Pain and Associated Functional Limitations of Wrist among Students using Smartphone- A Cross Sectional Study
Jomi John1,
Ganga.S.Govind2, Anjitha.P.P.3
Author: 1Jomi John, Assistant Professor, CPAS School of Medical Education, Gandhinagar, Kottayam, Kerala, India. Email Id:jomijohn333@gmail.com Co-Author: 3Anjitha P.P, BPT Student, CPAS School Of Medical Education, Gandhinagar, Kottayam, Kerala, India. Email Id:anjithaammu65@gmail.com Corresponding Author: 2Ganga S Govind, BPT Student, CPAS School Of Medical Education, Gandhinagar, Kottayam, Kerala, India. Email Id: 99gsg9@gmail.com
ABSTRACT
Background of Study: Smartphones become an indispensable part of human life. In the past decade, there is an increase in the number of smartphone users. Many studies reveals that, smartphone overuse may cause many musculoskeletal problems mainly on neck, shoulder, wrist, hand, upper back region etc. The purpose of the study was to find out the pain and associated functional limitations of the wrist due to smartphone use among students.
Methods: A cross-sectional survey was conducted among students of different colleges around Kerala in July 2021. Data was collected through self-structured questionnaire and were sent to students as Google forms with informed consent attached to it. Out of 671 samples only 532 were following the inclusion criteria and were selected for the study through convenient sampling. Patient-Rated Wrist Evaluation scale was used to assess the pain and disability of the wrist joint.
Results: The data analysis shows that, 58.08% subjects have mild pain, 18.6% students have moderate pain and 6.2% students have severe pain due to smartphone use.
Conclusion: The study concluded that there is a significant association between smartphone use with pain and functional disability experienced by the students in their wrist joint.
Author: 1Jomi John, Assistant Professor, CPAS School of Medical Education, Gandhinagar, Kottayam, Kerala, India. Email Id:jomijohn333@gmail.com Co-Author: 3Anjitha P.P, BPT Student, CPAS School Of Medical Education, Gandhinagar, Kottayam, Kerala, India. Email Id:anjithaammu65@gmail.com Corresponding Author: 2Ganga S Govind, BPT Student, CPAS School Of Medical Education, Gandhinagar, Kottayam, Kerala, India. Email Id: 99gsg9@gmail.com
ABSTRACT
Background of Study: Smartphones become an indispensable part of human life. In the past decade, there is an increase in the number of smartphone users. Many studies reveals that, smartphone overuse may cause many musculoskeletal problems mainly on neck, shoulder, wrist, hand, upper back region etc. The purpose of the study was to find out the pain and associated functional limitations of the wrist due to smartphone use among students.
Methods: A cross-sectional survey was conducted among students of different colleges around Kerala in July 2021. Data was collected through self-structured questionnaire and were sent to students as Google forms with informed consent attached to it. Out of 671 samples only 532 were following the inclusion criteria and were selected for the study through convenient sampling. Patient-Rated Wrist Evaluation scale was used to assess the pain and disability of the wrist joint.
Results: The data analysis shows that, 58.08% subjects have mild pain, 18.6% students have moderate pain and 6.2% students have severe pain due to smartphone use.
Conclusion: The study concluded that there is a significant association between smartphone use with pain and functional disability experienced by the students in their wrist joint.
Received on 26thApril 2022, Revised on 24thMay 2022, Accepted on 27thMay 2022DOI:10.36678/IJMAES.2021.V08I02.002
Introduction
Smartphones are one of the most
popular gadgets being used around the world1. This little device has
changed the way of communication among people and become anessential part in
our everyday life2.In the past decade, there is an increase in the
number of smartphone users, frequency of their use and duration of the use3,4.
The smartphone has combined features of normal mobile phones and other personal
digital assistant functions including Internet browsing, GPS navigation,voice
recognition, touch screen, large display, accessing e-mails, third-party
application knownas ‘apps’, motion sensor, capturing high quality photographs
and desktop synchronization5,6.
Now-a-days people are spending
most of their time in using smartphone and ignoring other aspects of life7.
At present, most ofthe people from all age group owns atleast one type of
mobile phone8. A study reported that about 79% of people from 18-44 years
of age have their smartphone with them all the time and they spent nearly 2
hours for walking without smartphones in their hand1.
