The associations of mobile touch screen device use with musculoskeletal symptoms and exposures: A systematic review

Gender differences in neck muscle activity during near-maximum forward head flexion while using smartphones with varied postures

Women frequently express heightened neck discomfort even though they exhibit smaller neck flexion (NF) during smartphone use. Differences in natural posture while using smartphones may result in varying muscle activation patterns between genders. However, no study focused on this issue. This study investigated the influence of gender on neck muscle activity and NF when using smartphones, ranging from slight (20°) to nearly maximal forward head flexion, across different postures. We analyzed smartphone usage patterns in 16 men and 16 women and examined these behaviors across different scenarios: standing, supported sitting, and unsupported sitting, at 20°, 30°, 40°, and the maximum head angles. During data collection, muscle activity was measured, expressed as a percentage of the maximum voluntary contraction (%MVC), in the cervical erector spinae (CES) and upper trapezius (UTZ), along with NF. Results show significant influences of gender, head angle, and posture on all measures, with notable interactions among these variables. Women displayed higher muscle activities in CES and UTZ, yet exhibited lesser NF, while using smartphones in both standing (12.3%MVC, 10.7% MVC, and 69.0°, respectively) and unsupported sitting (10.8%MVC, 12.3%MVC, and 71.8°, respectively) compared to men (standing: 9.5%MVC, 8.8%MVC, and 76.1°; unsupported sitting: 9.7%MVC, 10.8%MVC, and 76.1°). This study provides a potential rationale for gender-related disparities in injury outcomes, emphasizing that women experience higher neck and shoulder discomfort level, despite their smaller NF during smartphone use, as found in previous research. Additionally, the cervical flexion-relaxation phenomenon may occur when the head angle exceeded 40°. The near-maximum head angle during smartphone use might induce the cervical flexion-relaxation phenomenon, potentially aggravating neck issues. We recommend limiting smartphone usage postures that exceed the near-maximum head angle, as they are commonly adopted by individuals in the daily smartphone activities.

Assessing the Preservation of Lumbar Lordotic Curvature in Everyday Sitting Conditions Assessed with an Inertial Measurement System

Background/Objectives: Lumbar lordotic curvature (LLC), closely associated with low back pain (LBP) when decreased, is infrequently assessed in clinical settings due to the spatiotemporal limitations of radiographic methods. To overcome these constraints, this study used an inertial measurement system to compare the magnitude and maintenance of LLC across various sitting conditions, categorized into three aspects: verbal instructions, chair type, and desk task types. Methods: Twenty-nine healthy participants were instructed to sit for 3 min with two wireless sensors placed on the 12th thoracic vertebra and the 2nd sacral vertebra. The lumbar lordotic angle (LLA) was measured using relative angles for the mediolateral axis and comparisons were made within each sitting category. Results: The maintenance of LLA (LLAdev) was significantly smaller when participants were instructed to sit upright (-3.7 ± 3.9°) compared to that of their habitual sitting posture (-1.2 ± 2.4°) (p = 0.001), while the magnitude of LLA (LLAavg) was significantly larger with an upright sitting posture (p = 0.001). LLAdev was significantly larger when using an office chair (-0.4 ± 1.1°) than when using a stool (-3.2 ± 7.1°) (p = 0.033), and LLAavg was also significantly larger with the office chair (p < 0.001). Among the desk tasks, LLAavg was largest during keyboard tasks (p < 0.001), followed by mouse and writing tasks; LLAdev showed a similar trend without statistical significance (keyboard, -1.2 ± 3.0°; mouse, -1.8 ± 2.2°; writing, -2.9 ± 3.1°) (p = 0.067). Conclusions: Our findings suggest that strategies including the use of an office chair and preference for computer work may help preserve LLC, whereas in the case of cueing, repetition may be necessary.

Text neck is not associated with neck and upper limb disability in young adults who use smartphones

PURPOSE

The objective of the present study was to correlate neck and upper-limb disabilities with neck flexion in university students who are smartphone users. While handling smartphones, a posture with sustained neck flexion known as "Text Neck" is usually adopted, and some authors related to musculoskeletal symptoms on the neck and the upper limb. However, recent studies state that such an association is questionable.

METHODS

This is an observational study when evaluating 192 university students through questionnaires such as the Neck Disability Index (NDI), Disabilities of Arm, Shoulder, and Hand (DASH), besides the maximal neck flexion, grip and lateral pinch strength of the participants.

RESULTS

The sociodemographic questionnaire demonstrated that most participants had used the device for 5 to 10 years, for five or more hours per day. The DASH questionnaire scores presented an average of 7.2 points, while the data regarding grip and lateral pinch strength showed averages of 29.5 kgf and 8.8 kgf, respectively. The NDI questionnaire scores presented an average of 10.5. The average range of motion of the maximum neck flexion was 27°.

CONCLUSION

There was no association between neck flexion with the DASH and NDI or the grip and lateral pinch strength after the correlation and binary logistic regression analyses. The results show that the scores of DASH, NDI, hand grip and lateral pinch strength, have no association with the maximum neck flexion.

Perceived Discomfort, Neck Kinematics, and Muscular Activity During Smartphone Usage: A Comparative Study

OBJECTIVE

The present study aims to evaluate the effects of posture, task, and handgrip style on discomfort, neck kinematics, and concomitant muscular activity when using a smartphone (SP).

BACKGROUND

Along with the popularity of smartphones, musculoskeletal disorders have become prevalent among smartphone users. However, comprehensive aspects of discomfort, kinematics, and electromyographic responses across various conditions remain to be investigated.

METHOD

Twenty-four young smartphone users performed typing, video watching, and reading tasks while holding the smartphone both with one hand and with two hands while either sitting or standing. Neck kinematics and muscular activities were simultaneously recorded.

RESULTS

Working with SPs led to higher discomfort in the neck (p = 0.01), lower back (p = 0.01), and shoulder (p = 0.04) while sitting as compared to standing. Sitting was associated with greater neck flexion and more minor lateral bending for all tasks and grip styles (p < 0.05). Electromyographic analysis indicated significant differences between sitting and standing, with alterations being dependent on the test condition. Moreover, neck kinematics and muscular activities significantly differed based on the task nature, handgrip, and interactions.

CONCLUSION

This study highlights the risk of using smartphones in increased neck angle flexion and muscular activities fatigue. Thus, posture and handgrip should be considered while using SPs. As each test condition affects a specific dependent variable, a holistic approach is required to evaluate the responses of SP users' musculoskeletal systems.

APPLICATION

Results can be applied to develop guidelines for musculoskeletal disorders/discomfort prevention among SP users, especially with the rise of smartphone use during the COVID-19 pandemic.

Exercise intervention to reduce mobile phone addiction in adolescents: a systematic review and meta-analysis of randomized controlled trials

Background

The growing problem of adolescent mobile phone addiction has attracted significant attention, underscoring the importance of identifying approaches to address it. Exercise has been found to reduce adolescent mobile phone addiction; however, its mechanism remains unclear. This review aims to elucidate the potential moderating factors between exercise and mobile phone addiction based on previous studies to provide a reference for adolescents to effectively participate in exercise to reduce mobile phone addiction.

Methods

Articles were searched in the CNKI, Web of Science, Scopus, Cochrane, PsycINFO, and PubMed databases according to the inclusion criteria and followed the Preferred Reporting Items for Systematic Assessment and Meta-analysis (PRISMA). The quality of the literature was assessed by two independent reviewers using the Cochrane Collaboration Risk of Bias tool for methodological quality assessment. Meta-analysis was performed using Stata 15.1 software for Meta-analysis, standardized mean difference (SMD) was combined using a random effects model, and subgroup analysis was used to explore heterogeneity.

Results

A total of 12 studies, 17 samples, and 861 subjects were included in the meta-analysis, and all studies were randomized controlled trials. The findings revealed that the exercise intervention significantly reduced mobile phone addiction in adolescents (SMD = -3.11; 95% CI: -3.91, -2.30; p < 0.001). The intervention effect was moderated by multiple variables, such as the measurement tools, exercise intervention types, cycles, frequency, and duration of a single exercise intervention.

Conclusion

Our findings suggest that exercise could serve as an effective strategy for preventing or ameliorating mobile phone addiction in adolescents. Based on the results of this study, we encourage mobile phone-addicted adolescents to engage in a single exercise using a mix of skills for 30-60 min three or more times weekly for more than eight consecutive weeks.

Wrist motion is distinct between touch screen and manual or digital devices

BACKGROUND

Restricted motion during touch screen device use may contribute to wrist overuse injuries. Wrist radioulnar deviation and extension while using touch screen devices and digital or manual counterparts in male and female medical professional dominant and non-dominant hands were quantified to test the hypothesis that mobile touch screen device use reduces wrist motion.

