 years) and 383 males (median age 36.6 years, range 18.1–64.9 years)
participated in the study. The 733 subjects had 201 different job titles. The job titles of
‘assembler’ (101 subjects) and ‘painter’ (25 subjects) were common in four to seven
different sites. However, workers with the same job titles often perform quite different
tasks at different worksites and even within the same worksite. Other job titles, such as
‘hook fabricator’ or ‘deckhand’ were unique to particular worksites and only one
employee in the study population had each of those job titles. Although individual health
outcome data were also collected for each participant in the study, these results were
blinded from the exposure data collection personnel and the data are not included in the
present paper. For the purpose of comparing the applications of the two posture analysis
methods with the study population, the subjects were grouped into five different
categories according to the Selected Characteristics of Occupations Defined in the
Revised Dictionary of Occupational Titles (US Department of Labor 1993). These
categories were:

1. Sedentary work (job type S): exerting up to 10 lbs of force occasionally or a negligible
amount of force to lift, carry, push, pull or move objects, including the human body;
involves sitting most of the time, but may include walking or standing for brief
periods (122 workers or 16.6% of the study population).
2. Light work (job type L): exerting up to 20 lbs of force occasionally or up to 10 lbs
of force frequently or negligible amount of force constantly to move objects;
walking/standing for significant times, or sitting most of the time while using arm/
leg controls; working at production rate while constantly pushing or pulling
 2122 S. Bao et al.

materials, even though the weight of the materials is negligible (210 workers or
29.1% of study population).
3. Medium work (job type M): exerting 20–50 lbs of force occasionally, or 10–25 lbs of
force frequently or up to 10 lbs to constantly move objects (272 workers or 37.1%
of the study population).
4. Heavy work (job type H): exerting 50–100 lbs of force occasionally or 25–50 lbs of
force frequently or 10–20 lbs of force constantly to move objects (112 workers
or 15.3% of the study population).
5. Very heavy work (job type V): exerting more than 100 lbs of force occasionally or
more than 50 lbs of force frequently or more than 20 lbs of force to constantly move
objects (17 workers or 2.3% of the study population).

This study was approved by the Washington State Institutional Review Board. Written
consent from each subject was obtained prior to data collection and was available in
different languages along with verbal translation if necessary.
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2.2. Data collection

As part of the prospective study of risk factors of upper extremity MSDs, a battery of
comprehensive exposure variable data collection methods was designed and implemented
(Bao et al. 2006). During worksite visits, each worker was videotaped performing his/her
job. Cyclic single task jobs were filmed for 15 min and cyclic two- to four-task jobs were
filmed for 20 to 40 min (10 min for each task). For a non-cyclic job (e.g. maintenance),
three 10-min samples were recorded at randomly selected periods during the shift. This
was aimed at reducing the temporal component of exposure variability within individual
workers. To make the postural assessment easier, two synchronized video cameras were
used to capture the job performance from different angles and to cover both sides of the
worker. The video taping was completed by a minimum of one of three ergonomists
involved in the study teamed with a technician. Jobs were randomly assigned to the
ergonomists.

2.3. Data processing

Video tapes were digitized and processed in the laboratory. Postural coding processes
were carried out on these digitized video recordings and two types of posture analysis
were conducted: event-based and time-based.
Event-based posture analysis was based on each of the tasks in a job. Work postures
were observed by one of the three ergonomists for a minimum of 15 min. The assignment
was randomly and evenly distributed among the ergonomists. The ergonomists were
blinded from the health outcome data of the subjects. From each digitized video tape,
postures of the neck, shoulders, arms, hands and trunk were estimated according to a set
of pre-defined posture angles. The most common posture and the worst posture for each
of the body parts were estimated for each of the tasks in a job. Figure 1 shows a data
entry form for this posture analysis. An electronic version of this data entry form was
used for the data entry.
Time-based posture analysis was based on posture observations made from a set of
randomly selected points of time during a task (75 frames for a single task job, 80 frames
for a two-task job, 90 frames for a three-task job and 100 frames for a four-task job). The
analysis was done by trained laboratory analysts, who had no prior knowledge of
 Posture analysis and application in a RULA evaluation 2123
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Figure 1. Example of data entry interface for the event-based posture analysis (the
pictures shown being for illustrative purpose only and not representing the actual
analysis).