The innovations in technologies
have changed the traditional way of education. Currently, the COVID-19 pandemic
has changed our lives, especially in economy and educational sector. The
pandemic had force the educational institutions to stop taking offline classes
and lectures for the safety of students9. To ensure integrity and
continuity of education process, the institutions have been implement-ting a general
shift from traditional face-to-face teaching method/black board method to
digital platforms9,10. Most commonly proposed method was video
conference with interactive discussions. These changes in the educational system
increase the number of smartphone users and its use among students 11.
The main uses of smartphone are
chatting, tweeting, social media interactions, communication, formatting
documents and other activities2. These activities may lead to various
musculoskeletal problems as they engaged in the same position for a long period
of time repeatedly without making any specific movements1. Due to the
sudden exertion or prolonged, forceful, low amplitude and repetitive use of
mobile phones may lead to anincrease in musculoskeletal disorders of neck, arm,
forearm, wrist and hand across the World1,2. Incorrect posture and
wrong way of holding mobile phones are major causes of chronic musculoskeletal
pain1.
Smartphone overuse may decrease
the handgrip strength and hand function of their dominant hand. Increased usage
causes weakness in hand and wrist due to repeated movements of them, which in
turn leads tomany musculoskeletal disorders. The commonly reported
musculoskeletal disorders are DeQuervain’s tenosynovitis, Carpal Tunnel Syndrome,
Myofascial Syndrome in hand, symptoms of fibromyalgia, SMS thumb, Carpo-metacarpal
joint arthritis, tendinitis in extensor pollicis longus and adductor pollicis,
wrist tendonitis etc. Few studies also reveals that, some users experiences
numbness, tingling and burning sensation around the thenar eminence of the hand1,2,5,12,13,14.
With the advancement in
technologies, smartphone has become the most popular gadget bought by the
people worldwide. This makes our lifestyle more easeful and comfortable.
Regardless of the advantages of smartphone like communication, social
networking, gaming etc. it impacted the human lives adversely13,15. Young
population holds the majority of the smartphone consumers due to its wide
application. They spend more time on smartphone and other devices rather than
playing outside and interacting with the people16,17.
The rapid and extensive use of
smartphone may affect the quality of life of theusers13. The
increased use may cause many physical, psychological and social issues. The
major musculoskeletal problems reported by the smartphone users are neck pain, back
pain, wrist and thumb pain. Majority of the musculoskeletal problems are due to
improper posture and increased duration of use. Several studies show that most
of the smartphone users experiences wrist pain which may interfere with their
phone use13,17.
Therefore, the aim of this study
was toinvestigate the intensity of wrist pain and associated functional
limitations among the students using smartphones and its impact in their
quality of life.
METHODOLOGY
The study design was Cross-sectional study. The study was carried
out in July 2021. Participants were recruited from recognized colleges in
Kerala. Total 532 samples were selected for this study.
Inclusion criteria: Both male and female subjects aged between 18-25 included in this
study. Also, the selecting subjects should be students who use smartphone >1
hour continuously and currently studies in Kerala.
Exclusion criteria: Subjectswith history of hand surgery, fracture of wrist, Recent
accident or trauma of wrist, Recent history of taking analgesics, Liver
disease, Carpal Tunnel Syndrome, Neurological deficits, Inflammatory
arthropathy and Diabetes were excluded from the study.
Procedure: The
prepared Google forms were sent to students via WhatsApp and e-mails. It was
sent to about 700 people. From that 671 were agreed to participate in this
study and filled out the form. Out of 671 samples, only 532 were favoring the
inclusion criteria. Studies suggest that larger sample size may provide better
results. Thus, the sample size was estimated to as 532. The structured
questionnaire contains Demographic data, Patient-Rated Wrist Evaluation Scale
(PRWE)18, Cornell Mobile Phone Hand Discomfort Questionnaire (CHDQ)19
and some selected questions from Smartphone Addiction Scale-Short
Version(SAS-SV)20.
