Ergonomics International Journal ISSN: 2577-2953 Smartphone and Musculoskeletal Risk Factors: A Systematic Review Vahedi Z, Hajizadeh L and Garosi E* Review Article Department of Occupational Health Engineering, School of Public Health, Tehran Volume 3 Issue 1 University of Medical Sciences, Iran Received Date: January 24, 2019 Published Date: February 04, 2019 *Corresponding author: Ehsan Garosi, Department of Occupational Health DOI: 10.23880/eoij-16000193 Engineering, School of Public Health, Tehran University of Medical Sciences, Iran, Tel: +989122822013; Email: [email protected] Abstract Background: Smartphones (SPs) are one of the newest technologies that influence users’ daily lives. These technologies have both improved and exerted negative effects on our ways of living. With this issue in mind, we conducted a systematic review of studies on how SPs are used and its effects on muscle activity and joint motion in people’s upper extremities. Objective: This systematic review was aimed at surveying the effects of different tasks and typing styles by SP on SP user musculoskeletal disorders. Method: Articles on the level of muscular activity and the kinematics of neck, upper extremities, and wrist during SP use were searched over Google Scholar, PubMed, Research Gate, and Science Direct. The search yielded 513 articles, out of which 18 were selected on the basis of inclusion and eligibility criteria. Result: The reviewed articles showed that muscle activity and joint movement in the neck, wrist, and fingers were highly associated with the manner by which SP features were used. Two-handed and one-handed grips required different degrees of extension in the wrist and thumb. Conclusion: Although the reviewed studies provided various recommendations for the healthy and appropriate use of SPs, there continues to be a lack of research that establishes precise guidelines on working correctly with these devices. Such guidelines are important considering that the functions and applications of SPs are being rapidly developed. Keywords: Smartphone; Musculoskeletal Disorders; Electromyography; Motion Capture/Analyzer Abbreviations: SP: Smartphone; APL: Abductor Introduction Pollicis Longus; APB: Abductor Pollicis Brevis; ED: Extensor Digitorum (ED); VAS: Visual Analog Scale. According to the United Nations, the International Telecommunication Union reported that about four Smartphone and Musculoskeletal Risk Factors: A Systematic Review Ergonomics Int J 2 Ergonomics International Journal billion cell phones were produced worldwide in 2008 and indicated that these factors affect finger muscles instead it is predicted to pass 2.87 billion user by 2020 [1]. Adults, of the trapezius [11]. According to the author, typing style adolescents, and children have at least one smartphone influences neck flexion, whereas keypad type does not. (SP) or another kind of handheld device. The popularity of The author also found that engaging with large SPs can be attributed to their low price, light weight, and touchscreens involves considerable neck flexion and high ease of use. These devices have afforded people multiple muscle activity in finger flexors, wrist extensors, and the applications, on-demand access to the Internet, and trapezius. A study focusing on posture, typing style, and convenient texting, emailing, and calling, thus motivating gender revealed that 91% of users exhibited a flexed neck users, especially teenagers and young adults, to spend posture and that 90.3% of users use their wrists in an considerable time on their devices. A study indicated that unnatural position. A high proportion of the men the frequency of daily SP use has increased, with exhibited shoulder protraction, and a high proportion of Americans spending at least 2 hours per day and 20 hours the women positioned their elbows at an angle less than per week on their phones [2]. 90 degrees, especially while standing. Over 46.1% of the subjects typed with both thumbs, and one-third typed The use of SPs is going to have a specific posture that with only the right thumb. No difference was observed involves neck muscles and thumb. In this position, users between typing style and gender [12]. usually bend their neck and thumb near to its range of motion, most of the times [3]. Working with mobile The studies discussed above can serve as a guide for phones does not require much physical power, but professionals and practitioners in defining the problems holding and using the devices require a basic load and related to SP use and establishing the best approaches to force, especially when users carry out repetitive and high- preventing such problems as these studies demonstrate speed tasks [4]. It is revealed that, Mobile phone users the potential damage mechanisms