Does Smartphone Addiction Affect Cervical Spine Mobility, Head Posture, Body Awareness, and Pain Pressure Threshold?

Assessment of Body Awareness

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Body awareness will be assessed using a questionnaire designed to determine normal or abnormal sensitivity levels in body composition. The questionnaire consists of four subgroups: 1) Changes in body processes, 2) Sleep-wake cycle, 3) Prediction of disease onset, and 4) Prediction of body responses, with a total of 18 items. Participants were asked to rate each item using a scale from 1 to 7. It has a minimum score of 18 and a maximum score of 126, with higher scores indicating greater body awareness. The validity and reliability of this questionnaire have been reported to be high.

Assessment of head posture

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Head posture will be assessed using photographic methods and craniovertebral angle. The craniovertebral angle is calculated as the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7 \[23\]. An angle less than 49 degrees indicates an anterior head position.

Assessment of Cervical Pain Pressure Threshold (PPT)

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The cervical PPTs will be assessed using a mechanical pressure algometer (Baseline Force Gauge Model 12-0304; Baseline, NY, USA). A force will be applied perpendicularly to a 0.5 cm² area at an approximate rate of 3 N/s. While the patient is seated, pressure is applied at the midpoint of the upper trapezius muscle, and 2 cm lateral to the C2 spinous process bilaterally \[25\]. For each area, two measurements are taken at intervals, and the average of these measurements is calculated to determine the final value.

Assessment of general cervical mobility

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Cervical mobility will assessed using the CROM (Cervical Range of Motion) deluxe device, developed by the University of Minnesota. The CROM is an inclinometer system that utilizes gravity and magnetic effects \[26\]. It is validated for accuracy and reliability. The device consists of two fixed inclinometers for the sagittal and frontal planes, a horizontal inclinometer with a magnetic needle mounted on the top of the device, a magnetic neck brace, a scale-equipped arm with a ruler mounted on the top, and a vertebra locator arm with a weighing system.

Assessment of upper cervical mobility

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The CROM device is securely attached to the participant\'s head while they lay supine on a treatment table. The evaluator asks the participant to relax while the neck is brought to its maximum cervical flexion. In the full flexion position, the head and neck are passively rotated as far as possible within the limits of comfortable pain or physiological stiffness. The procedure is repeated twice on each side with a 30-second rest between tests. The sensitivity of the flexion-rotation test was found to be 91%, its specificity 90%, and its overall diagnostic accuracy 91% . The cervical flexion-rotation test is an important tool in identifying movement impairment at the C1/2 segment and can be used accurately and reliably even by inexperienced examiners.