Kyphotic posture in laptop and desktop users among employees of private Universities in Lahore Abdul Rehman 1, Sheikh Asad 2, Umer Maqsood 3*, Hafiz Sheraz Arshad 4 1 Physiotherapist, Ch. Muhammad Akram Research and Teaching Hospital Lahore. 2 Senior Physiotherapist, Department of Physiotherapy, Azra Naheed Medical College, Superior University, Lahore 3 Assistant Professor, Department of Physiotherapy, Azra Naheed Medical College, Superior University, Lahore 4 Assistant Professor, Department of Physiotherapy, Azra Naheed Medical College, Superior University, Lahore ARTICLE INFO *Corresponding Author: umer.maqsood@gmail.com DOI: 10.24081/nijesr.2018.1.0004 Keywords: Occiput wall distance kyphotic posture, Forward head posture ABSTRACT Objective: The objective of study was to find the association of kyphotic posture with type of computer used (laptop/desktop) among employees of private Universities in Lahore Pakistan. Methodology: An analytical associational study was conducted. Convenient sampling technique was used to select the 195 subjects. Self-made questionnaire was used to collect the demographic details. The Occiput wall distance test was applied to find the presence and measure the severity of kyphosis. Chi-square test was applied to analyze the association between computers usage (laptop & desktop) and gender, age, number of hours and severity of kyphotic posture in categorical and continuous variables, respectively. Results: Results showed presence of kyphotic posture in 186 (95.38%) respondents and absent in just 9 (4.62%) respondents. Total number of desktop users were 80,in which 5% were normal, 33.75% had mild kyphosis, 48.75% had moderate kyphosis and 12.5% had severe kyphotic posture and in case of laptop (n=115) users 4.35% were normal, 47.82% had mild kyphosis, 42.61% had moderate kyphosis and 5.22% had severe kyphotic posture. There was statistically no significant association between type of computer and severity of kyphotic posture.(p= 0.127). Conclusion: Although, kyphotic posture was not found to be associated with the type of computer use but the high proportion of this faulty posture in university employees is a threat to their health. Ergonomic awareness regarding optimal working posture could reduce this alarming condition and ultimately improve the quality of life of these employees I. INTRODUCTION We are living in an era of advance technology in which a lot of gadgets provoked in our educational system very effectively. Specially laptops and computers are promoted by the educational practitioners as the most useful tool for learning and to get information.[1] Excessive use of computer effects musculoskeletal system. Keeping posture in static position, staring at computer screen, and keeping the head in forward position increases lordotic curve in cervical vertebrae and upper thoracic vertebrae to retain stability, called FHP(forward head posture).[2] Keeping the head in flexed posture can cause the musculoskeletal disorder such as upper cross syndrome.[3] Altering the habitual posture during computer use is better than keeping a static posture. Sustained posture can increase the risk of spinal loading.[4] 34
Forward head posture distresses neck, shoulder and thoracic spine, probably causing overall inequality in the MSK system.[5] Prevalence of kyphotic posture in boys and girls is 21.4% and 15% respectively.[6] Computer in office setting should be set to maximize correct position, decrease neck bending with the use of document stands, height of screen modifications, proper chairs and supports[7].actual drawback of laptop is its design itself because keyboard and monitor screen are smaller than the computer and cannot be detached or set independently in office working table. This lack of adjustability can lead to abnormal posture, causing musculoskeletal discomfort.[8] Bad posture is a potential risk factor for musculoskeletal disorders. Stretching, strengthening, and mobility exercise techniques are to improve the musculoskeletal disorder for short duration. If we want long term benefits then we must re-educate the awareness of correct postural alignment.[9] The objective of this study was to find prevalence of kyphotic posture and find its association with laptop and desktop use. The gap of this study is that little to no work has been done regarding risk of kyphotic posture with type of computer (laptop & desktop) being used. While using computer in offices, employees do not focus on the position of their body. This study will improve awareness of employees to get knowledge about which device, (desktop or laptop) is better to be adopted to reduce the risk of abnormal posture.. II. METHODOLOGY It was a cross sectional study which was completed in a period of three months. Data was collected from faculty and administrative staff of private universities in Lahore. Convenient sampling technique was used to select 195 subjects. Data was collected from four universities of Lahore (Superior University, University of Lahore, Riphah International University, and University of South Asia) after taking permission from the administration of the concerned universities. An informed consent was also taken from the study participants. Demographic details of the participants were collected through a self-structured