Applied Ergonomics 74 (2019) 194–205

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Applied Ergonomics
journal homepage: www.elsevier.com/locate/apergo

The effect of spine discomfort on the overall postural (dis)comfort T

a,∗ a b c
Alessandro Naddeo , Rosaria Califano , Mariarosaria Vallone , Arianna Cicalese ,
Chiara Coccarod, Federica Marconee, Ervis Shullazif
a
Dept. of Industrial Engineering, University of Salerno, Italy
b
MInistry of Education, Italy
c
Whirpool EMEA, Italy
d
UIP Biogem, Italy
e
Amaris Geneva, Geneve (CH), Switzerland
f
Oerlikon Friction Systems, Italy

A R T I C LE I N FO A B S T R A C T

Keywords: Currently, the word ‘comfort’ is often used in relation to the marketing of products such as chairs, cars interiors,
Comfort evaluation clothing, hand tools and even airplane tickets. In this field of research, the aim of this study is to investigate the
Non-invasive postural analysis influence of spinal posture on postural (dis)comfort perception; the test case is the analysis of the interaction
Vending machines between humans and vending machines for purchasing food or beverages. A statistical sample of 20 healthy
Spine discomfort
students (subjects) performed the required tests, with each participant asked to take a product from three dif-
Information fusion
ferent vending machines (snacks, drinks and coffee). The subjects' postures were acquired non-invasively using
cameras; software and instruments for virtual prototyping were used for posture analysis and interaction
modelling, both questionnaires (subjective) and comfort-analysis software (objective) were used to rate the
perceived (dis)comfort. The results obtained from simulations and questionnaires were compared, and a method
to weigh the effect of the perceived spinal discomfort on overall postural (dis)comfort was proposed. These
results reveal a good correlation between subjective perception and objective evaluation obtained through si-
mulations, confirming the validity of the proposed method.

1. Introduction
During the last two decades, the market has been impacted by
several standards (e.g. EN ISO 14738, 2009; ISO 11226/2000; EN 1005-
3/2009) that set geometric parameters for machine design whose aim is
to improve the workers' safety. Meanwhile, the three parts of ISO
Normative series 11228 (part 1, 2 and 3 - 2009) deal with ergonomics
in the manual handling of objects. In ergonomics-driven product ana-
lysis, ISO 11228-3 is the most frequently applied standard, as it deals
with risk evaluation for repetitive movements while using a particular
product: after an initial screening of the checklist proposed by the ISO
Standards, the risk evaluation is often (Annarumma et al., 2008) based
on International standard ergonomic analysis methods, such as RULA
(McAtamney and Corlett, 1993), REBA (Hignett and McAtamney,
2000), LUBA (Kee and Karwowski, 2001), STRAIN INDEX (Moore and
Garg, 1995), OCRA (Occhipinti and Colombini, 1996; D'Oria et al.,
2010), OREGE (Valentin at al., 2004), NIOSH (Konz, 1982; Waters
et al., 1993). The ergonomics-driven design/redesign methods, such as
the one applied in Christensen and Nilsson (1999), Bassi et al., 2016
and Califano et al., 2016 can be improved by taking account also factors
causing (dis)comfort in order to work on them. But ergonomics does not
mean comfort.
In Naddeo et al. (2014a), it was stated that each element involved in
HMI experience can contribute to one or more kinds among four types
of (dis)comfort: Postural, Cognitive, Physiologic and Environmental.
This paper is focused on the postural (dis)comfort evaluation in Human-
artefact interaction (Vink, 2014) and specifically, deals with users'
postures while using a vending machine. A posture is defined by the
human body's joints, positions and movements; several studies like
Thompson, 2001 and Apostolico et al., 2013, addressed the need to
understand the behaviour of human joints in terms of Range Of Motion
(ROM) (Apostolico et al., 2013; Naddeo et al., 2015a), neutral (zero)

∗
Corresponding author.
E-mail address: anaddeo@unisa.it (A. Naddeo).