the workers’ health conditions. To reduce the effect of individual analyst variations,
the frames of each individual subject were assigned to two analysts for processing. Each
processed half of the frames and results of all frames were pooled.
A continuous angular scale was used to overcome potential categorization bias in an
analyst’s posture estimation that might be influenced by his/her overall perception about
the working conditions of the subject if a pre-defined posture system was used.
Angular data were entered and saved as continuous variables. No indication of any
subsequent grouping was provided at the data entry stage. The continuous angular
data were later grouped in the data processing stage using the pre-defined posture
categorization system.
A new exposure data entry and processing program (COMPASS) was developed to
provide the continuous scale entry interface and recording device for the posture
estimate. One of the COMPASS data processing screens is shown in figure 2. In this
screen, the worker is shown from the two camera angles at a randomly pre-selected video
frame. The analysts independently observed the working postures in their assigned video
frames and estimated the approximate positions of the various body parts by clicking on
the corresponding posture diagram. The continuous angular data were automatically
entered into a database.

2.4. Data analysis and statistics

Table 1 shows the pre-defined posture categories that were used in coding for the
event-based posture analysis. The same posture categorization system was also used in
the processing stage of the time-based posture analysis for the purpose of comparisons
with the event-based posture analysis. In fact, any posture categorization system can
 2124 S. Bao et al.
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Figure 2. Example of data entry interface for the time-based posture analysis (the
pictures shown being for illustrative purpose only and not representing the actual
analysis).

be used for the time-based posture analysis, since the original posture data were
continuous.
The most common posture and the estimated worst posture of the event-based posture
analysis data were determined separately at the task level for the individual subjects and
were compared to the corresponding posture parameters of the time-based posture
analysis.
In order to obtain the corresponding measures at the job level for the event-based
posture analysis data, the highest posture estimates among multiple tasks for each
individual subject were used as the worst postures at the job level. The most common
posture estimates were selected using the posture estimates corresponding to the longest
duration task. If task durations were equal among the tasks, the higher posture
estimates were used as the most common posture estimates at the job level.
The modified RULA method utilized only the postural parameters of the original
RULA method (McAtamney and Corlett 1993) in the calculation. Muscle use and
force/load factors were excluded in this modified RULA method. This was done by
calculating the individual RULA elemental scores for the upper arms, forearms, wrists,
neck and trunk at the task level using the event-based posture analysis data (most
common and worst postures). Since the present study was focused only on the upper
extremity, leg postures were not evaluated. Therefore, the RULA leg scores were set at
unity for both the most common and the worst postures in the calculation. Using these
elemental RULA scores, the RULA score A for the left and right side of the body and
score B for the neck, trunk and legs were obtained. All RULA scores were obtained at
the task level for the individual subjects. A time-weighted averaging method was used
to obtain the corresponding most common RULA scores at the job level for the
 Posture analysis and application in a RULA evaluation 2125

Table 1. Pre-defined posture categories and risk level definitions.

Posture category Risk level

Trunk flexion/extension
. Trunk neutral 758 to 208 1
. Trunk extension 2
. Trunk flexion 208 to 608 3
. Trunk flexion  608 4
Trunk lateral flexion
. Trunk neutral lateral flexion 1
. Lateral flexion 108 to 308 2
. Lateral flexion 4 308 3
Trunk twisting
. Trunk neutral twisting 1
. Trunk twisting 108 to 458 2
. Trunk twisting 4 458 3
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Upper arm flexion/extension

