Benefits of alternative computer mouse designs: A systematic review of controlled trials

Figures & data

Figure 1. Graphic representation of article search and selection process using PRISMA chart adapted from (Moher, Liberati, Tetzlaff, & Altman, 2009).

Table 1. Summary of individual articles included in the systematic review

Author (Year)	PEDro	ROB	Design	Participants	Environment	Intervention	Outcome measures	Conclusion
Chen and Leung (2007)	5	Unclear	Crossover design	12 participants 9 males and 3 females Age—23 ± 2	Familiar with using a computer mouse	Myoelectric activity of the forearm muscles of participants was assessed while using five different hand-fabricated computer mice with slanted angles of 0°,10°,20°,25°, and 30°, respectively	-Muscle activity was measured using electromyography (EMG)	−25° or 30° slanted mice caused lower muscle activity and more neutral postures
Conlon,Krause and Rempel (2008)	7	High	RCT	−206 participants -Age for conventional mouse group: 41.2 ± 8.43; for alternative mouse group: 43.3 ± 10.8; for support board plus conventional mouse group: 42.6 ± 10.3; for support board plus alternative mouse group: 44 ± 9.66	-Employed engineers or professional support for engineers with computer usage for at least 20 hrs./week. -Participants had some baseline discomfort and musculoskeletal disorder score	12 months experiment performed to compare the performance of 4 different groups where participants randomly assigned to a particular group that uses only 1 of the following mouse options throughout the study: a conventional mouse, a vertical mouse, a conventional mouse plus a forearm support board and a vertical mouse plus the forearm support board.	-Upon entry, each subject filled out a baseline health questionnaire -4 weeks after intervention began, participants underwent weekly assessments for potential presence of musculoskeletal disorders related to computer use. -Each week, participants filled out an online discomfort questionnaire that used 0–10 point scale.	-On average, the forearm support board significantly reduced right upper extremity discomfort -The vertical mouse significantly reduced neck/shoulder discomfort in comparison to the control group
Dehghan et al. (2015)	6	High	Crossover design	10 participants 6 males,4 Females Age: 25.8 ± 2.04	-Experienced visual display terminal operators	Following a brief familiarization period, each participant performed series of clicking, pointing and dragging tasks to compare the use of each a conventional mouse and 3 different alternative designs (vertical mouse, pen mouse and trackpad) Each mouse was used for 10 min.	-Functional parameters (task completion time and number of errors in clicking) were measured through use of appropriate software -Participants used 10-point visual analogue scales to rate clicking comfort, hand/wrist comfort and overall comfort	-Participants had the fastest task completion and lower percentage of error rate with the conventional mouse and vertical mouse more than the trackpad and pen mouse -The conventional rated significantly higher than the pen mouse and trackpad mouse in clicking comfort and overall comfort.
de Korte, de Kraker, Bongers, and van Lingen (2008)	3	High	Crossover design	15 participants 3 males, 12 females Age: 24 ± 2 years	-Experienced computer users	Each participant performed a series of mouse tasks lasting for few minutes to compare the use of a conventional and a biofeedback mouse	-Muscle activity was measured using EMG -Productivity was assessed objectively by the number of questions answered and the amount of correct answers within the time allowed and subjectively by rating four items on a 7-point scale, self-reported, questionnaire -Hovering behavior was determined using computer registration software (RSI-Master) -Discomfort was assessed by The Dutch validated method -Comfort and user friendliness were assessed with a 7-point scale, self-reported, questionnaire	-Productivity and discomfort measures showed no significant differences -The biofeedback mouse significantly decreased the amount of muscle activation and hovering behavior. This may reduce the risk for developing future musculoskeletal disorders.
Feathers et al. (2013)	6	High	Crossover design	21 participants 10 males, 11 females Age: 18–25 years	Students who reported to be familiar with computer and computer mouse usage.	Following a brief familiarization period, each participant performed series of clicking, pointing and dragging tasks to compare the use of a conventional mouse and four alternative desings (Isometrically scaled, Allometrically adjusted,Vertical mouse, Pronated-reducing mouse) -Random order was used with 1 min. Rest in between	−3D structural hand and mouse measurements were taken using a coordinate measurement machine. -Wrist posture was recorded using a twin-axis electrogoniometer -Participants completed a mousing experience survey after each use and a final survey at the end regarding ease of use, perceived mouse control, perceived comfort, attractiveness and overall preference	- Conventional mouse promoted the smallest median MCP angle and ulnar-deviation -Vertical Mouse rating was significantly higher for perceived control, perceived comfort and attractiveness. -Researchers concluded that a smaller metacarpophalangeal angle may contribute to increased performance and ease of use