https://doi.org/10.1016/j.apergo.2018.08.025
Received 30 November 2017; Received in revised form 11 June 2018; Accepted 29 August 2018
0003-6870/ © 2018 Elsevier Ltd. All rights reserved.
A. Naddeo et al.
positions (those which allow the maximum state of comfort) and
Comfort Range Of Motion (CROM) (Fagarasanu et al., 2004;
Christensen and Nilsson, 1999).
Looking back over the last 30 years, there are many papers (about
1500 from Scopus Database) dealing with (dis)comfort and posture;
among them, only about 80 deal with postural comfort related to spinal
comfort and few of them studied the mechanisms that are involved in
spinal comfort perception. Jacobson et al. (2002) investigated the ef-
fects of spine discomfort on the quality of the sleep. In Zenk et al.
(2007), and in Zenk et al. (2012), the overall seating comfort was
correlated to the spine comfort through the intervertebral disk pressure.
The lower the disc pressure is, the higher the perceived comfort is. In
2009, Franz et al., 2009 detected the behaviour of intervertebral discs'
pressure while using a lumbar massage system integrated in a car-seat
and correlated the measured pressure to the state of comfort of lumbar
part of a subject. In Donnelly et al. (2009), a study on the effect of an
Active Lumbar System (ALS) was studied in order to reduce the overall
discomfort during 8-h shifts of policemen inside their cars. The ALS was
able to modify the lumbar part of the spine's posture and the mod-
ifications were correlated to the reduction of perceived discomfort. In
2015, Meng et al., 2015 studied the effects of body height, weight and
lumbar support prominence on driver's lumbar loadings by the Chris-
tophy musculoskeletal lumbar spine model and correlated the per-
ceived comfort while seating to the lumbar muscles' loads. Wang et al.
(2016) investigated the effect of back to long-time-sitting comfort by a
qualitative analysis performed through questionnaires given to four
subjects. Finally, in Li et al. (2017), a finite element method approach
was used to correlate the pressure on the lumbar area to the perceived
comfort while seating.
Regarding the field of application of this study, a wide-reaching
research of papers (on Scopus, ISI-WOS and Google Scholar databases)
dealing with ergonomic/comfort-related problems for vending ma-
chines did not provide any results. In the previously mentioned studies,
the spine (dis)comfort perception is always studied as an effect of
something (pressure, interaction, muscular load) but the weight of the
spine (dis)comfort on the overall comfort has never been investigated.
In order to investigate how the spine discomfort contributes to the
overall (dis)comfort, a postural analysis was carried out using a cheap
and effective method based on the simplification of 4D photo-
grammetry method, which did not affect the efficiency of the job/task
(Naddeo et al., 2013a, 2014b). For (dis)comfort related analyses, we
used a method (Naddeo et al., 2013a, 2013b, 2017; Vallone et al., 2015;
Di Pardo et al., 2008; Bassi et al., 2016; Califano et al., 2016) based on
the following four steps: 1) Direct and indirect (pictures) observations
of users and vending machines; 2) information collection about vending
machines and about the actions involved in retrieving the product and
collecting the change; 3) data analysis; 4) comfort-index synthesis.
Methods and instruments allowed us to perform (dis)comfort analyses
that were efficient both in terms of design effort and development time.
Finally, a hypothesis of a ‘fusion rule’ for objective comfort perception
in the upper limbs and spine (dis)comfort was tested and correlated.
2. Material and methods
2.1. Purpose
The influence of spinal discomfort on overall postural (dis)comfort
has been investigated through the study of the interaction between
humans and three different vending machines (snack, drinks and a
coffee machine – see Fig. 1).
2.2. Participants
Twenty master students participated in the experiment. None had a
history of musculoskeletal disease. All the subjects were informed of the
nature of the tests, and written consent was obtained. All the subjects
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Applied Ergonomics 74 (2019) 194–205
were measured and classified, and their anthropometric measurements
are given in Table 1 below.
2.3. Setup
The (dis)comfort evaluation was performed on vending machines
(snack, drinks and a coffee machine) located in the University of
Salerno, Italy. Three cameras were positioned to acquire the postures
assumed by each subject for each vending machine. The cameras were
positioned to acquire photos from three points of view: side (Camera C),
behind (Camera B), and above (Camera A); the axis of Camera B is
perpendicular to the sagittal plane and the axis of Camera C is per-
pendicular to the coronal plane. The setup for the central vending
machine, as an example, is shown in Fig. 2. A simplified method based
on Photogrammetry 4D (Naddeo et al., 2013a, 2014b) and the use of
Kinovea® software allowed to acquire the subjects' movements and
postures. These data were used also for setting dummies that allowed
checking the acquired postures and simulating the way that customers
pick up the product and retrieve their change.
The perception of (dis)comfort was recorded using a questionnaire.
For each region of the upper limbs, perceived (dis)comfort was rated on
a 5-point scale. For each action, both overall (dis)comfort and spinal
(upper back and mid/lower back) discomfort were assessed. The
questionnaire is shown in Fig. 3.
2.4. Simulation software
CATIA® V5R16 was used for the virtual-modelling of the user en-
vironment and the devices. Several elements were modelled in-
dividually and then combined. DELMIA® Digital Human Modelling
(DHM) software was used for modelling a ‘dummy’ based on the real
subjects' anthropometric measurements (Vallone et al., 2015; Di Pardo
et al., 2008; Naddeo et al., 2017; Bassi et al., 2016; Califano et al.,
2016). The virtual dummy has necessary characteristics in terms of
flexibility, scalability and movements of body parts for our purposes
here. Detected and measured angles were used in the DELMIA® simu-
lation to replicate the anthropometric characteristics of involved sub-
jects and to simulate the real postures as closely as possible by applying
small corrections to the ‘free’ joints. All of the analysed postures (in-
serting coins, collecting change, and picking up the drink) were pro-
cessed using this method. The comparison of photos and simulation
screenshots was sufficient for tuning the simulation and obtaining very
good1 correlation results.
Objective-comfort2 evaluations were performed using CaMAN®
(Apostolico et al., 2013; Naddeo et al., 2015b; Naddeo et al., 2014b,
2015b, 2015b), a MATLAB® application developed at University of
Salerno, which takes the angles describing subject posture as input, and
which gives an index of upper limbs' postural comfort (CI) with a value
range of 1–10 as output. CaMAN® indexes were compared with those
obtained from the (dis)comfort questionnaires.
2.5. Procedure
The test protocol was explained to subjects 5 min before the test
itself. Subjects were asked to take a drink or snack from each of the
three vending machines. The sequence of use was changed for each
subject in a randomized way. For each vending machines, three tasks
1
The random evaluation of the upper extremities' positions of subjects after
the valorization of joints' angles in the cinematic chain, gave an error lower
than 10 mm.
2
In CaMAN®, an Index of Postural Comfort (IPC), obtained as weighted mean
of upper body parts' indexes, whose value is between 0 (absence of Comfort)
and 10 (Completely in comfort) has been used. The absence of postural comfort
has been considered as an uncomfortably situation.
A. Naddeo et al. Applied Ergonomics 74 (2019) 194–205

