Abstract
BACKGROUND:
There is a lack of information about the optimal setup of multiple screen configurations in virtual reality (VR) office work.
OBJECTIVE:
The objective of this study was to evaluate the effects of different screen configurations on neck flexion, rotation, neck muscle activity, and simulator sickness symptoms during Virtual Reality (VR) office work.
METHODS:
Twelve participants (7 males; 21 to 27 years old) performed copy-paste and drag-drop tasks in three different screen configurations (single screen, primary-secondary screen, and double screen) in a randomized order. Optical motion capture system, electromyography (EMG) device, and simulator sickness questionnaire (SSQ) were used to measure the users’ responses.
RESULTS:
Neck rotation angles, muscle activities, and VR sickness were significantly affected by the screen configurations (p < 0.021). The primary-secondary screen showed the highest right rotation angle (median: -33.47°) and left sternocleidomastoid (SCM) muscle activities (median: 12.57% MVC). Both single (median: 22.42) and primary-secondary (median: 22.40) screen showed the highest value of SSQ.
CONCLUSIONS:
The screen configurations in VR could be an important design factor affecting the users’ physical demands of the neck and VR sickness symptoms. Asymmetric neck rotations caused by the primary-secondary screen conditions should be avoided.
Keywords
Introduction
Virtual reality (VR) has emerged as a valuable tool for companies across various industries. Its applications range from training and simulation to product design and prototyping. Virtual reality simulations have the potential to offer users a wealth of information and data when used effectively and to their maximum capacity [1]. Through VR, users can mentally move and interact with objects like in real life. This cutting-edge technology has evolved to meet companies’ future design, training, and corporate communication needs [2–5]. One of the key advantages of VR is its ability to simulate complex environments, allowing users to train in a controlled and safe environment. This feature is particularly useful in high-risk industries such as aerospace and medical. By providing a realistic and immersive experience, VR can help workers train effectively and efficiently, reducing the risk of accidents and improving overall performance [6].
VR has emerged as a powerful tool for educational purposes, providing users with an immersive learning experience that allows for more interactive engagement with various subjects. A virtual reality office can adjust itself according to the user’s work requirements, creating a serene environment for work that can lead to increased productivity [7]. Working with multiple screens in VR can offer a truly immersive experience that promotes privacy and eliminates distractions, creating a distraction-free environment that allows for efficient multitasking [8]. By customizing their virtual workspace with multiple screens positioned and sized to their liking, users can create a workspace that is tailored to their individual needs, leading to a more enjoyable and productive work experience overall [9]. Moreover, the fun and engaging aspects of VR can also boost motivation and creativity, making it a useful tool for work and educational purposes alike [10]. As VR technology continues to advance, it has the potential to revolutionize the way we work, learn and interact with the world around us [11].
Dual-display configuration has been shown to increase user satisfaction and productivity, but it can also increase neck rotation compared to single-screen configuration[12]. While working in VR can provide a highly immersive experience, it can also lead to motion sickness and cybersickness over time. The potential adverse effects of VR, such as ocular exhaustion, disorientation, and nausea, can hinder users’ immersive virtual reality experience [13]. Therefore, assessing the level of comfort and discomfort experienced when performing tasks in virtual reality is crucial. Proper evaluation of these factors is imperative to ensure a satisfactory and safe virtual experience. As VR technology continues to evolve, it is important to consider both the benefits and risks associated with its use, and to ensure that users can fully reap its benefits while minimizing potential negative effects [2, 3].
Previous studies showed that adjustment of the display heights and targets on a computer screen could reduce the biomechanical exposures in the neck and shoulders in a conventional desktop setting [14–16]. Although previous studies showed important information for ergonomic guidelines of the conventional desktop setting, there is insufficient information about the optimal interface settings in office work in VR environment. Previous VR studies identified the optimal target locations and target sizes for gesture interactions in VR [2, 3] but there was no known studies investigating the optical VR screen configurations. This could be crucial to VR users’ head movement and associated physical demands. A recent systematic review study also found that VR users’ physical workload, posture, stress, and discomfort were less often investigated compared to other aspects of cybersickness, visual fatigue, mental workload, performance, spatial presence, and usability [17].
The aim of this study was to evaluate the effects of different screen configurations (single, primary-secondary, and double) on the neck motion, neck muscle activity, and simulator sickness symptoms while performing office work in virtual reality. We hypothesized that different screen configurations would affect users’ physical responses and subjective workload.
