1. Web-based learning program for adjusting computer workstation: development and validity test
Mr. Chawanwong Srinak
Faculty of Physical Therapy, Mahidol University

2. Background and Rationale
In Thailand, 63% of office workers complain about musculoskeletal symptoms associated with work (Janwantanakul et al., 2008)
In Britain, the cost associated with work-related upper limb disorders is £1.25 billion per year
(Korhan O, Mackieh A. 2010)

3. Background and Rationale
Ergonomics intervention
Ergonomic training in computer operators can improve
postural MSDs. (Zeidi IM et at al 2011)
Training method using self-modeling webcam photos improve
posture of computer users. (Maimon MT et al. 2012)
Limitation: costs, time, specific group

4. Background and Rationale
Web-based learning (WBL)
Since 1960 (Nicholson P. 1960)
Learning via internet or intranet (Nicholson P. 1960)
Used in various fields: Mathametrics (González JA. 2010),
Medical (Gerdprasert S.), Science (Sun KT. 2011)
Same or more effective than traditional instruction.
WBL may be used as a tool for ergonomics intervention.

5. Background and Rationale
Rucker NP 2004
Ergonomics web-based training VS traditional instruction.
Both methods had a significant improve in knowledge and
behavioral changes.
Local intranet
More virtual approach may be used

6. Purpose of the study General objective
to develop and evaluate the web-based program to reduce the
risk of the computer related musculoskeletal disorders for Thai computer users.
Specific objectives
1. to compare RULA for the computer workstation adjusted by
using with and without the web-based program.
2. to compare REBA for the computer workstation adjusted by
3. to determine satisfaction of the program.

7. Variables of the study Independent variable
- Web-based program for computer users
Dependent variables
- Rapid Upper Limb Assessment (RULA) score
- Rapid Entire Body Assessment (REBA) score
- Satisfaction questionnaire scores
Control variable
- Duration of workstation adjustment
- Duration of program use

8. Advantages of the study
A tool to decrease the risks of work related musculoskeletal
disorders for computer users.
A simplified program that can be used widespread.
A teaching tool for ergonomists, physical therapists, and
other health care professionals.

9. Methods Study design This study was divided in 2 phases:
1) Web-based program development.
2) Application test for the developed web-based program.

11. Criteria - Computer users who had frequent computer use.
- Without RSI or RSI was not greater than 2 (Browne et al. 1984)
"Symptoms fail to disappear overnight and begin to disturb
sleep. Performance on repetitive tasks is significantly
reduced. Physical signs may be apparent. The condition
usually persists for months."
- Never used to participate in ergonomics class or training.

12. Methods
Procedure
Screening
Informed consent
Setting the work station

14. Methods Complete the satisfaction questionnaire
Analyze photos by assessor

15. Data analysis Descriptive statistics - Demographic data & satisfaction
RULA & REBA
- Friedman test
- Wilcoxon sign rank test
SPSS for Windows version 17

16. Results
Higher RULA score refer to more postural risk

17. Results
Friedman test
Statistically significant difference in RULA score between groups with
2(3) = and p = 0.000
Post hoc analysis was performed by Wilcoxon sign-rank tests.
Median RULA score of period
A (3 to 6)
B (4 to 6)
C (3 to 5)
D (3 to 5)
There were significant differences between
Period B and C (Z = , p = 0.000)
Period B and D (Z= , p = 0.000)

18. Results
Higher REBA score refer to more postural risk

19. Results
Friedman test
Statistically significant difference in REBA score between groups with 2(3) = and p = 0.000
Post hoc analysis was performed by Wilcoxon sign-rank tests.
Median REBA score of period
A (5 to 7)
B (5 to 8)
C (3 to 6)
D (3 to 5)
There were significance differences between
Period A and C (Z = , p = 0.004)
Period A and D (Z = , p = 0.001)
Period B and C (Z = , p = 0.000)
Period B and D (Z = , p = 0.000)

20. Results Satisfaction in main categories Satisfaction Mean SD
Interpretation
1. Program use
2. Knowledge
3. Advantage
4.28
4.48
4.62
0.71
0.63
0.56
high
very high
Total
4.38
0.68

21. Discussion Program development (Jones & Muthaya 2009)
5 steps using the guidline of Jones and Muthaya in 2009 (29).
Discussion
Program development
(Jones & Muthaya 2009)
Validate content by experts - Ensure its content to be valid
Program development - Adobe Captivate 6
Tested by 60 PT students - Evaluate its content and interface of program
Revise - Improve both content and interface
Validate content by experts again - Final content validation

22. Discussion Content of program Introduction
- Basic knowledge: causes & symptoms of computer-related injuries.
- Understand the mechanism of injuries, early detect the symptoms.
- Realize & avoid inappropriate use of computer.
Workstation adjustment
- Step by step.
- Can choose the similar devices.
- Easy to use

23. Discussion Content of program Recommendation
- Behavior change and exercise for computer users.
- Maybe prevent or treat themselves.
Unexpected problems
- Common set up mistake and how to manage limitations of
devices setting.
Discussion and knowledge sharing
- Discussion between users on Facebook

24. Discussion Previous study of Rucker NP. 2004
- Instructer-taugh course & Developed web-based course
- The content was similar to the current study but his program was
available only via local network.
- Current study provided more selection of computer devices
and the step of workstation adjustment was easy to follow.

25. Discussion Application test of developed web-based program
Pre-post test design: suitable to evaluated the effectiveness of
program
The 20-minute rest break: minimize the fatigue.
base on the study of Szeto GPY. and Sham KSW. 2008
RULA: evaluate upper limb, Rueder R. 1996
REBA: evaluate whole body, Pillastrini P. et al 2007
- Satisfaction: evaluate users attitude toward the program, Kaveevivitchai C. et al 2009

26. Discussion RULA & REBA - Using web-based program:  RULA & REBA.
- Proper workstation adjustment: Improve more neutral
posture.
- The results similar with Taieb-Maimon M et al. and
Pillastini P et al.

27. Discussion The postural change
- Using web-based program:  RULA & REBA.
- Proper workstation adjustment: Improve more neutral posture.
- Biomechanically described.
In first session
Changed posture instead of adjusting the workstation.
Too low monitor - bend head forward
Too far monitor - lean head & trunks forward
reach hand
Too low chair - elevate shoulders or bend elbow more than
90 degrees.

28. Discussion Satisfaction
- Likert scale: range 1-5 (very low, low, moderate, high, very high). - Satisfaction of this program: high to very high.
- Easy to follow the program.
- The knowledge was new & important to know.
- The program was new, easy to access.
- Similar to the study of Kaveevivitchai C et al. 2009

29. Discussion Limitation and further study
Co-operation between a professional software developer
and researchers.
No control group.
Comparison with other ergonomics training.
Different populations: age, sex, and education.

30. Conclusion The developed web-based program - Valid tool.
- Able to help reduce the risk of the computer related
musculoskeletal disorders.
- Better working posture as indicated by better RULA and REBA.
- Available at
- First web-based ergonomics program in Thai language.
- Appropriate for Thai users.