METHODS

An active motion detection system was used to record wrist motion of 12 participants while: tablet swiping and turning book pages; raising a cell and traditional phone to the ear; texting and typing; and entering numbers on a cell phone and manual calculator. Medial and lateral wrist surface range of motion (ROM) and minimum and maximum wrist radial-ulnar deviation and flexion-extension were quantified.

RESULTS

Device, sex and handedness effects were determined (P<0.05). Maximum medial radial deviation and ROM were greater using a cell versus traditional phone. Maximum medial radial deviation was higher in the nondominant wrist during backward tablet swiping and while backward page turning versus tablet swiping. Maximum and minimum medial extension angles and ROM were greater while typing versus texting. Female nondominant hand maximum lateral extension and ROM were greater for typing versus texting and maximum medial extension and lateral extension ROM greater during manual versus cell phone calculator use with handedness combined. Maximum lateral extension and ROM were greater in females versus males using manual calculators.

CONCLUSIONS

Sex and handedness should instruct touch screen, digital and manual device design and use for optimal performance and injury prevention.

Design guidelines for limiting and eliminating virtual reality-induced symptoms and effects at work: a comprehensive, factor-oriented review

Virtual reality (VR) can induce side effects known as virtual reality-induced symptoms and effects (VRISE). To address this concern, we identify a literature-based listing of these factors thought to influence VRISE with a focus on office work use. Using those, we recommend guidelines for VRISE amelioration intended for virtual environment creators and users. We identify five VRISE risks, focusing on short-term symptoms with their short-term effects. Three overall factor categories are considered: individual, hardware, and software. Over 90 factors may influence VRISE frequency and severity. We identify guidelines for each factor to help reduce VR side effects. To better reflect our confidence in those guidelines, we graded each with a level of evidence rating. Common factors occasionally influence different forms of VRISE. This can lead to confusion in the literature. General guidelines for using VR at work involve worker adaptation, such as limiting immersion times to between 20 and 30 min. These regimens involve taking regular breaks. Extra care is required for workers with special needs, neurodiversity, and gerontechnological concerns. In addition to following our guidelines, stakeholders should be aware that current head-mounted displays and virtual environments can continue to induce VRISE. While no single existing method fully alleviates VRISE, workers' health and safety must be monitored and safeguarded when VR is used at work.

Effect of tablet tilt positioning on ergonomic risks and respiratory function

The static posture associated with continuous tablet use can lead to musculoskeletal disorders of the neck and upper extremities as well as respiratory function disorders. We hypothesized that 0-degree tablet placement (flat on a table) would affect ergonomic risks and respiratory function. Eighteen undergraduate students were divided into two groups (n = 9 per group). In the first group, the tablet was placed at a 0-degree angle, whereas in the second group, it was placed at a 40- to 55-degree angle on a student learning chair. The tablet was used continuously for 2 h for writing and internet use. Rapid upper-limb assessment (RULA), craniovertebral angle, and respiratory function were assessed. There was no significant difference in respiratory function, including forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), and FEV₁/FVC, between the groups (p = 0.09) or within groups. However, there was a statistically significant between-group difference in RULA (p = 0.001), with the 0-degree group having a greater ergonomic risk. There were also significant within-group differences between pre- and posttest. The CV angle differed significantly between groups (p = 0.03), whereby the 0-degree group had poor posture, as well as within the 0-degree group (p = 0.039), though not within the 40- to 55-degree group (p = 0.067). Undergraduate students who place their tablets at a 0-degree angle face increased ergonomic risks and higher potential for developing musculoskeletal disorders and poor posture. Thus, elevating the tablet and instituting rest intervals may prevent or decrease the ergonomic risks among tablet users.

Neck and Upper Extremity Musculoskeletal Symptoms Secondary to Maladaptive Postures Caused by Cell Phones and Backpacks in School-Aged Children and Adolescents

Technology is an essential part of our lives. Nowadays, it is almost impossible to leave the house without a cell phone. Despite the wide range of benefits of cell phones and handheld electronic devices, this evolution of technology has not come without a price. The pandemic of cell phone use among children and young adolescents has led to the emergence of a set of musculoskeletal (MSK) symptoms that have not been seen before in this age group. These symptoms can range from neck and shoulder discomfort to pain, peripheral neurological symptoms of the upper extremity, and long-term complications such as disk prolapse and degenerative disk disease of the cervical spine. This clinical presentation is known as “text neck syndrome.” In addition to MSK symptoms, text neck syndrome could also include eye and ear symptoms, psychological problems, peripheral neurological symptoms, and poor academic performance. Multiple mechanisms have been discussed by which cell phone use causes MSK symptoms. Maladaptive postures, a decrease in physical activity leading to obesity, and the direct effect of electromagnetic radiation are some of the mechanisms by which long-term use of cell phones leads to the clinical presentation of text neck syndrome and its long-term consequences. The purpose of this article is to review the literature, discuss the epidemiology of cell phone use and MSK symptoms associated with its use in children and adolescents, describe its clinical presentation, explain the pathophysiology behind it, and provide preventative guidelines that can be used by this age group to allow for the continued use of these electronics without harmful effects on their posture and long-term health.

Cognitive domain-independent aberrant frontoparietal network strength in individuals with excessive smartphone use

Excessive smartphone use (ESU) may fulfill criteria for addictive behavior. In contrast to other related behavioral addictions, particularly Internet Gaming Disorder, little is known about the neural correlates underlying ESU. In this study, we used functional magnetic resonance imaging (fMRI) to acquire task data from three distinct behavioral paradigms, i.e. cue-reactivity, inhibition, and working memory, in individuals with psychometrically defined ESU (n = 19) compared to controls (n-ESU; n = 20). The Smartphone Addiction Inventory (SPAI) was used to quantify ESU-severity according to a novel five-factor model (SPAI-I). A multivariate data fusion approach, i.e. joint Independent Component Analysis (jICA) was employed to analyze fMRI-data derived from three separate experimental conditions, but analyzed jointly to detect converging and domain-independent neural signatures that differ between persons with vs. those without ESU. Across the three functional tasks, jICA identified a predominantly frontoparietal system that showed lower network strength in individuals with ESU compared to n-ESU (p < 0.05 FDR-corrected). Furthermore, significant associations between frontoparietal network strength and SPAI-I's dimensions "time spent" and "craving" were found. The data suggest a frontoparietal cognitive control network as cognitive domain-independent neural signature of excessive and potentially addictive smartphone use.

The association between smartphone use and sleep quality, psychological distress, and loneliness among health care students and workers in Saudi Arabia

BACKGROUND

The use of smartphones among the general public and health care practitioners, in particular, is ubiquitous. The aim of this study was to investigate the relationship between smartphone addiction and sleep quality, psychological distress, and loneliness among health care students and workers in Saudi Arabia.

METHODS

This cross-sectional study used an online questionnaire to collect data on smartphone addiction, sleep quality, psychological distress, and loneliness as well as demographic information.

RESULTS

A total of 773 health care students and workers participated in the study, with an average age of 25.95 ± 8.35, and 59.6% female participants. The study found a positive significant association between smartphone addiction and psychological distress (F(1,771) = 140.8, P < 0.001) and emotional loneliness (F(1,771) = 26.70, P < 0.001). Additionally, a significant negative association between smartphone addiction and sleep quality was found (F(1,771) = 4.208, P = 0.041). However, there was no significant relationship between smartphone addiction and social loneliness (F (1,771) = 0.544, P < 0.461).

CONCLUSION

These findings suggest that smartphone addiction has a negative impact on psychological distress, sleep quality, and emotional loneliness among health care students and workers. It is important to promote strategies to reduce smartphone dependency in order to avoid the harmful consequences of smartphone addiction.

Relationship between musculoskeletal discomfort and cell phone use among young adults: A cross-sectional survey

BACKGROUND

Cell phone usage is highly prevalent among young adults. They are used for multiple purposes including communication, studies, social networking and entertainment. However, its excessive usage has been associated with adverse health outcomes.

OBJECTIVE

The objective was to find the association of cell phone usage with musculoskeletal discomfort (MSD) and its associated factors.

METHODS

A cross-sectional study was conducted on young adult students from a low-middle income country over a period of 3 months from December 2018 to February 2019. A structured questionnaire based on the Disabilities of the Arm, Shoulder and Hand (QuickDASH scoring) was used to record the musculoskeletal discomfort.

