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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 51  |  Issue : 4  |  Page : 136-139

Effect of smartphone use on hand dexterity in medical students: an observational cross-sectional study


1 Occupational Therapy School and Centre, Seth G.S. Medical College and KEMH, Mumbai, Maharashtra, India
2 Department of Occupational Therapy, Seth G.S. Medical College and KEMH, Mumbai, Maharashtra, India

Date of Submission29-Nov-2019
Date of Acceptance12-Dec-2019
Date of Web Publication03-Jan-2020

Correspondence Address:
Dr. Shilpshree Prashant Palsule
Occupational Therapy School and Centre, Seth G.S. Medical College and KEMH, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoth.ijoth_32_19

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  Abstract 


Background: The use of smartphone has increased over the past few years and is predicted to increase in future. The literature emphasizes the effect of smartphone usage on the neuromuscular activity and development of musculoskeletal disorders. The literature studying the effect of smartphone usage on hand function dexterity is limited. Hence, the study was formulated to find the effects of smartphone usage on hand dexterity using Purdue Pegboard Hand Dexterity Test and Smartphone Addiction Scale (SAS) as evaluation tools. Objectives: The research was designed to study the effect of smartphone use on bilateral hand dexterity in medical students. Design: An observational cross-sectional study design was chosen for the research. Methods: After institutional ethics committee approval, a sample of 220 medical students was recruited using convenient sampling for this observational cross-sectional study. SAS, a self-reporting scale, was administered to each medical student, and one-time assessment for hand dexterity on the standard Purdue Pegboard Hand Dexterity Test was performed. The scores of SAS were categorized as low (<86), moderate (86-106), and high (>106). The mean scores of the Purdue Pegboard Hand Dexterity Test were compared within the categories and with the available Indian norms using descriptive statistical methods, single sample t-test, and ANOVA analysis. Results: A positive correlation (r = 0.31, P = 0.00, 95% confidence interval [CI]: 0.18-0.42) was found between SAS scores and time spent on smartphone. Hand dexterity (Purdue Pegboard Hand Dexterity Test) scores did not show any statistically significant correlation with the time spent on the smartphone and SAS scores, except “dominant” and “total” scores of the test. The “Total” score correlated as weak negative with SAS scores (r = −0.16, P = 0.01, 95% CI: −0.14-0.11); on association analysis with the categories of SAS, statistically significant difference between the mean scores (P = 0.035, 95% CI: 40.33-41.47) was observed. The “Dominant” score correlated as weak negative with SAS scores (r = −0.155, P = 0.045, 95% CI: −0.149-0.116); the association analysis with the categories of SAS did not show any significant difference. Significant difference was observed between the mean hand dexterity test scores of our study sample and the available Indian norms of the Purdue Pegboard Hand Dexterity Test. Conclusion: This study concluded that the duration of active smartphone use (texting and scrolling) does not affect the hand dexterity. However, excessive smartphone usage (high SAS scores) may have a weak negative impact on dominant hand dexterity in medical students.

Keywords: Hand Dexterity, Hand Function, Purdue Pegboard, Smartphone Addiction


How to cite this article:
Shetty RJ, Gupta Y, Palsule SP, Kale J, Shah P. Effect of smartphone use on hand dexterity in medical students: an observational cross-sectional study. Indian J Occup Ther 2019;51:136-9

How to cite this URL:
Shetty RJ, Gupta Y, Palsule SP, Kale J, Shah P. Effect of smartphone use on hand dexterity in medical students: an observational cross-sectional study. Indian J Occup Ther [serial online] 2019 [cited 2020 Sep 22];51:136-9. Available from: http://www.ijotonweb.org/text.asp?2019/51/4/136/274809