that underlie texting hold their devices below eye level while texting, a task [13]. The aim of the current research was to that requires neck flexion. systematically evaluate previous studies on the manner by which SPs are used and such musculoskeletal risk Prolonged neck flexion while using SPs increases the factors that explored by objective methods. The results risk of neck pain as it injures the vertebral bodies of the are expected to illuminate SP-related issues that have not neck [2,5,6]. Gustaffson, et al. [7] in a cohort study on been considered by scientists in the fields of technology 7,092 SP users showed that after one year, the and health care. participants with no history of musculoskeletal disorders experienced pain in their hands and fingers, and the Methodology participants with a history of pain exhibited susceptibility to chronic neck and upper back disorders. Additionally, Articles on the level of muscle activity and the the findings also indicated that the continuous use of kinematics of upper extremities during SP use were mobile phones in an awkward posture lead to long-term searched over Google Scholar, PubMed, Research Gate, effects on the neck and upper extremities of the and Science Direct (2007–2017) on July 2017. Figure 1 participants. Similarly, electromyography studies of graphically illustrates the search strategy implemented in healthy users conducted by Xie, et al. [8] and Shieh [9] this work. The search was conducted using a combination showed that the participants felt pain in the neck and or string of suggested keywords by experts in shoulders while texting. biomechanics and ergonomics keywords as follows: “(musculoskeletal disorders OR pain OR discomfort OR In electromyography studies it was determined that disorder) AND (upper extremities OR neck OR hand OR during working by smartphones involve muscle activity of wrist) AND (electromyography OR motion the abductor pollicis longus (APL), abductor pollicis capture/analyzer OR electrogoniometer) AND brevis (APB), extensor digitorum (ED), and left and right (smartphone OR mobile phone OR cellphone OR handheld trapezius are increased. Moreover, the speed of finger device).” movements during abduction/adduction is higher than the speed of movement during flexion/extension [10]. The inclusion criteria were studies involving SP users and not tablet, notebook, or laptop (etc.) users; articles Keypads and typing styles are other factors that need published in English; case studies, cross-sectional to be examined in relation to the above mentioned effects research, and cohort studies; and studies involving the of SP use. Kietrys, et al. [11] showed that no association use of electromyography, electrogoniometers, and motion exists between keypads and typing styles but also capture. Literature reviews and pre-post interventional Vahedi Z, et al. Smartphone and Musculoskeletal Risk Factors: A Systematic Copyright© Vahedi Z, et al. Review. Ergonomics Int J 2019, 3(1): 000193. 3 Ergonomics International Journal studies were also excluded from the review. The database studies used only the questionnaire method, disregarded search yielded 513 articles, out of which 185 were the use of SPs in their examinations, involved excluded because of duplication and repetition. Initial 513 psychosocial investigations and mental patients, or articles, out of which 185 were excluded because of conducted only literature reviews. This left us with a final duplication and repetition. After the remaining articles sample of 18 articles. were read, a further 287 were eliminated because these Figure 1: Flowchart of search and inclusion strategy. Reading and evaluating previous studies on the issue decline in investigations in 2017 possibly because an of interest require the supervision of professionals in interpretation for this year was too early at this point. biomechanics, anatomy, and ergonomics (posture) and familiarity with electromyography, motion capture, and The participants in the reviewed studies were electrogoniometers. We therefore asked a biomechanics primarily females (136 females and 116 males) and were expert and an ergonomics specialist to assist us in reading in their 20s [2,5,8,11,14-22]. Some of the study and selecting the full text of 41 selected articles. participants were more than 30 years old [11-15]; one study did not specify the age of the subjects. Eight articles Results indicated that the participants are right handed [2,16,18,20,21,23-27]. In terms of phone characteristics, The results of the reviewed studies were organized two studies used emulated phones with physical keypads under the following categories: general characteristics, SP [18,25], most of the studies involved SPs with features, environmental characteristics,