Background: Excessive use of portable electronic devices causes neck flexion and the emergence of text neck syndrome (TNS). This study aims to explore the prevalence of TNS among medical students during the COVID-19 lockdown in Iraq.
Methods: A prospective cross-sectional web-based study was conducted from 1st to 20th March 2021 at the faculty of medicine, Diyala University, Iraq. A self-administered questionnaire was distributed among the medical students using Google Form through social media (WhatsApp group). The semi-structured questionnaire included the sociodemographic, the valid smartphone addiction scale-short version (SAS-SV), and the neck disability index (NDI). Univariate, bivariate, and multiple logistic regression were used to analyze the data. SPSS version 16. The statistical significance is considered at less than 0.05.
Results: Out of 273 medical students included in the study, 59.3% were males, unmarried (88.3%), and from the 1st year (21.6%). The mean age of students was 21.27 ± 1.74 years. The prevalence of text neck syndrome was 64.5%. About two-thirds (61.5%) of students were addicted to their smartphones and used them more than five h/daily (63.7%). Factors associated with neck disability were the students who did not warm up neck muscles before using the smartphone (OR = 8.796, 95% CI: 1.724 to 24.884), addicted to the smartphone (OR = 6.803, 95% CI: 3.455 to 13.397), experienced increase in daily hours using the smartphone during the COVID-19 related quarantine (OR = 5.370, 95% CI: 2.523 to 11.427), maintained smartphone use five hours and more daily (OR = 2.818, 95% CI: 1.422 to 5.587), had neck pain (OR = 2.876, 95% CI: 1.356 to 6.098), the female gender (OR = 2.756, 95% CI: 1.221 to 6.221), and those who did not have a frequent break when using the smartphone (OR = 2.693, 95% CI: 1.329 to 5.454).
Conclusion: In conclusion, the prevalence of neck disability was high among the surveyed medical students. Addiction and excessive smartphone use with a lack of attention to warm up the neck muscles before usage was the most prominent predictors of neck disability.
- Moran J, Briscoe G, Peglow S. Current technology in advancing medical education: perspectives for learning and providing care. Acad Psychiatry. 2018 Dec;42(6):796-799. doi: 10.1007/s40596-018-0946-y.
- Salameh MA, Boyajian SD, Odeh HN, Amaireh EA, Funjan KI, Al-Shatanawi TN. Increased incidence of musculoskeletal pain in medical students during distance learning necessitated by the COVID-19 pandemic. Clin Anat. 2022 May;35(4):529-536. doi: 10.1002/ca.23851.
- Alsiwed KT, Alsarwani RM, Alshaikh SA, Howaidi RA, Aljahdali AJ, Bassi MM. The prevalence of text neck syndrome and its association with smartphone use among medical students in Jeddah, Saudi Arabia. J Musculoskelet Surg Res 2021;5(4):266-72. doi:10.25259/JMSR_99_2021.
- Dighriri YH, Akkur MA, Alharbi SA, Madkhali NA, Matabi KI, Mahfouz MS. Prevalence and associated factors of neck, shoulder, and low-back pains among medical students at Jazan University, Saudi Arabia: A cross-sectional study. J Family Med Prim Care. 2019 Dec 10;8(12):3826-3831. doi: 10.4103/jfmpc.jfmpc_721_19.
- Ogunlana MO, Govender P, Oyewole OO. Prevalence and patterns of musculoskeletal pain among undergraduate students of occupational therapy and physiotherapy in a South African university. Hong Kong Physiother J. 2021 Jun;41(1):35-43. doi: 10.1142/S1013702521500037.
- Weleslassie GG, Meles HG, Haile TG, Hagos GK. Burden of neck pain among medical students in Ethiopia. BMC Musculoskelet Disord. 2020 Jan 8;21(1):14. doi: 10.1186/s12891-019-3018-x.
- Ali Chaudary A, Aslam F, Ali A, Asghar AR, Bashir H, Awais A, et al. Frequency of text neck syndrome in medical students due to excessive usage of electronic devices. JPOA [Internet]. 2019 Oct. 30;31(02):79-82.
- Silva AL, Smaidi K, Pires MHR, Pires OC. Prevalence of chronic pain and associated factors among medical students. Revista Dor. 2017;18(2):108–11.
- Du JY, Aichmair A, Schroeder JE, Kiely PD, Nguyen JT, et al. Neck pain and low back pain in medical students: a cross-sectional study. Int Arch Public Health Community Med2107; 1(1):1-9. doi.org/10.23937/iaphcm-2017/1710002.