RESULTS

Out of 803 questionnaires, data of 754 (94%) were entered and the remaining questionnaires (n = 49) were discarded due to incomplete answers. The mean age was 20.83 (1.62) years. In our study, there were 194 (25.7%) males and 560 (74.3%) female participants. Neck and shoulder were the most frequently affected regions. A significant difference in QuickDASH score was observed between genders (p-value p ≤ 0.001). Left-handed individuals scored significantly higher on QuickDASH score compared to right-handed individuals (p < 0.05). Increased musculoskeletal discomfort was reported by individuals with daily cell phone use of more than four hours (p < 0.05). A positive significant correlation was found between continuous one hour cell-phone use and higher mean QuickDASH scores (correlation coefficient 0.124, p value 0.001). Shorter eye-to-screen distance was significantly associated with MSD (p < 0.05).

CONCLUSION

Musculoskeletal discomfort is associated with the female gender, duration of cell phone use and a small eye-to-screen distance.

Smartphone Use Is Associated with Low Prevalence of Locomotive Syndrome among Elderly Individuals with Musculoskeletal Disorders

Objectives: Physical activity management through smartphone applications is increasing worldwide; however, it is unclear whether smartphone users among elderly Japanese individuals with musculoskeletal disorders are less likely to experience “locomotive syndrome” (LoS). We aimed to test the hypothesis that LoS in smartphone users had lower prevalence than that in non-smartphone users among elderly individuals with musculoskeletal disorders. Methods: Elderly participants, aged ≥60 years, who visited the outpatient clinic were enrolled. All participants were asked whether or not they used smartphones and were allocated into either the smartphone group or the non-smartphone group. After completing the 25-question Geriatric Locomotive Function Scale (GLFS-25), LoS prevalence was determined by 3-stage cutoff values of the GLFS-25 score (≥7, ≥16, and ≥24), and the total and three subdomain scores (body pain, movement-related difficulty, and psychosocial complications) were compared between the two groups. Generalized linear regression was then performed to confirm whether the use of smartphones was associated with lower GLFS-25 scores, even after controlling for confounders. Results: Overall, 266 participants, aged ≥60 years, were recruited. LoS prevalence was significantly higher in the non-smartphone group than in the smartphone group at all stages (all p < 0.001). Mean GLFS-25 total and subdomain scores were significantly lower in the smartphone group than in the non-smartphone group (all p < 0.001), and these statistical relationships were maintained even after controlling for age and sex. Conclusions: Smartphone use was associated with low LoS prevalence and low GLFS-25 scores among elderly individuals with musculoskeletal disorders, although the causal relationship remains unclear.

'There's good and bad': parent perspectives on the influence of mobile touch screen device use on prenatal attachment

The potential for human-computer interaction to have a substantial impact on adults is well documented. However, its potential importance prior to birth has rarely been reported. Parental use of smartphones and tablet computers could influence the relationship between parent and baby during pregnancy (prenatal attachment) and thus child development. Twenty-seven families were interviewed to explore how parents used these devices during pregnancy, and how device use influenced parents' thoughts, feelings and behaviours towards their baby while in utero. All used devices for a variety of purposes, and all described good levels of prenatal attachment. Parents described both disrupted and enhanced connectedness as a result of device use, and increased parental stress. The findings highlight a new opportunity for how device design and use guidelines could support families to maximise benefits and reduce detriments of device use to optimise prenatal attachment, and thus future parent-child attachment and child development. Practitioner summary: Many parents regularly use smartphones and tablet computers while pregnant. This qualitative study found that how devices were used either enhanced or disrupted feelings of prenatal attachment. Practitioners should be aware of potential beneficial and detrimental impacts of device use during pregnancy given implications for future attachment and child development.

The prevalence of bad posture and musculoskeletal symptoms originating from the use of gadgets as an impact of the work from home program of the university community

During the COVID-19 pandemic, the Universitas Indonesia (UI) implemented a work from home program (WFH) to curb the spread of the coronavirus, as the use of gadgets including mobile phones and tablets were becoming prolonged and more frequent. As a result, musculoskeletal symptoms in certain limbs due to awkward posture sprang up. Therefore, the aim of this study was to quantify the degree of the use of these devices among UI community during the WFH initiative, as well as to identify musculoskeletal complaints resulting from defective postures. Consequently, this cross-sectional survey employed an online-based questionnaire, and the minimum number of respondents was 1080, as calculated using Slovin Formula. Meanwhile, a total of 1083 individuals, including lecturers (118), students (709), and managerial staff (256), obtained from 14 faculties, three schools, as well as administrative centres, volunteered to respond to the online poll. Apparently, 95% of the scholars owned mobile phones while only 16% possessed tablets, and 56% had used phones for over 10 years. The typical posture when using mobile devices was a reclining position on a sofa or mattress for a duration of 1–3 h as recounted by 34.6%. Also, sitting at a table for less than 30 min was reported by 25.3% of the subjects who used tablets. Furthermore, 70.5% of the respondents complained of musculoskeletal discomfort, particularly in the neck (86.4%), lower back (75.9%), and right & left shoulders (76.2%). In addition, the postures significantly related to these grievances included sitting at a table, alongside a prone position whilst using a mobile phone, as well as a latent or floor-sitting posture when using a laptop, whether at a table or not. Therefore, it is essential to do stretching, limiting usage time, look away every 20 min at an object that is about 20 feet away for a full 20 s when using a gadget and having adequate rest time to reduce musculoskeletal complaints.

Application of the best-worst method approach for prioritizing risk factors of musculoskeletal disorders among mobile device users: A case study

BACKGROUND: Musculoskeletal disorders (MSDs) are the most common work–related health issues among mobile device (MD) users due to long hour of working during homestay. Various researches have been carried out earlier for identifying the MSD risk factors, though the risk factors’ priority and weightage play an important role for risk management. OBJECTIVE: In the current study, the priority and weightage for MSD risk factor (individual factor, personal factor, psychosocial factor, and subfactors in each factor) were identified using the best–worst method (BWM) for MD users through a case study. METHOD: A framework was proposed for evaluating the risk hierarchy. The rating data provided by decision–makers was analysed using BWM for optimistic risk factor outcomes. A sensitivity analysis was also performed on the prioritized risk factors/subfactors for the consistency check. RESULTS: Research results revealed that personal factor was the most prominent risk factor of MSDs, followed by psychosocial factor and individual factor. Further, the total time spent and gender were identified as most and least dominating risk subfactor of MSDs respectively. The evaluated priority and weightage of MSD risk factors were further validated using sensitivity analysis. CONCLUSION: The obtained outcomes may be helpful in reducing the MSDs risk factors among the MD users by ergonomic improvement.

Fatigue due to smartphone use? Investigating research trends and methods for analysing fatigue caused by extensive smartphone usage: A review

BACKGROUND: The easy accessibility of smartphones has led to a fivefold increase in their use. People use smartphones almost anywhere, including during travelling and studying. During the global COVID-19 pandemic, the average smartphone screen time has increased from 2.25 to 4.8 hours per day. In India, smartphone usage increased by 68%, and the average screen time increased from 2.42 to 6.9 hours. This dependency on smartphones has led to smartphone addiction. Inappropriate postures during the prolonged use of smartphones can exert adverse effects such as musculoskeletal disorders, digital eye strain, loss of focus and attention. OBJECTIVES: This study was undertaken to understand the effects of prolonged smartphone utilisation and explored fatigue measurement techniques. METHODS: A total of 130 studies examining the effects of smartphone utilisation published in the previous 10 years were identified from the following databases: IEEE, Science Direct, PubMed, PubMed Central, and Google Scholar are reviewed. This study was conducted from September 2019 to January 2021. RESULTS: One in every four adolescents were prone to smartphone addiction, which causes poor mental health. Moreover, India’s research on the effects of excessive smartphone usage is limited. CONCLUSIONS: Studies are required to establish the correlation between fatigue levels and smartphone usage patterns.

[Influence of screen time on the sleep quality of students]

Introduction

The restorative effects of sleep are essential for physical, cognitive, emotional, and behavioral daily performance in college. In addition to the stress of everyday student life, the use of screen devices at the forefront of pandemic-related online teaching is also increasing dramatically. Particularly during evening and nighttime hours, increased screen use may contribute to physical, psychological, and cognitive activation, which in turn may negatively affect students' sleep quality.

Methods

To determine possible associations between screen use in online teaching and its effects on sleep hygiene and quality, 216 students at Magdeburg-Stendal University of Applied Sciences anonymously and voluntarily participated in the online survey in May 2021. The positive ethics vote is available.

Results

The general sleep quality of the student body can be rated as poor in 68.9% (n = 149) of the surveyed students. In particular, students who worked predominantly on screen devices in the evening or at nighttime for their studies, and thus had a chronobiological tendency to be a night person, tended to have poorer sleep.