Houwink, Oude Hengel, Odell, and Dennerlein (2009)	4	High	Controlled Trial	30 participants 15 males, 15 females Age for the untrained group: 23–43; for the trained group: 19–58	-Experienced computer workers with an average computer usage of 38 hrs./week	Following a brief familiarization period, both groups performed standard pointing tasks with a standard mouse and an alternative (slanted) mouse. 15 participants received no training on how to hold the alternative mouse, whereas the remaining 15 participants received verbal instructions before and during use of the alternative mouse. -Randomization of mice was not performed.	-Surface EMG was used to test muscle activity for three wrist extensor muscles of the right arm. Amount of muscle activity was recorded as a percentage of maximal voluntary contraction -Position and orientation of the right forearm and hand were measured with electromagnetic motion analysis system -Time of task completion was recorded during all tasks	-Participants showed significantly less pronation, wrist deviation and muscle activity when using the alternative mouse - All positives results were further enhanced when training was provided.
Jung (2014)	5	Unclear	Crossover design	40 participants 20 males, 20 females Average age for males 23.2 ± 2.6 Average age for females: 21.7 ± 1.8	-Right-handed dominant -No experience utilizing a slanted mouse prior to experiment	Following a brief familiarization period, each participant performed a 15 series of clicking, pointing and dragging tasks to compare the use of a conventional mouse (slant angle 0°) to two alternative designs with slant angles of 30° and 50°, respectively.	-Completion time and error rate were measured through computer software -Discomfort was measured with Borg’s CR-10 scale -Satisfaction was measured through 7-point bipolar scale	-As the slant of the mouse increased, satisfaction decreased. -Discomfort of the upper extremity increased as the slant increased. -Due to the weight and unfamiliar posture, the standard mouse was preferred over the slanted mice for both performance and comfort.
King et al. (2013).	8	Low	RCT	-23 participants	Office workers with more than 4 hr/day of computer use	-Experimental group used the biofeedback mouse for 25 weeks -Control group used a standard mouse for 25 weeks Data was measured at weeks 0, 5 and 25	-Pain and discomfort levels of shoulder, UE and total body were assessed using the Daily Symptom Survey - Mouse and Keyboard use patterns were measured through the Hoverstop software via an electric-potential transducer in the mouse	-By the end of the study, the biofeedback mouse users had a significant reduction (37%) in the UE symptoms -A biofeedback mechanism may reduce the incidence of musculoskeletal disorders in office workers
Kluth and Keller (2015)	5	Unclear	Crossover design	-24 participants -Age range: 22–58	-Lab setting	Each participant performed a series of clicking, pointing and dragging tasks lasting for 4 h with appropriate breaks to compare the use of a conventional and roller bar mouse in a repeated measures crossover design	-Muscle activity was measured using EMG. -Comfort during task performance was measured using a bipolar 4-step scale questionnaire	-Muscle activity during the use of the rollerball mouse is substantially lower for males than for females - A significant reduction in complaints for the fingers was achieved by the rollerball mouse relative to the standard mouse
Kumar and Kumar (2008)	6	High	Crossover design	15 participants 7 males, 8 females Age: 30.67 (22–26)	Students and employees from a university with 6 months of working experience with computers	Following a brief familiarization period with the new mouse, each participant performed a series of clicking, pointing and dragging tasks lasting for few minutes to compare the use of a conventional and roller bar mouse in a repeated measures crossover design	-Digital telemetric EMG analysis system equipment was used to measure muscle activity for each test -After the tasks, subjects rated comfort for both input devices on a 1–5 scale for using the cursor, strain in the arm/hand and strain in the shoulder	-The roller bar mouse significantly lowered muscle activity in comparison with the conventional mouse -The conventional mouse was rated more comfortable in moving the cursor than the roller bar mouse (subject’s experience with the conventional mouse could have contributed to the preference over the roller bar mouse) -The roller bar mouse was found significantly better for strain in the hand and arm
Lee, Fleisher, McLoone, Kotani, and Dennerlein (2007)	6	High	Crossover design	20 participants 10 females, 10 males. Age: 28.6 ± 5.3 years	-Experienced computer. users with a mean self-estimated usage of 4.3 ± 2.6 h per week day	Without prior familiarization, participants completed steering, point clicking and dragging tasks to compare the standard mouse to four alternative mouse designs (No-right button, High force, push-forward and slide-forward buttons) Task completion time for each mouse was monitored using appropriate software	-Surface EMG signals were measured in four hand and forearm muscles using a custom- designed computer data acquisition software program -The number of errors during the steering tasks was recorded by the task software -Subjective usability ratings were measured on pre- and post-usability, approachability, comfort and task difficulty scores on continuous scales from 0 to 10	-Muscle activity of finger extensors decreased with alternative designs that incorporated a change in the button switch direction; however, there was higher flexor muscle loading and lower performance and usability associated with these devices -Participants ranked the reference mouse as most favorable followed by the no-right-button mouse, push-forward mouse and slide-forward mouse