. Upper arm flexion 08 to 208 1
. Upper arm extension 2
. Upper arm flexion 208 to 458 3
. Upper arm flexion 458 to 908 4
. Upper arm flexion 4 908 5
Wrist flexion/extension
. Wrist extension 08 to 158 1
. Wrist flexion 08 to 158 2
. Wrist extension 158 to 458 3
. Wrist flexion 158 to 458 4
. Wrist extension 4 458 5
. Wrist flexion 4 458 6
Upper arm inward/outward rotation
. Neutral rotation 1
. Inward rotation 158 to 458 2
. Inward rotation 4 458 3
. Outward rotation 4
Elbow flexion
. Elbow flexion 608 to 1008 1
. Elbow flexion 208 to 608 2
. Elbow flexion 4 1008 3
. Elbow flexion 08 to 208 4
. Elbow extension 5
Neck flexion/extension
. Neck flexion 0 to 20 1
. Neck extension 2
. Neck flexion 4 20 3
Neck lateral flexion
. Neck neutral lateral flexion 1
. Neck lateral flexion 108 to 308 2
. Neck lateral flexion 4 30 3
Neck twisting
. Neck twisting 08 to 108 1
. Neck twisting 108 to 458 2
. Neck twisting 4 458 3

(continued)
 2126 S. Bao et al.

Table 1. (Continued).

Posture category Risk level

Upper arm abduction/adduction

. Upper arm abduction 08 to 308 1
. Upper arm adduction 2
. Abduction 308 to 608 3
. Abduction 608 to 908 4
. Abduction 4 908 5
Wrist ulnar/radial deviation
. Wrist ulnar deviation 08 to 108 1
. Wrist radial deviation 08 to 58 2
. Ulnar deviation 108 to 208 3
. Radial deviation 58 to 158 4
. Ulnar deviation 4 208 5
. Radial deviation 5 158 6
Forearm supination/pronation
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. Pronation 08 to 908 1
. Supination 08 to 908 2
. Pronation 908 to 1808 3
. Supination 4 908 to 1808 4

Note: Risk level classification was based on the Rapid Upper Limb Assessment system, biomechanical
calculations and/or some physiological considerations. Higher score means higher risk.

individual subjects using the task distribution information and the most common
RULA scores at the task level. The highest ‘worst’ RULA score among the tasks was
used as the corresponding worst RULA score for multiple task jobs.
The continuous posture data in the time-based posture analysis were categorized
using the same pre-defined angular system as used in the event-based posture analysis
during the post-processing stage. The resulting posture frequency distribution was
calculated at the task level for the individual subjects. Using the posture frequency
distribution results, the most common postures were obtained by identifying the
postures with highest frequency of occurrence at the task level. The worst posture was
identified as the worst categorized posture that was identified in the task. Since many
posture parameters have two extremes (e.g. extreme wrist flexion and extension), a risk
level hierarchy was developed and used in the determination of worst postures for the
different posture parameters (table 1). The greater the risk level score, the higher the
injury risk for posture category. A similar approach to that used in the event-based
posture analysis was used to obtain the most common and worst postures at the job
level.
Time-weighted averaging was used to compute the corresponding posture frequency
distributions at the job level using the task distribution information. The postures with
the highest frequencies of occurrence at the job level were selected as the most common
postures for the job. The worst postures at the job level were the postures of the highest
risk, which occurred in any of the tasks within a job.
The modified RULA method was applied to the time-based posture analysis using
the postures captured by each of the analysed video frames. These elemental
RULA scores at the frame level (RULA score A for left and right body sides and
RULA score B for the neck, trunk and legs) were averaged to obtain the average or
most common modified RULA scores at the task level. The peak values of the
 Posture analysis and application in a RULA evaluation 2127

elemental RULA scores for the task were used as the worst RULA scores at the task
level.
Similar methods as those used in the event-based posture analysis were used to obtain
the RULA scores at the job level for the time-based posture analysis data.
Posture distributions, categorized using the pre-defined angular ranges, were calculated
for the five different job types (sedentary, light, medium, heavy and very heavy work)
for both the event-based and the time-based posture analyses at the job level. The
distributions of the modified RULA scores of the two posture analysis methods at the job
level were also calculated for the five different job types.
Correlation analyses were performed between the two posture analysis methods for the
categorized posture variables and modified RULA scores at the task level. Spearman’s
correlation coefficients were calculated as a measure of precision between the two
methods. The percentage of agreement and kappa statistics comparing the two methods
were also calculated.
All the statistical analyses were performed with the SAS statistical program (SAS
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2002), except the kappa analyses, which were completed using the STATA statistical
package (Stata Corp 2003).

