search for




 

A Study on the Smartphone Usage Environment and Musculoskeletal Symptoms of Public Health College Students
Int J Clin Prev Dent 2024;20(4):175-180
Published online December 31, 2024;  https://doi.org/10.15236/ijcpd.2024.20.4.175
© 2024 International Journal of Clinical Preventive Dentistry.

Hyo-Jeong Kim, Cheon-Hee Lee

Department of Dental Hygiene, Andong Science College, Andong, Korea
Correspondence to: Cheon-Hee Lee
E-mail: arisu0515@hanmail.net
https://orcid.org/0000-0002-3203-8025
Received December 6, 2024; Revised December 16, 2024; Accepted December 24, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: The basis of the study was to find out the general characteristics, smartphone use environment, and musculoskeletal symptoms through a self-administered questionnaire targeting college students in some regions, and to devise countermeasures and preventive programs to address future problems in smartphone use and improve them. We would like to provide data.
Methods: From September 1 to November 1, 2023, a non-face-to-face online survey was conducted targeting 230 and 1st, 2nd, and 3rd grade health students in Seoul, Gyeonggi-do, and Gyeongsangbuk-do.
Results: All of the survey subjects were using smartphones 100% of the time. They complained of musculoskeletal pain due to repetitive work in the same uncomfortable position for a long time without rest, and repetitive movements in a static position caused various problems due to neck and shoulder pain. may occur.
Conclusion: If the posture continues for a long period of time, back pain may occur due to a decrease in the function of the muscles around the waist, and if you use a smartphone in a sitting position for a long time, muscle pain may occur. It is believed that it can cause skeletal problems.
Keywords : smartphone, musculoskeletal system, usage environment, pain
Introduction

The medical field is becoming larger, more specialized, and more specialized, and requires the ability to actively respond to diverse work environments. These changes in the medical environment can cause physical and mental health problems due to complex and diversified work patterns also [1]. In particular, workers at dental medical institutions are prone to developing work-related musculoskeletal disorders due to the nature of their working environment and treatment posture, and interest in this is increasing. In a survey conducted by the Korea Communications Commission in 2021 on 6,834 men and women over the age of 13 nationwide, the smartphone ownership rate in Korea was found to be 93.4%, with 96.9% of teenagers, 92.2% of those in their 20s, 85.1% of those in their 30s, and 84.3% of those in their 40s, 70.4% in their 50s, 44.1% in their 60s, and 15% in their 70s. They responded that smartphones are an essential medium [1]. As seen from the above, teenagers and those in their 20s consider smartphones essential and their usage rate is higher than that of other age groups [2]. Smartphones go beyond simple phone calls and are becoming a part of our lives by allowing us to easily access a variety of information anytime, anywhere. Unlike regular mobile phones, smartphones provide various conveniences to users by adding Internet functions [2,3]. Acquiring infor-mation through a smartphone, such as searching on the internet for transportation, etc., forming social relationships through Instagram, chatting, and SNS, performing work such as writing documents, and leisure activities such as playing games, etc., are all aspects of daily life at the same time. Using a smartphone for a long time and performing continuous and repetitive movements in a certain posture can cause complaints of musculoskeletal disorders and cause inappropriate postures such as forward head posture or slouched posture [4]. Pain occurs due to tension in the muscles of the neck, shoulders, back of the hands, and lower back during the repeated process of looking at the monitor in such a fixed and incorrect posture. In addition to symptoms of musculoskeletal disorders, additional problems such as headaches and stress appear due to poor posture for a long time. Musculoskeletal disorders are usually caused by muscle use and prolonged exposure due to repetitive movements [5]. There are many previous studies on computer-related musculoskeletal disorders targeting computer-related students, and there are also many studies on subjective symptoms of VDT syndrome and related factors in middle and high school students [6]. However, as the rate of smartphone use among college students rapidly increases, research on the correlation between smartphone user posture and musculoskeletal symptoms by region is still insufficient. Therefore, the purpose of this study is to find out the general characteristics, smartphone use environment, and musculoskeletal symptoms through self-administered questionnaires targeting college students in some regions, and to identify future problems in smartphone use and countermeasures and prevention programs to improve them. We aim to provide basic data for research.

Materials and Methods

1. Research subjects

From September 1 to November 1, 2023, a non-face-to-face online survey was conducted targeting 230 1st, 2nd, and 3rd grade health students in Seoul, Gyeonggi-do, and Gyeong-sangbuk-do. After conducting a self-administered questionnaire survey, 209 questionnaires, excluding 21 question-naires with unclear answers, were selected as the final research subjects. This study was conducted after receiving approval from the Bioethics Committee of Andong Science College (IRB No: 70036-202307-0002-05).