Methods
Participants
A total of 12 participants (7 males and 5 females) aged 21 to 27 years old were recruited from university, for this study. Among all the participants, no one had a history of musculoskeletal pain or diseases in the upper extremity. The average (standard deviation) for height, age, and weight ranges were 167.85 (±8.96) centimeters, 24 (±1.95) years, and 68.23(±14.94) kilograms. This experimental protocol was approved by the Institutional Review Board of the University (HS22-0229) and all the participants in this project gave their written consent before participating in this study.
Instrumentation
Oculus Quest 2 with a controller having 1832*1920 resolution per eye with 72-120 Hz and 6 degrees of freedom was utilized in this study. The laptop was Bluetooth paired with the VR device for performing drag-drop and copy-paste tasks. The laptop set different screen configurations and paired with the VR device so users could experience the setting in a VR environment. Three different types of display configurations were set for the experiment: 1) single screen display (24 inches), 2) primary-secondary screen display (secondary screen was tilted at 15 degrees), and 3) double screen display (both screen were tilted at 15 degrees). These screen configurations were determined based on the previous study’s findings in a conventional desktop setting [12], as shown in Fig. 1.

Screen configurations (a) Single screen (b) Primary-Secondary screen, and (c) Double screen.
Reflective markers (14 mm diameter) were used for the 3D optical motion capture system with 8 cameras (Flex 13, Optitrack, OR, Natural Point) for the kinematic data collection of the upper extremity of the human body at the rate of 120 Hz. Twenty-seven markers were attached to the participant’s head, chest, pelvis, back, shoulder, arm, wrist, and hand according to the conventional Plug-in Gait marker set [18, 19].
Wireless Electromyography (EMG) sensors (Delsys Avanti Trigno) were used for measuring muscle activity at the frequency of 1000 Hz. The skin preparation, electrode placement, and identification of muscles were done as per the European Recommendation for surface Electromyography (EMG) [20]. The muscle activity was collected for four neck muscles of the bilateral sternocleidomastoid (SCM) and upper trapezius muscles to measure the neck muscle activity while experimenting At the end of the experiment, maximum voluntary contractions (MVCs) were collected for each of the four muscles twice with a break of 2 minutes between the contractions. For the MVCs of the upper trapezius muscles, the participant’s shoulders were abducted to 90° in the scapula plane with internal rotation and extended elbow (i.e., empty can posture) [21, 22]. The resistant force was applied at wrist. For the SCM muscles, the Theraband® Elastic band (red color) was placed to the participant’s forehead and opposite side of the band was attached to the fixed bar on the wall [23]. Participants performed neck flexion isometric contractions with resistance from the elastic band.
With a repeated-measures laboratory experiment, participants were instructed to perform two office tasks: copy-paste and drag-drop tasks using the controllers. The experimental photo and the user’s view in VR were shown in Fig. 2.

(a) Experimental photo with the motion capture data and EMG data acquisition setup (b) Double screen configurations in VR.
For the copy-paste task, participants were asked to copy the picture and paste them into the correct position. In contrast, in the drag-drop task, participants were given names in the Excel sheet, and they were required to drop the name from the cell into the correct folder. For each copy-paste and drag-drop task, it required different usage of the controllers to complete the tasks. We used Excel sheets with emoji (targets), and key numbers and the task was to refer to key numbers and paste or drop them (Fig. 1). For a single screen, two tabs were open in the single screen and the goal was to copy or drag the targets from the left tab and paste or drop it to the right tab. For the primary-secondary screen, participants copied or dragged targets from the front primary screen and pasted or dropped them into the right secondary screen. For the double screen, targets were placed on the left screen, and participants were required to paste or drag them into the right screen.
In randomized order, participants performed copy-paste and drag-drop tasks in three configurations of screens, each five minutes long. After completing each task, five minutes of the break was given. The screen display was adjusted to the eye height of each participant and a consistent arrangement of sitting was provided to all participants. In addition, a Simulator Sickness Questionnaire (SSQ) was used to measure each participant’s simulator sickness symptoms before and after conducting each task [24]. Seven components (general discomfort, fatigue, headache, blurred vision, difficulty focusing, nausea, and eyestrain) were considered for calculating the final score [25]. In this study, questions were clustered into three sub-score parameters oculomotor (general discomfort, fatigue, eyestrain, difficulty focusing, headache), disorientation (Difficulty focusing, nausea, and blurred vision), and nausea (general discomfort, and nausea) and each participant was asked to rate the severity of each item (‘0’ – none, 1- slight, 2- moderate and 3- high) before and after each task [26].
