An Investigation of the Effect of Smartphone Usage Levels on Cervical Posture, Tongue Pressure, Balance, and Neck Disability in Individuals With Rheumatoid Arthritis and Ankylosing Spondylitis

NCT07627542 | Recruiting

• 1 other identifier: 30246.R1
• Study Type: observational
• Target: 111
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Rheumatoid Arthritis (RA); Forward Head Posture; Ankylosing Spondylitis (AS)

Keywords

Text Neck; Smartphone Addiction; Neck Pain; Postural Balance; Neck Muscle Strength; Tongue Pressure

Outcome Measures

Primary Outcomes (1)

• 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.

  At baseline (Single assessment session)

Secondary Outcomes (6)

• Neck Disability Index (NDI)

  At baseline (Single assessment session)

• Craniovertebral Angle (CVA)

  At baseline (Single assessment session)

• Neck Extensor Muscle Strength

  At baseline (Single assessment session)

• Single-Leg Stance Test (SLST) Performance

  At baseline (Single assessment session)

• Pressure Pain Threshold (PPT)

  At baseline (Single assessment session)

Study Arms (3)

Rheumatoid Arthritis (RA) Group

Patients diagnosed with Rheumatoid Arthritis by a rheumatologist, with a stable disease activity score (DAS28 \< 3.2), aged 18-65, and using a smartphone for at least 2 hours daily.

Ankylosing Spondylitis (AS) Group

Patients diagnosed with Ankylosing Spondylitis by a rheumatologist, with a stable disease activity score (BASDAI \< 4), aged 18-65, and using a smartphone for at least 2 hours daily.

Healthy Control Group

Healthy individual volunteers aged 18-65 with no history of rheumatological, neurological, or chronic musculoskeletal diseases, and using a smartphone for at least 2 hours daily.

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

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).

You may qualify if:

• 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).
• For the Ankylosing Spondylitis (AS) Group: Diagnosed with AS by a rheumatologist, with a stable disease activity score (BASDAI \< 4).

You may not qualify if:

• 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.
• Severe limitation in jaw opening.
• Presence of acute neck trauma or malignancy.
• Lower extremity amputation or advanced arthritis that prevents performing the balance test.
• Active use of muscle relaxants or advanced sedative medications.

Sponsors & Collaborators

• Merve Şahin: lead

Study Sites (1)

Necmettin Erbakan University Faculty of Medicine Hospital, Rheumatology Outpatient Clinic

Konya, Meram, 42090, Turkey (Türkiye)

RECRUITING

Related Publications (5)

• Bennett JL, Pratt AG, Dodds R, Sayer AA, Isaacs JD. Rheumatoid sarcopenia: loss of skeletal muscle strength and mass in rheumatoid arthritis. Nat Rev Rheumatol. 2023 Apr;19(4):239-251. doi: 10.1038/s41584-023-00921-9. Epub 2023 Feb 17.

  PMID: 36801919 RESULT

• Ahmed EA, Atar S, Atar Y, Sari H, Anarat MEA, Salturk Z, Karaketir SG, Uyar Y, Kuru O. Evaluation of the Swallowing and Voice Functions in Ankylosing Spondylitis Patients. Dysphagia. 2022 Apr;37(2):455-462. doi: 10.1007/s00455-021-10340-1. Epub 2021 Jul 14.

  PMID: 34259915 RESULT

• Castien RF, van der Wouden JC, De Hertogh W. Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis. J Headache Pain. 2018 Jan 26;19(1):9. doi: 10.1186/s10194-018-0833-7.

  PMID: 29374331 RESULT

• Portelli A, Reid SA. Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: A 2-Group Comparative Observational Study. J Manipulative Physiol Ther. 2018 Feb;41(2):123-128. doi: 10.1016/j.jmpt.2017.10.004. Epub 2018 Jan 17.

  PMID: 29338884 RESULT

• Ulutatar F, Unal-Ulutatar C, Duruoz MT. Cervical proprioceptive impairment in patients with rheumatoid arthritis. Rheumatol Int. 2019 Dec;39(12):2043-2051. doi: 10.1007/s00296-019-04419-0. Epub 2019 Aug 21.

  PMID: 31435752 RESULT

MeSH Terms

Conditions

Arthritis, Rheumatoid; Spondylitis, Ankylosing; Internet Addiction Disorder; Neck Pain

Condition Hierarchy (Ancestors)

Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Connective Tissue Diseases; Skin and Connective Tissue Diseases; Autoimmune Diseases; Immune System Diseases; Axial Spondyloarthritis; Spondylarthropathies; Spondylarthritis; Spondylitis; Spinal Diseases; Bone Diseases; Ankylosis; Technology Addiction; Behavior, Addictive; Compulsive Behavior; Impulsive Behavior; Behavior; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Fatma ERDEO, Assistant Professor

  Necmettin Erbakan University Faculty of Health Sciences

  STUDY DIRECTOR

Central Study Contacts

Fatma ERDEO, Assistant Professor

CONTACT

+90505 443 17 78; ferdeo@erbakan.edu.tr

Merve ŞAHİN, PT

CONTACT

+905528255101; mervesahin5101@gmail.com

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Physiotherapist, MSc Student

Study Record Dates

• First Submitted: May 31, 2026
• First Posted: June 4, 2026
• Study Start: April 9, 2026
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): November 1, 2026
• Last Updated: June 9, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)