Fig. 1. Virtual models of vending machines.

Table 1
Subjects measures.

Age (years) Mass (Kg) Height (mm) Sleeve outseam (mm) Armpit height (mm) Waist height (mm)

Mean 24.22 70.67 1720.56 563.44 1333 1067.38

Std. Deviation 2.21 13.63 92.96 48.74 68.65 55.57
Minimum 21 46 1550 470 1193 981
Maximum 28 93 1870 640 1465 1180

Fig. 2. Setup.
were considered: inserting coins, collecting change, and picking up the
product. At the end of each task, the subjects were asked to complete
the (dis)comfort questionnaire. During each task, the postures of the
subjects were acquired via three photos: one from the lateral side, one
from the back side, and a third from a point 3 m above the head, useful
to evaluate the head/hand angles with more accuracy. The photos were
taken simultaneously. The subjects were free to assume any posture
they wanted.
In order to acquire the postural angles, the photos for each action
made by the participants (inserting coins, collecting change, and
picking up the product), for each vending machine, were processed
using KINOVEA® software. Analysis was made of the following upper
limbs' movements: shoulder flexion, shoulder abduction, elbow flexion,
wrist radio-ulnar deviation, and neck frontal flexion. An example of the
postural angle acquisition is shown in Fig. 4. Here, to reach the drink,
the subject had his/her right arm and forearm extended, with the left
arm in a free position.
After measuring the angles of the joints involved in all the activities,
we carried out the simulation using DELMIA® software for each of the
activities described above (Fig. 5). The numerical-experimental corre-
lation between the real and virtual working environments revealed very
small differences between the real subject's posture and angles acquired
by photogrammetric analysis. In some cases, a slight modification of
angle values was needed to guarantee that the dummy was able to reach
and touch the object/commands. The fact that these changes were very
small demonstrated the validity of the photogrammetric acquisition
method, previously verified in Naddeo et al. (2013a) and in Naddeo
et al. (2013b). Some angles were not recognizable from the photos due