Discussion

The effects of long screen time in the evening and nighttime hours can have far-reaching consequences on sleep patterns and awareness of physical needs for breaks and sleep. Online teaching in times of the COVID-19 pandemic in particular led to an increase in screen time alongside equally high levels of personal use. This could result in a continued negative impact on sleep hygiene and quality, not only at the expense of daytime concentration and performance but rather of physical and mental health.

Health Risks and Musculoskeletal Problems of Elite Mobile Esports Players: a Cross-Sectional Descriptive Study

BACKGROUND

Mobile-gaming athletes sit in the same posture for prolonged periods, contributing to significant health risks. This study investigated the health profiles, fatigue, pain and complaints, and musculoskeletal problems of full-time mobile-gaming athletes.

METHODS

A total of 50 elite mobile-gaming athletes were involved in this study. They were the starting lineup players from all ten professional teams competing in a top-tier multiplayer online battle arena tournament. A survey was conducted to evaluate their fatigue patterns, pain levels, and complaints. A descriptive analysis was conducted to evaluate the athletes' health profiles [body mass index (BMI), fat ratio], fatigue, number of complaints, and musculoskeletal problems. The associations of career duration with BMI, fat ratio, and the total number of confirmed injuries were then determined using Spearman's rank correlation test.

RESULTS

A total of 46% and 44% of the participants felt tired frequently and occasionally, while 34% and 58% experienced eyestrain frequently and occasionally, respectively. More than 30% of the participants reported headache and rhinitis. A longer esports career duration was associated with a reduction in BMI (r = -0.272, p = 0.056). Career duration had no significant association with smoking habits (p = 0.666), alcohol habits (p = 0.655), coffee habits (p = 0.946), rounds of games for which the player could maintain concentration (p = 0.253), ease of eyestrain (p = 0.569), tiredness (p = 0.510), dizziness (p = 0.071), or leg numbness (p = 0.318).

CONCLUSION

The findings of this study stress the significance of esports injuries and indicate preventive measures for both athletes and recreational players.

Spine Posture, Mobility, and Stability of Top Mobile Esports Athletes: A Case Series

Professional esports athletes spend a long time in the same sitting posture during training and competition. Mobile esports may exacerbate potential postural problems because of the closer and unsupported arms and because athletes spend more time in a forward-/flexed-head posture. Prolonged sitting in these postures carries significant health risks and may lead to musculoskeletal problems and injuries. The objective of this retrospective study is to assess the posture, mobility, and stability of the spine for professional mobile esports athletes. We collected spine-assessment data from 48 athletes participating in a top-tier league on a real-time-strategy battle-arena online game. The spinal assessment was conducted using the SpinalMouse® under upright standing and trunk flexion in addition to the Matthiass test. Measurements were converted into Idiag Scores by the SpinalMouse® software. The Idiag Posture, Idiag Mobility, and Idiag Stability scores were 62.50 (IQR: 21), 63.50 (IQR: 19.5), and 54.50 (IQR: 14.5), respectively, and were significantly lower (p < 0.001) than the reference normative value (100). Age was found to have a weak positive correlation with the posture score (ρ = 0.29, p = 0.048). Although career duration appeared to lower the scores, the association was insignificant (p > 0.05). The scores also had no significant association with body height, body mass, body mass index, and esports team (p > 0.05). It was anticipated that mobile-based esports would attenuate the biomechanics of the spine and increase the likelihood of musculoskeletal problems, such as neck and back pain.

Screen time and health issues in Chinese school-aged children and adolescents: a systematic review and meta-analysis

BACKGROUNDS

Many literature reviews summarized relationships between screen time and child health, but they only included a few studies conducted in Chinese children and adolescents. The potential influence of screen time may vary by social context. The current systematic review and meta-analysis aimed to evaluate relationships between screen time and health issues among Chinese school-aged children and adolescents.

METHODS

Peer-reviewed articles written in Chinese and English were retrieved from CNKI, Wanfang, PubMed, Embase, and Web of Science from inception to June 2020. The Downs & Black checklist was applied to assess study quality. Meta analyses used random effect models and mixed effects model to calculate pooled adjusted odds ratios and 95% confidence intervals. Heterogeneity, sensitivity, and publication bias were assessed using Q and I2 statistics, "one-study removed" analysis, the funnel plot, trim and fill analysis, and classical fail-safe N, respectively.

RESULTS

In total, we identified 252 articles reporting 268 studies with unique samples. These studies investigated relationships between screen time and health issues of adiposity, myopia, psycho-behavioral problems, poor academic performance, cardiometabolic disease risks, sleep disorder, poor physical fitness, musculoskeletal injury, sub-health, and miscellaneous issues of height and pubertal growth, injury, sick leave, and respiratory symptoms. Proportions of studies reporting positive relationships with screen time were lowest in adiposity (50.6%) and higher in myopia (59.2%) and psycho-behavioral problems (81.8%). Other health issues were examined in 10 or less studies, all of which had more than half showing positive relationships. The pooled odds ratio from 19 studies comparing health risks with the screen time cutoff of 2 hours per day was 1.40 (95% CI: 1.31 to 1.50, I2 = 85.9%). The pooled effect size was 1.29 (95% CI: 1.20 to 1.39) after trimming 7 studies for publication bias adjustments.

CONCLUSIONS

Findings exclusively generated from Chinese school-aged children and adolescents resonate those mainly from western countries. Evidence suggests that higher levels of screen time are related with greater risks of various health issues, although the relationships appear to be weak and intertwined with other confounding factors. Future studies need to investigate health-specific dose effects and mechanisms of screen time.

Field Study of Postural Characteristics of Standing and Seated Smartphone Use

Prior investigations have been primarily conducted in a laboratory to examine the effects of the smartphone use on the neck and head positions, whether these results are applicable to actual conditions is still unknown. This field survey thus analyzed the neck flexion (NF), head flexion (HF), gaze angle (GA), and viewing distance (VD) of smartphone users in public areas in Taipei, Taiwan. Six hundred smartphone users (300 men and 300 women) were photographed sagittally in standing, supported sitting, or unsupported sitting postures while using a smartphone. Results showed that women had significantly less NF and HF and shorter VDs than male users. Regardless of gender, higher NF was observed for standing than for sitting. Women had similar NF and HF while sitting supported and unsupported, but both were significantly lower than those while standing. By contrast, male users had higher NF and HF during unsupported sitting than during supported sitting. The NF (45°-50°) was much greater than the recommended maximum safe NF of 15°. Women may be at higher risk of visual strain because of shorter VD.

Using touchscreen mobile devices-when, where and how: a one-week field study

This cross-sectional study explored the objectively measured Touchscreen Mobile Device (TSMD) use in free-living conditions. Data on TSMD use, gross body posture (lying, sitting, standing, stepping), and location of use (workplace, home, other) were collected over seven consecutive days from 54 adults (mean ± SD, 38 ± 10 years). The average duration of TSMD use was 152 ± 91 min/day, with a TSMD engagement of 51 ± 35 times/day. Participants under 30 years spent significantly more time on their TSMD, averaging 230 ± 108 min/day. By location, 54 ± 17% of use occurred at home and 24 ± 15% at work. The most common posture adopted during any TSMD use was sitting (77 ± 5 2 min/day), with participants also spending considerable time lying down in the home environment (39 ± 49 min/day). These findings provide valuable insights into how adults are using TSMDs, including the postures and locations of use. Further research is needed on the health and wellbeing implications of these usage patterns. Practitioner summary: This study explored Touchscreen Mobile Device (TSMD) use in free-living conditions among 54 adults (mean ± standard deviation, 38 ± 10 years). Participants under 30 years spent significantly more time on their devices. More than half of the time spent using TSMD occurred at home while sitting and lying down.Abbreviations: TSMD: touchscreen mobile device; SD: standard deviation; MSD: musculoskeletal disorder; HDR: higher degree by research; SEES: School of Earth and Environmental Sciences; UK: The United Kingdom; USA: United States of America; SAS: statistical analysis system; ANOVA: analysis of variance; SPSS: statistical package for the social sciences; h: hour; min/d: minutes per day; d: day; ICC: intraclass correlation; CI: confidence interval; min: minute; GPS: global positioning systemsHighlightsTouchscreen mobile device use and gross body posture were quantified objectively.The most common postures for touchscreen mobile device use were lying and sitting.Touchscreen mobile devices were used around twice as much at home than at work.Use at home, with a predominance of the lying posture, needs further investigation.

Assessment of the Effect of Smartphone Usage on the Range of Motion and Fatigability of the Joints and Muscles of the Thumb Among Users: A Cross-Sectional Study in Central India

Introduction

The ability of adaptation is unique to humankind. Technology advances have introduced many appliances that increasingly are smaller in size and handheld. These devices on prolonged usage affect the thumb joint complex, and this study was therefore designed to assess any changes in the movement of the thumb joint complex and fatigability secondary to the increasing usage of smartphones in different orientations in the Central Indian population.

