Effect of smartphone application on pain, disability and forward head posture on young adults with excessive usage of a smartphone: A pilot study

Main Article Content

A Akodu
O Ipinnimo
A Osuntoki


Background. Excessive usage of smartphones has been linked to forward head posture (FHP) leading to musculoskeletal disorders of the spine.

Objective. To determine the effect of smartphone applications on pain and disability levels in the neck, shoulder, lower back and FHP among young adults with excessive smartphone usage.

Methods. In this randomised controlled pilot study, 31 young adults (24 female and 7 male, aged 21.35 (standard deviation 1.74 years) who exhibited excessive smartphone usage were enrolled. They were recruited from the College of Medicine, University of Lagos in Nigeria and randomly allocated to three groups: smartphone application (SPA) only, SPA with ergonomic advice (SPA+EA) and EA only. Outcome assessments were conducted before, at 4 weeks, and after 8 weeks of the intervention.

Results. The outcome of this study revealed significant improvements in the assessed variables across all three groups (SPA, SPA+EA, EA) post intervention, including FHP (p=0.0001, p=0.003, p=0.002), pain intensity in the neck (p=0.01, p=0.02, p=0.0001), neck disability level (p=0.0001, p=0.0001, p=0.0001), functional disability (p=0.001, p=0.001, p=0.007) and shoulder pain disability (p=0.0001, p=0.001, p= 0.0001). However, no significant between-group differences (p>0.05) were noted in the outcomes across the groups, except for FHP (p=0.027) at the end of the 8th week of intervention.

Conclusion. It was concluded that the SPA group was more effective in improving FHP, though all the groups displayed significant effects in all the outcomes.

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Effect of smartphone application on pain, disability and forward head posture on young adults with excessive usage of a smartphone: A pilot study. (2024). Southern African Journal of Public Health, 7(1), e1175. https://doi.org/10.7196/
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How to Cite

Effect of smartphone application on pain, disability and forward head posture on young adults with excessive usage of a smartphone: A pilot study. (2024). Southern African Journal of Public Health, 7(1), e1175. https://doi.org/10.7196/


AkoduAK,AdenekanYA,ZibiriRA.Smartphoneaddiction, psychological status, pain related disability of neck and shoulder among undergraduates in College of Medicine, University of Lagos. S Afr J Public Health 2020;4(3):71-75. https://doi.org/10.7196/SHS.2020.v4.i5.115

Kwon M, Kim DJ, Cho H, Yang S. The smartphone addiction scale: development and validation of a short version for adolescents. PloS One 2013;8:e56936. https:// doi.org/10.1371/journal.pone.0056936

HeyoungL,NguyenTG,AhnH,ChoiSW,KimDJ.Comparing the self-report and measured smartphone usage of college students: a pilot study. Psychiatry Investig 2017;14(2):198- 204. https://doi.org/10.4306/pi.2017.14.2.198

Arslan A, Unal AT. Examination of cell phone usage habits and purposes of education faculty students. Int J Human Sci 2013;10(1):182-201.

Akodu AK, Akinbo SRA, Young QO. Correlation of smartphone addiction, craniovertebral angle, scapular dyskinesis and selected anthropometric variables amongst physiotherapy undergraduates. J Taibah Univ Medical Sci 2018;13(6):528-534 https://doi.org/10.1016/j. jtumed.2018.09.001

Kang J. The effect of the forward head posture on postural balance in long time computer-based worker. Annals Rehabil Med 2012;36(1):98-104. https://doi. org/10.5535/arm.2012.36.1.98

Gupta VK, Arora S, Gupta M. Computer-related illnesses and Facebook syndrome: what are they and how do we tackle them. Medicine Update 2013;23:676-679.

