The purpose of this cross-sectional and comparative study is to investigate the impact of smartphone addiction on the cervical posture, musculoskeletal system, balance, and tongue pressure in individuals diagnosed with Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS), and to compare these findings with a healthy control group. Smartphone addiction has become a major contributing factor to postural alterations such as Text Neck Syndrome. This study aims to evaluate and compare the Craniovertebral Angle (CVA), neck extensor muscle strength, Pressure Pain Thresholds (PPT) of the neck and shoulder, Single-Leg Stance (SLS) static balance, and tongue pressure among three distinct groups. A healthy control group will be included as a reference baseline to differentiate the postural and functional deterioration caused by rheumatological diseases from the additional mechanical load imposed by smartphone dependency. To eliminate the misleading effects of acute pain, joint swelling, and severe functional limitations during flare-ups, only patients with stable disease activity (DAS28 \< 3.2 for RA and BASDAI \< 4 for AS) will be enrolled. This approach aims to examine the pure biomechanical relationship between technological dependency and cervical functions, independent of active systemic inflammation.
Aged 18 to 65 years.
Using a smartphone for at least 2 hours daily.
Able to understand and follow postural commands during clinical measurements.
For the Rheumatoid Arthritis (RA) Group: Diagnosed with RA by a rheumatologist, with a stable disease activity score (DAS28 < 3.2).
History of prior surgical intervention in the cervical region.
Presence of neurological diseases (e.g., Parkinson's disease, ALS).
Severe visual or hearing impairment.
Vestibular system disorders.
The study population consists of adult patients diagnosed with Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) who are actively followed at the Rheumatology Outpatient Clinic of Necmettin Erbakan University Faculty of Medicine Hospital. Additionally, age-matched healthy volunteers recruited from the community with no systemic, neurological, or chronic musculoskeletal disorders will serve as the control group. All participants must fulfill the specific age criteria (18 to 65 years) and technological dependency baseline (using a smartphone for at least 2 hours daily).
Case-control
Cross-sectional
Not listed
Smartphone Addiction Scale-Short Version (SAS-SV)
The SAS-SV is a 10-item self-reported questionnaire used to evaluate the level of smartphone dependency. Each item is rated on a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). Total scores range from 10 to 60. The cutoff scores were determined to be 31 for men and 33 for women, with higher scores indicating a higher risk and severity of smartphone addiction.
Neck Disability Index (NDI)
The NDI is a 10-item questionnaire measuring neck pain-related disability and its impact on functional activities. Each item is scored from 0 (no disability) to 5 (total disability). Total scores range from 0 to 50, where higher scores represent greater functional neck impairment and disability. (0-4 points: no disability, 5-14 points: mild disability, 15-24 points: moderate disability, 25-34 points: severe disability, 35 points and above: complete disability)
Craniovertebral Angle (CVA)
CVA will be measured in degrees using a manual goniometer to objectively assess forward head posture. The center of the goniometer will be placed on the C7 spinous process, with one arm vertical to the ground and the other pointing to the tragus of the ear. The average of three trials will be recorded. A lower angle indicates a greater severity of forward head posture (cutoff value is 50°).
Neck Extensor Muscle Strength
Neck extensor strength will be evaluated using a digital handheld dynamometer placed at the level of the occipital protuberance while the participant sits upright. Participants will perform three maximal isometric contractions pushing backward, and the average value will be recorded in Newtons (N). Higher values indicate better muscle strength.
Single-Leg Stance Test (SLST) Performance
Static balance performance will be evaluated on the non-dominant leg with eyes open and eyes closed. The duration the participant maintains balance will be recorded in seconds, with a maximum ceiling effect of 60 seconds. Higher durations indicate better static balance stability.
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Merve Şahin
Lead sponsor
Necmettin Erbakan University
Sponsor institution