Materials and methods

An analytical cross-sectional study was performed to assess changes in the ranges of motion (ROM) of the thumb joint complex with a sample size of 137 selected nonrandomly and categorized on the basis of the orientation of smartphone usage by physical goniometer and a standardized questionnaire to assess fatigability.

Results

Most movements of the thumb joint complex corresponded to the existing standard values. The study found significant changes in the movement of passive flexion of the left metacarpophalangeal (MCP) joint and borderline significant modifications in the active extension of the left interphalangeal (IP) joint, passive extension of the left interphalangeal joint, and passive flexion of the left carpometacarpal (CMC) joint among the groups of participants. The Borg CR10 value of fatigue was “one,” indicative of no excessive fatigue after smartphone usage.

Conclusion

There are no significant changes in the ranges of motion of the joint complex of the thumb in mobile phone users over a period of time. The orientations and the increased duration of usage also did not cause any fatigue in the muscles of the thumb.

Changes in deep neck muscle length from the neutral to forward head posture. A cadaveric study using Thiel cadavers

Forward head posture (FHP) is one of the most common postural deviations. Deep neck muscle imbalance of individuals with FHP is of primary concern in clinical rehabilitation. However, there is scarce quantitative research on changes in deep neck muscle length with the head moving forward. This study aimed to investigate changes in deep neck muscle length with different severity levels of FHP. Six Thiel‐embalmed cadavers (four males and two females) were dissected, and 16 deep neck muscles in each cadaver were modeled by a MicroScribe 3D Digitizer in the neutral head posture, slight FHP, and severe FHP. The craniovertebral angle was used to evaluate the degrees of FHP. Quantitative length change of the deep neck muscles was analyzed using Rhinoceros 3D. In slight FHP significant changes in length occurred in four muscles: two shortened (upper semispinalis capitis, rectus capitis posterior minor) and two lengthened (longus capitis, splenius cervicis). In severe FHP all occipital extensors were significantly shortened (10.6 ± 6.4%), except for obliquus capitis superior, and all cervical extensors were significantly lengthened (4.8 ± 3.4%), while longus capitis (occipital flexor) and the superior oblique part of the longus colli (cervical flexor) were lengthened by 8.8 ± 3.8% and 4.2 ± 3.1%, respectively. No significant length change was observed for the axial rotator. This study presents an alternate anatomical insight into the clinical rehabilitation of FHP. Six muscles appear to be important in restoring optimal head posture, with improvements in FHP being related to interventions associated with the occipital and cervical extensors.

Weaknesses of research methodologies on musculoskeletal disorders associated with mobile touch-screen devices

The objective of the currently study is to point out the weaknesses of some recent researches, which were done about the effects or symptoms of using Touch Screen Mobile Devices on the human musculoskeletal system. In this article, we reviewed the research processes performed in recent 26 randomly selected papers about musculoskeletal disorder to clarify the common weaknesses of these published articles. The electronic database search and reference search were conducted in four different databases: Medline, PubMed, Web of Science, and Scopus. We noticed that none of the reviewed papers had performed the experimental design phase of a scientific research. Additionally they had not validated the assumptions of the statistical methods used in their researches. Therefore, their findings are doubtful. In this article, we proposed practical outlines for a reliable experimental research.

Burden of neck pain and associated factors among smart phone user students in University of Gondar, Ethiopia

BACKGROUND

Mobile technology has spread rapidly around the globe. In 2018 the numbers of mobile subscribers in Ethiopia hit 66.2 million. Musculoskeletal complaints related to smartphone use in different body parts have been reported ranging from 8.2% to 89.9%. Neck pain has the highest prevalence rate, which ranges from 17.3% to 67.8%. However, there is limited evidence on the burden of neck pain related to Smartphone usage and no research is done in Ethiopia. Therefore, this study was conducted to determine the burden of neck pain and factors associated with smartphone use in Ethiopia.

PURPOSE

The objective of this study was to identify the prevalence and factors associated with neck pain among smartphone users at University of Gondar.

METHODS

Institutional based cross-sectional study was conducted from November to December 2019 to determine the prevalence and associated factors of neck pain, with a sample of 845 university student smartphone users at University of Gondar, Ethiopia. A self-administered questionnaire adapted from the Nordic musculoskeletal questionnaire was used to collect data. Independent variables which had a significant association were identified using logistic regression models. Results were reported by using texts and frequency distribution tables.

RESULTS

Out of 845 questionnaires distributed, 808 students responded; hence, the response rate was 95.6%. The overall prevalence of neck pain among smart phone users in the past 12 months was 47.4% (95% CI, 44.1-50.9%). Attending 5th year (AOR: 3.907, 95% CI: 1. 952-7.82) and 6th year (AOR: 2.93,95% CI: 1,304-6.59), regular physical exercise (AOR: 2.405, 95% CI: 1.549-3.734), cigarette smoking (AOR: 5.415, 95% CI: 2.685-10.919), residency (AOR: 1.681, 95% CI: 1.181-2.391), break while using smartphone (AOR: 3.253 95% CI: 2.252-4.699), used smartphone > 6 hour per day (AOR: 2.782 (1.528 95% CI: 1.528-5.063), used other devises (AOR: 3.158 95% CI: 2.128-4.689), number of social media used daily (AOR: 2.007 95% CI: 1.228-3.2788), used devise for playing game (AOR: 1.484 95% CI: 1.024-2.15) were factors significantly associated with neck pain.

CONCLUSION

The current study depicted that nearly half of the study participants reported neck pain in the past 12 months. Attending last year of university, personal characteristics, use of smart phone for longer period, playing game, not taking break, other electronic device use, increased number of social media use were associated with neck pain among smartphone users.

Association of individual and device usage factors with musculoskeletal disorders amongst handheld devices users during homestay due to pandemic

Purpose

The COVID-19 pandemic is spreading in India and different parts of the world. The outbreak delivered not only the condition of dying from infection but also forced people (especially office workers and students) to perform all working (office work, classes, assignments, etc.) and non-working activities (leisure activities such as social media, gaming, etc.) at home using handheld devices (HHDs). In this situation, HHD usage for longer durations is mainly responsible for work-related health issues. Therefore, the paper aims to explore HHD usage patterns and musculoskeletal disorders (MSDs) amongst HHD users during homestay and the impact of individual and HHD usage–related factors on MSDs.

Design/methodology/approach

From different states of India, 651 people (especially HHD users from universities and industries) were sampled by using systematic cluster random sampling. In addition, an online questionnaire was used to collect data on the prevalence and risk factors of MSDs. Finally, mean comparisons and chi-square analysis was used to analyse the collected data.

Findings

The prevalence rate of MSDs was higher in upper body parts as compared to the lower body parts. The association of gender with MSDs in various body parts was substantial. The time spent on various working and non-working activities using HHDs was significantly associated with MSDs in upper body parts.

Practical implications

Homestay work may be used as an alternative working arrangement, and the risk factors that have the most significant impact on the health of HHD users may be identified by organizations. The findings suggest the proper use of HHDs as per their essential need with intermediate recreational activities.

Originality/value

It is observed that the musculoskeletal health of office workers and university students is a cause for concern during homestay. The current study provides the prevalence of MSDs experienced by HHD users and the association of individual and HHD usage factors with MSDs.

Neck Muscular Load When Using a Smartphone While Sitting, Standing, and Walking

OBJECTIVE

Myoelectric activity of neck extensor muscles and head kinematic variables, when using a smartphone for one-handed browsing and two-handed texting while sitting, standing, and walking, were evaluated to compare the neck muscular load during these tasks and across the posture conditions.

BACKGROUND

There has been limited research on the relation between head-down postures and the muscular load on the neck of smartphone users.

METHODS

Twenty-one asymptomatic young users were asked to perform one-handed browsing and two-handed texting tasks in each of the posture conditions, and the myoelectric activities of the neck extensor muscles, head kinematic variables, and upper back posture were quantified.

RESULTS

The muscle activation level when using a phone during walking was 21.2% and 41.7% higher than that of sitting and standing on average (p < .01). Head vertical and angular accelerations were also significantly greater (p < .01) for walking than for sitting and standing conditions. Between the two conducted tasks, participants flexed their heads more significantly (p < .01) with higher activation of the neck extensor muscles (p < .01) when texting as compared to when browsing.

CONCLUSION

Results indicate that two-handed texting while walking would be the most physically demanding scenario for neck musculature, and it might be attributable to the dynamics of the head while walking with the head facing downwards.

APPLICATION

These findings can be used to better understand the potential relation between smartphone use and the occurrence of neck musculoskeletal problems and to inform the users of the ergonomic risks of using smartphones while walking.

