A field study on spinal postures and postural variations during smartphone use among university students

Machine learning models for classifying non-specific neck pain using craniocervical posture and movement

OBJECTIVE

Physical therapists and clinicians commonly confirm craniocervical posture (CCP), cervical retraction, and craniocervical flexion as screening tests because they contribute to non-specific neck pain (NSNP). We compared the predictive performance of statistical machine learning (ML) models for classifying individuals with and without NSNP using datasets containing CCP and cervical kinematics during pro- and retraction (CKdPR).

DESIGN

Exploratory, cross-sectional design.

SETTING AND PARTICIPANTS

In total, 773 public service office workers (PSOWs) were screened for eligibility (NSNP, 441; without NSNP, 332).

METHODS

We set up five datasets (CCP, cervical kinematics during the protraction, cervical kinematics during the retraction, CKdPR and combination of the CCP and CKdPR). Four ML algorithms-random forest, logistic regression, Extreme Gradient boosting, and support vector machine-were trained.

MAIN OUTCOME MEASURES

Model performance were assessed using area under the curve (AUC), accuracy, precision, recall and F1-score. To interpret the predictions, we used Feature permutation importance and SHapley Additive explanation values.

RESULTS

The random forest model in the CKdPR dataset classified PSOWs with and without NSNP and achieved the best AUC among the five datasets using the test data (AUC, 0.892 [good]; F1, 0.832). The random forest model in the CCP dataset had the worst AUC among the five datasets using the test data [AUC, 0.738 (fair); F1, 0.715].

CONCLUSION

ML performance was higher for the CKdPR dataset than for the CCP dataset, suggesting that ML algorithms are more suitable than classical statistical methods for developing robust models for classifying PSOWs with and without NSNP.

Association between smartphone addiction and myofascial trigger points

BACKGROUND

The purpose of this study was to clarify the relationship between smartphone addiction and miyafascial trigger points in university students.

METHODS

A cross-sectional study of university students was conducted for the purpose of this study. The participants were assessed based on age, gender, dominant side, the amount of time they spent on their smartphones, the purpose of their use, and their posture. The Smartphone Addiction Scale Short Form (SAS-SF) was used to determine addictes and non-addicts. The cut-off value of SAS-SF is 31 and above for male and 33 and above for female.

RESULTS

There were 136 participants in the study. The posture score for addicts and non-addicts ones was not significantly different (p > 0,05), but the number of trigger points, maximal bending posture and trigger points in the right levator scapula and right cervical erector muscles were significantly higher in the smartphone addict participants (p < 0,05).

CONCLUSIONS

Smartphone addiction in university students is associated with postural changes and trigger points in the bilateral levator scapula and right cervical erector muscles. Public health programs should be developed to raise awareness about smartphone addiction, encourage screen breaks, and emphasize physical activity and exercise regularly.

Designing and Developing a Vision-Based System to Investigate the Emotional Effects of News on Short Sleep at Noon: An Experimental Case Study

Background: Sleep is a critical factor in maintaining good health, and its impact on various diseases has been recognized by scientists. Understanding sleep patterns and quality is crucial for investigating sleep-related disorders and their potential links to health conditions. The development of non-intrusive and contactless methods for analyzing sleep data is essential for accurate diagnosis and treatment. Methods: A novel system called the sleep visual analyzer (VSleep) was designed to analyze sleep movements and generate reports based on changes in body position angles. The system utilized camera data without requiring any physical contact with the body. A Python graphical user interface (GUI) section was developed to analyze body movements during sleep and present the data in an Excel format. To evaluate the effectiveness of the VSleep system, a case study was conducted. The participants' movements during daytime naps were recorded. The study also examined the impact of different types of news (positive, neutral, and negative) on sleep patterns. Results: The system successfully detected and recorded various angles formed by participants' bodies, providing detailed information about their sleep patterns. The results revealed distinct effects based on the news category, highlighting the potential impact of external factors on sleep quality and behaviors. Conclusions: The sleep visual analyzer (VSleep) demonstrated its efficacy in analyzing sleep-related data without the need for accessories. The VSleep system holds great potential for diagnosing and investigating sleep-related disorders. The proposed system is affordable, easy to use, portable, and a mobile application can be developed to perform the experiment and prepare the results.