questionnaire. Occiput Wall Distance test was applied in each participant to measure the severity of kyphosis. OWD gives best prognostic ability for the risk of kyphosis (sensitivity 92.31%, specificity 76.47% with the ability to correctly classify up to 83.33%).Researcher used to classify the subjects into three group according to severity of kyphosis upon the basis of OWD test, including mild (lesser or equal to 5.0 cm), moderate (5.1 8.0 cm), and severe (greater than 8.0 cm). All collected data was entered in computer program SPSS version 20 and analyzed through this software. Chi-square test was applied to analyze the association between computers (laptop & desktop) and gender, age, number of hours and severity of kyphotic posture in categorical and continuous variables, respectively. The descriptive statistics (Mean±SD) was used to explain the occiput wall distance of each participant. III. RESULTS A total 195 respondents were included in the study from four different universities in which 114(58.5%) were males and 81(41.5%) were female respondents. Out of 114 male respondents, 51 were desktop users and 63 were laptop users, and out of 81 female respondents, 29 were desktop users and 52 were laptop users. No significant association was found between gender and computer (laptop &desktop) in use (P=0.211). Out of 35 respondents (17.9%), 14 desktop users and 21 laptop users belonged to the age group 20-25 years, 93 respondents (47.7%) 47 desktop and 46 laptop users belonged to the age group 25-30 years, 37 respondents (19%) 10 desktop and 27 laptop users belonged to the age group 30-35 years and the 30 respondents (15.4%) 9 desktop and 21 laptop users belonged to the age group 35-40 years. There was statistically significant association between age and type of computer system in use (P=0.046). Total 49 respondents, 8 desktop and 41 laptop users use the system 3-4 hours per day, 47 respondents, 12 desktop and 35 laptop users use the system 4-5 hours per day, 99 respondents, 60 desktop and 39 laptop users use the system 5-6 hours per day. There was statistically significant association between number of hours and type of computer system in use (P=0.000).Kyphotic posture was present in 186 respondents, out of which 76 were desktop users and 110 were laptop users. 9 respondents did not have kyphotic posture, among them 4 were desktop users and 5 were laptop users. There was no statistically significant association between occurrence of kyphotic posture and type of computer used among employees of private universities of Lahore (P=0.127). 35
Table1: Association of type of computer used with gender, age, number of hours & kyphotic posture Gender Age No. of Hours Kyphotic posture Desktop Laptop Total Male 51 63 114 Female 29 52 81 Total 80 115 195 20-25 years 14 21 35 25-30 years 47 46 93 30-35 years 10 27 37 35-40 years 9 21 30 Total 80 115 195 3-4 Hours 8 41 49 4-5 Hours 12 35 47 5-6 Hours 60 39 99 Total 80 115 195 Yes 76 110 186 No 4 5 9 Total 80 115 195 P =0.211 P=0.046 P=0.000 P=.0.127 Table-2: Difference in Mean occiput wall distance between desktop and laptop users. Desktop (n=80) Laptop (n=115) Mean±SD Min(cm) Max(cm) Mean±SD Min(cm) Max(cm) Occiput wall distance 5.468±2.296 0.00 cm 10.00 4.906±2.083 0.0 M 10.70 In desktop users Mean±SD occiput wall distance of the participants was 5.468±2.296 centimeter. Minimum distance was 0.00 cm and Maximum distance was 10.00 cm. In laptop users Mean±SD occiput wall distance of the participants was 4.906±2.083 centimeter. Minimum distance was 0.00 cm and Maximum distance was 10.70 cm. Table 3: Association of type of computer used with severity of kyphosis. Severity of Kyphotic posture Type of computer Normal Mild Moderate Severe Total N % n % n % n % Desktop 4 5% 27 33.75% 39 48.75% 10 12.5% 80 Laptop 5 4.35% 55 47.82% 49 42.61% 6 5.22% 115 Total 9 4.62% 82 42.05% 88 45.12% 16 8.21% 195 P value 0.127 36
60% 50% 40% 30% 20% 10% 0% Normal Mild Moderate Severe Severity of kyphotic posture Desktop Laptop The table shows that P-value 0.127 so there was no statistically significant association between type of computer and severity of kyphotic posture. According to this study, out of total 80 desktop users, 4 (5%) were normal, 27 (33.75%) had mild kyphosis,39 (48.75%) had moderate kyphosis, and 10 (12.5%) were having severe kyphotic posture. Among laptop users, 5 users (4.35%)were normal, 55 users(47.82%) had mild kyphotic posture,49 users (42.61%) had moderate kyphotic posture and 6 users (5.22%) were having severe kyphosis. Out of total 195 respondents, 9 (4.62%) were normal, 82 (42.05%) had mild kyphotic posture, 88 (45.12%) had moderate kyphotic posture and 16 (8.21%) respondents were having severe kyphotic posture. IV. DISCUSSION This study tried to explore the prevalence of kyphotic posture, the association between presence of kyphotic posture and type of computer used among employees of private universities of Lahore, Pakistan. Although, no study has been reported yet about kyphotic posture in laptop and desktop users but there are some studies related to computer users in other aspects like upper spinal misalignments, musculoskeletal, arms and legs pain, and neck disability. According to the results of this study researcher found that numbers of desktop users were less (49%) than laptop users (51%). According to Smith et al. (2009) between the years of 2006-2009 the ownership of a laptop increased from 65.4% to 88.3% whilst desktop ownership reduced from 71% to 44%, signifying the shift towards laptop use.