Health in the palm of your hand-part 2: design and application of an educational module for young people on the risks from smartphone abuse and the opportunities of telemedicine and e-Health

BACKGROUND

The evolution of mHealth is strictly related to the evolution of the mobile-technology and in particular of the smartphone. However, it is increasingly becoming clear that excessive use of the smartphone has implications for health in terms of emerging risks and in particular (I) the text neck, (II) the addiction, (III) the use of deceptive Apps in mHealth and today telemedicine and e-Health solutions to face this are strongly needed. What young people need is a package of solutions that allow them to tackle all three of these problems at the same time through dedicated tools and specific material on these topics. However up to now this is lacking. The purpose of the study was the design and application of a teaching package focused in this field and specific for young people, the target population for the emerging risks.

METHODS

A teaching package was developed in a school-work alternation program for the secondary schools at the Italian National Institute of Health, according the Italian Law. It was available on the basis of proposals offered publically. It provided a two weeks stage on the topics: the risks from smartphone abuse and Telemedicine and e-Health solutions.

RESULTS

A specific electronic survey in this field was available at the end of the stage. The survey was submitted to 500 young subjects (50% male; 50% females; mean age 15.9 y; std-dev 1.2 y) at school and/or in meeting initiatives. The outcome demonstrated: (I) that the knowledge on the postural risk (text neck) was very poor, while the desiderata of Apps for correcting the posture was very high; (II) the feasibility to obtain feedback on the risk of addiction through a cyber-psychology approach; (III) a worrying position in relation to non-medical Apps confused with the medical ones.

CONCLUSIONS

The study demonstrated how the young people mBorn can familiarize with some aspects of telemedicine and e-Health and be at the same time a kind of spreader of a correct vision of the ratio between user and smartphone and the knowledge on both the mTech and the related problems.

Health in the palm of your hand-part 1: the risks from smartphone abuse and the role of telemedicine and e-Health

BACKGROUND

The evolution of the Telemedicine and e-Health is strictly related to the evolution of the mobile-technology. If today it is possible to successfully use a wide range of mHealth applications, playing an important role in Telemedicine and e-Health, health care has surely a gratitude debt with the smartphone. However, it is increasingly becoming clear that excessive use of the smartphone has implications for health in terms of risks and it is therefore necessary to tackle the various gaps and/or the role that Telemedicine and e-Health itself has in this field.

METHODS

Through an overview to literature, Web and App stores the study faced the implications for health from the excessive use of the smartphone and therefore the various gaps and/or the role that Telemedicine and e-Health itself has in this area both in the prevention and in the monitoring with particular regard to the three components: eHealth, mHealth and eLearning.

RESULTS

The study found (I) as emerging risks: the text neck, the risk of addiction and the risk in the use of deceptive Apps in mHealth; (II) as Telemedicine and e-Health useful approach: the design of Apps for the text neck prevention and the relevant acceptance and effectiveness assessment; the design and application of electronic surveys for tele-assessment of the addiction risk; the design and application of information and training path on the deceptive Apps in mHealth.

CONCLUSIONS

The key role of Telemedicine and e-Health in the prevention and monitoring of the risks from smartphone abuse has been clearly identified and the young people has been identified as target population and the relevant need to design specific teaching packages in this field focused on them.

Computer vision syndrome among Saudi population: An evaluation of prevalence and risk factors

Introduction

In the recent era of technological evolution, electronic devices have become an essential part of our lives, not merely in professional work settings, but also in daily leisure activities. Although these devices have simplified our lives, they are associated with a wide variety of health complaints. Thus, the so-called computer vision syndrome (CVS) has become a growing public health problem and has gained significant attention as it plays an important role in the quality of life of each individual, which in turn has put an increased burden on the health care system. Eye symptoms are among the most reported, yet extraocular symptoms were frequently described as adding an extra load.

Method

An electronic survey was distributed randomly through social media platforms among the general population in Saudi Arabia, between the period from July to December 2017, irrespective of their sociodemographic factors, aiming to determine the prevalence of CVS and to verify the most common associated risk factors.

Results

In total, 690 participants were involved in our study, with a mean age of 33.8 years. Of these, 77.6% suffer from CVS, with eye-burning being the most common ocular symptoms (71%), as well as itching (67.5%), blurred vision (65%), tearing (62.3%), and other eye symptoms being reported. Neck/shoulder pain was found to be the most prevalent extra ocular symptom (85.2%); also back pain and headache are frequently expressed (78% and 70% respectively). A significant positive correlation was observed between CVS symptoms and time spent using the devices (P-value: 0.002).

Conclusion

As technology advances, electronic devices have become a common tool that is used for different purposes on daily basis. We found in our study that the so-called computer vision syndrome is a growing public health problem. Thus, community education about the impact of such a lifestyle for proper handling of electronic devices must be addressed to avoid such health complaints.

Influence of neck flexion angle on gravitational moment and neck muscle activity when using a smartphone while standing

This study compares the effects of different neck flexion angles on neck gravitational moment and muscle activity of users that stand and operate a smartphone. Thirty-two healthy young adult smartphone users performed texting tasks for three minutes at four different neck flexion angles (0°, 15°, 30°, and 45°) while standing. Neck gravitational moment and cervical erector spinae (CES) and upper trapezius (UT) activity were investigated. When the neck flexion angle increased, the gravitational moment of the neck increased significantly. The muscle activity of CES significantly increased when the neck flexion angle increased, whereas that of UT decreased. The lowest gravitational moment of the neck at 0° flexion was consistent with the lowest CES muscle activity and the lowest neck discomfort score. In conclusion, for texting while standing, adults should maintain their neck posture at 0° flexion to reduce the gravitational force acting on the cervical spine and alleviate neck discomfort. Practitioner Summary: During smartphone use when standing, excessive neck flexion (30° and 45° flexion) should be avoided. The suggested neck posture when operating a smartphone while standing is 0° flexion. Abbreviations: CES: cervical erector spinae; UT: upper trapezius; COG: centre of gravity; MSDs: musculoskeletal disorders; CROM: cervical range of motion; sEMG: surface electromyography; VAS: visual analogue scale; MVCs: maximum voluntary contractions.

Influence of physical activity and postural habits in schoolchildren with scoliosis

BACKGROUND

Scoliosis is considered one of the main musculoskeletal changes in childhood, and is characterized by three-dimensional changes in the spine. Schoolchildren is a group who are directly exposed to this condition because they go through a rapid growth phase in adolescence, added to other external factors such as school environment and daily living habits such as little physical activity. This study aimed to identify the risk factors associated with scoliosis in schoolchildren.

METHODS

An observational, retrospective case control study with a quantitative approach was carried out in the city of Santa Cruz/RN. The presence of scoliosis was assessed using the Adams test and physical activity by the Daily Physical Activity Index (IPAQ) and by a questionnaire on competitive sports practice, in addition to a questionnaire on postural habits in childhood and adolescence. Conditional multiple logistic regression was performed for statistical analysis, and the adjusted Odds Ratios (OR) and the respective confidence intervals (95%) of the outcome variable were estimated.

RESULTS

A total of 156 schoolchildren participated in the study, with an average age of 13.9 years, with 55.1% being female and 44.9% male, attending between the 6th grade of elementary school and the 3rd year of high school. Furthermore, 42.9% of these participants were considered irregularly active and only 33.3% practiced physical activity on a regular basis. After bivariate analysis and conditional logistic regression, little physical activity was shown to be a risk factor for scoliosis (p = 0.041; OR: 2.81; 95% CI: 1.04-7.57), while the postural habits evaluated in this study did not show a statistical association with scoliosis.

CONCLUSION

Low practice of physical activity and schoolchildren being classified as irregularly active were considered as risk factors for scoliosis, however postural habits do not seem to be associated with this condition.

The Digital Divide in the Era of COVID-19: An Investigation into an Important Obstacle to the Access to the mHealth by the Citizen

In general, during the COVID-19 pandemic there has been a growth in the use of digital technological solutions in many sectors, from that of consumption, to Digital Health and in particular to mobile health (mHealth) where an important role has been played by mobile technology (mTech). However, this has not always happened in a uniform way. In fact, in many cases, citizens found themselves unable to take advantage of these opportunities due to the phenomenon of the Digital Divide (DD). It depends on multifaceted aspects ranging from the lack of access to instrumental and network resources, to cultural and social barriers and also to possible forms of communication disability. In the study we set ourselves the articulated goal of developing a probing methodology that addresses the problems connected to DD in a broad sense, capable of minimizing the bias of a purely electronic submission and evaluating its effectiveness and outcome. At the moment, we have submitted the survey both electronically (with an embedded solution to spread it inside the families/acquaintances) and using the wire phone. The results highlighted three polarities (a) the coherence of the two methods; (b) the outcome of the entire submission in relation to key issues (e.g., familiarity on contact tracing Apps, medical Apps, social Apps, messaging Apps, Digital-health, non-medical Apps); (c) a Digital Divide strongly dependent on age and in particular for the elderly is mainly evident in the use of mTech in general and in particular in mHealth applications. Future developments of the study foresee, after adequate data-mining, an in-depth study of all the aspects proposed in the survey, from those relating to access to resources, training, disability and other cultural factors.

