































 

Epidemiology and Society Health Review| 
ESHR 

Vol. 7, No. 2, 2025, pp. 105-114 ISSN 2656-6052 (online) | 2656-1107 (print) 
      http://journal2.uad.ac.id/index.php/eshr/index                                                      eshr@ikm.uad.ac.id                                                                                                                                   

 
 

      10.26555/eshr.v7i2.13897  

 
105 

 
 

  

Research Article 
 

The Relationship Between Sitting Posture When Using 
Digital Devices and the Risk of Low Back Pain in Final Year 
Students 

Novita Sari1, Lili Eky Nursiah N1*, Eva Flourentina Kusumawardani1, Jun 
Musnadi Is1, Dian Fera1 

1 Faculty of Health Science, Universitas Teuku Umar, Nanggroe Aceh Darussalam, 
Indonesia 

 
* Correspondence: lilieky@utu.ac.id.  
 
Received 06 July 2025; Accepted 13 July 2025; Published 13 Sept 2025 
 

ABSTRACT 

Background: Low Back Pain (LBP) refers to discomfort in the lower back and is recognized 
as the leading cause of global disability, with 619 million cases reported in 2020. This 
number is expected to rise as students become increasingly dependent on digital devices 
due to technological advancements. Non-ergonomic sitting postures while using laptops or 
smartphones may increase spinal pressure and contribute to functional impairments. This 
study aims to examine the relationship between sitting posture when using digital devices 
and the risk of LBP among final-year Public Health students. 

Method: A cross-sectional analytical study was conducted with 117 respondents selected 
through simple random sampling from a population of 168 students. Sitting posture was 
assessed using the Rapid Entire Body Assessment (REBA) method, and the risk of LBP 
was measured using the Oswestry Disability Index (ODI) questionnaire. 

Results: The results showed that most students adopted non-ergonomic sitting postures 
(60.7%), with the highest proportion experiencing moderate disability (41.9%). Statistical 
analysis revealed a significant association between sitting posture and LBP risk (P = 0.00). 

Conclusion: There is a significant relationship between sitting posture and the risk of LBP 
among students. Poor posture increases the likelihood of functional limitations due to back 
pain. It is recommended that students adopt ergonomic sitting habits and perform regular 
stretching to reduce LBP risk. These findings may serve as a reference for developing 
targeted health promotion and prevention strategies within the university setting. 

Keywords: Low back pain; Sitting posture; Ergonomic; Students; REBA 

http://journal2.uad.ac.id/index.php/eshr/index
mailto:eshr@ikm.uad.ac.id
https://doi.org/10.26555/eshr.v3i1.3629
mailto:lilieky@utu.ac.id


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INTRODUCTION 

Low Back Pain (LBP) is a musculoskeletal complaint characterized by pain in the area 
between the lower ribs and upper buttocks. This pain may manifest as a dull ache, sharp 
sensation, or general discomfort, and can radiate to the lower extremities. LBP can affect 
individuals across all population groups, impairing mobility, reducing quality of life, limiting 
work activities, and decreasing productivity.1 This condition is commonly caused by 
musculoskeletal disorders and exacerbated by biomechanical factors, such as non-ergonomic 
sitting posture.2 According to the Global Burden of Disease (GBD) report, LBP is the leading 
cause of global disability, affecting approximately 619 million people in 2020 and projected to 
increase to 843 million cases by 2050.3  

Advances in information technology have brought significant changes to student learning 
patterns in the digital age. Learning activities are increasingly shifting to digital platforms, 
including online learning systems, access to electronic journals, and the use of academic 
support applications. As a result, students have become highly dependent on digital devices 
such as laptops, tablets, and smartphones to support their daily academic tasks.4 

However, prolonged use of digital devices is not always accompanied by proper ergonomic 
behaviour. Many students tend to use laptops or smartphones in sitting positions that do not 
adhere to ergonomic principles, such as slouching, leaning the head too far forward, raising 
the shoulders, or positioning the screen at an angle misaligned with the line of sight.5 Such 
improper posture, if maintained over time, can lead to excessive pressure on the lumbar region 
(lower back),6 thereby increasing the risk of musculoskeletal disorders, including lower back 
pain (LBP).7 

An ergonomic sitting posture is characterized by a straight back, relaxed shoulders, buttocks 
in contact with the backrest of the chair, both feet flat on the floor, and a stable overall body 
position.8  When using a laptop or computer, the wrists should remain straight, the elbows and 
arms should form a 90-100 degree angle, the neck should be aligned with the screen, and the 
hips should form a 90-degree angle with the thighs.9 The same principles apply when sitting 
on the floor; maintaining neutral posture remains essential, whether sitting cross-legged or 
with legs extended and the back straight. Sitting cross-legged with a hunched back can 
increase pressure on the spine and impair the proprioceptive system (i.e., the body’s ability to 
sense position) in the lumbar region.10 