For the kinematic data captured by the optical motion capture system, the filtering of raw kinematic data was employed using the 4th-order Butterworth filter having 6 HZ of the cut-off frequency. The neck flexion and rotation angles were calculated using the biomechanics software (Visual 3D, C-motion, Inc., Germantown). The kinematic data were summarized into the 10th, 50th, and 90th percentiles [22, 27].
The root mean square (RMS) value of EMG was calculated and the normalized muscle activities (% MVC) were calculated using Delsys EMG Works software and MATLAB. The normalized muscle activities were summarized as the 10th, 50th, and 90th percentiles [28].
Statistical analysis
Due to the non-normality of the data, non-parametric analysis of ANOVA, Kruskal-Wallis tests were conducted to determine the effects of three different screen configurations on the neck flexion and rotation angles, neck normalized muscle activities of SCM and upper trapezius muscles, and SSQ scores. The significance level was set as 0.01. For the SSQ, the summated values of each component were summarized to understand the contributions of the final scores by different screen configurations.
Results
Neck angles
The peak neck flexion angle (90th percentile) and all ranges of neck rotation angles were significantly affected by the screen configurations (p < 0.001), as seen in Table 1. For the peak neck flexion angle, primary-secondary angle showed the highest angle (median: 18.41°) followed by the dual screen (median: 16.51°). For the neck rotation angle, primary-secondary screen showed the highest right rotation angle (median: –33.47°) whereas the dual screen showed the highest left rotation angle (median: 24.88°).
Median value (interquartile range), and statistical significances of the 3D neck angle measures by different screen configurations. Kruskal-Wallis tests were conducted
Median value (interquartile range), and statistical significances of the 3D neck angle measures by different screen configurations. Kruskal-Wallis tests were conducted
Note: *denotes that p-value < 0.01. For flexion/extension, negative value indicates the extension. For rotation angle, negative value indicates the right rotation.
All ranges of bilateral SCM muscle activities except the right SCM 10th percentile values were significantly different by the screen configurations (p < 0.021), as shown in Table 2. For the peak left SCM muscle activities, primary-secondary screen showed the highest value (median: 12.57% MVC), whereas the dual screen showed the highest value (median: 9.94% MVC) of right SCM muscle activities. All ranges of left upper trapezius muscle activities were significantly affected by the screen configurations (p < 0.001). For the peak left trapezius muscle activity, primary-secondary screen showed the greatest value (median: 11.68% MVC). For the right upper trapezius muscle activities, the peak value was significantly influenced by the screen configurations (p < 0.001) whereas the median value was not significantly affected (p = 0.051). Dual screen showed the highest value (median: 9.62% MVC) of right trapezius peak muscle activity.
Median value (interquartile range), and statistical significances of the neck normalized muscle activities(% MVC) by different screen configurations. Kruskal-Wallis tests were conducted
Median value (interquartile range), and statistical significances of the neck normalized muscle activities(% MVC) by different screen configurations. Kruskal-Wallis tests were conducted
Note: *denotes that p-value <0.01.
The final normalized SSQ score (post-pre) was significantly affected by the screen configurations (p < 0.001). Both single (median: 22.42) and primary-secondary (median: 22.40) screen showed the highest value compared to the dual screen (median: 11.22) setting.
In addition, summated values of each component in SSQ by different screen configurations were compared (Fig. 3). Single screen showed the highest scores of fatigue, headache, nausea, and eyestrain whereas primary-secondary screen showed the highest values of general discomfort, blurred vision, and difficulty focusing.

Summated values of each component in SSQ by three different screen configurations.
This laboratory-based study evaluated the impact of different screen configurations on neck flexion and rotation angles, neck muscle activities, and simulator sickness symptoms in VR. The experiment results showed that the screen configurations significantly affected neck rotation angles, neck muscle activities, and simulator sickness symptoms. Primary-secondary screen caused the greatest amount of right neck rotation (median: –33.47°), which could be associated with the highest demand of left SCM muscle activities (median: 12.57% MVC). Participants showed the lowest values of general discomfort, headache, blurred vision, difficulty focusing, and nausea in Dual screen configuration.