3. Results
3.1. Identifying the most common and worst postures in tasks using the two methods
Among the 733 subjects, 589 (80.4%) had jobs comprising only one task, 69 (9.4%)
had two-task jobs, 34 (4.6%) three-task jobs and 41 (5.6%) four-task jobs. In total,
there were 993 task-level postural observation records for the 733 subjects.
Based on the event-based posture analysis data, there was little variation between the
different observed tasks for many of the postural parameters of the most common
posture measures. For these postural parameters, the most common postures were often
in the posture angle categories involving the neutral postures. For instance, the most
common posture of trunk flexion and extension for 95% of the observed tasks was trunk
flexion between 08 and 208. The most common posture for the neck in lateral flexion was
08 to 108, which occurred in 98% of the tasks. Upper arm abduction of 08 to 308 occurred
in 95% of the observed tasks.
For other postural parameters, the variation between the observed tasks was larger.
For instance, about 50 to 60% of the observed jobs had the most common elbow flexion
in the range 608 to 1008. Of the observed tasks, 60% had the most common posture in the
wrist extension range of 08 to 158 angles. Similar patterns were found for the most
common postural parameters in the time-based posture analysis. Among the exceptions
was that, according to the time-based posture analysis results, the most common neck
twisting posture was neck twisting 108 to 458 instead of 08 to 108 for approximately 73%
of the observed tasks. Only 47% of the observed tasks had their most common wrist
angles in extension of 08 to 158.
The between-task variation was much larger in the measures of the worst postures.
Table 2 shows the frequency and percentage of observed tasks that had the worst
postures in the highest risk posture categories for the event-based and time-based posture
analyses. The time-based posture analysis method identified more tasks in the worst
postures for the highest risk levels than the event-based posture analysis method. The
differences were very large (44 to 74%) for some postural parameters, such as upper arm
rotation, elbow flexion and forearm supination and pronation.
 2128 S. Bao et al.

Table 2. The frequency and percentage of observed tasks that had the worst postures in the
highest risk angular sectors using event-based and time-based posture analyses.

Event-based Time-based
Angle sector for the worst posture Frequency % Frequency %

Trunk flexion 4608 251 25 224 23

Trunk twisting 4458 160 16 75 8
Trunk lateral flexion 4308 111 11 66 7
Neck flexion 4208 736 74 956 96
Neck twisting 4458 463 47 829 84
Neck lateral flexion 108 to 308 15 2 53 5
L. Upper arm flexion 4908 240 24 427 43
R. Upper arm flexion 4908 279 28 481 49
L. Upper arm abduction 4908 159 16 212 21
R. Upper arm abduction 4908 198 20 274 28
L. Upper arm outward rotation 167 17 880 89
R. Upper arm outward rotation 220 22 922 93
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L. Elbow flexion 5208 232 23 880 89

R. Elbow flexion 5208 242 24 898 91
L. Wrist flexion 4458 103 10 153 15
R. Wrist flexion 4458 135 14 150 15
L. Ulnar deviation 4208 and radial deviation 4158 383 39 583 59
R. Ulnar deviation 4208 and radial deviation 4158 442 45 625 63
L. forearm supination/pronation 4908 317 32 786 80
R. forearm supination/pronation 4908 344 35 778 79

Note: Rows highlighted in bold are postural variables with large differences between event-based and time-
based analyses.