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Fig. 3. (Dis)comfort questionnaire.
Fig. 4. Angular detection for picking up the coffee.
to the relative position of the human and the machine. In these in-
stances, we manually adjusted the dummy's posture to appear as nat-
ural as possible. An analysis of visibility and over-positioning of
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Applied Ergonomics 74 (2019) 194–205
software images and video was performed to validate the simulation.
The last phase of the analysis involved determining the comfort
indexes for each posture assumed by the participants and, due to the
cost of simulation, by their dummies, in order to verify that these
postures were more or less ‘comfortable’. Based on the angular mea-
surements performed for each tested object, the set of angles helped us
to determine the indexes of postural comfort (IPC) by CaMAN®. The
results in terms of simulation and postural (dis)comfort prediction
provided by the use of DELMIA®/CaMAN® allowed performing a sen-
sitivity analysis, and fine-tuning it using numerical/experimental cor-
relation.
3. Results
Table 2 gives the comfort values obtained from CaMAN® (C) and the
questionnaires (Q) for the analysed vending machines.
The comfort analysis highlighted a substantial difference between
the two methods used to evaluate the comfort indices. To understand
the correlation between acquired data and variables for each vending
machine, a multivariate analysis was performed. SPSS rel.13 statistical
analysis software was used to perform these analyses. Spearman cor-
relation coefficients were calculated to determine the strength of the
relationships between all the variables.
The correlation analysis highlighted two relevant results:
1. An absence of correlation between height and total subjective (dis)
comfort (questionnaire) and between height and total objective
comfort (CaMAN® objective-comfort) was detected;
2. Total subjective (dis)comfort, in some cases, was not correlated with
A. Naddeo et al. Applied Ergonomics 74 (2019) 194–205

Fig. 5. Virtual interaction between a subject and a vending machine.

Table 2
Score Comfort, by questionnaire (Q) and by CaMAN®(C), for each vending machines and each participant.

Comfort snack: picking Comfort snack: collecting Comfort coffee: picking Comfort coffee: collecting Comfort drink: picking Comfort drink: collecting
up the product the change up the product the change up the product the change

Q C Q C Q C Q C Q C Q C

Mean 2.89 8.11 3.56 7.08 5.67 7.59 3.89 7.08 4.56 7.34 4.56 6.61
Std. Deviation 1.21 0.37 1.41 0.90 1.61 0.81 1.19 0.90 1.33 0.71 1.67 0.86
Minimum 2 6.90 2 4.94 4 5.66 2 4.94 2 5.35 2 5.41
Maximum 6 8.41 6 8.24 10 8.56 6 8.24 6 8.03 6 7.57

Table 3
An extract of the correlation matrices for collecting change from the coffee vending machine.

Age (years) Mass (Kg) (Dis)comfort (Dis)comfort (Dis)comfort upper (Dis)comfort Global CaMAN® Comfort
Questionnaire neck back arm Index

Age 1 0.40 −0.26 -.54(*) −0.35 0.05 0.00

Mass – 1 −0.37 −0.08 −0.33 0.16 0.16
(Dis)comfort Questionnaire – – 1 .53(*) .77(**) .63(**) -.49(*)
(Dis)comfort neck – – – 1 .71(**) .48(*) −0.04
(Dis)comfort upper back – – – – 1 .70(**) −0.14
(Dis)comfort arm – – – – – 1 −0.34
Global CaMAN® Comfort Index – – – – – – 1
(Dis)comfort forearm 0.009 0.124 .587(*) .486(*) .589(*) .875(**) -.555(*)
(Dis)comfort wrist 0.009 0.124 .587(*) .486(*) .589(*) .875(**) -.555(*)
CaMAN® Flexion/extension neck 0.156 0.111 −0.381 0.088 −0.095 −0.16
CaMAN® Lateral extension neck 0.121 0.269 -.483(*) −0.171 −0.199 −0.314 .833(**)
CaMAN® Flexion/extension elbow −0.049 0.29 0.012 0.027 −0.066 0.043 −0.31
CaMAN® Flexion shoulder −0.022 0.124 −0.344 0.143 0.057 −0.052 .798(**)
CaMAN® Abduction/adduction 0.082 0.113 -.472(*) −0.224 −0.196 −0.307 .897(**)
shoulder
CaMAN® Flexion/extension wrist 0.042 0.225 0.393 0.195 0.182 0.206 −0.041
CaMAN® Radial/ulnar deviation 0.072 0.198 -.575(*) −0.169 −0.348 −0.401 0.326
wrist
Height 0.152 .718(**) −0.253 0.059 −0.171 0.055 0.428