Neck and shoulder strains under various head flexing positions while standing and sitting with and without back support for male and female smartphone users

This study recruited 30 young participants (15 men and 15 women) to examine the smartphone usage patterns in three postures (standing, supported sitting, and unsupported sitting) and at five head angle (HA) positions (0°-40°). Cervical erector spinae (CES) and upper trapezius (UTZ) muscle activity, neck flexion (NF), gaze angle (GA), viewing distance (VD), and discomfort scores were collected. Results showed that HA and posture almost affected all responses, while CES muscle activity, NF, and VD differed between sexes. Strain in the neck and shoulder region increased with HA increase. Particularly, when the HA exceeded 20°, the discomfort scores considerably increased. Unsupported sitting should be avoided during smartphone use because of relatively poor responses in all variables. However, both standing and supported sitting have their respective benefits. Sex-related differences were typically observed in the standing position, with women tending to have lower NF but higher CES muscle activity compared with men.Practitioner summary: Although smartphones have become daily necessities, the overall quantitative neck and shoulder strain of using smartphones in different postures is rarely evaluated. We suggest that maintaining the HA within 20° is recommended because of relatively low load on the neck and shoulders. An unsupported sitting should be avoided during smartphone use.

Effect of day time on smartphone use posture and related musculoskeletal disorders risk: a survey among university students

BACKGROUND

Musculoskeletal disorders (MSDs) are one of the most important problems among young smartphone users worldwide. Portability leads to a wide variety of postures during the different activities of the day. The objective evaluation of these postures coupled with ergonomic tools allows evaluating the level of MSD risk to which users are exposed.

METHODS

The purpose was to investigate the effect of the time of day on the posture adopted during smartphone use among university students. The study was conducted through a cross-sectional survey of 263 university sports students. Four time of day, i.e. morning, afternoon, evening and night, and a taxonomy of 41 postures called SmarTaxo were considered. SmarTaxo included 18 sitting, 11 standing, 10 lying and 2 walking postures and their ergonomic score. After checking the normality of the data, a non-parametric Kruskal-Wallis test was used to study the effect of the time of day on the use duration of the different postures.

RESULTS

The total mean duration use per typical weekday was 5.39 ± 2.19 h for males and 5.15 ± 1.60 h for females with maximal duration during evening. The average smartphone use durations were statistically longer in afternoon and evening for all sitting (9.44 and 9.22 min respectively, p < 0.05) and calling (3.38 and 3.33 min respectively, p < 0.05) postures. The longest duration for standing postures was recorded for afternoon (8.91 min, p < 0.05). The lying postures were significantly more present in evening (19.36 min). Some postures were more used during a time of day. The side-lying posture was used more in evening and has an ergonomic score of 6, i.e. a high MSD risk.

CONCLUSIONS

The survey showed that users are exposed to MSDs regardless of posture and time of day. Sitting postures are used more in the morning and afternoon while lying postures are used more in the evening. As long as the rate of use is so high (> 5 h per day), young people will remain highly exposed to MSDs.

Severity of slouched posture during smartphone use is associated with the musculoskeletal discomfort, daily usage, and school year among adolescents