Lin, Young, and Dennerlein (2015)	5	High	Crossover design	12 participants 6 males, 6 females Age: 27.6 ± 6.6	Volunteers	-Each participant completed a series of standardized mouse pointing and browsing tasks of 8 min duration to compare four different pointing device (Standard mouse, Trackball, Standalone touch pad, and Roller-style mouse)	-Muscle activity was measured using EMG -Posture was recorded by Optical 3D motion analysis system -All participants responded to two survey questions about overall upper extremity discomfort and task difficulty	-The roller-style mouse elicited significantly less extensor carpi radialis muscle activity. -The standard mouse was easier to use. -Shoulder abduction and flexion were greater for the laterally located mouse, whereas internal rotation and pronation were greater for the centrally located mice -Ulnar deviation was greatest for the trackball and least for the touchpad. -Small differences in posture may indicate elevated or reduced risk of developing musculoskeletal injury, depending on the design.
Meijer, Sluiter, and Frings-Dresen (2009)	4	High	RCT	354 participants 176 in control group (94 males and 82 females) and 178 in intervention group (94 males and 84 females) Average age: 44	-Office workers with working tasks consisting mainly of computer use (over 4 h a day) for at least 2 days a week	-The intervention consisted of a feedback mouse with a sensor that detected the presence of a hand on or just above the mouse without active use for more than 12 s -The control group utilized a standard computer mouse -A randomized controlled trial was performed with one baseline measurement and two post-measure- ments at 4 and 8 months after the start of the intervention.	-Physical disability was assessed using the Dutch version of the “Quick Disability Arm Shoulder Hand” questionnaire -Registration software was used to measure mouse usage duration and frequency of rest breaks	- Prevalence and incidence of musculoskeletal symptoms did not differ between the intervention group and control group at 4 and 8 months after baseline -Mouse usage duration significantly decreased in the intervention group compared to the control group - The feedback signal mouse significantly reduced disability scores compared to the control group
Odell and Johnson (2015)	6	High	Crossover design	12 participants 6 males, 6 females Age: 32.7 (20–52)	Experienced computer mouse users with at least 10 h per week computer use	-Following a familiarization period of 2–4 min of mouse use, participants completed some pointing and clicking tasks to compare the efficacy of five different mouse designes (Vertical mouse, Standard mouse and three different concept mice)	-Right-hand wrist angles were measured with an electrogoniometer and forearm pronation/supination was measured with an inclinometer mounted to the distal end-block of the electrogoniometer -Fatigue of the hand, wrist, forearm and shoulder were measured using a BORG rating scale -Mouse model preference was measured using a 7-point Likert scale	-The concept mice offered less pronated and deviated wrist postures in comparison with the standard mouse -The concept mice resulted in similar performance, in regard to pointing times, to the standard mouse -Subjective measures indicated a preference for the standard mouse
Oude Hengel, Houwink, Odell, van Dieen, and Dennerlein (2008)	5	Unclear	Crossover design	-30 participant -15 males, 15 females -Age: 29.8 (19–58)	-Healthy adult -Right-handed individuals Workstation consisted of a chair without armrest	Subjects completed a repeated measures design comparison of six different commercially available computer mice. For each mouse, participants performed standard pointing tasks, a dragging task and a steering task. Each task lasted for approximately 1 min.	-Muscle activity was measured using EMG -Comfort and preference were measured by a subjective questionnaire	-Smaller computer mice increase the biomechanical load and risk for developing musculoskeletal injury. -Acute use of these computer mice may not pose high risk, but prolonged and chronic use of these smaller mice may cause injury to the user.
Quemelo and Vieira (2013)	5	Unclear	Crossover design	-16 participants -6 male 10 female -Age: 26 ± 3	-Right-handed volunteers -Physical therapy students with similar schedules and computer use requirements	-Following a familiarization period of at least 16 h of use over two weeks, participants completed some steering and pointing tasks to compare the time needed to finish the tasks with both the pen-style vertical mouse and standard computer mouse. With the Fitt’s Law test.	-Muscle activity was measured using EMG -Wrist postures measured by electrogoniometry -Computer work evaluation was measured by subjective adapted questionnaire	-With the exception of wrist extension, the vertical mouse produced more favorable postures - The upper trapezius tended to be more active when using the vertical mouse - Questionnaires indicated good user satisfaction with the vertical mouse in relation to setting it up, using it, productivity while using it and comfort. -Performance was better when using the standard computer mouse
Schmid, Kubler, Johnston, and Coppieters (2015)	5	Unclear	Crossover design	-21 participants -13 Female, 8 male -Age: 50 ± 8.8	-Volunteers	Subjects completed a repeated measures design comparing four different mouse designs (Standard, Standard with mouse gel pad, Standard with a gliding palm support and a Vertical mouse) while performing a series of 5 min point and click tasks	-Carpal tunnel pressure was measured using an epidural catheter -Wrist flexion-extension, wrist ulnar-radial deviation were measured using an electrogoniometer	-The vertical mouse significantly reduced ulnar deviation and the gel mouse pad and gliding palm support decreased wrist extension - None of the ergonomic devices reduced carpal tunnel pressure.