* Correlation is significant at the 0.05 level.

** Correlation is significant at the 0.01 level.
The complete correlation matrixes are shown in the Appendix.

CaMAN® global comfort. However, in other cases, such as collecting Table 4

change for coffee, the correlation between the two comfort indexes Values of A.
was opposite (Table 3).
A 1-A

0.2 0.8
0.4 0.6
0.6 0.4
0.8 0.2

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A. Naddeo et al. Applied Ergonomics 74 (2019) 194–205

Fig. 6. Sensitivity analysis for the coffee and drinks machines.

in the upper limbs and spine was tested and correlated to ‘quantify’ the
Table 5 influence of both in contributing to overall postural (dis)comfort.
CaMAN® comfort index for three different change-box heights. The new global comfort index is defined by the following formula
(1):
High change box Global CaMAN® Index
Global Comfort Index = A * IPC + (1-A) Index (Questionnaire Back&
415 mm 6.55
Lumbar); 0 ≤ A≤1 (1)
515 mm 6.88
615 mm 6.91
The subjective mid/lower back index was obtained by taking the
arithmetic average between these two subjective indexes. The overall
(dis)comfort index was calculated for each subject as the combination
of two perceptions, as per Table 4 below:
It has been hypothesized that this last contradiction was due to the A new statistical analysis was performed to verify a possible cor-
strong influence of the mid/lower back posture on total subjective (dis) relation between the new calculated index and the global subjective
comfort. This hypothesis was confirmed by the strong correlation be- (dis)comfort index.
tween overall subjective (dis)comfort and subjective mid/lower back This new analysis revealed some relevant results. For the drinks and
(dis)comfort. coffee vending machines, as the subjective mid/lower back discomfort
(1-A) increased, the new comfort index showed a stronger correlation
with the initial subjective (dis)comfort index. This result indicates that
4. Sensitivity analysis for tuning a fusion rule
subjects felt discomfort in the mid/lower back area, which strongly
influenced their total subjective (dis)comfort (Fig. 6).
To understand the influence of perceived spine discomfort on
In order to verify the proposed method, the scenario of A = 1 has
overall postural (dis)comfort, we created a new global comfort index to
been computed. As forecasted, both for coffee vending machine and for
include the subjective comfort of the spine (mid/lower back). To
drinks vending machine, the Spearman coefficient for A = 1 is lower
achieve this, a hypothesis of the ‘fusion rule’ for (dis)comfort perception

Fig. 7. Three steps of simulation with change-box located in higher positions.