3.2. Relationship between the two methods

Table 3 shows the percentage of agreement and the kappa statistics comparing the event-
based and time-based posture analysis methods. When the most common posture was
used to classify postures, the agreement in terms of percentage was quite high (55 to 95%)
for most postures except neck twisting (33%) and wrist flexion/extension (30% and
32%). This agreement was mainly attributable to the majority of postures being in the
neutral sectors. However, the kappa statistics showed poor to slight agreement
(kappa 5 0.20). Only neck flexion and extension, left elbow flexion and forearm supina-
tion and pronation postures had moderate agreement according to the kappa statistics
(kappa 0.21 to 0.40). Correlation analysis showed that the Spearman correlation co-
efficients for most posture variables were lower than 0.21, except for neck flexion/
extension, elbow flexion and forearm supination/pronation where the Spearman correla-
tion coefficients ranged between 0.22 to 0.34.
The percentage of agreement for the worst posture comparison between the two
methods was generally low (19 to 73%). Kappa statistics also showed poor to slight
agreement (kappa 5 0.20), with the exception of trunk flexion and extension, as well as
upper arm flexion and extension postures where the agreement was moderate (kappa 0.21
to 0.40). Correlation analysis showed that the Spearman correlation coefficients for most
posture variables were less than 0.17, except for trunk flexion/extension posture where the
coefficient was 0.51, upper arm flexion/extension 0.43 and 0.48 for the left and right upper
arm respectively, and 0.36 and 0.41 for left and right upper arm abduction/adduction.
 Posture analysis and application in a RULA evaluation 2129

Table 3. Comparison of posture classification and Rapid Upper Limb Assessment (RULA)
scores using the two posture analysis methods.

Most common posture Worst posture

Posture variable % agreement Kappa % agreement Kappa

Comparison of each observed task

Trunk flexion and extension 94.1 0.02 52.1 0.27
Trunk lateral flexion 94.6 0.03 46.1 0.07
Trunk twisting 75.4 0.03 56.2 0.03
Neck flexion and extension 61.7 0.24 73.1 0.04
Neck lateral flexion 94.7 0.11 50.3 0.03
Neck twisting 32.7 0.03 45.9 0.02
Left upper arm flexion and extension 60.6 0.13 47.9 0.21
Right upper arm flexion and extension 54.7 0.09 53.2 0.27
Left upper arm abduction and adduction 94.3 0.01 35.2 0.15
Right upper arm abduction and adduction 93.4 0.05 38.7 0.18
Left upper arm inward and outward rotation 58.4 0.15 20.9 0.03
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Right upper arm inward and outward rotation 58.1 0.10 24.4 0.02
Left elbow flexion 56.6 0.21 19.4 0.03
Right elbow flexion 55.2 0.18 19.2 0.02
Left wrist flexion and extension 32.4 0.01 22.4 0.03
Right wrist flexion and extension 30.2 0.01 25.8 0.06
Left wrist ulnar and radial deviation 88.2 0.00 25.6 0.02
Right wrist ulnar and radial deviation 83.0 0.02 30.4 0.04
Left forearm supination and pronation 88.3 0.21 29.9 0.02
Right forearm supination and pronation 91.4 0.24 35.7 0.06
Comparison of calculated RULA scores for each job
Left hand RULA score A* 23.7 0.01 26.1 0.04
Right hand RULA score A* 21.3 0.00 28.5 0.09
RULA score B{ 16.9 0.01 12.2 70.01

Note: Cells highlighted in bold are kappa values 4 0.20.

*RULA score for the left or right side of the upper extremities.
{RULA score for the neck, trunk and legs.

3.3. Rapid Upper Limb Assessment scores of event-based and time-based posture
analyses
Table 4 lists the summary statistics of the RULA scores, using the two posture analysis
methods at the job level. The RULA scores for the left and right sides of the upper
extremities (score A) and the neck/trunk/legs (score B), using the most common posture
data of the time-based posture analysis, were statistically higher than those of the event-
based posture analysis ( p 5 0.05). Score B, using the worst postures of the time-based
posture analysis, was also higher than that of the event-based posture analysis ( p 5 0.05),
but this was not the case for RULA score A ( p 4 0.05).
Table 3 also shows the results for agreements of RULA scores at the job level when the
two posture analysis methods were used. The agreement between the two posture analysis
methods, in terms of both percentage agreement and the kappa statistics, was poor for all
the RULA scores, irrespective of the method of posture categorization used (the most
common or worst posture). Correlation analysis between the RULA scores using the two
posture analysis methods showed that the Spearman correlation coefficients ranged from
0.19 to 0.41 when the postures were categorized by the worst posture and from 0.04 to
0.28 when the postures were categorized by the most common posture.
 2130 S. Bao et al.

Table 4. Rapid Upper Limb Assessment (RULA) scores calculated from the most common
postures and the worst postures using the event-based and time-based posture analysis data.