Table 2. Quality assessment of articles included in the systematic review using the PEDro scale

Study (authors/year)	Rating (0–10)	Itemized responses
Chen and Leung (2007)	5	Eligibility criteria*: yes; random allocation: no; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
Conlon, Krause, and Rempel (2008)	7	Eligibility criteria: yes; random allocation: yes; concealed allocation: yes; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: yes; adequate follow-up: no; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
Dehghan et al. (2015)	6	Eligibility criteria: yes; random allocation: yes; concealed allocation: yes; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: no; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
de Korte et al. (2008)	3	Eligibility criteria: yes; random allocation: no; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: no; intention-to-treat analysis: no; between-group comparisons: yes; point estimates and variability: yes.
Feathers et al. (2013)	6	Eligibility criteria: no; random allocation: yes; concealed allocation: yes; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: no; between-group comparisons: yes; point estimates and variability: yes.
Houwink et al. (2009)	5	Eligibility criteria: yes; random allocation: no; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: no; between-group comparisons: yes; point estimates and variability: yes.
Jung (2014)	5	Eligibility criteria: yes; random allocation: no; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
King et al. (2013)	8	Eligibility criteria: yes; random allocation: yes; concealed allocation: yes; baseline comparability: no; blind subjects: no; blind therapists: yes; blind assessors: yes; adequate follow-up: yes; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
Kluth,Keller (2015)	5	Eligibility criteria: no; random allocation: no; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
Kumar and Kumar (2008)	6	Eligibility criteria: yes; random allocation: yes; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
Lee et al. (2007)	6	Eligibility criteria: no; random allocation: yes; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
Lin et al. (2015)	5	Eligibility criteria: yes; Random allocation: No; Concealed allocation: no; Baseline comparability: yes; Blind subjects: No; Blind therapists: no; Blind assessors: no; Adequate follow-up: yes; Intention-to-treat analysis: yes; Between-group comparisons: Yes; Point estimates and variability: Yes.
Meijer et al. (2009)	4	Eligibility criteria: yes; random allocation: yes; concealed allocation: yes; baseline comparability: no; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: no; intention-to-treat analysis: no; between-group comparisons: yes; point estimates and variability: yes.
Odell and Johnson (2015)	6	Eligibility criteria: yes; random allocation: yes; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
Oude Hengel et al. (2008)	5	Eligibility criteria: yes; random allocation: no; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
Quemelo and Vieira (2013)	5	Eligibility criteria: yes; random allocation: no; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.
Schmid et al. (2015)	5	Eligibility criteria: yes; random allocation: no; concealed allocation: no; baseline comparability: yes; blind subjects: no; blind therapists: no; blind assessors: no; adequate follow-up: yes; intention-to-treat analysis: yes; between-group comparisons: yes; point estimates and variability: yes.

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Conlon, C. F. , Krause, N. , & Rempel, D. M. (2008). A randomised controlled trial evaluating an alternative mouse and forearm support on upper body discomfort and musculoskeletal disorders among engineers. Occupational and Environmental Medicine , 65(5), 311–318. doi:10.1136/oem.2006.032243

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