Mbada CE, Olaoye MI, Dada OO, et al. Comparative efficacy of clinic-based and telerehabilitation application of Mckenzie therapy in chronic low-back pain. Int J Telerehab 2019;11(1):41-58. https://doi.org/10.5195/ijt.2019.6260

Hebden L, Chey T, Allman-Farinelli M. Lifestyle intervention for preventing weight gain in young adults: a systematic review and meta-analysis of RCTs. Obes Rev 2012;13(8):692- 710. https://doi.org/10.1111/j.1467-789X.2012.00990.x

Alexander JC, Joshi GP. Smartphone applications for chronic pain management: a critical appraisal. J Pain Res 2016;9:731-734. https://doi.org/10.2147/JPR.S119966

Torous JB, Chan SR, Yellowlees PM, Boland R. To use or not? Evaluating ASPECTS of smartphone apps and mobile technology for clinical care in psychiatry. J Clin Psychiatry 2016;77(6):e734-738. https://doi.org/10.4088/JCP.15com10619

McEvoy MD, Hand WR, Stiegler MP, et al. A smartphone-based decision support tool improves test performance concerning application of the guidelines for managing regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy. Anesthesiology 2016;124(1):186-198. https://doi.org/10.1097/ALN.0000000000000885

Mbada CE, Oyewole AI, Maikudi L, et al. Effect of WhatsApp-based reminders on adherence to home exercise program. Int J Telemed Clinic Prac 2022;3(4):341-350. https:// doi.org/10.1504/IJTMCP.2022.123139

Brennan DM, Mawson S, Brownsel S. Telerehabilitation: enabling the remote delivery of healthcare, rehabilitation and self-management. Stud health technol inform 2009;145:231-248. https://doi.org/10.3233/978-1-60750-018-6-231

Dario AB, Cabral AM, Almeida L, et al. Effectiveness of telehealth-based interventions in the management of non-specific low back pain: a systematic review with meta-analysis. Spine J 2017;17,42-1351. https://doi.org/10.1016/j.spinee.2017.04.008

Cohen J. Statistical power Analysis for the Social Sciences Hillsdale. New Jersey, Lawrence Erlbaum Associates. Second Edition, 1988.

Faul F, Erdfelder E, Lang A G, Buchner. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39,175-191. https://doi.org/10.3758/BF03193146

Sosnowski K, Mitchell ML, White H, et al. Feasibility study of a randomised controlled trial to examine the impact of the ABCDE bundle on quality of life in ICU survivors. Pilot Feasibility Stud 2018;4:32. https://doi.org/10.1186/s40814-017-0224-x

Quek J, Pua YH, Clark RA. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Man Ther 2013;18(1):65-71. https://doi.org/10.1016/j. math.2012.07.005

Akodu AK, Akinfelye A, Atanda L, Giwa S. Work-related musculoskeletal disorders of the upper extremity with reference to working posture of secretaries. S Afr J Occup Ther 2015;45(3):16-22. https://doi.org/10.17159/2310-3833/2015/v45n3/a4

Ebara T, Yoshitake R, Shimomura Y, et al. Seven practical human factors and ergonomic tips for teleworking/ home learning using tablet/smartphone device. Japan Human factors and ergonomics society. First edition, 2020. https://www.ergonomics.jp/gpdb/gpdb-list. html?gddb_id=90&listpage=2

Castarlenas E, Jensen M, vonBaeyer CL, Miró J. Psychometric properties of the Numerical Rating Scale to assess self-reported pain intensity in children and adolescents: A Systematic Review. Clin J Pain 2017;33(4):376-383. https://doi.org/10.1097/AJP.0000000000000406

Roach KE, Budiman-Mak E, Songrsiridej N, Lertratanakul Y. Development of a shoulder pain disability index. Arthritis Rheumatol 1991;4:143-149. https://doi.org/10.1002/ art.1790040403

Kopec JA, Esdaile JM, Abrahamowicz M, et al. The Quebec back pain disability scale: Conceptualisation and development. J Clin Epidemiol 1996;49:151-161. https://doi. org/10.1016/0895-4356(96)00526-4

Macdermid JC, Walton DM, Avery S, et al. Measurement properties of the neck disability index: A Systematic review. J Orthop Sport Phys Ther 2009;39(5):400-417. https://doi. org/10.2519/jospt.2009.2930

North American Spine Society (NASS). Cervical Exercise: The backbone of spine treatment. 2022. https://www.spine.org/knowyourback/prevention/exercise/cervical-exercise (accessed 30 January 2022).

Akodu AK, Odunsi FA, Giwa SO. Effect of neck stabilisation exercise on Pain, Disability, Craniovertebral angle and psychological status in patient with non-specific chronic neck pain. J Riphah Coll Rehabil Sci 2018;6(1):10-15.