According to the 2019 National Health Interview Survey (NHIS), the prevalence of low back 
pain among individuals aged 18 years and older reached 39% and tends to increase with age. 
(The most recent NHIS data from 2023 also indicates that approximately 24.3% of adults aged 
18 and older report experiencing chronic pain lasting three months or more, while 8.5% are 
affected by high-impact chronic pain that interferes with daily activities and work. In Indonesia, 
the 2021 National Health Survey (RISKESDAS) recorded 12,914 cases of low back pain 
(LBP), accounting for 3.7% of the population. Several provinces, including Aceh, have a 
prevalence rate higher than the national average.11 

Previous studies have shown that the use of digital devices is closely associated with an 
increased risk of LBP. A study conducted by Purnomo at University X in Makassar found that 
85% of students used digital devices for 4–8 hours per day. Poor ergonomic sitting posture 
was reported by 78% of students as the second most frequent complaint, typically involving 
sitting in a hunched position and looking at screens positioned below eye level. Additionally, 

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68% of students reported experiencing back pain after sitting for extended periods in non-
ergonomic postures.12 

An initial survey of 13 final-year students at Teuku Umar University revealed that 7 of them 
reported pain ranging from the upper to lower body, including the shoulders, back, buttocks, 
and even extending to the legs. These complaints were often accompanied by persistent and 
disruptive soreness, especially when sitting for prolonged periods or while resting at night. 
Some students reported difficulty sleeping due to ongoing pain and stated that they frequently 
used topical analgesics, such as medicated oils, to relieve discomfort. 

However, to date, no specific research has examined the relationship between sitting posture 
while using digital devices and the risk of low back pain (LBP) among students at Teuku Umar 
University. Final-year students tend to have prolonged sitting durations and exhibit poor 
ergonomic posture habits while working on their final projects, thereby increasing their risk of 
developing musculoskeletal disorders. This study aims to evaluate the relationship between 
sitting posture during digital device use and the risk of LBP among final-year students in the 
Public Health Program at Teuku Umar University. The findings of this study are expected to 
serve as a foundation for promoting ergonomic awareness in educational settings to help 
prevent musculoskeletal disorders among students. 

 
METHOD 

This research employed a quantitative method with an analytical approach and a cross-
sectional design. It was conducted from March to April 2025 in the Public Health Study 
Program at Teuku Umar University, Meulaboh, Aceh Barat, Indonesia. The study population 
consisted of all active students from the 2021 cohort who were registered in the university's 
academic system, totalling 168 individuals. The sample size was calculated using a proportion 
formula for a finite population, with a 95% confidence level and a 5% margin of error, resulting 
in a final sample of 117 respondents. 

The sample in this study was selected using simple random sampling. The inclusion criteria 
were active enrollment in the current semester and willingness to participate in the research 
procedures. The exclusion criteria included respondents who declined to participate in the 
research procedures and those with a history of severe musculoskeletal disorders or spinal 
injuries that could affect body posture. Data were collected through direct observation and 
face-to-face questionnaire administration. 

Sitting posture was assessed using the Rapid Entire Body Assessment (REBA) method, an 
ergonomic observation tool used to evaluate posture-related risk based on the analysis of 
specific body parts, including the neck, back, upper and lower arms, wrists, and legs.13 In this 
study, REBA scores were classified into three categories: low risk (scores 1–3, categorized 
as ergonomic), moderate risk (scores 4–7, categorized as less ergonomic), and high risk 
(scores 8–10, categorized as non-ergonomic). The risk of low back pain was assessed using 
the standardized Oswestry Disability Index (ODI) questionnaire, which consists of 10 items 
designed to evaluate the level of disability caused by low back pain in relation to daily 
functional activities. The ODI classifies disability into five categories: minimal disability, 
moderate disability, severe disability, crippled, and bedbound. 

The independent variable in this study was the students' sitting posture while using digital 
devices, and the dependent variable was the level of risk for low back pain (LBP). Data were 
analyzed using univariate analysis to describe the frequency distribution of respondent 

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characteristics and research variables. Bivariate analysis was conducted using the chi-square 
test to determine the relationship between sitting posture and LBP risk. The significance level 
was set at p < 0.05.14 

This study received ethical approval from the Health Research Ethics Committee of the 
Faculty of Public Health, Teuku Umar University (No. 1116/UN59.F2/DT.01/2025). Informed 
consent was obtained from all respondents prior to data collection. 

