Association Between the Duration of Smart Phone Use and Back Dysfunction in Patients With Low Back Pain
Condition: Mechanical Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Observational

Summary: 
      This study investigates the association between the duration of smart phone use and back pain
      and proprioception deficits in patients with chronic mechanical low back pain (CLBP).

      It is hypothesized that increased duration of smart phone use will be associated with

        1. Increased back pain as measured by the Visual Analogue Scale (VAS)

        2. Reduced proprioception acuity as indicated by increased angle of error of back
           repositioning as measured by isokinetic dynamometer.
    

Detailed description: 
      After patient screening against inclusion and exclusion criteria, eligible patients will be
      informed about the aim of the study and all testing procedures. Then, they will be asked to
      participate in the study, if agreed an informed consent will be signed . Basic demographic
      information as well as questions regarding the average daily smart phone use will be
      collected .

      Patient will be tested in two separate sessions. During each session, the participant will be
      given a standardized phone and will be asked to play a standardized game "subway surfers "
      from a standardized sitting position for 10 or 30 minutes.

      Pain and back repositioning error will be measured before and after the smart phone use. Pain
      will be measured first, then repositioning error.

      Pain measurement:

      Each participant will be instructed to rate the current level of pain by placing a mark
      across the horizontal VAS line. The distance in millimeters from the lower limit will be
      measured using a ruler.

      Proprioception acuity:

      Biodex isokinetic system preparation:

      First, the system will be calibrated according to the manufacturer guidelines. For
      initialization of the Biodex system, the device, computer and dynamometer power will be
      switched on and all device attachments will be removed. Then, the start key in the control
      panel will be pressed. Few seconds will be allowed for the dynamometer shaft to rotate freely
      until the system displays a message that it is initializing the dynamometer. Once the
      initialization procedure is completed, the start key will be pressed again as indicated by
      the system status window. The personal data of each subject will be entered into the
      computer.

      Repositioning error measurement:

      Each participant will then be seated on the Biodex chair with his or her low back fitted
      backwards against the lumbar pad. Both knees will be fixed in place using two anterior curved
      leg pads. Legs will be kept relaxed vertically with both feet off the ground. The upper trunk
      will be fastened to the back of the chair using a belt. Both thighs will be fastened to the
      chair using straps while forearms will be kept crossed over the chest. The seat will be
      adjusted to allow the axis of rotation of the dynamometer to be at the level of L5/S1 disc
      space. Participants will be instructed to close their eyes during test performance. The
      limits of available range of motion (ROM) will determined for each participant by starting at
      the 0° position (neutral sitting with hips flexed 90°) and then instructing the participant
      to flex his or her trunk as much as possible to determine the available ROM in flexion and
      examine his or her ability to reach the target position for the isokinetic test (30° of
      lumbar flexion). The dynamometer will be locked in the 0° position to provide a fixed
      starting position for all participants during all trials The chosen protocol allows the
      participants to perform 1 familiarization trial followed by 1 actual test; this step will be
      repeated 3 times so that there will be 3 familiarization trials and 3 actual testing
      procedures. The average of the 3 actual testing results will be retrieved from the isokinetic
      device software. During the familiarization trial and after covering the eyes, participant
      will be instructed to flex his or her trunk until it is stopped by the machine at 30° of
      flexion. This position will be held for 5 seconds. The patients will be instructed to
      remember this position in order to reproduce it as precisely as possible during the
      subsequent actual test procedure. During the actual test procedure, the tested participants
      will press a hold button when they assume the target position to allow the device to record
      and save the reached angle. During the data collection process, no visual (eyes will be
      closed) or verbal feedback will be provided for the participants.

      The results of the test will be recorded and printed by the isokinetic machine. It will
      include the value of error of every trial and the average error of the 3 trials.
    

Intervention name(s): Smart phone use
Intervention type(s): Other
Intervention description(s): Patients will be asked to use the smart phone while seated for either: (1) 10 minutes or (2) 30 minutes.
Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Seventy male and female adults will be recruited from out patient clinic of the faculties
        of Physical therapy and medicine, Cairo University. Further, physical therapy students who
        are diagnosed with CLBP will be recruited via advertising on social media.
      
Keywords: Mechanical Low Back Pain; Smart phone; Low Back Pain; Chronic Mechanical Low Back Pain; CLBP