Real-time measurement of the craniovertebral, thoracic kyphosis, and lumbar lordosis angles during natural and smartphone usage postures in sitting were analysed in a cohort of 560 adolescents using independent t-tests and Spearman's correlations between their reported musculoskeletal symptoms, daily device use and school year. Students with musculoskeletal symptoms (mean difference: 4.1-9.4°, p < .001) and in secondary schools (mean difference: 13.6-29.4°, p < .001) had a greater forward-head posture quantified by craniovertebral angle in both postures. Loss of lumbar lordosis was found in students spending ≥2 h/day on electronic devices (mean difference: 3.2°, p = .029) and those with musculoskeletal symptoms (mean difference: 5.4°, p = .001). Secondary school students exhibited a greater thoracic kyphosis when using smartphones (mean difference: 3.3°, p = .003). Findings suggest the urgent need for early and proactive intervention targeted to minimise the risk of developing musculoskeletal disorders related to intense device use for young adolescents.Practitioner Summary: Adolescents: (1) in higher school year had increased forward-head posture (FHP) and thoracic kyphosis; (2) with musculoskeletal symptoms had increased FHP and loss of lumbar lordosis, and; (3) with extended device use had a loss of lumbar lordosis. Early intervention targeting young adolescents promoting optimal posture and habit of device use is warranted.

Examining Potential User Experience Trade-Offs Between Common Computer Display Configurations

OBJECTIVE

To determine how ultrawide (UW) and dual displays configurations can influence neck biomechanics and performance compared to a single display.

BACKGROUND

Studies have assessed neck kinematics and performance when using dual displays, but these studies have used screen sizes smaller than today's display size, have inconsistent participant placement, and few have assessed these two variables together.

METHODS

Seventeen participants completed five tasks on six display configurations. Neck kinematics and performance were tracked for each configuration.

RESULTS

Centered configurations produced significantly different median neck rotation angles compared to secondary configurations (p < .001) for three of the tasks. A 34" curved UW display with a longer viewing distance produced similar neck kinematics to a single 24" display with the potential to also reduce screen interactions. When compared to single, the benefit of secondary versus centered monitors was dependent on the type of task being performed. Users may prefer the UW, centered dual, and secondary dual configurations over the single display.

CONCLUSION

The benefit of secondary versus centered displays is dependent on the type of task being performed. Dual displays are still beneficial but should be used with a monitor arm to switch between centered and secondary configurations as necessary. Future work should look at larger UW displays to see if these results hold compared to dual display configurations.

APPLICATION

The results can be used to make evidence-based guidelines for displays based on size and task. Researchers can use this information to design future studies looking at specific configurations.

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.

Dose-response relationship between daily screen time and the risk of low back pain among children and adolescents: a meta-analysis of 57831 participants

BACKGROUND

The risk of low back pain (LBP) increases steeply during adolescence, and adolescents with LBP are more likely to have low back pain in their adult years. This study aimed to investigate the dose-response relationship between daily screen time and the risk of low back pain among children and adolescents.

METHODS

PubMed, the Cochrane Library, Embase, and Web of Science were searched to collect relevant studies on daily screen time and the risk of low back pain from the establishment of the database up to December 2022. Two investigators independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata16.0 was used to perform a dose-response meta-analysis and the methodological quality evaluation of the included studies.

RESULTS

The results of the meta-analysis showed that there is a positive correlation between daily computer time (OR = 1.32, 1.05-1.60), daily mobile phone time (OR = 1.32, 1.00-1.64), daily TV watching (OR = 1.07, 1.04-1.09) and the risk of low back pain, separately. The dose-response meta-analysis showed that there is a linear relationship between daily computer use and low back pain. The risk of low back pain increased by 8.2% for each 1-hour of daily computer use.

CONCLUSIONS

Screen time is related to the risk of low back pain, and there is a linear relationship between daily computer use and the risk of low back pain. A number of strategic measures should be taken to prevent adolescents from developing severe low back pain.