 
RESULTS 

Of the 117 respondents presented in Table 1, the majority were aged ≤ 21 years (67.5%) and 
female (87.2%). The most common duration of sitting while using digital devices was 2–4 
hours per day (38.5%). A total of 66 respondents (56.41%) reported performing stretching 
exercises while sitting, and the most frequently used digital device was a laptop (54.5%). 
Regarding the type of final project, most respondents were working on a scientific paper 
(68.4%). 

Table 1. Frequency Distribution of Characteristics of Final-Year Public Health Program 
Respondents, Class of 2021 

 
Characteristics of 

Respondent  
        n = 117 Percentage (%) 

Age Group 
 ≤ 21 Years 
 22 Years 
≥ 23 Years 

 
79 
34 
4 

 
                 67.5 
                 29.1 
                 3.4 

Gender 
Male 
Female 

15 
102 

12.8 
87.2 

Sitting Duration 
≤ 2 Hours 
2 - 4 Hours 
≥ 4 Hours 

29 
45 
43 

24.8 
38.5 
36.8 

Applying Stretching 
Yes 
No 

 
66 
51 

 
56.4 
43.6 

Type of Digital Device 
Laptop 
Smartphone 

 
64 
53 

 
54.5 
45.3 

Type of Final Project 
Thesis 
Scientific Paper 

 
37 
80 

 
31.6 
68.4 

The majority of respondents had non-ergonomic sitting postures (60.7%). Additionally, 30.8% 
of respondents exhibited less ergonomic sitting postures, while only 8.5% had ergonomic 
sitting postures. Regarding the level of LBP risk based on the Oswestry Disability Index (ODI), 
most respondents were categorized as having minimal disability (45.3%), followed by 
moderate disability (41.9%). Furthermore, 9.4% of respondents were classified as having 
severe disability, 2.6% as crippled, and only 0.9% fell into the bedbound/exaggerating 
category (Table 2). 

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Table 2. Univariate analysis results of sitting posture and low back pain (LBP) risk levels 
among respondents 

 

 

 

 

 

 

Table 3. The results of the bivariate analysis of 117 respondents showed that among students 
with ergonomic sitting postures, the majority were in the minimal disability category, with 4 
individuals (3.4%), followed by moderate disability with 6 individuals (5.1%). In the group with 
less ergonomic sitting postures, most respondents were in the minimal disability category (26 
individuals, 22.2%), followed by moderate disability (7 individuals, 6.0%), crippled (3 
individuals, 2.6%), and none in the bedbound category (0 individuals, 0.0%). 

Meanwhile, the group with non-ergonomic sitting postures demonstrated a broader distribution 
of risk. A total of 36 respondents (30.8%) were in the moderate disability category, 23 
respondents (19.7%) in the minimal disability category, and 11 respondents (9.4%) in the 
severe disability category. Additionally, 3 respondents (2.6%) were categorized as crippled, 
and 1 respondent (0.9%) was categorized as bedbound. 

Furthermore, the chi-square test yielded a p-value of 0.000 (p < 0.05), indicating a statistically 
significant association between sitting posture while using digital devices and the level of low 
back pain risk among students. 

Table 3. Relationship between sitting posture when using digital devices and the risk of low 
back pain 

 Risk of Low Back Pain  

 

Sitting 
Posture 

Minimum 
Disability 

Moderate 
Disability 

Severe 
Disability 

Crippled Bedbound  

 P- Value 

 

 

0,00 

n % n % n % n % n % 

Ergonomic 4 3.4 6 5.1 0 0.0 0 0.0 0 0.0 

Less Ergonomic 26 22.2 7 6.0 0 0.0 3 2.6 0 0.0 

Not Ergonomic 23 19.7 36 30.8 11 9.4 3 2.6 1 0,9 

Total 53 45,3 49 41,9 11 9,4 3 26 1 9,9 

 

DISCUSSION  
The majority of respondents in this study were female, reflecting the general demographic 
composition of the Public Health Study Program, which is predominantly female. Most 
respondents were aged ≤21 years, placing them in the young age category, typically 

Variable n = 117 Percentage (%) 
Sitting Posture 
Ergonomic 
Less Ergonomic 
Not Ergonomic 

 
10 
36 
71 

 
8.5 
30.8 

      60.7 
Risk of LBP 
Minimal Disability 
Moderate Disability 
Severe Disability 
Crippled 
Bedbound/ Exaggerating 

53 
49 
11 
3 
1 

45.3 
41.9 
9.4 
2.6 
0.9 

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characterized by relatively optimal tissue regenerative capacity and spinal stability. However, 
a non-ergonomic sitting posture combined with prolonged sitting time still presents a potential 
risk for musculoskeletal disorders.15 In this study, most students reported a sitting duration of 
2 to 4 hours per day, with laptops being the primary device used to complete final assignments. 
Additionally, several respondents were noted to rarely perform stretching exercises while 
sitting. A lack of stretching activities may increase biomechanical stress on the spine and 
contribute to the development of lower back pain. 