Demographics: Other
than common demographic data (name, age, gender, place, contact and educational
details) some other questions were also added to the questionnaire like
duration of phone usage (continuously and throughout day), mode of online
class, preferred position for attending classes and also the purpose of
smartphone usage other than calling and text messaging, including:(i) Social
Networking (ii) Entertainment (iii) News (iv) Games (v) Online Class and (vi)
Research and Homework.
Patient-Rated Wrist Evaluation Scale (PRWE): The pain and disability was assessed
through Patient-Rated Wrist Evaluation questionnaire (PRWE). PRWE is a 15-item
questionnaire designed to measure pain and disability at wrist joint. It allows
patients to rate their wrist pain and disability levels from 0 to 10, and
consists of 2 subscales; pain subscale and function subscale. Pain subscale
contains 5 items. Function subscale is further divided into 2 sections i.e.
specific activities (having 6 items) and usual activities (having 4 items). The
maximum score of each subscale is 50 and minimum is 0. Test-retest reliability
of PRWE was found excellent18.
Cornell Mobile Phone Hand Discomfort Questionnaire (CHDQ): The CHDQ is a six-item questionnaire
with a hand map diagram of six shaded areas of the hand that contains questions
regarding the prevalence of musculoskeletal pain, discomfort, and interference
with work. The questionnaire was filled in by the participants based on their
dominant hand. This scale provides an information about which part of the hand
is most impaired12,19.
Smartphone Addiction Scale-Short Version (SAS-SV): Some of the questions asked were taken
from Smartphone Addiction Scale short version (SAS-SV). Smartphone addiction
was assessed using the SAS-SV. This is the short version of the scale developed
by Kwon et al; with internal consistency and concurrent validity. This is
10-item self-report instrument with 6 points Likert scale. SAS-SV address the
following areas, daily life disturbance, withdrawal, cyberspace oriented
relationship, overuse, and tolerance. It has good validity and reliability for
the assessment of smartphone addiction1,20.
Outcome measures
Patient-Rated
Wrist Evaluation Scale (PRWE)
Cornell
Mobile Phone Hand Discomfort Questionnaire (CHDQ)
RESULTS
A total of 532 participants were included in this study from the collected data containing 671 samples. The participation rate was 78.81% (532/675), 4 of them were disagreed to participate and 139 samples were excluded from the study and 532 were analyzed for t
Smartphones are one of the most
popular gadgets being used around the world1. This little device has
changed the way of communication among people and become an essential part in
our everyday life2. In the past decade, there is an increase in the
number of smartphone users, frequency of their use and duration of the use3,4.
The smartphone has combined features of normal mobile phones and other personal
digital assistant functions including Internet browsing, GPS navigation,voice
recognition, touch screen, large display, accessing e-mails, third-party
application known as ‘apps’, motion sensor, capturing high quality photographs
and desktop synchronization5,6.
Now-a-days people are spending
most of their time in using smartphone and ignoring other aspects of life7.
At present, most of the people from all age group owns atleast one type of
mobile phone8. A study reported that about 79% of people from 18-44 years
of age have their smartphone with them all the time and they spent nearly 2
hours for walking without smartphones in their hand1.
The innovations in technologies
have changed the traditional way of education. Currently, the COVID-19 pandemic
has changed our lives, especially in economy and educational sector. The
pandemic had force the educational institutions to stop taking offline classes
and lectures for the safety of students9. To ensure integrity and
continuity of education process, the institutions have been implementing a general
shift from traditional face-to-face teaching method/black board method to
digital platforms9,10. Most commonly proposed method was video
conference with interactive discussions. These changes in the educational system
increase the number of smartphone users and its use among students 11.
The main uses of smartphone are
chatting, tweeting, social media interactions, communication, formatting
documents and other activities2. These activities may lead to various
musculoskeletal problems as they engaged in the same position for a long period
of time repeatedly without making any specific movements1. Due to
the sudden exertion or prolonged, forceful, low amplitude and repetitive use of
mobile phones may lead to an increase in musculoskeletal disorders of neck, arm,
forearm, wrist and hand across the World1,2. Incorrect posture and
wrong way of holding mobile phones are major causes of chronic musculoskeletal
pain1.