The peak neck flexion was significantly affected by the screen configurations. For the peak neck flexion angle, both primary-secondary and dual screen conditions showed higher values (median: 16.51 to 18.41°) compared to the single screen (median: 9.35°). Three different screen configurations were consistently set as the eye height of each participant while sitting. This difference might be related to the coupled motions while participants were rotating their heads [29]. For the single screen, participants did not require the neck rotation, and their postures were consistently in a neutral position. Both primary-secondary and dual screen required the participants’ neck rotation, which could induce the neck flexion angle as a coupled motion.
The screen configurations significantly influenced all ranges of neck rotation angles. Primary-secondary screen increased the right rotation angle by 24° compared to the single screen. This could be due to the screen setup of primary-secondary screen as seen in Fig. 1. The primary screen was set in front of the participant, and the secondary screen was placed on the right side. This required substantial neck right rotation to perform the copy-paste and drag-drop tasks. The neck rotation 50th percentile angle confirmed this asymmetric neck rotation. While single and dual screen’s median angle were -5.02° and 0.07°, respectively, the primary-secondary’s value was -9.84°. The previous study evaluated the effects of different document locations on neck movement during computer use [30]. They found that placing the document on the flat desktop surface caused the greatest neck rotation compared to using the lateral document holder or using the Microdesk platform. These findings indicate that the neck rotation angles were significantly influenced by the locations of the screen [2]. Prolonged asymmetric neck rotations due to the primary-secondary screen could cause a neck discomfort and musculoskeletal disorders [12, 31].
One previous study also investigated the user’s neck rotation, discomfort, and VR sickness during text-intensive tasks in VR [31]. They found that frequent head rotations in VR could lead to the physical discomfort. The SSQ results showed that the visual discomfort was the primary symptoms due to the difficulty in reading texts. They tested the text intensive tasks for 60 minutes, and VR sickness symptoms were gradually increased over time. These indicate that frequent neck rotations during VR office work could increase the physical discomfort and VR sickness, and this could be exacerbated with asymmetric rotations [17, 32]. A recent systematic review study also found that the muscle fatigue and musculoskeletal discomfort were affected by 15 different factors, and the magnitude of the impact varied depending on tasks and interactions [32]. Moreover, the task difficulty and time pressure could lead to acute stress of the VR users as well, which was aligned with the present study’s findings [17, 32].
The neck muscle activities were significantly affected by the screen configurations. Differences of the neck muscle activities could be associated with the changes of the neck motions based on the muscle force-length relationships [33, 34]. For the peak left SCM muscle activities, primary-secondary screen increased the muscle activities by 4.3% MVC compared to the single screen condition. This could be associated with the substantial right neck rotation with primary-secondary screen condition. Over 30° of right neck rotation could stretch the opposite (left) side of the SCM muscles, which could cause an increased tension of the Left SCM muscle. This was consistent with the previous study showing that left SCM muscle activities increased with cervical rotation to the right [35]. Similar trend was also observed in upper trapezius muscles. For the left Trapezius peak muscle activities, primary-secondary screen (median: 11.68% MVC) showed the highest values followed by dual screen condition (median: 10.81% MVC). The difference relative to the single screen condition was greater in left Trapezius muscles (up to 3.5% MVC) compared to the right Trapezius muscle (up to 1.9% MVC). This suggests that sustained asymmetrical neck rotation due to the primary-secondary screen could increase the neck muscular loading, and discomfort.
The screen configurations significantly affected the participants’ simulator sickness symptoms. Both single and primary-secondary screen configurations showed a twice higher SSQ final scores compared to the dual screen setting. For single screen condition, the biggest symptoms were eyestrain, headache, difficulty focusing, general discomfort, and nausea. This could be related to the limited screen size while performing the copy-paste and drag-drop tasks rather than the neck motion and muscle activities. This is because the single screen showed lower neck angles and muscle activities compared to other settings. Several participants in this study expressed that the single screen’s size was too small to work on the copy-paste and drag-drop tasks using two parallel Excel windows, and this led them to feel more unfavourable to the single screen setting. Two Excel sheet were open in parallel within the single screen of 24 inches, this could cause a precise control and concentration of participants [13]. Although primary-secondary screen used two screens, participants still showed high symptoms of blurred vision, difficulty focusing, general discomfort, and headache. This could be associated the asymmetric neck rotation to perform the tasks. A systematic review stated that users felt greater discomfort when they were engaged with rotational movement compared to translational movements [13, 36]. The results suggest that VR sickness could be a concern for performing copy-paste and drag-drop document tasks with single or primary-secondary screen conditions.