  Introduction Top


Smartphones are portable handheld electronic devices with highly developed technological functions.[1] There are approximately 299.24 million smartphone users in India,[2] with average usage of 3 h/day.[3] Overuse of these devices may stress the musculoskeletal structures of the wrist and hand causing pain and discomfort, exposing them to various cumulative trauma disorders.[4],[5],[6],[7] Previous literature on the assessment of hand functions and muscle activity in smartphone users suggest that repeated use of smartphone affects the hand functions.[4] A study by İnal et al. on the effect of smartphone usage on hand functions and muscle activity suggested that repeated use of smartphone may affect the hand functions, however it was not measured using a standardized test.[4] Although smartphone usage is predicted to increase in future,[2] its effect on hand dexterity is still being researched. Hence, the study was formulated to analyze the effect of active smartphone use (scrolling and texting) on hand dexterity, wherein the Smartphone Addiction Scale (SAS) and Purdue Pegboard Hand Dexterity Test were administered to medical students; the mean scores obtained were correlated with that of SAS and were also compared with the available Indian norms.


  Methods Top


An observational cross-sectional research was designed and conducted on medical students in the occupational therapy department of a tertiary care hospital. The research was approved by the institutional ethics committee. Medical students were recruited from August 2018 to September 2019. Initially, a pilot study was performed on twenty medical students, where each participant was administered the SAS, and the level of smartphone usage was evaluated.

The SAS consists of 33 questions rated on a 6-point Likert scale ranging from 1 to 6, which assesses the individuals subjectively on perceived smartphone usage pattern.[4],[8] They were then divided into three categories according to their SAS score as low, moderate, and high smartphone users, based on the pilot study. A total of 220 medical students using smartphones, between the ages of 18 and 27 years, both males and females, were recruited through convenient sampling method. Those having Visual Analog Scale score >2 (pain) or having any diagnosed musculoskeletal, neurological, or psychiatric illness were excluded from the study. Written informed consent was taken from each recruited medical student who voluntarily agreed to participate in the study.

A comfortable seating and standard table of height of 30” was used to administer the Purdue Pegboard Hand Dexterity Test. This hand function test assesses finger dexterity which is defined as the ability to make rapid, skillful, controlled movement of small objects where fingers are primarily involved.[9] Demographics of all medical students such as age, gender, number of hours of active smartphone usage (scrolling and texting), scores of the SAS scale, and Purdue Pegboard Test, i.e., right hand score, left hand score, both hand score, total score, and assembly scores, were recorded on a predesigned case record form. The total time taken for the entire assessment was about 20 min for each participant.

Data were compiled and tabulated using Microsoft Excel version 10. Descriptive statistics such as mean, median, percentages, percentiles, and standard deviations (SDs) were used to describe the data. Bivariate analysis for association was done using Pearson's correlation and Fisher's exact test. Quantitative variables were analyzed using ANOVA and t-test. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. was used wherever applicable. At the outset of the study, the level of significance was set at P < 0.05 and 95% confidence interval (CI).