Smartphone overuse may decrease
the handgrip strength and hand function of their dominant hand. Increased usage
causes weakness in hand and wrist due to repeated movements of them, which in
turn leads to many musculoskeletal disorders. The commonly reported
musculoskeletal disorders are De Quervain’s tenosynovitis, Carpal Tunnel Syndrome,
Myofascial Syndrome in hand, symptoms of fibromyalgia, SMS thumb, Carpo-metacarpal
joint arthritis, tendinitis in extensor pollicis longus and adductor pollicis,
wrist tendonitis etc. Few studies also reveals that, some users experiences
numbness, tingling and burning sensation around the thenar eminence of the hand1,2,5,12,13,14.
With the advancement in
technologies, smartphone has become the most popular gadget bought by the
people worldwide. This makes our lifestyle more easeful and comfortable.
Regardless of the advantages of smartphone like communication, social
networking, gaming etc. it impacted the human lives adversely13,15. Young
population holds the majority of the smartphone consumers due to its wide
application. They spend more time on smartphone and other devices rather than
playing outside and interacting with the people16,17.
The rapid and extensive use of
smartphone may affect the quality of life of the users13. The
increased use may cause many physical, psychological and social issues. The
major musculoskeletal problems reported by the smartphone users are neck pain,
back pain, wrist and thumb pain. Majority of the musculoskeletal problems are
due to improper posture and increased duration of use. Several studies show
that most of the smartphone users experiences wrist pain which may interfere
with their phone use13,17.
Therefore, the aim of this study
was to investigate the intensity of wrist pain and associated functional
limitations among the students using smartphones and its impact in their
quality of life.
METHODOLOGY
The study design was Cross-sectional study. The study was carried
out in July 2021. Participants were recruited from recognized colleges in
Kerala. Total 532 samples were selected for this study.
Inclusion criteria: Both male and female subjects aged between 18-25 included in this
study. Also, the selecting subjects should be students who use smartphone >1
hour continuously and currently studies in Kerala.
Exclusion criteria: Subjects with history of hand surgery, fracture of wrist, Recent
accident or trauma of wrist, Recent history of taking analgesics, Liver
disease, Carpal Tunnel Syndrome, Neurological deficits, Inflammatory
arthropathy and Diabetes were excluded from the study.
Procedure: The
prepared Google forms were sent to students via WhatsApp and e-mails. It was
sent to about 700 people. From that 671 were agreed to participate in this
study and filled out the form. Out of 671 samples, only 532 were favoring the
inclusion criteria. Studies suggest that larger sample size may provide better
results. Thus, the sample size was estimated to as 532. The structured
questionnaire contains Demographic data, Patient-Rated Wrist Evaluation Scale
(PRWE)18, Cornell Mobile Phone Hand Discomfort Questionnaire (CHDQ)19
and some selected questions from Smartphone Addiction Scale-Short
Version(SAS-SV)20.
Demographics: Other
than common demographic data (name, age, gender, place, contact and educational
details) some other questions were also added to the questionnaire like
duration of phone usage (continuously and throughout day), mode of online
class, preferred position for attending classes and also the purpose of
smartphone usage other than calling and text messaging, including:(i) Social
Networking (ii) Entertainment (iii) News (iv) Games (v) Online Class and (vi)
Research and Homework.
Patient-Rated Wrist Evaluation Scale (PRWE): The pain and disability was assessed
through Patient-Rated Wrist Evaluation questionnaire (PRWE). PRWE is a 15-item
questionnaire designed to measure pain and disability at wrist joint. It allows
patients to rate their wrist pain and disability levels from 0 to 10, and
consists of 2 subscales; pain subscale and function subscale. Pain subscale
contains 5 items. Function subscale is further divided into 2 sections i.e.
specific activities (having 6 items) and usual activities (having 4 items). The
maximum score of each subscale is 50 and minimum is 0. Test-retest reliability
of PRWE was found excellent18.
Cornell Mobile Phone Hand Discomfort Questionnaire (CHDQ): The CHDQ is a six-item questionnaire
with a hand map diagram of six shaded areas of the hand that contains questions
regarding the prevalence of musculoskeletal pain, discomfort, and interference
with work. The questionnaire was filled in by the participants based on their
dominant hand. This scale provides an information about which part of the hand
is most impaired12,19.