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than A = 0,8; this result highlight the contribution of CaMAN® and
support the hypothesis of the paper and the conclusion as following.
However, results differed for the snack vending machine. For each
value of 1-A, there was no correlation between the new index and the
global subjective index. This lack of correlation was probably due to the
subjective discomfort of subjects also relating to the lower limbs, as the
removal of snacks entailed a bending of the legs.
5. Proposal of comfort-driven improvement of vending machine
To improve the general posture, the geometry of the virtual vending
machine was “virtually” modified. In particular, the height of the
‘change box’ of the coffee vending machine was raised (Fig. 7). The
altered vending machine model was used to perform new simulations
using DELMIA® and to acquire new virtual postures. Two new config-
urations were tested, with change box heights of 515 mm and a
615 mm, respectively. The height of the original was 415 mm.
Simulation outputs were elaborated using CaMAN® software and the
relative index of comfort is given in Table 5 below.
The improvement of the comfort index is evident. By increasing the
height of the change box, both back flexion and arm flexion decreased.
It was only possible to perform a simulation correlation thanks to the
alignment between simulated and real processes.
This example can be considered as a proposal of guideline that can
be followed for several kinds of product improvement.
6. Discussion and conclusions
Our analysis of the vending machines used an experimental method
based on photo/video recording and photogrammetry, coupled with the
use of DHM commercial software and comfort rating software devel-
oped by the authors. The importance of posture and task analysis was
highlighted by centring this method on pictures captured by cameras
and video, and processed -using Kinovea software-by photogrammetric
and images analyses. All these acquisition methods are very cheap and
easy to use. The precision of the acquisition method allowed to reach a
very good level of numerical/experimental correlation (angle errors less
than 5% in the first simulation run), as well to avoid using complicated
and expensive acquisition methods like Motion capture systems. Being
the method not invasive and touchless, it allows to override all issues
related to the effect of acquisition systems to subjects' (dis)comfort
perception, as stated in the model of perception in Naddeo et al.
(2014b).
About (dis)comfort analysis, the results obtained by the ques-
tionnaires and CaMAN® demonstrate that the CaMAN® comfort index is
not sufficient for the evaluation of (dis)comfort in complex contests.
The experimental tests and the data elaboration highlighted that the
limit of CaMAN® is mainly due to the lack of information about mid/
lower back comfort, which are instead accounted for in the ques-
tionnaire.
The main research question to which this paper wants to answer is:
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Applied Ergonomics 74 (2019) 194–205
how can we take into account the spine discomfort in the overall (dis)
comfort analysis and how much the overall judgement is affected by it?
On the basis of previous experience, a hypothesis of ‘information-
fusion rule’ for (dis)comfort perception in the upper limbs and spine
was tested and correlated to ‘quantify’ the influence of both in con-
tributing to overall postural (dis)comfort. In order to tune the right
weight to give into the proposed formula, a sensitivity analysis was
performed and the overall (dis)comfort index was calculated for each
subject as linear weighted combination of two perceptions. The
Spearman correlation coefficients were calculated to determine the
strength of the relationships between all the variables obtained by the
proposed fusion rule.
We hypothesized and verified that, once the values of correlation
became significant to very strong, the right weights have been chosen.
The results gave us a high statistical correlation corresponding to
weights, for perceived spine discomfort, between 60 and 80%. It means
that, in a complex movement involving upper limbs movements and
spine flexion, this last one, especially the mid/lower part, has the ma-
jority of the weight in perceiving (dis)comfort sensations.
The verification of the proposed method was obtained by making
the new statistical correlation between the Objective comfort, obtained
by CaMAN® and the subjective overall (dis)comfort obtained by ques-
tionnaires once subtracted the spine comfort obtained by questionnaire.
The results demonstrate the validity of the approach.
A limitation of this study can be found in the low number of subjects
used for experiments. Nevertheless, the statistical sample shows an
internal coherence sufficient for developing the study; probably it was
also due to the narrow clustering of the age and the “social extraction”
of the subjects: this is the other limit of this study.
A future improvement of this kind of analysis can be implemented
through the acquisition and the evaluation of the postural perceptions
due to lower limbs. In fact, in our study, a set of experiments cannot be
pro-cessed correctly because some subjects flexed their knee to bring
the product from the vending machines. This limitation suggested us
that even if the fusion rule seems to work well in this application, it did
not worked when the lower limbs were involved in the movement. For
this kind of more complex movement, further investigations are
needed.
At the end of the work, an example of redesign for vending ma-
chines has been presented, which allow to develop guidelines for
comfort-driven redesign by using virtual prototyping techniques
(DELMIA®/CaMAN®/MATLAB® software application). By generalizing
the proposed method, a guideline for comfort-driven product im-
provement could be written for different categories of products.
Finally, we can state that the most relevant result of this study is
that spine discomfort has a very high weight on the overall postural
(dis)comfort and, probably, opens to new frontiers in the field of pos-
tural comfort studies. Since a model of spinal (dis)comfort will not be
developed –and probably this is, today, the biggest challenge in the
comfort topic developments-the proposed method seems to be the ea-
siest and the lower invasive in the literature.
 Appendix