2. Research tools

General characteristics such as cell phone type and gender were confirmed, and the measurement tool used in this study to investigate subjective symptoms of musculoskeletal disorders in college students was a questionnaire revised and supplemented through literature review [7-9] and was conducted at Cornell University in the United States. The musculo-skeletal disease symptom questionnaire [6,10] developed by was used to investigate subjective musculoskeletal symptoms, pain frequency, and pain level.

3. Research analysis

The statistical analysis of the data collected for this study was performed using the IBM SPSS 20.0 program, which provided protection and protection to identify the common right and prime-specific intensity scale subjective symptoms of the study subjects. In addition, if there were subjective symptoms of pain in each part of the skeletal system, the pain frequency, pain level, and praise were compared. Except for Cronbach α, pain duration was 0.936, pain severity was 0.620, and pain frequency was 0.914, which were above 0.6 for each discomfort item (Table 1).

Table 1 . The questionnaire analysis contents

VariableItemsCronbach α
Pain period70.936
Pain level70.620
Pain frequency70.914

Results

1. General characteristics of research subjects

Looking at the general characteristics of the study subjects, by gender, there were 164 women (78.5%) and 45 men (21.5%), and by smartphone type, 75.6% were iPhones, 23.4% were Samsung Galaxy phones, and 1% were LG phones (Table 2).

Table 2 . General characteristics

VariableCategoryN Percen-tage (%)
SexFemale16478.5
Male4521.5
Smartphone typeIphone15875.6
Samsung (Galaxy) phone4923.4
LG phone21


2. Smart usage environment of research subjects

The places where smartphones are used are 35.9%, excluding home/dormitory 45.8%, subway/public transportation 23.1%, library 4.7%, classroom 17.3%, and restaurant 8.9%, lying prone was found to be 10.2%. The purpose of smartphone use was 28.7% for Instagram, YouTube, and Facebook, 20.3% for music and movies, 17.3% for search, 12.3% for games, 3.0% for document work, and 0.3% for other purposes. The average smartphone usage time was 2 hours, with 51.7% using it for more than 4 hours, 20.1% using it for more than 3 hours to 4 hours, 20.1% using it for more than 2 hours but less than 3 hours, 5.7% using it more than 1 hour but less than 2 hours, and 1.9% using it less than 1 hour. Abnormal users were found to be 91.9% (Table 3).

Table 3 . Smart usage environment

VariableCategoryN %
Smartphone where to use (duplicate response)Home/dormitory20645.8
Library214.7
Classroom7817.3
Restaurant408.9
Public transportation10423.1
Etc.10.2
Smartphone posture of use (duplicate response)Sit down15935.9
Lie down15735.4
Standing8218.5
Lying down4510.2
Smartphone purpose of use (duplicate response)Search11517.3
Game8212.3
Document work335.0
Instagram, YouTube, Facebook19128.7
Phone call10716.1
Music, movies13520.3
Etc.20.3
Smartphone average usage time<1 h41.9
≤1 h, <2 h125.7
≤2 h, <3 h4220.1
≤3 h, <4 h4220.1
≤4 h10851.7
Etc.10.5


3. Musculoskeletal subjective symptoms of research subjects

1) Musculoskeletal subjective symptoms by region

Regarding pain by pain area, the areas where pain is currently felt include neck pain 51.2%, wrist pain 11%, shoulder pain 10%, finger and back pain, 5.7% pain areas (all), and arm/elbow pain and hand pain 2.9%. In particular, neck pain was found to be the most common (Table 4).

Table 4 . Musculoskeletal subjective symptoms by region

Area/painN%M±SD
Pain areaPain area (all)115.33.55±5.803
Neck10751.21.77±0.425
Shoulder21101.90±0.301
Arm/elbow62.91.50±0.548
Hand62.91.67±0.516
Hand wrist2411.51.79±0.415
Finger125.71.92±0.289
Waist125.71.92±0.289


2) Musculoskeletal pain duration, pain level, and pain frequency by region

The duration of neck pain was reported as less than 30 minutes by 70.8%, 1-3 hours by 12.4%, and no pain by 8.6%. The duration of shoulder pain was less than 30 minutes for 55.5%, 1-3 hours for 8.1%, and no pain for 29.2%, indicating a lower pain prevalence compared to the neck. For arm/elbow pain, the duration was less than 30 minutes for 56.5%, 1-3 hours for 3.8%, and no pain for 37.3%, showing a higher prevalence than the shoulder. For hand pain, 56.9% reported a duration of less than 30 minutes, while for wrist pain, the figure was 51.7%. The 1-3 hour duration was 3.3% for hands and 8.1% for wrists, with wrists showing higher rates. The proportion reporting no pain was 38.3% for hands and 35.9% for wrists. Finger pain duration was less than 30 minutes for 54.1%, 1-3 hours for 4.8%, and no pain for 38.3%. Lower back pain was reported as lasting less than 30 minutes by 46.9%, 1-3 hours by 10%, and no pain by 36.8% (Table 5).