Smartphone Addiction Scale-Short Version (SAS-SV): Some of the questions asked were taken
from Smartphone Addiction Scale short version (SAS-SV). Smartphone addiction
was assessed using the SAS-SV. This is the short version of the scale developed
by Kwon et al; with internal consistency and concurrent validity. This is
10-item self-report instrument with 6 points Likert scale. SAS-SV address the
following areas, daily life disturbance, withdrawal, cyberspace oriented
relationship, overuse, and tolerance. It has good validity and reliability for
the assessment of smartphone addiction1,20.
Outcome measures
Patient-Rated
Wrist Evaluation Scale (PRWE)
Cornell
Mobile Phone Hand Discomfort Questionnaire (CHDQ)
RESULTS
A total of 532 participants were included in
this study from the collected data containing 671 samples. The participation
rate was 78.81% (532/675), 4 of them were disagreed to participate and 139
samples were excluded from the study and 532 were analyzed for the final
results. From the data obtained, there was a female predominance.
Demographical
Details:
he final results. From the data obtained, there was a female predominance.
Demographical Details:
Testing Association Using Chi- Square test
Association Between Pain And Phone use
Conclusion: Table 1 shows the distribution and Chi-square test of the association between time of smartphone use and wrist pain. The intensity of pain recorded from 0 to 10 were grouped as 0, 1(1-3), 2(3-6) and 3(6-10). The class 0 indicates no difficulty, 1-mild pain, 2- moderate pain and 3- severe pain. Here, the calculated value of Chi-square test is 18.39 and the corresponding P value is 0.031, which is less than 0.05. So, we reject the null hypothesis, i.e. there is a significant association between smartphone use and pain (how often do you have pain).
Association Between Function And Phone Use
Conclusion: Table
2 shows the distribution and chi-square test of the association between time of
Smartphone use and functional activities. The intensity of pain recorded from 0
to 10 were grouped as 0, 1(1-3), 2(3-6) and 3(6-10). The class 0 indicates no
difficulty, 1-mild pain,
2- moderate pain and 3-
severe pain. Here, the calculated Chi-square value is 17.64 and the
corresponding P value is 0.04, which is less than 0.05. So, we reject the null
hypothesis. That is, there is a significant association between smartphone use
and functional activities.
Testing Association Using Anova Test
Null Hypothesis; Ho:
there is no significant difference between the variance of Total Pain based on
smartphone use.
Conclusion: Table
4 shows the ANOVA test for usual activities and smartphone use. Here P Value is
less than 0.05. So, we reject the null hypothesis. That is there is a
significant differ-
ence between the
variance of usual activity based on smartphone use.
This
can also be proved using F value. The calculated value is f(3,528)=5.12 and the
P value is 0.002 which is less than
0.05. So, we reject the null hypothesis and accept the alternative hypothesis
i.e. there is a significant association between functional limitations and
smartphone usage.
Phone use and Total Pain
Null Hypothesis, Ho:
there is no significant difference between the variance of Total Pain based on
smartphone use.
Conclusion: Table
6 shows the results of ANOVA test for phone use and total pain. Here P Value is
less than 0.05. So, we reject the null hypothesis. That is there is a
significant
difference between the
variance of Total Pain based on smartphone use.
This can also be proved using F value. The calculated value is f(3,528)=3.14 and the P value is 0.025 which is less than 0.05. So, we reject the null hypothesis and accept the alternative hypothesis i.e. there is a significant association between smartphone usage and total pain.
Conclusion: A, B, C, D, E,
F represents the wrist and different parts of the hand. Here, A indicates
index, middle and lateral aspect of 4th finger, B-medial aspect of 4th
finger and little finger, C-thumb, D- palm, E- thenar eminence and F-wrist.
From the data, it is clearly indicated that 4.6% of them i.e. 24 students
reported severe pain in index finger, middle finger and 4th (ring) finger while
using mobile phone. In this, 13 students have slight discomfort due to pain, 4
of them have moderate discomfort and 7 students were felt very uncomfortable
due to the pain. Among this, 5 students reported that this pain doesn’t
interfere with their phone usage, a slight interference have reported by 17
students and only 2 students have reported a higher interference of the pain
with their phone usage.