In terms of sitting posture, several respondents in this study demonstrated non-ergonomic 
postures, making this group the largest among the three posture categories. This finding is 
consistent with research by Salva and Putri at Ibnu Khaldun University, Bogor, which found 
that students with poor posture and prolonged sitting habits exhibited higher levels of 
functional disability.16 Based on direct observations using the Rapid Entire Body Assessment 
(REBA) instrument, respondents in this category were generally found to sit with markedly 
hunched backs, sharply inclined necks, and a lack of lumbar support. Indicating high risk and 
requiring immediate corrective actions.17  

These observations are consistent with the findings presented in Table 1, which shows that 
the majority of respondents with non-ergonomic sitting postures experienced moderate 
disability. This category reflects moderate functional impairment, typically characterized by 
lower back pain that begins to interfere with daily activities such as prolonged sitting, lifting 
light objects, or reduced concentration during academic tasks.18 This correlation reinforces the 
understanding that the poorer the quality of sitting posture, the greater the risk of developing 
musculoskeletal disorders, particularly low back pain (LBP). However, the data also reveal 
variations in disability levels within this group, including some respondents categorized as 
having minimal disability and even one case of bedridden status. This suggests that, beyond 
posture, other contributing factors such as sitting duration, lack of stretching habits, previous 
injuries, academic stress, and insufficient physical activity also influence the severity of LBP 
in a multifactorial manner. 

Furthermore, these findings highlight the research by Almeida at the State University of São 
Paulo (UNESP), Brazil, which highlighted that habitual slouching and insufficient activation of 
core muscles (core stability) can lead to muscular weakness in the spinal support system and 
contribute to the development of LBP.19 Likewise, Tae Sung In from Gimcheon University, 
Korea, demonstrated that incorrect sitting posture during digital device use can result in 
alterations to spinal curvature, which is closely associated with LBP complaints.20 

In addition, the less-ergonomic sitting posture category represented the second largest group 
in this study. Based on observational findings, postures in this group typically exhibited mild 
deviations from the neutral sitting position, such as a moderately forward-leaning back, a 
downward-tilted neck, and insufficient arm or lumbar support. These positions often occur 
when students use laptops on flat surfaces without adjusting screen height or sit on chairs that 
lack lower back support. According to the REBA method, such postures are classified as 
moderate risk, indicating the need for medium-term preventive interventions to avoid the 
development of musculoskeletal complaints. This finding is consistent with Sari, who 
conducted a study among nursing students at Poltekkes Kemenkes Tanjungkarang, 
Lampung, who found that students with less ergonomic sitting postures had a 1.8 times higher 
risk of experiencing mild to moderate low back pain compared to those with ergonomic 
posture. 

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Statistically, most respondents in this group fell into the minimal disability category, in which 
lower back pain has only a mild impact on daily activities and has not yet resulted in significant 
functional limitations. However, several respondents were also classified in the moderate 
disability category, indicating that the pain had begun to interfere with functional tasks such 
as prolonged sitting, carrying light loads, and completing academic assignments.18,21 Of 
particular concern is the presence of respondents in the crippled category, which clinically 
describes significant limitations in daily functioning and a substantial decline in physical 
capacity. The emergence of this severe condition within a group that does not exhibit extreme 
postural abnormalities suggests that other contributing factors, such as prolonged sitting 
duration, academic stress, and insufficient physical activity, may be involved. These findings 
reinforce the notion that even slight postural deviations, when combined with extended sitting 
periods and poor movement patterns, can contribute to LBP. Light muscle activation and 
periodic postural adjustments are therefore essential to preventing further musculoskeletal 
deterioration. 