[10].this study demonstrates the results upon the basis of P- value which is 0.127, showing that there was no Figure 1: Severity of kyphotic posture 37 significant association between type of computer and presence of kyphotic posture. According to this study in case of desktop users 5 % were normal, 33.75% were mildly kyphotic,48.75% were moderately kyphotic and 12.5% were having severe kyphotic posture, and in case of laptop users 4.35 % were normal, 47.82%were mildly kyphotic, 42.61% were moderately kyphotic and 5.22% were having severe kyphotic posture. According to Sjan-Mari Van et al, analysis seen that the correlation of thoracic angle with discomfort and stress was non-significant. The thoracic angle showed very little variations in the angle between postures because the thoracic region is the most inflexible region of the spine[11]. According to Janwantanakul.et al, musculoskeletal symptoms are very common in spine among employees and office worker.1185 respondents were included in this study, 42% of subjects reported neck and head musculoskeletal symptoms. Prolonged sitting, particularly with poor workstation ergonomics, may cause prolonged static contraction of muscles and altered spinal curvature.[12] Ariens G.A.M. et al. (2001) found that higher forward neck bending may result in greater tension in posture stabilizing muscles and increased compressive forces in the articulations of neck resulting in a higher risk of work related musculoskeletal disorders.[13] Schlossberg et al.(2004) exposed that eight or more years of computer use more than ten hour/week and weekly computer use for more than twenty hour to be significantly associated with frequent or continuing computer related arms disorders[14]. Another Scandinavian study reports that almost seven thousand office workers with the average time consumed at the
computer reported to be 23 hour/week, and had moderate to severe musculoskeletal symptoms.[15]. According to briggs et al, height of screen affects neck flexion during computer use, and our workstations are normally not adjusted. In the recent studies males were four centimeter taller than females, suggesting that they may have needed greater head and neck bending to view the computer, while females may have extended their trunk to raise their eye height.[16] V. CONCLUSIONS Although, kyphotic posture was not found to be associated with the type of computer use but the high proportion of this faulty posture in university employees is a threat to their health. Ergonomic awareness regarding optimal working posture could reduce this alarming condition and ultimately improve the quality of life of these employees. OWD KP FHP MSK NOMENCLATURE Occiput Wall Distance Kyphotic posture Forward head posture Musculoskeletal ACKNOWLEDGEMENT The authors acknowledge administration of Superior University Lahore, Riphah International University, Lahore campus, University of South Asia, and University of Lahore, for granting permission to approach their employees for data collection, and extending possible support in this regard. Authors are also thankful for subjects for providing data. REFERENCES [1] A. D. Kroemer and K. H. Kroemer, Office Ergonomics: Ease and Efficiency at Work: CRC Press, 2016. [2] H. Alyami and A. M. Albarrati, "Comparison of Spinal Angles in a Typing Task on a Laptop and a Desktop Computer: A Preliminary Study," American Journal of Occupational Therapy, vol. 70, pp. 7006350020p1-7006350020p8, 2016. [3] P. R. Mosaly, "Multifactor association of job, individual and psychosocial factors in prevalence of distal upper extremity disorders and quantification of job physical exposure," International Journal of Industrial Ergonomics, vol. 55, pp. 40-45, 2016. [4] Y. Brink, Q. Louw, and K. Grimmer, "The amount of postural change experienced by adolescent computer users developing seated related upper quadrant musculoskeletal pain," Journal of Bodywork and Movement Therapies, 2017. [5] J.-H. Kang, R.-Y. Park, S.-J. Lee, J.-Y. Kim, S.-R. Yoon, and K.-I. Jung, "The effect of the forward head posture on postural balance in long time computer based worker," Annals of rehabilitation medicine, vol. 36, pp. 98-104, 2012. [6] L. Ghorbani, A. H Daneshjoo, A. B Nazarian, and A. M Mohammadi Domieh, Assessment of the prevalence of kyphosis disorders in students vol. 44, 2010. [7] F. Sabeen, M. S. Bashir, S. I. Hussain, and S. Ehsan, "Prevalance of neck pain in computer users," Annals of King Edward Medical University, vol. 19, p. 137, 2013. [8] A. Werth and K. Babski-Reeves, "Effects of portable computing devices on posture, muscle activation levels and efficiency," Applied ergonomics, vol. 45, pp. 1603-1609, 2014. [9] K. Kaur, P. G. Das, P. Lenka, and S. Anwer, "Immediate Effect of Posture Correction of Trapezius Activity in Computer Users Having Neck Pain An Electromyographic Analysis," Internet Journal of Allied Health Sciences and Practice, vol. 11, p. 10, 2013. [10] N. I. Bedenik, B. Pahor, and Z. Kravanja, "An integrated strategy for the hierarchical multilevel MINLP synthesis 38
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