DISCUSSION
This study was conducted to evaluate the
relation between wrist pain and its associated functional limitations among
students using smartphone. 532 students who satisfy the inclusion criteria were
selected for the study. The age of the participants ranges from 18-25 years.
The subjects selected were residents of Kerala. Subjects with recent accidents
or trauma of wrist, hand surgery, fracture of wrist, recent history of taking
analgesics, liver disease, carpal tunnel syndrome, neurological deficits,
inflammatory arthropathy and diabetes were excluded from the study. The data
was collected through Google forms with informed consent attached to it. The
participants were aware of the study and the fact that they can withdraw from
the study at any time.
Pain and functional limitations of wrist were
assessed using Patient-Rated Wrist Evaluation Scale (PRWE). It was scored by
the students themselves. It consists of two subscales; pain and functions
scale. This allows the subjects to rate their wrist pain and disability levels from
0 to 10. The outcome measures were analyzed by using Chi-square test and ANOVA
test to interpret the results. Some questions were taken from Cornell Mobile
Hand Discomfort Questionnaire (CHDQ) for getting information about which part
of the hand is more involved and whether any discomfort while using smartphone.
The results of the present study shown that
wrist pain is the common problem arising from smartphone users, thereby
supporting the alternative hypothesis i.e. there is a significant relation between
smart phone usage and wrist pain.
Mobile phones are one of the major
communication devices. The number of mobile phone users increasing every year.
According to statistics taken in 2016, the number of users was more than 7
billion and this count may expect to rise in coming years. Recent studies show
that, there is a rapid increase of smartphone use among students. Due to
COVID-19 pandemic, the traditional way to teaching is not possible. With the
advancement of technologies, face-to-face method has shifted to online
platforms. While there are many advantages, smartphone have some demerits too.
The prolonged use of smartphone can affect on the physical, mental and social
life.
According to the results of the present study
58.26% subjects had mild pain over the wrist; it was found comparable to the
previous study by Amjad et al2. They reported 48% of subjects with
frequency of minimal (1-20) wrist pain and disability. However it was little
higher than the findings of Ayman Baabdullah et al5; they reported
20.4% of participants had pain over thumb/wrist. The pain due to smartphone
usage may also cause several functional limitations on daily life. The result
of the current study shows 63% of subjects with usage hours between 4 to 6
continuously had mild functional limitation.
In a study by Parasuraman et al.21,
reported 26% frequency of wrist pain among smartphone users. Participants of
the study were using smartphones for roughly less than one hour, whereas in the
current study the majority of participants i.e. 43.23% of them have smartphone
usage of more than 4 to 6 hours per day. The variations in the duration may due
to the Covid-19 pandemic. In the recent years, smartphone use has been
tremendously increased due to the social restrictions caused by Covid-19. The
people tends to spend more time on social media and other platforms to escape
from their loneliness and to maintain their social interactions via these
digital platforms (Fernandes B et al)22. Thus the results of the
current study shows majority of the participants spend more than 4-6 hours per
day on smartphone which was consistent with Amjad et al.2
In the current study, it is found that most
of the participants are from the age group of 21 years having a frequency of
124. Majority of the participants i.e. 80.45% are females. From the results it
is clear that, most of the participants have physical discomfort while using
smartphone. They spent most of their time on smartphone other than online class
(27.95%) are for entertainment purpose and social networking.
The objective of using PRWE in the study was
to provide an assessment of wrist pain and its associated functional
limitations. Chi-square Test and ANOVA Test were used to interpret the
collected data.
Chi-square Test was used to get an account
for the association between the wrist pain and functional activities with phone
use. From the data, it is found that majority of the students i.e. 230 have
using smart phone for 4-6 hours continuously in a day. The value of Chi-square
test for pain and smartphone was 18.39 and having a P value of 0.031. So, the
result shows that there is a significant association between Smartphone use and
wrist pain. The value of Chi-square test for smart phone and functional
activities is 17.64 and the P value is 0.04. Thereby, the result shows that
there is a significant association between Smartphone use and functional
activities.