Snack Machine Comfort Comfort Comfort Comfort Comfort Comfort Comfort Flexion/ Lateral Flexion/Extension
A. Naddeo et al.

picking neck back arm lumbar forearm wrist Rotation neck Extension neck elbow

Comfort picking R*/C** R**/C* R*/C* C* R*/C** C*

Comfort neck R*/C** R** /C** R**/C** R**/C** C** R*/C**
Comfort back R**/C* R**/C** R** /C** R**/C** R**/C** R**/C**
Comfort arm R*/C* R**/C** R**/C** R* /C** R** /C** R** /C**
Comfort lumbar C* R** /C** R**/C** R*/C** C** R**/C**
Comfort forearm R*/C** C** R**/C** R**/C** C** R**/C**
Comfort wrist C* R*/C** R**/C** R**/C** R** /C** R**/C**
Flexion/Rotation neck R**
Lateral Extension neck R**
Flexion/Extension elbow
Pronation/Supination elbow
Flexion shoulder R* C*
Abduction/Adduction shoulder R* C**
Flexion/Rotation wrist C*
Radial/Ulnar deviation wrist
Global caman index C* R**/C**
Stature
Arm
Forearm

201
Total arm
Axilla height

Snack Machine Pronation/ Flexion Abduction/ Flexion/ Radial/Ulnar Global Stature Arm Forearm Total Axilla
Supination shoulder Adduction Extension deviation wrist Caman arm height
elbow shoulder wrist index

Comfort picking
Comfort neck
Comfort back
Comfort arm
Comfort lumbar
Comfort forearm
Comfort wrist C* C*
Flexion/Rotation neck R* R**/C**
Lateral Extension neck C* R**
Flexion/Extension elbow C**
Pronation/Supination elbow (-)R*
Flexion shoulder
Abduction/Adduction shoulder
Flexion/Rotation wrist C** C**
Radial/Ulnar deviation wrist (-)R* C** (-)C* (-)C*
Global caman index C** (-)R*
Stature R**/ R**/ R**/ R**/
Applied Ergonomics 74 (2019) 194–205

C** C** C** C**

 Arm (-)C* R**/ R** / R** / R** /
C** C** C** C**
Forearm R** / R**/ R**/ R**/
C** C** C** C**
A. Naddeo et al.

Total arm (-)C* R**/ R** / R**/ R**/

C** C** C** C**
Axilla height (-)R* R**/ R**/ R**/ R**/
C** C** C** C**

R = Product collection C = Change collection.

** = Correlation is significant at the 0.01 level; * = Correlation is significant at the 0.05 level; (-) = Negative correlation.

Coffee Machine Comfort Comfort Comfort Comfort Comfort Comfort Comfort Flexion/Rotation Lateral Extension Flexion/Extension
picking neck back arm lumbar forearm wrist neck neck elbow

Comfort picking 1 R**/C* R**/C** R**/C** R**/C** R**/C* R**/C* (-)C*

Comfort neck R**/C* 1 R**/C** R**/C* R**/C** R**/C* R**/C*
Comfort back R**/C** R**/C** 1 R**/C** R**/C** R*/C* R*/C*
Comfort arm R**/C** R**/C* R**/C** R**/C** R**/C** R**/C**
Comfort lumbar R**/C** R**/C** R**/C** R**/C** R*/C** R**/C**
Comfort forearm R**/C* R**/C* R*/C* R**/C** R*/C** R**/C** (-)C*
Comfort wrist R**/C* R**/C* R*/C* R**/C** R**/C** R**/C** (-)C*
Flexion/Rotation neck C*
Lateral Extension neck (-)C* (-)C* (-)C* C*

202
Flexion/Extension elbow
Pronation/Supination
elbow
Flexion shoulder R* C** R*/C** (-)C*
Abduction/Adduction (-)C* (-)C* (-)C* C** C**
shoulder
Flexion/Rotation wrist
Radial/Ulnar deviation (-)C*
wrist
Global caman index (-)C* (-)C* (-)C* C** C**
Stature R* C*
Arm C* C**
Forearm R*
Total arm R* C*
Axilla height R*

Coffee Machine Pronation/ Flexion Abduction/Adduction Flexion/ Radial/Ulnar Global Caman Stature Arm Forearm Total Axilla
Supination elbow shoulder shoulder Extension wrist deviation wrist index arm height

Comfort picking R* (-)C* (-)C* (-)C*

Comfort neck
Comfort back
Comfort arm
Comfort lumbar
Applied Ergonomics 74 (2019) 194–205
 Comfort forearm (-)C* (-)C*
Comfort wrist (-)C* (-)C*
Flexion/Rotation neck C** C** C** R*/C* R* R* R*
Lateral Extension neck R*/C** C** C** C* C** C*
A. Naddeo et al.