Table 5 . Musculoskeletal pain duration, pain level, pain frequency

VariableNeck
N (%)
Shoulder
N (%)
Arm/elbow
N (%)
Hand
N (%)
Hand wrist
N (%)
Finger
N (%)
Waist
N (%)
Pain durationLess than 30 minutes148 (70.8)116 (55.5)118 (56.5)119 (56.9)108 (51.7)113 (54.1)98 (46.9)
Less than 1 to 3 hours26 (12.4)17 (8.1)8 (3.8)7 (3.3)17 (8.1)10 (4.8)21 (10)
Less than 3 to 9 hours5 (2.4)3 (1.4)3 (1.4)2 (1)4 (1.9)3 (1.4)7 (3.3)
Less than 1 day4 (1.9)7 (3.3)1 (0.5)1 (0.5)2 (1)1 (0.5)0 (0)
Less than 1 week8 (3.8)5 (2.4)1 (0.5)2 (1)2 (1)2 (1)6 (2.9)
No pain18 (8.6)61 (29.2)78 (37.3)76 (37.3)76 (36.4)80 (38.3)77 (36.8)
Pain levelMild pain143 (68.4)115 (55)118 (56.5)119 (56.9)109 (52.2)111 (53.1)98 (46.9)
Moderate pain37 (17.7)27 (12.9)10 (4.8)8 (3.8)17 (8.1)17 (8.1)27 (12.9)
Severe pain5 (2.4)3 (1.4)0 (0)2 (1)7 (3.3)0 (0)5 (2.4)
Very severe pain1 (0.5)0 (0)1 (1.5)0 (0)1 (0.5)1 (0.5)0 (0)
No pain23 (11)64 (30.6)80 (38.3)80 (38.3)75 (35.9)80 (38.3)79 (37.8)
Pain frequencyOnce every 6 months99 (47)81 (38.8)87 (41.6)89 (42.6)75 (35.9)84 (40.2)76 (36.4)
Once every 2-3 months17 (8.1)14 (6.7)11 (5.3)13 (6.2)12 (5.7)9 (4.3)17 (8.1)
Once a month31 (14.8)19 (9.1)13 (6.2)11 (5.3)20 (9.6)16 (7.7)14 (6.7)
Once a week27 (12.9)21 (10)14 (6.7)16 (7.7)19 (9.1)16 (7.7)17 (8.1)
Daily14 (6.7)10 (4.8)1 (0.5)1 (0.5)5 (2.4)2 (1)12 (5.7)
No response21 (10)64 (30.6)83 (39.7)79 (37.8)78 (37.3)82 (39.2)73 (34.9)


4. Research subjects’ experience with exercise, treatment, and prevention education for musculoskeletal pain

The survey revealed that 63.1% of respondents with musculoskeletal pain had experience with exercise, while 34.9% did not. Among the types of exercise reported, 37.8% engaged in fitness training (strength training), 27.2% participated in posture correction exercises, and 16.7% chose walking. Regar-ding experiences with musculoskeletal pain treatment, 78.9% indicated they had undergone treatment, whereas 17.7% reported no treatment experience. For treatment methods among university students with musculoskeletal pain, 38.3% opted for massages (manual therapy), 16.9% visited orthopedic clinics, and 9.7% chose traditional Korean medicine clinics. Additionally, 50.9% of the students used pharmacies to obtain patches or medications as a treatment method. Concerning prior education on musculoskeletal prevention, 85.2% of respondents reported no educational experience, while 12.0% had received such education (Table 6).

