This study involving human participants was approved before recruitment by the Human Research Ethics Committee of Shanghai Material Engineering School (Approval no. 4701BC5746). All participants provided written informed consent before baseline assessment. Consent covered study participation, publication of aggregate results, and deposition of de-identified analytical data. Direct identifiers were stored separately from coded research records and were not deposited.
Study design, setting, and participants
This multicenter, assessor-blinded, randomized 2 × 2 factorial controlled study evaluated two multicomponent factors: a fixed versus individually adjustable furniture package and a basic versus optimized IEQ package. Their combination formed four parallel groups. The study was conducted at six office sites from September 8, 2025, to February 27, 2026; each participant completed four intervention weeks after baseline assessment and workstation/environmental commissioning. Eligible workspaces measured 3.2–8.5 m2 and were used primarily for computer-based work. Figure 1 summarizes the study flow, the factorial structure, and assessments.
Each site contributed 40 participant-workstations, with 10 assigned to each factorial group. To prevent cross-contamination between intervention groups, each of the six study sites used four strictly dedicated rooms or physically separated zones (one for each factorial condition), yielding a total of 24 independent zones, each containing 10 participant workstations. Contamination was systematically controlled by restricting adjustable furniture to assigned zones, applying tamper-evident labels to condition-specific IEQ devices, and explicitly instructing participants to use only their assigned workstations. Site intervention staff actively monitored spatial compliance and verified room-to-condition mapping weekly to ensure fidelity. Reported models adjust for site, and repeated-measures models cluster observations within participants.
Participants were recruited through workplace notices, institutional mailing lists, and staff briefings. Eligibility required age 20–55 years, at least 28 working hours per week, at least four hours of daily computer work, use of the same workspace for at least three months, and expected availability during follow-up. Exclusion criteria were pregnancy, recent spinal or limb surgery, acute injury requiring work restriction, a neurological or vestibular condition affecting standing balance, a clinically prescribed workstation, planned absence exceeding five workdays, inability to complete the computer tasks, pain above 8/10, or progressive neurological symptoms. Participant flow was documented using verified screening logs. A total of 265 employees were assessed for eligibility; 25 were excluded before randomization (18 did not meet the inclusion criteria, and 7 declined to participate). The remaining 240 eligible employees provided informed consent and were randomized, with 60 participants allocated to each of the four factorial groups. Overall comfort for week 4 was successfully captured for all 240 allocated participants. A standardized CONSORT flow diagram detailing the enrollment, allocation, follow-up, and analysis phases is presented in Figure 1.
Sample size, allocation, and masking
The target sample of 240 allowed approximately 12% attrition above the calculated minimum of 212 for the primary outcome (two-sided α = 0.05, 90% power, Cohen’s f = 0.20 for the interaction, and a baseline-to-follow-up correlation of 0.50). An independent statistician generated the allocation sequence using variable block sizes of 8 and 12, stratified by study site and baseline overall comfort. To ensure strict allocation concealment, the sequence was secured within a centralized, password-protected electronic database. Designated site research staff sequentially enrolled participants and conducted baseline assessments. Group allocation was automatically unblinded to the site intervention team via the electronic system only after the respective participant's baseline assessment was fully locked. Outcome assessors and data analysts remained blinded to group allocation until completion of the primary analysis. This study was not prospectively registered in a public clinical trial registry because the interventions focused on occupational ergonomics and indoor environmental engineering among healthy office workers, rather than therapeutic medical treatments. Nevertheless, to ensure methodological transparency, the comprehensive study protocol and statistical analysis plan (SAP) were approved by the institution and formally locked prior to participant enrollment and any data decoding.
Furniture and indoor environmental interventions
The furniture factor was a multicomponent package rather than a desk-only intervention (Figure 2 and Table 1). To guarantee consistent implementation across all six study sites, standardized operating procedures (SOPs) were established, and centralized training was mandated for all site research and installation personnel prior to study commencement. The fixed package comprised the existing 720–750 mm desk, chair, and standard monitor/input device arrangement. The adjustable package comprised a 650–1250 mm electric sit–stand desk, an adjustable chair, a monitor arm or stable riser when required, input-device repositioning, clearance for sit-to-stand movement, a 25-minute individualized adjustment session, and posture-change training. Participants were encouraged to gradually alternate between sitting and standing; desk height was recorded every minute. A desk-height episode was defined as five or more consecutive minutes with the desk ≥150 mm above that participant’s seated reference height. Because height does not establish body posture, this measure is reported as above-threshold time rather than standing exposure.
The IEQ factor was also multicomponent. The basic package retained existing ventilation, lighting, thermal, acoustic, and filtration operations, with safety corrections as required. The optimized package targeted 23.0–25.0°C, 45%–60% relative humidity, carbon dioxide (CO₂) below 800 ppm, task illuminance of 400–500 lux, equivalent continuous noise no greater than 45 dBA, and fine particulate matter (PM2.5) no greater than 15 µg/m3 using coordinated ventilation, temperature control, blinds/task lighting, equipment or barrier changes, and filtration/housekeeping measures. A five-variable daily-mean composite was met only when temperature, humidity, CO₂, illuminance, and noise were all within target on that valid workday; PM2.5 was reported separately. Variable-specific and composite daily-mean attainment rates were systematically calculated by group and site for subsequent analysis. Room-level attainment cannot be calculated without the missing room map.
