The relationship between use of personal electronic devices and musculoskeletal pain in children : a systematic review

Purpose Musculoskeletal disorders (MSDs) in the adult population have increased over the past ten years. Evidence suggest that this is due to the rapid development and usage of computer technology and personal electronic devices (PEDs). Research has identified risk factors associated with musculoskeletal (MSK) pain as: duration of use, type of device used, and positions people are using them in. Similarly, children’s usage of PEDs has rapidly increased. With this growth comes a need to understand the potential link between PED use and MSK pain in children. There is a dearth of evidence related to risk factors linked to children’s use of PEDs and any relationship between this usage and MSK pain. It is important to explore and identify these risk factors. Methods A systematic review was conducted to explore the link between children’s MSK pain and their PEDs usage. The aim was to appraise the current research exploring whether there is an association between children’s (aged 3-17 years) MSK pain and their usage of PEDs, as well as to identify any potential risk factors. Electronic searches of EBSCO (CINAHL, SPORT Discus with Full Text), Ovid Online (Amed and MEDLINE), and PubMed Central were conducted for cross-sectional, observational or experimental studies. An integrative narrative synthesis process was followed, and the quality of the papers were reported on using the standard quality assessment criteria for evaluation primary research papers from a variety of fields. Results N=12,671 articles were screened, n=43 studies eligible for inclusion. Of those 43 studies n=35 were cross-sectional, seven cohort studies and one was a test-re-test. N=27 of the cross-sectional studies used subjective measurement, such as questionnaires (Nordic Muscular Questionnaire, the most commonly used) and the pain visual analogue scale, seven used both subjective and objective measures (i.e. questionnaires, 3D posture analysis, and EMG) and eight used only objective measures. The quality of the articles ranged from 0.95 to 0.28, more than 50% of the papers being under 0.50. No papers were excluded based on quality. The current evidence base suggests limited evidence of a link between PED usage and MSK pain in children. However, potential risk factors themes were found; type of device, length of time, and positions adopted when using the device. Conclusions The review concluded that due to the low quality of papers, predominance of subjective outcome measures used and the lack of longitudinal studies that the identified risk factors could not be conclusively demonstrated as being linked to the impact of PED usage on MSK pain. More research is needed, utilising either cohort or longitudinal designs, using both objective and subjective outcome measures which will provide a greater understanding. Implications The results from the systematic review highlight the gap in knowledge and the need for further research. Also highlighted the need to move away from a reliance on subjective measures, and lab-based research to the integration of objective measures within free living environments. Strengthening and developing the evidence base to ensure high quality preventative interventions can be designed to help reduce the impact of the identified risk factors