Table 6 . Experience with exercise, treatment, and prevention education for musculoskeletal pain

VariableN (%)

YesNoNo response
Exercise132 (63.1)73 (34.9)4 (1.9)
Gym (strength training)50 (37.8)
Yoga10 (7.6)
Posture correction exercises36 (27.2)
Walking exercise22 (16.7)
Etc.14 (10.6)
Treatment experience165 (78.9)37 (17.7)7 (3.34)
Oriental medicine clinic16 (9.7)
Orthopedic clinic28 (16.9)
Pain relief patches (medication)37 (22.4)
Massage84 (50.9)
Preventive education25 (12.0)178 (85.2)3 (1.44)

Discussion

This study investigated and analyzed the general characteristics, smartphone usage environments, musculoskeletal symptoms and pain by body region, duration and severity of pain, and experiences of exercise, treatment, and preventive education related to musculoskeletal pain among health-related students in Seoul, Gyeonggi-do, and Gyeongsangbuk-do. The majority of participants were female (164 individuals, 78.5%), and the most commonly used smartphone type was the iPhone (158 individuals, 75.6%), indicating a preference among university students. Regarding smartphone usage environments, the primary locations were at home/dormitories (45.8%) and on subways/public transportation (23.1%), showing a tendency to use smartphones more often when alone. The primary purposes of smartphone usage were social media such as Instagram, YouTube, and Facebook (28.7%), followed by listening to music and watching movies (20.3%). The average daily smartphone usage time was over 4 hours for 49.1% of the participants. The most commonly reported musculoskeletal pain area was neck pain (51.2%), while the lowest was arm/elbow pain and hand pain (2.9%). This suggests that smartphone use often involves prolonged, static, and repetitive tasks in uncomfortable postures rather than using the device in proper postures at home. Such habits can lead to musculoskeletal pain, and repetitive movements in static postures may cause various issues, particularly neck and shoulder pain. Studies by Bonney and Corlett [11], Braun and Amundson [12], Lee et al. [13], and Nemmers et al. [14] have shown that as the usage time of video display terminals increases, the flexion angles of the cervical and lumbar spine also increase. Additionally, research by Shaghayegh et al. [15] and Wong et al. [16] suggests that prolonged postures can lead to a reduction in the function of the muscles around the lower back, which may cause back pain. Therefore, it is believed that using smartphones for extended periods while sitting may lead to musculoskeletal problems. In the studies by Shaghayegh et al. [15] and Wong et al. [16], it was suggested that prolonged posture can lead to the dysfunction of muscles around the lower back, which can cause back pain. Therefore, it is considered that using smartphones for long periods while sitting can lead to musculoskeletal problems. The duration of musculoskeletal pain in various body parts showed that 70.8% of individuals experienced neck pain for less than 30 minutes, which was the highest percentage, while 8.6% reported no pain. For shoulder pain, 55.5% experienced it for less than 30 minutes, and 29.2% reported no pain, which was lower than the neck pain incidence. For arm/elbow pain, 56.5% reported pain lasting less than 30 minutes, and 37.3% had no pain. For hand pain, 56.9% reported pain for less than 30 minutes, and 51.7% for wrist pain, while 38.3% and 35.9% reported no pain, respectively. For finger pain, 54.1% experienced it for less than 30 minutes, and 38.3% reported no pain. For lower back pain, 46.9% experienced pain for less than 30 minutes, and 36.8% reported no pain.

In a study by Kim et al. [17], Park and Park [7] on musculoskeletal symptoms among dental workers, younger age groups showed higher experiences of musculoskeletal symptoms in the shoulder, lumbar region (back, lower back), and lower limbs (legs, knees, feet). Although there were some differences in the affected areas, the results were similar to those of this study. The experience of managing musculoskeletal pain through exercise was reported by 63.1% of respondents, while 34.9% reported no experience with exercise. The types of exercise include strength training (37.8%), posture correction exercises (27.2%), and walking exercises (16.7%). Regarding treatment experiences for musculoskeletal pain, 78.9% of respondents reported having received treatment, while 17.7% reported no treatment experience. The most common treatment methods among university students with musculoskeletal pain were massage (38.3%), orthopedic clinics (16.9%), and traditional Korean medicine clinics (9.7%). 26.6% of students visited hospitals for treatment. Additionally, 50.9% of students chose pharmacy treatments such as patches or medications. Musculoskeletal disorders have diverse and uncertain causes, and early detection often relies on subjective symptoms felt by the worker. Identifying musculoskeletal disorders requires precise testing, which is time-consuming and challenging, making it a type of occupational disease. The survey found that 85.2% of participants had no prior experience with musculoskeletal prevention education, while 12.0% had some experience. This study aimed to investigate the smartphone environment, musculoskeletal symptoms, and fatigue perception symptoms among some health-related students, with the goal of providing basic data for the prevention of musculoskeletal disorders and health management for students using smartphones. The limitations of this study include the fact that the survey was conducted in a specific region, and musculoskeletal symptoms were self-reported based on subjective judgment, making it difficult to generalize the results. In the future, it is necessary to conduct a prospective study on the factors related to musculoskeletal disorders based on objective data from medical examinations.