Based on the statistical analysis, the ANOVA
test mean value with Standard deviation of Usual Activity and Phone use was
6.54±7.84, degree of freedom between groups was 3 and within groups was 529, f
value was 5.12 and the p value is 0.002. Thus, result shows that there is a
significant association between the functional limitations and smartphone use.
While the ANOVA test mean value with Standard
Deviation of phone use and total pain was 11.4 ± 8.63 degree of freedom between
groups was 3 and within groups was 529, f value was 3.14 and the p value is
0.025. The result shows that there is a significant association between
smartphone use and total pain.
Smartphone usage can interfere in people’s
life in many aspects. Increased smartphone use may results in many
musculoskeletal problems mainly on neck, shoulder, elbow, hand, wrist and upper
back region. Mustafaoglu et al.1 reported that prolonged smartphone
use may allow the wrist to be in an inappropriate posture for a period of time
and cause weakness to the hand and the wrist. Another study by Inal et al.23
reported that in strong smartphone users, the repetitive and extensive
wrist flexion and extension movements during smartphone use can affect the
median nerve and may lead to Carpal Tunnel Syndrome. The study also reported
that placing the thumb and the wrist in static posture will probably cause an
increased load to these joints, muscles, tendons and associated structures.
Although, the results of the present study is similar to the results of Amjad
et al.2, increased smartphone use can induce wrist pain and this
pain can leads to functional limitations on their daily life activities.
It will be more accurate if the study was
conduct in direct contact with the subjects rather than by Google Forms.
Increasing the sample size and age criteria i.e., below 18 years and above 25
years can be attempted. Participants were University students with a slight
bias towards female students and do not represent the total population of the
university students. Therefore, the results cannot be generalized to other
population. It was found to be difficult for students to fill out the lengthy
questionnaire and hence it affects the quality of data and also the results.
The study setting can be extended i.e. participants from outside Kerala can
also be included. Questions regarding the holding position of smart phone and
the screen size in the questionnaire can bring more accurate results.
Further studies can be done with more sample
size, increasing the age criteria i.e. below 18 years and above 25 years and
extending the study setting to outside Kerala. Can include questions related to
position for holding the mobile phone and screen size in the survey
questionnaire can be attempted. Bringing equality in the male and female ratio
can fetch more accuracy. Data can be collected by direct method instead of
Google Forms. Decreasing the span of the questionnaire can also be attempted.
Ethical clearance: Ethical
clearance has obtained from CPAS School of Medical Education, Gandhinagar,
Kottayam, Kerala with reference number BPTPA/EC/SMEGNR/2021/ 01 dated on
30/06/2021.
Conflict of interest: There was no
conflict of interest to conduct this study.
Fund for the study: It was a self
financed study.
CONCLUSION
The result of the study shows that the
smartphone users experience pain and functional limitations in the wrist joint
due to overuse.
Based on the statistical analysis, mean value
with Standard Deviation of usual activity with smartphone use 6.54 ± 7.84 and
mean value with Standard deviation of phone use with total pain was 11.4 ±
8.63. The results of the study shows that there is a significant association
between smartphone use with pain and function of the wrist joint.
Also, the result shows that there is a
statistically significant difference between the variance of smartphone use
with usual activity and pain.
After analyzing the study, it can be
concluded that increased duration of smartphone usage may lead to pain and
functional disability of the wrist joint. Therefore, the study rejects the null
hypothesis and accepts the alternate hypothesis.
REFERENCE
Mustafaoglu R, Yasaci Z, Zirek E, Griffiths MD, Ozdincler AR. The relationship between smartphone addiction and musculoskeletal pain prevalence among young population: A cross-sectional study. The Korean Journal of Pain. 2021; 34(1);72-81.
Amjad F, Farooq M, Batool R, Irshad A. Frequency of wrist pain and its associated risk factors in students using mobile phones. Pakistan Journal of Medical Sciences. 2020;36(4).
Eitivipart AC, Viriyarojanakul S, Redhead L. Musculoskeletal disorder and pain associated with smartphone use: A systematic review of biomechanical evidence. Hong Kong Physiotherapy J. 2018;38(2);77–90.
Goggin G. Cell phone culture: Mobile technology ineveryday life. New York: Routledge, 2012.