A 12-week Active Break intervention study involving young individuals demonstrated that 
taking short breaks, including stretching and hip/lumbar mobilization exercises, every 30 
minutes of sitting significantly reduced the intensity of lower back pain and discomfort.22 A 
Previous study also emphasizes that even slight deviations from a neutral posture, such as 
mild bending or leaning forward, if sustained over prolonged periods without active stretching, 
can increase pressure on the spine and surrounding tissues, eventually contributing to lower 
back pain.23 

Meanwhile, in the group with ergonomic posture, a more unique and contrasting pattern was 
found compared to the previous two categories. The ergonomic sitting posture category was 
the group with the fewest respondents in this study. Based on direct observation, the posture 
in this category is characterized by an upright sitting position, with the back and neck in a 
neutral position, and the use of a desk and chair that properly support the body. Based on the 
REBA method, this posture is categorized as low risk, meaning it does not require urgent 
ergonomic intervention, but it still needs to be maintained to prevent musculoskeletal 
complaints.  

Although the respondents in this group technically maintained postures that complied with 
ergonomic principles, the data indicate that some still experienced moderate disability. This 
suggests that prolonged sitting, limited body movement, and the habit of studying without 
breaks may contribute to an increased risk of low back pain, even when posture appears 
visually correct. Previous research reported that remaining in a static sitting position for 
extended periods can restrict natural movement and result in uneven weight distribution 
across the spine, thereby sustaining muscle tension even when the body appears to be in a 
neutral position. This perspective aligns with biomechanical principles, which emphasize the 
importance of movement variability in preventing muscle fatigue and reducing excessive static 
load.24,25 

This finding is also supported by previous research, who state that proper sitting posture does 
not necessarily guarantee the absence of LBP complaints—particularly when it is combined 
with prolonged sitting durations and a lack of physical activity. Therefore, even if one’s sitting 
posture meets ergonomic standards, incorporating active habits such as regular stretching 
and routine changes in sitting position remains essential as part of a comprehensive LBP 
prevention strategy.26 

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This finding is consistent with the relationship patterns observed across the three sitting 
posture categories, indicating that the risk of LBP may arise in all groups, albeit with varying 
levels of severity. These findings underscore the central role of sitting posture in maintaining 
musculoskeletal health, particularly among final-year students, who belong to the productive 
age group. The application of ergonomic principles—such as using appropriately designed 
desks and chairs, positioning screens at eye level, and incorporating regular stretching—
remains crucial as part of a long-term prevention strategy for low back pain (LBP). 

Furthermore, the findings of this study also contribute to the development of educational 
ergonomics theory, particularly for digital-native groups such as contemporary university 
students. These individuals face not only physical risks from poor sitting posture but also 
academic pressures that influence sitting duration, concentration levels, and a tendency to 
disregard physical comfort. According to a previous study, an orthopedic specialist at Seoul 
National University Bundang Hospital, maintaining the spine’s natural curvature (lumbar 
lordosis) while sitting is essential to avoid excessive pressure on the spinal discs, which may 
lead to chronic pain.27 Therefore, promoting ergonomic sitting behavior and enhancing 
learning environments that support such practices are essential components of promotional 
and preventive efforts to reduce the risk of LBP within the university setting. 

However, there are several limitations in this study that should be considered when 
interpreting the results. The assessment of sitting posture using the REBA method was 
conducted manually by researchers without professional certification in ergonomics, which 
may have introduced bias in determining postural angles and scores, despite the method’s 
inherently objective framework. Additionally, the use of the Oswestry Disability Index (ODI) for 
pain assessment relies on self-reported data, which is inherently subjective and may be 
influenced by various psychological and social factors. The use of simple random sampling in 
this study also presents limitations, as it does not account for variations in sitting habits or 
duration of digital device use in a more stratified or targeted manner. These limitations should 
be taken into account in future research to achieve more standardized, objective, and 
generalizable findings.  

CONCLUSION 

This study found a significant relationship between sitting posture and the risk of low back pain 
among final-year students. Students with non-ergonomic sitting postures were more likely to 
experience low back pain, ranging from minimal to severe disability levels. These findings 
indicate the need for promoting ergonomic sitting behaviors, adjusting study environments to 
meet ergonomic standards, and incorporating active breaks to reduce the risk of 
musculoskeletal disorders in students. 

Acknowledgement 

We would like to thank the supervisors and examiners of the public health study program and 
the Faculty of Public Health for granting research permission. 

 

 

 

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Declarations 

Authors' contribution 

EF contributed to the preparation of the research proposal. LE contributed to the preparation 
of the discussion and data analysis and discussion. JM and DF contributed to the improvement 
of the research article for submission. 

Funding statement 

 This study was conducted without financial support from any party. 

Conflict of interest 

The authors declare that this study is free from conflict of interest. 

 
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https://doi.org/10.26555/eshr.v3i1.3629