Score A (left)* Score A (right)* Score B*

Statistics EB TB EB TB EB TB
RULA scores calculated from the most common postures
n 733 733 733 733 733 730
Mean 1.8 2.7 1.8 2.8 1.3 2.3
SD 0.7 0.4 0.8 0.4 0.5 0.4
Median 2.0 2.6 2.0 2.8 1.0 2.3
Minimum 1.0 0.9 1.0 1.0 1.0 0.7
Maximum 4.0 5.0 4.0 5.0 4.0 3.4
Skewness 0.7 0.5 0.6 0.7 1.8 70.1
Kurtosis 0.1 5.5 70.2 6.2 3.0 0.2
Score A (left) Score A (right) Score B*
Statistics EB TB EB TB EB TB
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RULA scores calculated from the worst postures

n 733 733 733 733 733 730
Mean 4.9 4.8 5.1 5.0 3.4 5.0
SD 1.6 1.0 1.6 1.2 1.5 0.9
Median 5.0 4.0 5.0 5.0 3.0 5.0
Minimum 1.0 3.0 1.0 2.0 1.0 3.0
Maximum 9.0 9.0 9.0 9.0 7.0 7.0
Skewness 0.1 0.8 0.1 0.8 0.7 0.0
Kurtosis 70.2 0.2 70.4 0.4 70.1 71.1

n ¼ number of jobs (subjects); EB ¼ event-based posture analysis; TB - time-based posture analysis.

*Significant difference between the event-based and time-based analysis result, p 5 0.0001.

3.4. Posture risk in different types of jobs

For some postural parameters, both the event-based and the time-based posture analysis
methods were able to demonstrate the relative postural risk levels between the different
types of jobs (figure 3). For instance, both methods were able to detect that more workers
performing moderate, heavy and very heavy work (job types M, H and V) had
trunk flexion greater than 608 as the worst posture than in other types of jobs (job types
L – light work and S – sedentary work, figure 3a). However, for other postural
parameters, both methods were only able to distinguish groups with large differences in
postural risk levels (for example, wrist flexion greater than 458 as the worst posture, as
shown in figure 3b) between sedentary work (job type S) and very heavy manual work
(job type V). The two methods could not provide consistent results when the between-
group differences in the postural risk levels were not obvious; for example, job type M
had more workers in the high risk wrist posture category than job type L according to the
event-based posture analysis, but these results were reversed in the time-based posture
analysis (figure 3b).

4. Discussion
4.1. The use of event-based and time-based posture analysis methods
The event-based posture analysis method used in the present study was easy to use as
only two data points (the most common and the worst postures) needed to be collected
 Posture analysis and application in a RULA evaluation 2131
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Figure 3. Distribution of jobs in the ‘worst’ posture of (a) trunk flexion 4608 and (b)
wrist flexion 4458, using the two posture analysis methods. n ¼ number of subjects;
S ¼ sedentary work; L ¼ light work; M ¼ medium work; H ¼ heavy work; V ¼ very heavy
work.

for each body part in each task. Analysts observed subjects working during the sampled
time periods and evaluated the postural risk level in a subjective manner to obtain the
most common and worst postures in a work task. There was no detailed information
regarding duration for the different postures, making it difficult to identify the most
common postures if two postures occurred similarly frequently. It was also difficult in
some situations for an analyst to determine the worst postures, since vague definitions in
terms of risk level hierarchy existed. For example, if a worker had excessive wrist flexion
and extension during his/her task performance, the decision of the worst posture could be
 2132 S. Bao et al.