Environmental and furniture-use monitoring
Place environmental monitors 0.8–1.2 m above the floor and 0.5–1.0 m from the usual seated position, away from direct sunlight, windows, supply outlets, computers, and other local sources. Record temperature, relative humidity, and CO₂ each minute and PM2.5 every five minutes. Measure illuminance and noise during standardized tasks and three scheduled 30-minute periods on two ordinary workdays per week. Cross-check instruments before deployment; exclude the first 10 minutes after placement and periods of movement, disconnection, covering, handling, or out-of-range operation. Define a valid day as having at least six occupied hours between 08:30 and 17:30.
Outcome measures and assessment schedule
Complete baseline assessment before allocation and week 4 assessment on intervention days 26–32, preferably within the same two-hour time window. The primary item asks: “Considering your workstation and the surrounding indoor environment together, how comfortable was your workspace during the previous 5 working days?” (1 = extremely uncomfortable; 7 = extremely comfortable). Study-specific items 1–7 assess posture, thermal, air-quality, visual, and acoustic comfort; environmental comfort is the arithmetic mean when at least 3 of the 4 environmental items are available. Neck and lower back discomfort: use 0–10 ratings for the preceding five workdays. Productivity, satisfaction, fatigue, and performance tasks are defined in Table 2, which provides every prompt, scoring rule, schedule, measurement-property limitation, and practical interpretation. Because these study-specific items lack externally validated reliability coefficients and minimal important differences, continuous effects and 95% CIs—not invented cutoffs—are emphasized.
Standardized work-performance assessment
Administer a 35-minute computer battery covering proofreading, data entry, visual search, and rule-based classification. Calculate accuracy as correct items divided by attempted items × 100 and speed as correct units per 35 minutes. Provide a 10-minute practice, counterbalance parallel baseline/week 4 forms, pause interruptions shorter than two minutes, and repeat within three workdays after longer technical interruptions. Score the exploratory divergent-thinking task from 0–100 using fluency, flexibility, and originality.
Intervention fidelity, protocol deviations, and safety
Define adherence to adjustable furniture as at least 30 minutes of above-threshold desk use on at least 3 workdays per week during at least 3 intervention weeks. Define optimized-IEQ adherence as meeting the five-variable daily-mean composite on at least 75% of valid monitored workdays. Retain all allocated participants in the primary analysis. Record incorrect condition for at least five consecutive workdays, relocation for more than 25% of the intervention, fewer than 10 valid workdays, or missing week 4 primary outcome as major deviations. At weekly checks, document new/worsening discomfort, dizziness, instability, lower-limb fatigue, work interruption, any suspension, reassessment, and adverse effect; suspend standing-desk use and reassess after a ≥3-point discomfort increase, dizziness while standing, or symptoms affecting walking or normal work.
Data management and missing-data handling
Store all records under coded participant identifiers and keep direct identifiers in a separately access-controlled file. Before locking, check ranges, consistency, duplication, allocation, sensor summaries, and outcomes against source files and site logs. Retain plausible extremes; correct only verified transcription, unit-conversion, or device errors. Summarize missingness by variable, group, site, and assessment. Do not impute wholly absent monitoring days. The deposited files contain de-identified participant-level, weekly, and workday summaries; direct identifiers, item-level keystroke logs, room maps, screening logs, and separate safety logs were not included in the public deposit.
Statistical analysis
Analyses used generic statistical programming software and libraries listed in the separate Table of Materials. Continuous variables are reported as mean ± standard deviation, and categorical variables as n (%); baseline significance tests were not used. All statistical analyses were executed in accordance with the prespecified SAP, with one transparently reported post-audit deviation. According to the prespecified SAP, the primary analysis modeled week 4 overall comfort, testing the main effects of adjustable furniture, optimized IEQ, and their interaction, while adjusting for baseline overall comfort, baseline lower-back discomfort, and workspace area. The interaction term was retained irrespective of statistical significance. However, as a post-audit deviation aimed at ensuring exact computational reproducibility and robust variance estimation given the small number of macro-clusters (k = 6 sites), the originally planned random-intercept specification was replaced with fixed site indicators utilizing HC3 heteroscedasticity-robust standard errors.
Apply analogous site-adjusted factorial models to secondary outcomes, including the corresponding baseline value when available, and control the false discovery rate within prespecified outcome families using the Benjamini–Hochberg method. Model weekly trajectories using generalized estimating equations with participant clustering and site indicators. Conduct per-protocol and major-deviation-exclusion analyses. Label bootstrap mediation (5,000 resamples) exploratory, and report both direct and indirect effects; examine temperature, CO2, illuminance, and noise nonlinearity with restricted cubic splines. Use two-sided tests and 95% CIs. Table 3 maps outcomes to models and clearly distinguishes primary, secondary, sensitivity, and exploratory analyses.