The influence of smartphone use on spinal posture - A laboratory study

BACKGROUND

Smartphones have become increasingly more popular and complicated tasks can be performed with these devices. However, the increasing use is associated with shoulder and neck pain, as well as with psychological addiction.

RESEARCH QUESTION

Do different smartphone tasks lead to changes in spinal posture and pelvic position? Is there a relationship between smartphone addiction and changes in posture?

METHODS

A cross-sectional study including 50 participants was performed. Test subjects completed the Smartphone Addiction Scale and the SF-36 health questionnaire. Subjects spinal posture and pelvic position during different smartphone tasks were measured through a surface topography system. The different tasks were: standing in an upright position, simulating a phone call, texting with one or two hands during standing or while walking on a treadmill. Paired T-tests and ANOVA tests were performed to evaluate differences. The Kendall rank test was used to investigate the association between clinical scores and changes in spinal posture.

RESULTS

All smartphone tasks lead to a significant increase in thoracic kyphosis and trunk inclination during standing and while walking. A significant increased lumbar lordosis was also found. Texting with one or two hands correlated with increased surface rotation. No associations between smartphone addiction and changes of the spinal posture were reported.

SIGNIFICANCE

This represents the first surface topography study that investigated the influence of different smartphone tasks on the spinal posture and pelvic position during standing and while walking. With the results of this study we demonstrated that smartphone use leads to significant changes of sagittal and frontal spine parameters. Further research should focus on the evaluation of possible detrimental effects of long-term smartphone use on the spinal posture and on the development of preventive measures.

Text Neck Syndrome in Children and Adolescents

Neck pain is a prevalent health problem, largely reported in adult patients. However, very recent data show that new technologies are inducing a shift in the prevalence of this relevant issue from adulthood to all of the pediatric ages. In fact, the precocious and inappropriate use of personal computers and especially cell phones might be related to the development of a complex cluster of clinical symptoms commonly defined as "text neck syndrome". The purpose of this article is to analyze the new phenomenon of the "text neck syndrome", the underlying causes and risk factors of musculoskeletal pain, that can be modified by changes in routine life, in different cultures and habits, and on the "text neck syndrome" as increased stresses on the cervical spine, that can lead to cervical degeneration along with other developmental, medical, psychological, and social complications. Findings support the contention that an appropriate approach for an early diagnosis and treatment is crucial to properly evaluate this emerging issue worldwide in children and adolescents who spend a lot of time watching smartphones and computers; additional research with more rigorous study designs and objective measures of musculoskeletal pain are needed to confirm significant relationships. Existing evidence is limited by non-objective measures and the subjective nature of musculoskeletal pain.

Prevalence of mobile device-related lower extremity discomfort: a systematic review

Mobile device users often experience musculoskeletal discomfort due to the intensive use of these devices in static body postures. Prolonged sitting and standing at work and in free time are risk factors for various diseases and all-cause mortality. Prolonged static postures are the main cause of lower extremity discomfort. A systematic search of the articles was conducted in four different electronic databases. All selected papers were appraised using a critical appraisal tool. Fourteen studies were selected for the review. The prevalence of musculoskeletal complaints ranged from 0.4 to 72.9%. Mobile device-related lower extremity discomfort ranged from 0.4 to 9.6%. The most common body posture among mobile device users in the selected studies was sitting. There is some evidence for the association between lower extremity pain and mobile device use. Experts should take this review as a basis to provide appropriate and effective ergonomic measures, especially for working mobile device users.

Two-dimensional taxonomy of internet addiction and assessment of smartphone addiction with diagnostic criteria and mobile apps

A recent review by Montag et al. raised a taxonomical argument about internet addiction. We propose a two-dimensional taxonomy of internet addiction by both the device and the content as the solution. For the assessment of smartphone addiction, measurements should be based on functional impairment and validated by diagnostic criteria rather than solely on self-reported questionnaires. We detail the potential of mobile applications (apps) to improve the assessment of smartphone addiction. App-generated indicators could fulfill the unmet need of assessment of smartphone addiction and facilitate future assessment and treatment planning of smartphone addiction.

Musculoskeletal pain and risk factors associated with smartphone use in university students

Background:

Smartphone has become a very popular necessity among students. An individual has to look at their phone's small monitor and perform repetitive movements in an awkward posture for a prolonged duration.

Objectives:

To assess the prevalence of musculoskeletal pain and associated risk factors in university students because of smartphone usage.

Subjects and Methods:

A cross-sectional study was conducted with 2000 university students using a semi-structured questionnaire comprising demographic profile, smartphone usage characteristics, presence of musculoskeletal pain, and specific area of pain according to the body region.

Results:

Among the 2000 students, 44.05% reported musculoskeletal pain. The most common sites of pain were the neck (34.2%), thumb (17.45%), lower back (16.7%), and elbow (16.6%). There was an association between prevalence of musculoskeletal pain with the size of the smartphone (P = 0.005), the predominant purpose of smartphone usage (P = 0.002), position preferred while using smartphone (P = 0.000), and the level at which smartphone is held during usage (P = 0.05). Logistic regression analysis revealed that the strongest predictor of musculoskeletal pain was the size of the smartphone.

Conclusion:

The study reported that the prevalence of pain in smartphone users is high with common sites being neck, thumb, and lower back region. Also, the size of the smartphone had a significant association with musculoskeletal pain.

Prevalence of mobile device-related musculoskeletal pain among working university students: a cross-sectional study

The aim of the present study was to investigate usage patterns of mobile devices and their impact on users' musculoskeletal system among working university students in Slovenia at the Faculty of Chemistry and Chemical Technology of the University of Ljubljana. An Internet-based survey was sent to students' e-mail addresses and students provided information about usage patterns and reported on musculoskeletal pain (MSP) that may relate to mobile device usage in the past 12 months. A total of 535 students (63% females and 37% males) aged 18 years or older completed the survey and fulfilled the inclusion criteria. The results showed that the prevalence of MSP was 39.6%. Most musculoskeletal symptoms were reported in the back (57.1%) and shoulder (50%). Statistically significant differences in exposure to mobile devices and MSP between genders were found (p < 0.05). This study highlights the importance of knowledge of mobile device ergonomics among working students.

Influence of virtual keyboard design and usage posture on typing performance and muscle activity during tablet interaction

This study aimed to determine the effects of virtual keyboard designs and postures on task performance and muscle activity during tablet use. Eighteen healthy adults were randomly assigned to one of three postures (DESK, LAP, BED) to complete six sessions of 60-minute typing on a tablet with three virtual keyboards (STD, WIDE, SPLIT) twice in an experimental laboratory. Keystroke dynamics and muscle activity of the forearm and neck-shoulder regions were measured by electromyography. The split virtual keyboard was found to be associated with faster typing speed (SPLIT vs STD, p = .015; SPLIT vs WIDE, p < .001) and decreased muscle activity of extensor digitorum communis (SPLIT vs STD, p = .021). Lap posture was associated with faster typing speed (p = .018) and higher forearm muscle activity (p < .05). Typing performance decreased (p < .001) with elevated neck extensor muscle activity (p = .042) when the task duration prolonged. The split virtual keyboard showed potential to improve tablet ergonomics under various postures. Practitioner Summary: Tablets have become widely used for a variety of tasks and have gradually expanded into the realm of mobile productivity and education. Adequate designs of virtual keyboards for tablets show the potential for increased task performance and decreased muscle activity pertinent to typing activity and posture constraints imposed by non-traditional work positions. Abbreviations: WPM: words per minute; IKI: inter-key press interval; EMG: electromyography; EDC: extensor digitorum communis; FDS: flexor digitorum superficialis; CES: cervical erector spinae; UT: upper trapezius; EA: electrical activity; MVC: maximum voluntary contraction; APDF: amplitude probability distribution function.

A systematic review of musculoskeletal complaints, symptoms, and pathologies related to mobile phone usage

BACKGROUND

In the past decade, mobile phone usage rates have increased and there have been concerns that overuse of mobile phones may contribute to various musculoskeletal (MSK) problems.

OBJECTIVES

The aim of the present study was to systematically review available literature on the prevalence of MSK complaints, symptoms, and pathologies associated with mobile phone use.