  Results Top


Out of the 220 medical students, 127 (58%) were female and 93 (42%) were male. Out of the total of 198 SAS score, the maximum score found in our sample population was 162 and minimum score was 48, with a mean score ± SD of 96.94 ± 21.78, as shown in [Table 1]. Based on the study results, SAS scores <86 (the 30th percentile was 85) were categorized as low smartphone users, scores from 86 to 106 were categorized as moderate category users, and scores above 106 (the 70th percentile was 106) as high category smartphone users. These SAS scores differ slightly with the categories according to previous studies.[4] According to our analysis, low category users comprised 30.5% (n = 67), moderate category comprised 40% (n = 88), and high category comprised 29.5% (n = 65) of the total sample size. Time spent on smartphone varied between 0.5 h/day and 10 h/day, with a mean ± SD of 3.78 ± 1.93 h/day. A positive correlation was found between the time spent on smartphones and SAS scores with Pearson's correlation coefficient (r) =0.313 and P = 0.000 at 95% CI: 0.18-0.42. On regression analysis, R2 was found to be 0.098 [Figure 1]. No correlation was found between the time spent on smartphones and hand dexterity [Table 2]. A weak negative correlation was found between the SAS score and the dominant hand dexterity score with correlation coefficient (r) = −0.155 and significance (P) (two tailed) of 0.045 at 95% CI: −0.282 to − 0.023, as shown in [Table 2]. In addition, a weak negative correlation was found between the SAS score and the total hand dexterity score with correlation coefficient (r) = −0.168 and significance (P) (two tailed) of 0.125 at 95% CI: −0.149-0.116 [Table 2]. Categories of SAS scores were analyzed for association with dominant hand dexterity score, and no significant difference in the mean scores between the three groups of SAS scores was found (P = 0.61 at 95% CI: 14.84-15.29) [Table 3]. Whereas on analyzing the categories of SAS scores for association with total hand dexterity score, significant difference in the mean scores between the three groups of SAS scores with P = 0.035 at 95% CI: 40.33-41.47 and 5% alpha error was found [Table 3]. There was no significant difference in the mean scores of nondominant hand dexterity, both hand dexterity and assembly between the three groups of SAS score. [Table 3] also summarizes the values of means and SDs for each of the subtest of Purdue Pegboard Hand Dexterity Test. It shows that as the level of addiction of smartphone usage increases, as reflected by high scores on the SAS, the mean performance values on most of the subtests of hand dexterity decrease. Although not a primary objective of our study, a single sample t-test was conducted to determine if a statistically significant difference existed between the means of Purdue Pegboard Hand Dexterity Test scores of the study sample and the means of the available Indian norms.[9]t-values and P values are mentioned in [Table 4], and the significance was calculated at 95% confidence level (P = 0.05, two tailed) Statistically significant difference was observed between the hand dexterity test scores of our study sample and the normative data which were published in 2006.[9]
Table 1: Analysis of Smartphone Addiction Scale Scores

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Figure 1: Correlation between Time Spent on Smartphone and Smartphone Addiction Scale Scores

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Table 2: Correlation between Purdue Pegboard Hand Dexterity Test Scores and (1) Time Spent on Smartphone and (2) Smartphone Addiction Scale Score

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Table 3: Comparison between the Hand Dexterity Scores of Each Category and Smartphone Addiction Scale Score

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Table 4: Normative Data of Purdue Pegboard Hand Dexterity Test (Males and Females) from the Study

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  Discussion Top


Comparison of hand dexterity scores from Purdue Pegboard Hand Dexterity Test was done between the different categories of SAS scores. A total of 220 medical students were recruited, out of which the majority were females (58%). The mean score of the SAS derived for the current population was 96.94 out of a total score of 198, which was comparatively higher than the score as stated in 2015.[4] This can be attributed to easy access to internet usage, social networking, virtual gaming, and digitalization of all the services lately.[10] On the basis of data collected, the average time spent by the medical students using smartphones actively, i.e., performing the task of scrolling and texting, is 3.78 h, which has increased over the years from 3 h 15 min in 2014.[11] There is a positive correlation between time spent on active smartphone usage and their SAS scores; hence, it can be stated that students who use their smartphones actively for a longer period of time tend to get more dependent on their smartphones. Literature suggests that increased use of smartphones may affect hand functions such as pinch and grip strength,[4] but, in our study, we found that hand dexterity may not be affected, as neither positive nor negative correlation was found between hand dexterity and time spent on active smartphone usage. Furthermore, when mean dexterity score of dominant hand was compared with the categories of SAS scores, it was suggested that there was no significant difference in the mean scores of dominant hand, nondominant hand, both hands, and assembly. Active smartphone use with single hand has increased hand muscle activities[1],[12] and may also affect the motor performance of the thumb,[13] decreasing the overall dexterity of the hand. The statistically significant difference found between the mean scores of Purdue Pegboard Hand Dexterity Test of our sample and that of the normative data described in the literature,[9] suggests that hand dexterity may have deteriorated in view of increased smartphone usage, which involves continued active use of hand muscles.[13] A recent study by Oberoi, on the effect of smartphone addiction on gross hand dexterity in young adults showed similar results.[14] Our study results are in agreement with those of previously published literature.