assigned to either the wrist flexion or the wrist extension if one was not clearly worse than
the other.
In contrast, the time-based posture analysis used in the present study was more time-
consuming, even though the ‘click-on-screen’ method helped eliminate the angle degree
conversion process of the analyst. Unlike the event-based posture analysis method, this
method provided detailed information on the distribution of the various postures, based
on the analysis of the selected video frames. With information on both amplitude and
duration of the different postures available, the analyst was able to set a quantitative
rule for determining the most common and the worst postures. The time-based
posture analysis also provided a new dimension to the posture exposure – the total
duration of a postural loading, which was not available in the event-based posture
analysis method.
When determining postural risk levels, both the event-based and time-based methods
used a risk level categorization system (table 1). This is different from the original RULA
method (McAtamney and Corlett 1993). For example, when a worker had both wrist
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flexion and/or wrist extension of the same degree, the RULA method would consider
them the same risk level. However, in the modified method used, they had to be assigned
with different levels simply because a so-called ‘worst’ posture for the job had to be
identified. This determination is often difficult, as it is not really known which one is
actually more risky. In the study, higher risk was assigned to flexed wrist than to extended
wrist (if they had the same amount of deviation from the neutral position), based on the
argument that the strength of an extended wrist is higher than that of a flexed wrist
(Chengalur et al. 2004). This was applied to both the event-based and time-based posture
analysis. This risk level categorization could be changed if the argument was based on
other physiological measures. For example, the carpal tunnel pressure is higher at
extended wrist postures compared to flexed postures (Keir et al. 2007). Therefore, a
higher risk level could be given to an extended wrist than to a flexed wrist if carpal tunnel
pressure was used as a criterion.
The results showed that the time-based posture analysis was able to identify more jobs
in awkward postures than the event-based posture analysis (table 2). This may suggest
that during the mental processing stage of the event-based posture analysis, the analyst
might have ‘missed’ some of the extreme postures, even though the analyst was supposed
to review the complete task recording. In the time-based posture analysis, the analyst
coded selected frames, which were a sample of the complete performance record, and the
worst posture was identified from the selected frames. With the consideration that only a
limited number of video frames were selected for the time-based posture analysis, this
method might also have ‘missed’ some of the extreme postures.
The large differences for certain postural parameters between the analysis methods
(upper arm outward rotation, elbow flexion 5208 and forearm supination/pronation
4908) might also be a result of possible differences between the different analysts in
posture definition interpretations for complicated work postures. In the present study,
ergonomists performed the event-based posture analysis while laboratory technicians
completed the time-based posture analysis. In a separate inter-rater reliability study with
the same analyst groups (results not yet reported), it was found that there were no
differences in 12 of the 20 posture estimations between the two groups ( p 4 0.05).
However, the ergonomist raters had higher posture estimations in four posture para-
meters than the technician raters, and lower posture estimations in the other four posture
parameters ( p 5 0.05), although the differences were not in the same directions as the
differences observed between the two analysis methods.
 Posture analysis and application in a RULA evaluation 2133

The time-based posture analysis method was based on a sample of individual frames of
job video recordings. The postural distribution, in terms of percentage of his/her task
time that a worker spent in certain angular sectors, was calculated based on these posture
samples. However, the frequencies at which the body parts were in or out of a particular
angular sector were not available from this analysis. This could only be obtained from
continuous frame by frame posture observations (Kilbom et al. 1986a). This type of
analysis is even more time-consuming than the time-based postural sampling used in the
present study. It was also difficult for the analyst to observe multiple postural parameters
and code multiple categories simultaneously. Therefore, repeated reviews of the recorded
video would have to be performed if multiple postural parameters with multiple posture
category coding were necessary. This type of posture analysis has been used in many
research projects, but rarely by ergonomics practitioners.
Both the event-based and the time-based posture analysis methods seemed to be able to
detect postural risk differences between different job groups (figure 3), although the
number of job found in the different risk categories varied between the two methods. This
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may suggest that both methods might be useful for evaluating postural risk levels between
jobs groups, although the power of detecting differences would differ. Certain postures,
such as trunk flexion/extension and upper arm flexion/extension, may have been easier to
observe than others in both methods, so that comparable results were found. However, for
other postural parameters, such as wrist flexion/extension, comparable results could only
be found when there were large postural risk differences between the job groups.
In general, the agreement between the event-based and time-based posture analysis
methods was not good. However, the two methods could produce similar results for the
‘most common’ postures when the worker was in neutral postures as indicated by high
percentages of agreement (table 3). Large discrepancies existed when the postures were
away from the neutral-range postures, as reflected by the poor kappa statistics and lower
percentages of agreement (table 3). The agreement between the two observational
methods was better for neck flexion/extension, elbow flexion and forearm supination/
pronation postures where the ‘most common’ postures were concerned, and for the trunk
flexion/extension and upper arm flexion/extension where the ‘worst’ postures were
concerned. For the most common postures, some posture parameters had high percen-
tages of agreement, but poor kappa statistics (table 3). This is because kappa is influenced
by trait prevalence (distribution) and base rates. As a result, kappas are seldom com-
parable across studies, procedures or populations (Thompson and Walter 1988, Feinstein
and Cicchetti 1990). Kappa may be low, even though there are high levels of agreement
and even though individual ratings are accurate.
Poor agreement was also reflected in the association analyses between the two methods.
Results of the two methods were generally not correlated to each other for most postural
parameters. Some weak correlations were found for neck flexion/extension, elbow flexion
and forearm supination/pronation when postures were classified by the ‘most common’
postures, and for trunk flexion/extension, upper arm flexion/extension and the upper arm
abduction/adduction when postures were classified by the ‘worst’ postures. These results
suggest that the two posture analysis methods used in the present study likely do not
produce the same results.