- Smith DR, Leggat P. Prevalence and distribution of musculoskeletal pain among Australian medical students. J Musculoskeletal Pain. 2007;15(4):39–46. doi: 10.1300/J094v15n04_05.
- Güneş S, Ulusoy BH, Aygen E, Murat E, Köklüoğlu B, Kuzyaka BA, et al. Musculoskeletal system pain and related factors during online education in the COVID-19 pandemic among Ankara university faculty of medicine students, Turkey. J Ankara Univ Fac Med 2022; 75:36-41. doi: 10.4274/atfm.galenos.2021.93898
- Dolah J, Loh Jo Yie J, Lee Shiau Gee L. Improving knowledge of text neck and neck pain using interactive smartphone application for undergraduate students in Universiti Sains Malaysia. Gendang Alam; 2020:143-158. https://doi.org/10.51200/ga.vi.2522.
- Mathew K V B, Walarine MT. Neck pain among smartphone users: an imminent public health issue during the pandemic time. jidhealth [Internet]. 2020 Sep. 29;3(Special1):201-4. doi: 10.47108/jidhealth.vol3.issspecial1.65.
- Rafi AM, Varghese PR, Kuttichira P. Concerns and confidences expressed by teaching staff about the shift of medical education to online mode in South India during the COVID 19 pandemic. jidhealth [Internet]. 2020 Dec. 24;3(Special2):272-5. https://doi.org/10.47108/jidhealth.Vol3.IssSpecial2.81.
- Meng SQ, Cheng JL, Li YY, Yang XQ, Zheng JW, Chang XW, Shi Y, Chen Y, Lu L, Sun Y, Bao YP, Shi J. Global prevalence of digital addiction in general population: A systematic review and meta-analysis. Clin Psychol Rev. 2022 Mar; 92:102128. doi: 10.1016/j.cpr.2022.102128.
- Portelli A, Reid SA. Cervical proprioception in a young population who spend long periods on mobile devices: a 2-group comparative observational study. J Manipulative Physiol Ther. 2018 Feb;41(2):123-128. doi: 10.1016/j.jmpt.2017.10.004.
- Lee S, Choi YH, Kim J. Effects of the cervical flexion angle during smartphone use on muscle fatigue and pain in the cervical erector spinae and upper trapezius in normal adults in their 20s. J Phys Ther Sci. 2017 May;29(5):921-923. doi: 10.1589/jpts.29.921.
- Zhong Y, Ma H, Liang Y-F, Liao C-J, Zhang C-C, Jiang W-J. Prevalence of smartphone addiction among Asian medical students: A meta-analysis of multinational observational studies. International Journal of Social Psychiatry. April 2022. doi:10.1177/00207640221089535
- Alotaibi MS, Fox M, Coman R, Ratan ZA, Hosseinzadeh H. Smartphone addiction prevalence and its association on academic performance, physical health, and mental well-being among university students in Umm Al-Qura University (UQU), Saudi Arabia. Int J Environ Res Public Health. 2022 Mar 21;19(6):3710. doi: 10.3390/ijerph19063710.
- Sohn SY, Krasnoff L, Rees P, Kalk NJ, Carter B. The Association between smartphone addiction and sleep: a UK cross-sectional study of young adults. Front Psychiatry. 2021 Mar 2; 12:629407. doi: 10.3389/fpsyt.2021.629407.
- Bavli Ö, Katra H, Günar BB. Investigation of smartphone addiction levels among university students. International Journal of Cultural and Social Studies 2018; 4 (1):326-333.
- Alhazmi AA, Alzahrani SH, Baig M, Salawati EM, Alkatheri A. Prevalence and factors associated with smartphone addiction among medical students at King Abdulaziz University, Jeddah. Pak J Med Sci. 2018 Jul-Aug;34(4):984-988. doi: 10.12669/pjms.344.15294.
- Regiani Bueno G, Garcia LF, Marques Gomes Bertolini SM, Rodrigues Lucena TF. The Head Down Generation: Musculoskeletal Symptoms and the Use of Smartphones Among Young University Students. Telemed J E Health. 2019 Nov;25(11):1049-1056. doi: 10.1089/tmj.2018.0231.
- Shin LY. A Comparative Study of Mobile Internet Usage between the U.S. and Korea. Journal of European Psychology Students2014; 5(3): 46–55. Doi: http://doi.org/10.5334/jeps.cg.
- Ali Jadoo SA. The second wave of COVID-19 is knocking at the doors: have we learned the lesson? jidhealth [Internet]. 2020 Oct. 8;3(Special1):183-4. doi: 10.47108/jidhealth.vol3.issspecial1.72.