STUDY DESIGN

Systematic review.

METHOD

In this systematic review, Medline (Pubmed), Wiley, WOS, and EMBASE electronic databases were searched for studies published in English between January 1, 2000 and March 25, 2019 using the following. KEY TERMS: 'mobile phone', 'smartphone', 'musculoskeletal pain', 'pain', 'musculoskeletal symptoms', and 'musculoskeletal pathology'.

RESULTS

The search strategy identified 196 papers, of which 18 met the inclusion criteria. Among the studies included in the systematic review, five were high quality, twelve were of acceptable quality, and one was of low quality. The review demonstrated that the prevalence of MSK complaints among mobile phone users ranged 8.2%-89.9%, and that neck and upper back complaints had the highest prevalence rates ranging from 55.8% to 89.9%. The most common MSK symptom associated with mobile phone use was pain. Myofascial pain syndrome, fibromyalgia, thoracic outlet syndrome, tendonitis, and De Quervain's syndrome were the most commonly associated MSK pathologies.

CONCLUSION

The evidence concerning MSK complaints among mobile phone is somewhat limited because the data were obtained from cross-sectional and case-control study results. Consequently, there is need for higher quality and prospective studies to better understand the relationship between mobile phone use and MSK symptoms and pathologies.

Posture and time spent using a smartphone are not correlated with neck pain and disability in young adults: A cross-sectional study

PURPOSE

To determine the impact of smartphone use on neck impairment and functional limitation in university students.

METHODS

A cross-sectional correlational study was conducted in a sample of students selected through convenience sampling between September 2016 and March 2017. The inclusion criteria were university students at the School of Medicine and Surgery, routine/daily use of mobile devices with advanced computing and connectivity capability built on an operating system, and aged 18-30 years. Participants completed questionnaires that measured general characteristics of smartphone use and demographic characteristics. Neck pain was assessed using a visual analogue pain score (VAS) and a pain drawing (PD); disability status was measured using the Neck Disability Index (NDI-I); and cervical postures while using the phone were captured using the Deluxe Cervical Range of Motion (CROM) device.

RESULTS

A total of 238 volunteers were recruited (22.4 ± 2.2 years of age, 53.4% males), 35.9% of whom were overweight (>25 BMI). Regarding neck pain, 42.4% reported mild pain, 8.4% had moderate pain, and the remaining 49.2% had no pain. NDI-I and VAS were 3.8 ± 3.8 and 13.6 ± 18.4 mm, respectively. The pain categories did not influence the variables. No significant correlations were observed between the number of hours spent and posture (CROM) while using a smartphone and neck pain and NDI-I.

CONCLUSION

While half of young medical students reported neck pain, the use of smartphones was not correlated with neck pain and disability. While we wait for future prospective studies, there is no reason to recommend a change in smartphone use habits among young adults in the meantime.

Exploring the Reliability and Validity of the TechU-Q to Evaluate Device and Purpose Specific Screen Use in Preschool Children and Parents

Young children are increasingly using mobile technology, with potential for positive and negative developmental consequences. Parents are responsible to guide children in their use of technology based on recommendations and guidelines. Guidelines for screen use in young children have been based on little empirical information on contemporary screen use. This study surveyed parents of young children (n = 96, mean child age 3.0, SD 1.0 years) from three settings (Australia, United States) to test the reliability and validity of a new tool to capture richer data on technology use within a techno-microsystem. The TechU-Q demonstrated reasonable test-retest reliability and face and construct validity. Young children averaged more than 60 min per day of total technology use, mostly using TV, tablet computers, and mobile phones. The primary purposes for child use were educational and watching videos. Parental attitudes towards technology and parent use were associated with their child's use. Future guidelines should utilize detailed descriptions of technology use by device and purpose to provide more relevant advice on technology use for young children.

A prospective longitudinal study of mobile touch screen device use and musculoskeletal symptoms and visual health in adolescents

This study aimed to examine prospective associations of mobile touch screen device (i.e. smartphone, tablet) use and patterns of use with musculoskeletal symptoms and visual health among adolescents. A representative sample of 1691 adolescents in Singapore (51% girls; 10-19 years) completed an online questionnaire at baseline and one-year follow-up. After adjusting for potential confounders, prospective associations were found between baseline smartphone use and follow-up neck/shoulder (OR = 1.61(95%CI = 1.06-2.44)) and low back (OR = 1.86(1.10-3.14)) symptoms; tablet use was also associated with neck/shoulder, low back and arms symptoms (OR = 1.33(1.04-1.71)to1.52(1.18-1.95)). No associations were observed between the duration of smartphone/tablet use and symptoms. Baseline patterns of use (bout length, certain types of activities, multitasking) were associated with follow-up musculoskeletal symptoms. Smartphone/tablet use was not related to visual outcomes (visual symptoms, wearing glasses/contact lenses, myopia) at follow-up. These findings suggest that patterns of smartphone/tablet use (though not the duration of use) can pose a prospective risk for musculoskeletal symptoms.

Cervical spine joint loading with neck flexion

Cervical spine flexion is a common posture for those using computers, tablets, and smartphones; the latter being dubbed 'text-neck' in recent years. Coincidentally, flexion has been flagged as a significant mechanical risk factor for the development of chronic neck pain. Unfortunately, few modelling endeavours have attempted to quantify the intervertebral joint loads throughout the cervical spine in flexion, while still accounting for muscular activation. Eight healthy male subjects undertook five trials beginning in a neutral posture, flexed to 45 degrees, and returned to a neutral posture. 3 D head-trunk angles and surface electromyography from 10 neck muscles (5 bilaterally) were used as inputs into an inverse dynamic cervical spine model based on a 50th percentile male to compute the compression and anteroposterior (AP) shear forces for this flexion task. In general, compression increases cranially to caudally throughout the cervical spine, but levels off at the C5-C6 level. Conversely, in a neutral posture, there is a constant 18 N of anterior shear at each joint level. Compression increased twofold throughout the cervical spine with flexion, whereas anterior shear increased fourfold in the upper cervical spine and dramatically decreased caudally. The dramatic change in joint kinetics provides some mechanical evidence for the role of posture and interplay with muscle activity in the development of chronic neck pain. Results from this study can reinforce the need for appropriate workstation and monitor configurations and support the increased loading hypothesised to occur in 'text neck' postures. Practitioner summary: The purpose of this investigation was to quantify the compression and shear forces in the neck in 45 degrees of flexion compared to neutral. Flexion increased compression throughout the cervical spine 1.6-fold compared to a neutral posture. In the upper cervical spine, AP-shear increased four-fold compared to neutral. Abbreviation: AP: anteroposterior.

[Major health consequences a rising from the continued use of new electronic devices with visual display units]

The exponential advance of information and communication technologies (ICT) in the last decade has led to the increasingly widespread use of new electronic devices (NED) in the workplace. The emergence of new concepts such as telework from home or mobile work (ework) represents a clear example of this phenomenon. However, the benefits resulting from these changes in work dynamics may mask potential occupational risks and impacts on health and safety derived from "nonresponsible" use of new technologies. The objective of this study was to analyze the impact of NED use in the work environment and to point out the resulting health consequences. It has been observed that desktop computers are still the most frequently used devices, except in mobile work environments, where laptops and smartphones are more prevalent. The emerging health problems detected are mainly associated with musculoskeletal, visual and psychosocial disorders. This work demonstrates the need to continue deepening the study of the emerging pathologies associated with new work environments and possible intervention measures.

Work-related risk factors for Carpal Tunnel Syndrome among Majmaah University female touchscreen users

Objectives:

This study aimed to explore the prevalence of carpal tunnel syndrome symptoms among female touchscreen users at Majmaah University, Saudi Arabia and to make a comparison for the wrist range of motion between probable CTS and non-CTS female touchscreen users.

Methods:

Two hundred and twenty-two female touchscreen users were enrolled in the present study. Among this cohort, fifty-two were academic members, 40 were employees and 130 were undergraduates. A Digital Inclinometer device was used to assess ROM of the wrist movements. A computer-based questionnaire, Phalen’s test, and Tinel’s sign were used to investigate the presence of CTS symptoms. The study was conducted between November 2018 and February 2019 at Majmaah University.

Results:

The prevalence of probable CTS was 34.2% among touchscreen users; the percent of probable CTS was significantly higher in undergraduates compared to other touchscreen users. There was a significant reduction in wrist flexion between the tested groups.

Conclusion:

Female touchscreen users at Majmaah University tended to have a high-risk for CTS. Wrist ROM measurements, particularly wrist flexion, could be a beneficial indicator for anticipating deviations in wrist posture after long-term touchscreen use. It is necessary to consider the job nature, age, BMI, and duration of using touchscreen as risk factors for CTS symptoms.