Comparing the effect of the posture of using smartphones on head and neck angles among college students

Smartphone users' posture can affect the musculoskeletal load of the user's neck. This study aims to compare the effect of the posture of using smartphones on head and neck angles among college students. The cross-sectional study was conducted among 80 college students. The Severity of Neck Pain (SNP) and the head and neck tilt angles, the gaze angle, and the amount of change in the forward head posture were determined. The angles were measured in three postures including standing, sitting on a chair with and without a backrest. Most of the participants (51.3%) reported moderate and severe neck pain. The angles during using smartphone had a significant difference in different positions, so that the best head (100.6 ± 11.3°) and neck (32.5 ± 11.2°) tilt angles and gaze angle (58.2 ± 13.7°) were in sitting position with leaning on a backrest of the chair. Head (109.6 ± 14.4°) and neck (22.0 ± 12.6°) tilt angles, and the forward head posture (15.9 ± 4.9 cm) have the worst posture in sitting position on a chair without a backrest while gaze angle (67.1 ± 12.0°) has the most awkward posture in standing. Practitioner summary: The posture of using a smartphone affects the amount of pressure on the neck. This study aims to investigate the effect of different positions of using smartphone on head and neck angles among Iranian university students. The angles during using smartphone had a significant difference in different positions.

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.

Acute Pain, Neck Extensor Endurance, and Kinematic Changes Resulting from Sustained Neck Flexion during Smartphone Use

OCCUPATIONAL APPLICATIONSThe National Occupational Research Agenda for Musculoskeletal Health in the United States identified that with the changing nature of the traditional office environment, mobile devices are now frequently used for longer durations, warranting research on the impacts of mobile computing on musculoskeletal health. A recent study of office workers showed that those with "smartphone overuse" were six times more likely to report neck pain. Working in pain may also result in withdrawal and less proactive extra-role behaviors at work (such as making recommendations at work and willing to help colleagues). We found that 30-minutes of mobile device use resulted in pain reporting in the neck and upper back when the device was used with neck flexion. This musculoskeletal pain could lead to acute concerns during the workday and long-term problems over time.

Extracting cervical spine popping sound during neck movement and analyzing its frequency using wavelet transform

With the excessive use of smartphones, cervical spine pain is becoming increasingly prevalent. A denoised cervical spine popping sound can aid in monitoring and estimating the state of the cervical spine. However, cervical spine popping sounds that are collected when a subject performs neck movements is contaminated by constant noise. Therefore, a denoising algorithm called Wavelet Transform-Based Stationary-Nonstationary (WTST-NST) is adopted to remove the noise. The input signal is decomposed using wavelet transform to obtain the wavelet coefficients. The wavelet coefficients are then separated into two parts, the nonstationary part and the stationary part, using stationary-nonstationary filtering technology. Finally, the wavelet coefficients of the nonstationary part are reconstructed to obtain the denoised cervical spine popping sound. In addition, the frequency components of the sound are analyzed using the multiresolution analysis of the wavelet transform. The experimental results demonstrate that the implementation of the WTST-NST algorithm in the sound analysis of cervical spine facet joints efficiently reduces the overlapped noise, producing an almost pure cervical spine popping sound. Furthermore, the frequency components of cervical spine popping sounds during the smartphone use period are significantly higher than that in the non-use period and are significantly associated with self-reported neck and upper back pain during the smartphone use period. Therefore, the WTST-NST algorithm preserved almost all the features of the sampled input signal. The denoised cervical spine popping sound can be used to quickly and conveniently monitor the status of the cervical spine during the smartphone use period.

Repetitive patterns in the locations of touch errors for two-thumb text entry on a smartphone

This study investigated repetitive patterns in the locations of touch errors as a function of the shapes and positions of soft buttons on a smartphone for two-thumb text entry. Forty-three right-handed college students with smartphone-use experience were recruited for testing. An experimental application was developed, and the locations and frequencies of touch errors were measured for the button combinations of seven shapes and eight positions. More than 70.0 % of touch errors occurred within 2 mm from the boundaries of the buttons. In terms of direction, touch errors were primarily observed below the buttons, across all the button shapes and positions. Simultaneously, touch errors often appeared on the lateral sides of the buttons: (1) close to the proximal phalange of the thumbs when the buttons were placed near the initial positions of the thumbs and (2) close to the initial positions of the thumbs when the buttons were placed near the top and bottom ends of the keyboard.