- Bhandari S, Shaktawat AS, Patel B, Dube A, Kakkar S, Tak A, Gupta J, Rankawat G. The sequel to COVID-19: the antithesis to life. jidhealth [Internet]. 2020 Oct. 1;3(Special1):205-12. doi: 10.47108/jidhealth.vol3.issspecial1.69.
- Saadeh H, Al Fayez RQ, Al Refaei A, Shewaikani N, Khawaldah H, Abu-Shanab S, Al-Hussaini M. Smartphone Use Among University Students During COVID-19 Quarantine: An Ethical Trigger. Front Public Health. 2021 Jul 26; 9:600134. doi: 10.3389/fpubh.2021.600134.
- 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: e83558. https://doi.org/10.1371/journal.pone.0083558.
- Awwad WM, Alabdulkarim NH, Alhaidri NE. Exploratory and confirmatory factor analysis of the Arabic neck disability index: A cross-sectional study. J Musculoskelet Surg Res 2021; 5:171-7. doi:10.25259/JMSR_54_2021.
- Sample Size Calculator by Raosoft, Inc.; 2021. Available from: http://www.raosoft.com/samplesize.html. [Accessed on 19 September 2021].
- Ahmed S, Akter R, Pokhrel N, Samuel AJ. Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: a cross-sectional survey study. J Public Health (Berl.)2021; 29: 411–416. https://doi.org/10.1007/s10389-019-01139-4
- Lee JI, Song HS. The correlation analysis between hours of smartphone use and neck pain in the Gachon university students. The Acupuncture 2014; 31(2): 99-109. doi: 10.13045/acupunct.2014028.
- Liu H, Zhou Z, Zhu E, Huang L, Zhang M. Smartphone addiction and its associated factors among freshmen medical students in China: a cross-sectional study. BMC Psychiatry. 2022 May 2;22(1):308. doi: 10.1186/s12888-022-03957-5.
- Eldesokey S, Gomaa Z, Sabri Y, El-Gilany AH, Elwasify M. Smartphone addiction among medical students in mansoura university. Egypt J Psychiatr 2021; 42:50-6. doi: 10.4103/ejpsy.ejpsy_47_20.
- Dhamija S, Shailaja B, Chaudhari B, Chaudhury S, Saldanha D. Prevalence of smartphone addiction and its relation with sleep disturbance and low self-esteem among medical college students. Ind Psychiatry J 2021;30, Suppl S1:189-94
- Szpakow A, Stryzhak A, Prokopowicz W. Evaluation of threat of mobile phone – addiction among Belarusian University students. Prog Health Sci. 2011; 1:96e101.
- Dixit S, Shukla H, Bhagwat AK, Bindal A, Goyal A, Zaidi AK, et al. A study to evaluate mobile phone dependence among students of a medical college and associated hospital of central India. Indian J Community Med. 2010; 35:339341. doi: 10.18203/2320-6012.ijrms20170143.
- Khan MM. Adverse effects of excessive mobile phone use. Int J Occup Med Environ Health. 2008;21(4):289-93. doi: 10.2478/v10001-008-0028-6.
- Lee H, Kim MS, Son HK, Ahn S, Kim JS, Kim YH. Discriminating power of sociodemographic and psychological variables on addictive use of cellular phones among middle school students. Taehan Kanho Hakhoe Chi. 2007 Oct;37(6):957-65. Korean. doi: 10.4040/jkan.2007.37.6.957.
- Al-Samarrai MAM, AL- Any BN, Al-Delaimy AK, Yahyaa BT, Ali Jadoo SA. Impact of internal displacement on psychosocial and health status of students residing in the hostel of Anbar University, Iraq. jidhealth [Internet]. 2020 May 25;3(1):140-4.
- Damasceno GM, Ferreira AS, Nogueira LA, Reis FJ, Andrade IC, Meziat-Filho N. Text neck and neck pain in 18-21-year-old young adults. Eur Spine J 2018; 27:1249-54. doi: 10.1007/s00586-017-5444-5.
- Kim HJ, Kim JS. The relationship between smartphone use and subjective musculoskeletal symptoms and university students. J Phys Ther Sci. 2015 Mar;27(3):575-9. doi: 10.1589/jpts.
- Al-Hadidi F, Bsisu I, AlRyalat SA, Al-Zu’bi B, Bsisu R, Hamdan M, et al. Association between mobile phone use and neck pain in university students: A cross-sectional study using numeric rating scale for evaluation of neck pain. PLoS One 2019;14: e0217231. doi: 10.1371/journal.pone.0217231.
- 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 Jun;28(6):1669-72. doi: 10.1589/jpts.28.1669.