For the practical implications, the screen configurations in VR could be an essential design factor while performing office works in a VR environment. Based on the results, the user’s neck motion and muscle activities were notably influenced by different screen configurations. Although dual screen showed fewer sickness symptoms than single or primary-secondary screens, eyestrain still exhibited high with the dual screen setting. This may be improved with the higher resolutions of contents and bigger size of the VR screen. This hypothesis could be tested in further study in both controlled laboratory setting and real office environment.
The findings of this research make a significant contribution to the field of VR office work by shedding light on the critical role of screen configurations in shaping users’ physical experiences and well-being. The study’s identification of the impact of different screen setups on neck flexion, rotation, muscle activity, and simulator sickness symptoms provide valuable insights for the design and optimization of VR workspaces. The observation that asymmetric neck rotations induced by the primary-secondary screen configuration should be avoided is particularly noteworthy, offering practical guidance for developers and designers aiming to create more ergonomic and user-friendly VR environments. Moreover, the study’s use of objective measurements, including optical motion capture and electromyography, enhances the scientific rigor of the findings. Overall, this research contributes not only to our understanding of the physical demands imposed by VR office work but also offers actionable recommendations for mitigating discomfort and improving the overall user experience in virtual environments.
Although the study was carefully designed, several limitations were noted. First, the sample size was limited in this study. Due to the low sample size and non-normality of the data, we conducted a non-parametric test and set the significance level as 0.01 instead of 0.05. As mentioned earlier, a majority of measures were statistically significant with different screen configurations. Nonetheless, future study could increase the sample size to make study findings more generalizable. In addition, the qualitative method such as an interview or focus group meeting of the small sample size subjects could be added to enrich the data. Second, limited number of document tasks were tested in this study. Copy-paste and drag-drop tasks have commonly occurred in the office setting, and we determined these tasks based on the previous study’s findings [12]. Nonetheless, other office tasks such typing and reading could be explored further and determine whether screen configurations still affect the measures. Lastly, we only studied the short-term exposure of different screen configurations in this study. Long-term exposure of different screen conditions may exacerbate the physical demands of the neck and VR sickness symptoms. Further study could determine the changes of the users’ response over time.
Conclusions
The screen configurations significantly affected the neck flexion and rotation angle, neck muscle activities, and VR sickness symptoms. Both primary-secondary and dual screen configurations increased the neck flexion and rotation angles, which were associated with increased neck muscle activities. Especially, primary-secondary screen showed asymmetric neck rotation (right rotation over 30°), which could increase the neck muscle activities of the opposite side (left SCM muscle). Prolonged exposure of the asymmetric neck loading due to the primary-secondary screen configuration may increase the risk of musculoskeletal disorders of the neck and shoulders. Based on SSQ score, both single and primary-secondary screen showed twice higher scores compared to the dual screen setting. The major contributing factors were blurred vision, nausea, headache, difficulty focusing, and general discomfort. The results suggest that a single screen should offer sufficient display size (higher than 24 inches) for copy-paste and drag-drop office tasks. For the multiple-screen settings, the screen setting inducing more balanced neck rotations (e.g., dual screen) could be beneficial to reduce the concentrated physical loading of the neck. Future study could explore the feasibility and impact of different screen configurations in a real office setting that consist of diverse sequence and types of offices tasks occurring the entire day. The major contributions of this research include actionable recommendations for optimal screen configurations in VR office work. The study findings would be useful to understand the impact of different screen configurations to the users’ neck physical demands and simulator sickness symptoms, and to assist improving the design layouts of the screen configurations. These findings underscore the importance of considering not only the physical demands imposed on users but also the potential for simulator sickness when designing VR workspaces.
Ethical approval
Northern Illinois University, HS22-0229.
Informed consent
Each participant provided informed consent prior to the commencement of the experiment.
Conflict of interest
None.
Footnotes
Acknowledgments
None.
Funding
None.