Ergonomic arm support prototype device for smartphone users reduces neck and shoulder musculoskeletal loading and fatigue

Smartphone use is a risk factor for both neck and shoulder musculoskeletal disorders. The objective of this study was to evaluate an ergonomic arm support prototype device, which may help improve posture while using a smartphone, by determining its effect on muscle activity, muscle fatigue, and neck and shoulder discomfort. Twenty-four healthy young adult smartphone users performed 20 min of smartphone game playing under two different conditions, smartphone use with support prototype device (i.e. intervention condition) and without (i.e. control condition), while neck and shoulder posture were controlled at 0° neck flexion and 30° shoulder flexion. Activity and fatigue of four muscles were measured using surface electromyography (sEMG), these were: anterior deltoid (AD), cervical erector spinae (CES), upper trapezius (UT) and lower trapezius (LT). The intervention condition showed significantly decreased activity of all muscles. Fatigue of all muscles, except LT, significantly increased over time compared to the start point in the control condition. There was no significant difference in muscle fatigue between each time point in the intervention condition. In conclusion, the ergonomic arm support prototype device can be used as ergonomic intervention to reduce neck and shoulder muscle loading and fatigue.

Smartphone Use among Undergraduate STEM Students during COVID-19: An Opportunity for Higher Education?

Due to the COVID-19 pandemic, students worldwide have continued their education remotely. One of the challenges of this modality is that students need access to devices such as laptops and smartphones. Among these options, smartphones are the most accessible because of their lower price. This study analyzes the usage patterns of smartphone users of undergraduate Science, Technology, Engineering, and Math (STEM) students during the COVID-19 pandemic. This cross-sectional descriptive study included 365 students: 162 (44.4%) women and 203 (55.6%) men from a Chilean university. The results revealed that students often accessed the learning management system (LMS) with their computers rather than with their smartphones. Students were connected to the LMS for more hours on their computers than on their smartphones. However, they spent more hours simultaneously connected on their computers and smartphones than just on their computers. During the day, students accessed the LMS mainly from 13:00 to 1:00. The number of connections decreased from 1:00 to 8:00 and increased from 8:00 to 13:00. The LMS resource that students accessed the most using smartphones was discussion forums, while the one they accessed the least was wiki pages. We expect these results to motivate faculties to schedule their activities during the hours students tend to be online and promote discussion forums.

An investigation of an ergonomics intervention to affect neck biomechanics and pain associated with smartphone use

BACKGROUND

Neck discomfort and pronounced neck flexion have been associated with smartphone use.

OBJECTIVE

Eye glasses with a 90 deg prism in each lens were investigated as a potential intervention to reduce awkward head and neck postures during activities involving viewing the device.

METHODS

Sixteen smartphone users with neck pain and 9 asymptomatic users performed a texting task on a smartphone with and without the prism glasses, in sitting and standing postures in a laboratory setting.

RESULTS

Cervical erector spinae and upper trapezius muscle activity, head posture and motion, performance, discomfort and other subjective perceptions were assessed. Prism glasses reduced neck extensor muscle activity, neck flexion, and head tilt compared to the direct view. In the symptomatic group, the intervention produced less neck and shoulder discomfort compared to the direct view.

CONCLUSIONS

This intervention could offer an alternative way of interacting with a smartphone while texting in stationary postures, by reducing exposure to pronounced flexed neck and head posture commonly seen in users, and thereby could reduce neck discomfort associated with smartphone use.

Sitting dynamics during computer work are age-dependent

This laboratory study aimed to characterize the dynamics of sitting during a 40 min computer task in 20 younger (YG) and 18 older (OG) computer users. The position of the center of pressure (COP) in anterior-posterior (AP) and medial-lateral (ML) direction was computed. The range, velocity, area, standard deviation (SD) and sample entropy (SaEn) values were extracted. The range, velocity and area of the COP displacement were larger in the AP while the SD and SaEn were respectively larger and smaller in both AP and ML for the OG than the YG. The findings revealed altered dynamics of sitting among older computer users.