4.2. The use of the most common and worst postures

In the present study population, the ‘most common’ postures for some postural para-
meters (e.g. trunk flexion/extension and trunk lateral flexion) often occurred near the
 2134 S. Bao et al.

neutral position. The between-job variability for these parameters was small. It might be
difficult to find any significant effect with these parameters when performing modelling
with health outcome parameters. Between-job variability was present for the ‘most
common’ posture measures of elbow flexion, wrist flexion/extension and neck flexion/
extension. This pattern of the ‘most common’ postures may suggest that the measure of
‘most common’ posture may be useful for particular body parts (elbow, forearm and
wrist, and neck flexion/extension) where different tasks, tool uses and workstation
settings may influence the ‘most common’ postures. However, other postures, such as
trunk and neck lateral flexion and twisting often remain in the neutral positions ‘most of
the time’ for most tasks. The measurement of the ‘most common’ postures for these
postural variables may not always be a valuable use of resources.
Larger variability occurred in the ‘worst’ posture measures among the different
postural parameters. Therefore, the ‘worst’ posture measure might be more useful in
modelling with health outcome parameters, although this is uncertain until it is tested.
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4.3. The use of the modified Rapid Upper Limb Assessment method
The modified RULA scores from the time-based posture analysis were higher than those
obtained from the event-based posture analysis (table 4). This may be because the time-
based posture analysis often tended to identify more postures in the higher risk categories
(table 2).
There was poor agreement between the RULA scores obtained by the two different
postural analysis methods. They were also not correlated to each other. Therefore, risk
evaluation criteria generated, based on one postural analysis method, would not be
equivalent to those evaluated by the other method. Ergonomics practitioners should be
cautious when they are evaluating posture risks using the original proposed RULA
criteria, which were validated by a study of a small number of computer operators
(McAtamney and Corlett 1993).

5. Conclusions
Based on the results of the present study, it is concluded that the event-based and time-
based posture analysis methods may be used to quantify postural risk levels for different
jobs. However, these procedures often do not produce the same results. Therefore, one
method should not be expected to be used as an alternative for the other. Risk evaluation
criteria and postural analysis methods should be clearly specified for postural parameter
measurement or composite index computations. The posture analysis method should be
clearly described, so that users can follow exact procedures and obtain comparable
results. Other issues such as sensitivity, validity and reliability of the various posture
analysis methods also need to be addressed (although these are not mentioned specifically
in the present paper), in order to make recommendations on the posture parameters that
should be measured when using any of the methods.

Acknowledgement
We acknowledge the important contributions of Ruby Irving, Benjamin Hamilton, Cindy
Orr, Jessica Keller, Larry Taing, Pat Woods, Tiffany Ballard, Hieu Pham, Christina
Buntin and Nancy Caldwell in data collection and processing and of Caroline Smith in
coordination of field data collections. This research was funded in part by the
 Posture analysis and application in a RULA evaluation 2135

US National Institute for Occupational Safety and Health (OH1007316) and the
Washington State Department of Labor and Industries.

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