Conclusion

This study conducted an online, non-face-to-face survey targeting 209 1st, 2nd, and 3rd grade health students in Seoul, Gyeonggi-do, and Gyeongsangbuk-do from September 1 to November 1, 2023, and obtained the following results.

1. 100% of those surveyed are using smartphones. 75.6% mainly own an iPhone, and the places of smartphone use were at home/dormitory at 45.8%, subway/public transportation at 23.1%, library at 4.7%, classroom at 17.3%, and restaurant at 8.9%.

2. The purpose of using smartphones was in the following order: Instagram, YouTube, and Facebook at 28.7%, music and movies at 20.3%, search at 17.3%, games at 12.3%, and document work at 3.0%.

3. The frequency of smartphone use was high when most of the subjects were alone, and their posture was to use smartphones while sitting or lying down, which was not a well-established working environment, and there was a high possibility of musculoskeletal disorders.

The average daily smartphone use time was 49.1% for more than 4 hours, 20.9% for more than 3 hours - less than 4 hours, 25.0% for more than 2 hours - less than 3 hours, and 6.8% for more than 1 hour - less than 2 hours, with 90% of users using more than 2 hours per day. %, which accounted for the majority of the survey subjects.

From the above results, in order to prevent musculoskeletal diseases caused by smartphone use among health and medical students, education or prevention programs regarding long-term use and incorrect posture should be implemented.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

References
  1. Jeon SH, Han GS: A study on dental hygienist environmental working conditions and subjective pain symptoms. J Korean Acad Oral Health 35: 347-59, 2011.
  2. Yoon HK, Kim DS, Park M: Relationship between knowledge of and attitude towards musculoskeletal disorder and bad postural habits in nursing students. J Korea Contents Assoc 14: 430-41, 2014.
    CrossRef
  3. Kim KI, Choi SY, Park DH: A study on relationships between characteristics of smart usage and symptoms of MSDs. J Korea Saf Manag Sci 18: 119-29, 2016.
    CrossRef
  4. Kim Y, Kang M, Kim J, Jang J, Oh J: 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 20: 10-7, 2013.
    CrossRef
  5. Kim IS, Kim KY, Park SG, Choi YW, Noh HN, Kim JA: Muscle properties analysis of SCM muscle using smartphone postures. J Korean Clin Health Sci 5: 991-7, 2017.
  6. Jeon H: A delphi study on the mitigation measures of smartphone over-dependence among out-of-school adolescents. Forum Youth Cult 79: 101-33, 2024.
    CrossRef
  7. Park JR, Park JY: A study on the factors that affect dental hygienist's work related musculoskeletal symptoms. J Korean Acad Dent Health 31: 416-31, 2007.
  8. Kim MA: Risk factors of work-related musculoskeletal symptoms in dental hygienists. [thesis], Gachon University, [Incheon], 2009.
  9. Kim JH, Yoo WK: Subjective symptoms and risk assessment of musculoskeletal disorders of the dental hygienists. J Korean Soc Dent Hyg 12: 67-79, 2012.
    CrossRef
  10. Park J, Kang S, Jeon H: The effect of using smart-phones on neck and shoulder muscle activities and fatigue. Phys Ther Korea 20: 19-26, 2013.
    CrossRef
  11. Bonney RA, Corlett EN: Head posture and loading of the cervical spine. Appl Ergon 33: 415-7, 2002.
    Pubmed CrossRef
  12. Braun BL, Amundson LR: Quantitative assessment of head and shoulder posture. Arch Phys Med Rehabil 70: 322-9, 1989.
  13. Lee SY, Lee DH, Han SK: The effects of posture on neck flexion angle while using a smartphone according to duration. J Korean Soc Phys Med 11: 35-9, 2016.
    CrossRef
  14. Nemmers TM, Miller JW, Hartman MD: Variability of the forward head posture in healthy community-dwelling older women. J Geriatr Phys Ther 32: 10-4, 2009.
    Pubmed CrossRef
  15. Shaghayegh Fard B, Ahmadi A, Maroufi N, Sarrafzadeh J: Evaluation of forward head posture in sitting and standing positions. Eur Spine J 25: 3577-82, 2016.
    Pubmed CrossRef
  16. Wong CK, Coleman D, diPersia V, Song J, Wright D: The effects of manual treatment on rounded-shoulder posture, and associated muscle strength. J Bodyw Mov Ther 14: 326-33, 2010.
    Pubmed CrossRef
  17. Kim CH, Nam SH, Lee JY: The effect of some dental clinic workers' working environment and health habit upon their musculoskeletal disorder subjective symptom. J Dent Hyg Sci 9: 531-8, 2009.


December 2024, 20 (4)