Mallin G, Murphy S. The effectiveness of a 6-week Pilate’s programme on outcome measures in a population of chronic neck pain patients: A pilot study. J Body Mov Ther 2013;17(1):376-384.

Kim YG, Kang MH, Kim JW, Jang JH, Oh JS. Influence of the duration of smartphone usage on flexion angles of the cervical and lumbar spine and on reposition error in the cervical spine. Phys Ther Korea 2013;20:10-17. https://doi.org/10.12674/ptk.2013.20.1.010

Park HC, Kim YS, Seok SH, Lee SK. The effect of complex training on the children with all of the deformities including forward head, rounded shoulder posture, and lumbar lordosis. J Exerc Rehabil 2014;10:172-175. https://doi.org/10.12965/jer.140113

Kim SY, Koo SJ. Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults. J Phys Ther Sci 2016;28:1669-1672.

Ahmed S, Mishra A, Akter R, Shah H, Sadia AA. Smartphone addiction and its impact on musculoskeletal pain in neck, shoulder, elbow, and hand among college going students: 33. a cross-sectional study. BFPT 2022;27(5):1-8. https://doi.org/10.1186/s43161-021-00067-3

Brennan DM, Mawson S, Brownsel S. Telerehabilitation: enabling the remote delivery of healthcare, rehabilitation and self-management. Stud Health Technol Inform 2009;145:231-248. https://doi.org/10.3233/978-1-60750-018-6-231

Jung SI, Lee NK, Kyung KW, Kim K, Lee DY. The effect of smartphone usage time on posture and respiratory function. J Phys Ther Sci 2016;28(1):186-189. https://doi.org/10.1589/ jpts.28.186

Strong KA, Parks SL, Anderson E, Winett R, Davy B. Weight gain prevention: identifying theory-based targets for health behavior change in young adults. J Acad Nutr Diet 2008;108(10):1708-1715. https://doi.org/10.1016/j.jada.2008.07.007

Svingen J, Rosengren J, Turesson C, Arner M. A smartphone application to facilitate adherence to home-based exercise after flexor tendon repair: a randomised controlled trial’. Clin Rehabil 2021;35(2):266-275.

Zapata KA, Wang-Price SS, Fletcher TS, Johnston CE. ‘Factors influencing Adherence to an app-based exercise program in adolescents with painful hyperkyphosis’. Scoliosis Spinal Disord 2018;13(1):11.

Lambert TE, Harvey LA, Avdalis C, et al. ‘An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial’. J Physiother 2017;63(3):161-167.

Akodu AK, Ajepe TO, Shorunke MA. Effects of Neck Stabilisation and Isometric Neck Exercises on Non-Specific Chronic Neck Pain: A Pilot Study. J Riphah Coll Rehabil Sci 2020;8(1):9-17. https://doi.org/10.5455/JRCRS.2020080104

Shoukat H, Sharif F, Irfan A. Effectiveness of isometric neck exercises in neutral spine and multiple angle isometrics in patients with non-specific neck pain. Rawal Medical J 2022;45:977-980.

KongYS,KimYM,ShimJM.Theeffectofmodifiedcervicalexerciseonsmartphoneuserswith forward head posture. J Phys Ther Sci 2017;29:328-331. https://doi.org/10.1589/jpts.29.328

Prashant N, Pradnya H, Pratiksha D. Effect of ergonomic advice on neck pain among engineering students of Belagavi city, Karnataka: an observational study. Int J Med Res Health Sci 2017;6(6):77-81.

Pillastrini P, Mugnai R, Bertozzi L, et al. Effectiveness of an ergonomic intervention on work- related posture and low back pain in video display terminal operators: A 3 year cross-over trial. Appl Ergon 2010;41:436-443. https://doi.org/10.1016/j.apergo.2009.09.008

Berolo S, Wells RP, Amick BC. Musculoskeletal symptoms among mobile hand-held device users and their relationship to device use: a preliminary study in a Canadian university population. Appl Ergon 2011;42:371-378. https://doi.org/10.1016/j.apergo.2010.08.010

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