Baabdullah A, Bokhary D, Kabli Y, Saggaf O, DaiwaliM,Hamdi A. The association between smartphone addiction and thumb/wrist pain :A cross-sectional study. Medicine 2020; 99; 10(e19124).
Choi JS, Yi B, Park JH, et al. The uses of the smartphone for doctors: anempirical study from samsung medical center.Healthc Inform Res2011;17;131–8.
Ammati R, Kakunje A, Karkal R, Nafisa D, Kini G, Chandrashekaran P. Smartphone Addiction among Students of Medical University in South India: A Cross-Sectional Study. Annals of International Medical and Dental Research. 2018; 4(2); 21276.
Xie Y, Szeto G, Dai J. Prevalence and risk factors associated with musculoskeletal complaints among users of mobile handheld devices: A systematic review. Applied Ergonomics. 2017;59(PtA);132-42.
Rajab MH, Gazal AM, Alkattan K. Challenges to online medical education during the COVID-19 pandemic. Cureus. 2020;12(7); e8966.
Bringman-Rodenbarger L, Hortsch M. How students choose E‐learning resources: The importance of ease, familiarity, and convenience. FASEB BioAdvances. 2020; 2(5); 286–95.
Alsoufi A, Alsuyihili A, Msherghi A, Elhadi A, Atiyah H, Ashini A, et al. Impact of the COVID-19 pandemic on medical education: Medical students’ knowledge, attitudes, and practices regarding electronic learning. PLoS One.2020;15 (11); e0242905.
Ahmed S, Akter R, Pokhrel N, Samuel A. Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: a cross-sectional survey study. Journal of Public Health. 2019;29(2);411-416.
Bhamra JK, Naqvi WM, Arora SP. Effect of smartphone on hand performance and strength in the healthy population. Cureus [Internet]. 2021;13(6);e15798.
Zirek E, Mustafaoglu R, Yasaci Z, Griffiths MD. A systematic review of muscu-loskeletal complaints, symptoms, and pathologies related to mobile phone usage. Musculoskeletal SciPract 2020; 49; 102196.
Chen B, Liu F, Ding S, Ying X, Wang L, Wen Y. Gender differences in factors associated with smartphone addiction: a cross-sectional study among medical college students. BMC Psychiatry [Internet]. 2017;17(1); 341.
Singh MKK, Samah NA. Impact of smartphone: A review on positive and negative effects on students. Asian Soc.Sci [Internet]. 2018;14(11); 83.
Woo EHC, White P, Lai CWK. Musculoskeletal impact of the use of various types of electronic devices on university students in Hong Kong: An evaluation by means of self-reported questionnaire. Man Ther. 2016;26; 47-53.
Mehta SP, MacDermid JC, Richardson J, MacIntyre NJ, Grewal R. A systematic review of the measurement properties of the patient-rated wrist evaluation. J Orthop Sports PhysTher [Internet]. 2015;45(4);289–98.
Erdinc O, Hot K, Ozkaya M. Turkish version of the Cornell Musculoskeletal Discomfort Questionnaire: cross-cultural adaptation and validation. Work [Internet]. 2011; 39(3);251-60.
Kwon M, Kim D-J, Cho H, Yang S. The smartphone addiction scale: development and validation of a short version for adolescents. PLoS One [Internet]. 2013; 8(12); e83558.
Parasuraman S, Sam A, Yee SK, Chuon BC, Ren L. Smartphone usage and increased risk of mobile phone addiction: A concurrent study. Int J PharmInvestig [Internet]. 2017;7(3);125.
Fernandes B, Biswas UN, Tan-Mansukhani R, Vallejo A, Essau CA. The impact of COVID-19 lockdown on internet use and escapism in adolescents. Rev psicolclín con niñosadolesc [Internet]. 2020;7(3); 59-65.
İnal EE, Demİrcİ K, Çetİntürk A, Akgönül M, Savaş S. Effects of smartphone overuse on hand function, pinch strength, and the median nerve: Smartphone Overuse. Muscle Nerve [Internet] 2015;52(2);183-8.
Citation: Jomi John, Ganga S Govind, Anjitha P P(2022). Pain and Associated Functional Limitations of Wrist among Students using Smart Phone-A Cross Sectional Study, ijmaes; 8 (2); 1248-1260.