Smartphone Addiction and Thoracic Hyperkyphosis in Children

Relationship Between Smartphone Addiction and Thoracic Hyperkyphosis in Children

Smartphones are advanced devices that have evolved beyond basic calling and messaging functions, offering features comparable to computers due to the development of mobile operating systems. In addition to their technical capabilities, smartphones have become increasingly appealing to children, adolescents, and adults through continuously updated websites, applications, and social networks that provide access to current information and opportunities for social interaction.

Excessive use of smartphones and similar technological devices can be defined as mobile phone addiction or internet addiction. The risk of smartphone addiction is particularly high among children and adolescents. The prolonged use of smartphones, which are now an integral part of daily life, may negatively affect physical capacity, including the musculoskeletal system. Previous studies have shown that increased smartphone use is associated with neck/shoulder and upper extremity/back discomfort. This increased usage can lead to non-neutral spinal postures and sustained muscular loading. Due to the central role of the spine within the kinetic chain, postural changes and muscular strain in the spine may affect movement quality in both upper and lower segments. For example, excessive neck flexion while texting can have widespread effects on spinal alignment and function. Therefore, smartphone use may cause significant changes in thoracic kyphosis and lumbar lordosis.

Thoracic hyperkyphosis is commonly detected during adolescence and encompasses a range of spinal deformities from mild postural changes to rigid deformities accompanied by soft tissue and structural alterations. In children and adolescents, three main types of hyperkyphosis are observed: postural kyphosis, Scheuermann's kyphosis, and congenital kyphosis.

Postural hyperkyphosis is the most common type. It results from the weakness of antigravity muscles responsible for upright posture, leading to curvature of the spine under external forces. This type of curvature is not rigid and can often be corrected voluntarily when the individual is instructed to stand upright. Postural hyperkyphosis typically occurs during adolescence and is characterized by a thoracic kyphosis angle generally below 65 degrees. It is a common yet often overlooked condition in healthy adolescents and can be identified through school screenings.

Today, the growing use of smartphones and the associated rise in technology addiction have contributed to the increasing prevalence of postural hyperkyphosis, which is caused by prolonged incorrect postures. It has also been reported that postural habits developed during childhood often persist into adulthood.

If left untreated, hyperkyphosis that begins in adolescence may continue into adulthood, potentially increasing healthcare expenditures. With the rising incidence of hyperkyphosis linked to smartphone addiction, it is crucial to address this deformity beginning in adolescence, both from a health and economic perspective. Many authorities advocate for the inclusion of scoliosis and hyperkyphosis in school screening programs. However, routine screenings for skeletal system problems are not conducted in schools. Moreover, the limited number of studies in this area have primarily focused on scoliosis, and to date, no screening studies have addressed hyperkyphosis specifically.

Study Overview

• Status: Completed
• Conditions: Hyperkyphosis
• Intervention / Treatment: Other: Assessment

• Study Type: Observational
• Enrollment (Actual): 77

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey, 34010
    • Istinye University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: N/A

• Sampling Method: Probability Sample

Study Population

Individuals between the ages of 7 and 14 who are receiving primary education and meet the inclusion criteria will be included in this study planned to evaluate the relationship between smartphone addiction and thoracic hyperkyphosis in children with thoracic hyperkyphosis.

Description

Inclusion Criteria:

• Being between 7-14 years old
• Using a smartphone for more than a year
• Daily smartphone usage time >60 minutes

Exclusion Criteria:

• Those who have had major surgery or trauma related to the musculoskeletal system, especially the spine and upper extremities
• Difficulty in perceiving commands
• Rigid deformity in the spine (Scheuermann Kyphosis)
• Congenital deformity

