On the neck it is closed with a strap and Velcro. Who needs heat especially in the neck, does not get here, what he seeks either you put the belt on tight, although then passes heat to the neck, but the hard belt is more than uncomfortable and downright chokes. Or you hold it loose, then the heating effect is hardly noticeable and the pillow is in the upper back to bad. The lower belt is somewhat, but sits above the waist and so does not have a good grip. Sit upright is virtually impossible, the stiff pillow nestles in no way to the back.
But even if one is on the pillow (in my opinion the only way to use it at all), you have to set the highest level, so that sufficient heat penetrates. And even then ... I use it in the evening before bedtime reading and even though I'm wearing the upper body with a T-shirt, it is at level 3 just moderately warm. During the day in winter with normal clothing can be completely forgotten the pillow so. Maybe the picture would have to provide food for thought with the summery clad lady ...
On top of that you are already so dislocated when creating the cushion with the Gurtgedöns that you only really get backache.
The whole structure is good only as an idea, this implementation brings precious little. A normal flat heating pad to sit on it or lie on it is rather better - this one is at least not choked. I would buy it again and do not think the price clearly excessive.