Flexion/Extension (-)C*
elbow
Pronation/Supination R* R*
elbow
Flexion shoulder C* C** R* R*/C*
Abduction/Adduction C* C**
shoulder
Flexion/Rotation wrist R** R** R*
Radial/Ulnar R* R** R**
deviation wrist
Global caman index R* C** C** R** R** C*
Stature R**/ R**/ R**/ R**/C**
C** C** C**
Arm R** C* R**/ R**/ R**/ R**/C**
C** C** C**
Forearm R* R**/ R**/ R**/ R**/C**
C** C** C**
Total arm R**/ R**/ R**/ R**/C**
C** C** C**
Axilla height R*/C* R**/ R**/ R**/ R**/
C** C** C** C**

203
R = Product collection C = Change collection.
** = Correlation is significant at the 0.01 level; * = Correlation is significant at the 0.05 level; (-) = Negative correlation.

Drinks Machine Comfort Comfort Comfort Comfort Comfort Comfort Comfort Flexion/Rotation Lateral Extension Flexion/Extension
picking neck back arm lumbar forearm wrist neck neck elbow

Comfort picking C** R**/C** C** R**/C*

Comfort neck C** R**/C** C** R** C* C*
Comfort back R**/C** R**/C** C** R**/C* C* C*
Comfort arm C** C** C** R* R*
Comfort lumbar R**/C* R** R**/C* C*
Comfort forearm R* R**/C**
Comfort wrist C* C* R* C* R**/C*
Flexion/Rotation neck R**/C**
Lateral Extension neck R**/C**
Flexion/Extension elbow
Pronation/Supination
elbow
Flexion shoulder
Abduction/Adduction (-)R* C** C**
shoulder
Flexion/Rotation wrist
Applied Ergonomics 74 (2019) 194–205

(-)C*
 Radial/Ulnar deviation
wrist
Global caman index (-)C* (-)C* R**/C** R**/C**
Stature R*/C** R*
A. Naddeo et al.

Arm R* C* R*
Forearm C* C* C* R*/C** R*
Total arm R**/C**
Axilla height C* C* R*/C* R*

Drinks Machine Pronation/ Flexion Abduction/Adduction Flexion/ Radial/Ulnar Global Caman Stature Arm Forearm Total Axilla
Supination elbow shoulder shoulder Extension wrist deviation wrist index arm height

Comfort picking C*
Comfort neck
Comfort back R* C*
Comfort arm (-)C** (-)C* R*/ C* R*/C** R**/ R*/C*
C** C**
Comfort lumbar (-)R* (-)C* R* R* R* R*
Comfort forearm
Comfort wrist
Flexion/Rotation neck C** R**/C**
Lateral Extension neck C* R**/C**
Flexion/Extension
elbow
Pronation/Supination

204
elbow
Flexion shoulder (-)R* R*
Abduction/Adduction (-)R* C** (-)R*/
shoulder (-)C*
Flexion/Rotation wrist
Radial/Ulnar R*/C**
deviation wrist
Global caman index C** R*/C** (-)C*
Stature R* R**/ R**/ R**/ R**/C**
C** C** C**
Arm R**/ R**/ R**/ R**/C**
C** C** C**
Forearm (-)C* R**/ R**/ R**/ R**/C**
C** C** C**
Total arm R**/ R**/ R**/ R**/C**
C** C** C**
Axilla height (-)R*/(-)C* R**/ R**/ C** R**/
C** C** C**

R = Product collection C = Change collection.

** = Correlation is significant at the 0.01 level; * = Correlation is significant at the 0.05 level; (-) = Negative correlation.
Applied Ergonomics 74 (2019) 194–205
A. Naddeo et al.
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