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Group 1; Individuals between the ages of 7 and 14 who are receiving primary education and meet the inclusion criteria will be included in this study planned to evaluate the relationship between smartphone addiction and thoracic hyperkyphosis in children with thoracic hyperkyphosis.	Other: Assessment; Individuals between the ages of 7 and 14 who are receiving primary education and meet the inclusion criteria will be included in this study planned to evaluate the relationship between smartphone addiction and thoracic hyperkyphosis in children with thoracic hyperkyphosis.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Smartphone Addiction Scale-Short Form	Smartphone Addiction Scale-Short Form will be used to measure smartphone addiction. The smartphone addiction scale, developed to measure the risk of smartphone addiction in young people, is a six-point Likert-type scale consisting of 10 items with one factor (1: strongly disagree and 6: strongly 15 agree) and is based on self-reporting. The internal consistency and concurrent validity of the scale were confirmed with a Cronbach's alpha of 0.911. The total score is minimum 10 and maximum 60. It was evaluated that the risk of addiction increases as the score increases. In the Korean sample, the cut-off value was specified as 31 for men and 33 for women. Turkish validity and reliability studies were conducted by Noyan et al. in 2014.	4 weeks
Flexicurve Ruler	Flexicurve Ruler will measure thoracic curvature and calculate kyphosis index. Kyphosis index is the value found by dividing the width of the thoracic curvature by its length.	4 weeks
Wall-Occiput Distance	The increase in the thoracic kyphosis angle will be evaluated and recorded with the wall-occiput distance measurement. The distance between the occiput and the wall will be measured with a ruler while the individual to be tested is standing in contact with the wall.	4 weeks
Range of Motion	Cervical region flexion, extension, lateral flexion and rotation movements, upper extremity shoulder flexion, extension movements, trunk flexion, lateral flexion and extension angles will be measured bilaterally with a digital goniometer. Measurements will be repeated 3 times and the average value will be recorded in degrees	4 weeks
The shortness of the pectoral muscles	The shortness of the pectoral muscles will be evaluated with a tape measure.	4 weeks
Sit-Reach test	The shortness of the hamstring muscle will be evaluated with the Sit-Reach test.	4 weeks
Satisfaction with Body Image	There is no scale specific to hyperkyphosis deformity in the literature that evaluates individuals' perception of satisfaction with their body image. In the existing studies in the literature, a numerical scale between 0 and 10 was used to evaluate how the perception of satisfaction with body image changes in hyperkyphosis deformity. According to the scale, 0 represents very satisfied with appearance, while 10 represents not satisfied with appearance at all.	4 weeks
Height	The vertical distance from the top of the head to the heels of the individual. It will be measured in centimeters.	4 weeks
Weight	The mass of the individual's body in relation to gravity. It will be expressed in kilograms.	4 weeks
Sociodemographic Status Assessment	The sociodemographic status of the participants will be recorded with an assessment form prepared by the researchers. Information on age, gender, dominant side, duration and habits of smartphone use,will be questioned. Participants' privacy will be respected throughout the study, and no photographs will be taken.	4 weeks
Posture analysis with Posture Screen Mobile Application	Posture analysis will be used to determine postural deviations that may occur in individuals. Posture analysis will be performed via the "Posture Screen" application, which can be accessed via smartphones.	4 weeks
Waist Circumference	A circumferential measurement taken with a tape measure at the narrowest point of the waist, or at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest, to assess abdominal fat distribution. It will be measured in centimeters.	4 weeks

Collaborators and Investigators

• Sponsor: Istinye University

Study record dates

Study Major Dates

• Study Start (Actual): June 23, 2025
• Primary Completion (Actual): August 1, 2025
• Study Completion (Actual): August 1, 2025

Study Registration Dates

• First Submitted: June 23, 2025
• First Submitted That Met QC Criteria: June 23, 2025
• First Posted (Actual): July 2, 2025

Study Record Updates

• Last Update Posted (Actual): August 21, 2025
• Last Update Submitted That Met QC Criteria: August 20, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: posture; smartphone addiction; thoracic hyperkyphosis
• Additional Relevant MeSH Terms: Technology Addiction; Bone Diseases; Musculoskeletal Diseases; Spinal Diseases; Compulsive Behavior; Impulsive Behavior; Spinal Curvatures; Internet Addiction Disorder; Behavior, Addictive; Kyphosis
• Other Study ID Numbers: 23/114

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No