Limitations

The limitations of the study are: only medical college students were selected for the convenience of sampling; the study could have been done on individuals in a particular geographical region for better generalization at a population. The administration of the test was not at the best time suitable for the medical students, which could have affected their performance. Number of years of smartphone usage was not taken into consideration as a variable for analysis. Hence, our results may be limited to the findings noted in the study.


  Conclusion Top


This study concluded that the duration of active smartphone use (texting and scrolling) does not affect the hand dexterity. However, excessive smartphone usage (high SAS scores) may have a weak negative impact on dominant hand dexterity in medical students.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
  References Top

1.
Lee M, Hong Y, Lee S, Won J, Yang J, Park S, et al. The effects of smartphone use on upper extremity muscle activity and pain threshold. J Phys Ther Sci 2015;27:1743-1745.  Back to cited text no. 1
    
2.
Number of Smartphone Users in India 2015-2022 | Statistic. Statistic. Available from: https://www.statista.com/statistics/467163/forecast-of-smartphone-users-in-india. [Last accessed on 2018 Nov 30].  Back to cited text no. 2
    
3.
Seethraman G. Indians Spend Roughly 3 Hours a Day on Smartphones, but are they Paying Big Bucks for Apps? The Economic Times. Economic Times; 2018. Available from: https://economictimes.indiatimes.com/magazines/panache/indians-spend-roughly-3-hours-a-day-on-smartphones-but-are-they-paying-big-bucks-for-apps/articleshow/62866875.cms. [Last accessed on 2018 Nov 30].  Back to cited text no. 3
    
4.
İnal EE, Demİrcİ k, Çetİntürk A, Akgönül M, Savaş S. Effects of smartphone overuse on hand function, pinch strength, and the median nerve. Muscle Nerve 2015;52:183-188.  Back to cited text no. 4
    
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Berolo S, Wells RP, Amick BC 3rd. Musculoskeletal symptoms among mobile hand-held device users and their relationship to device use: A preliminary study in a Canadian university population. Appl Ergon 2011;42:371-378.  Back to cited text no. 5
    
6.
Eapen C, Kumar B, Bhat AK. Prevalence of cumulative trauma disorders in cell phone users. J Musculoskelet Res 2010;13:137-145.  Back to cited text no. 6
    
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Xie Y, Szeto G. A study of muscle activity in using touchscreen smartphone among young people with and without neck-shoulder pain. Physiotherapy 2015;101:e1668-e1669.  Back to cited text no. 7
    
8.
Kwon M, Lee JY, Won WY, Park JW, Min JA, Hahn C, et al. Development and validation of a smartphone addiction scale (SAS). PLoS One 2013;8:e56936.  Back to cited text no. 8
    
9.
Desai K, Kene K, Doshi M, More S, Desai S. Normative data of Purdue pegboard on Indian population. Indian J Occup Ther 2006;37:69-72.  Back to cited text no. 9
    
10.
Prasad S, Harshe D, Kaur N, Jangannavar S, Srivastava A, Achanta U, et al. A study of magnitude and psychological correlates of smartphone use in medical students: A pilot study with a novel telemetric approach. Indian J Psychol Med 2018;40:468-475.  Back to cited text no. 10
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11.
Smith A. Smartphone Ownership 2013. Pew Research Center: Technology. Pew Research Center: Internet, Science and Technology; 2014. Available from: http://www.pewinternet.org/2013/06/05/smartphone-ownership-2013. [Last accessed on 2018 Nov 30].  Back to cited text no. 11
    
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Ko PH, Hwang YH, Liang HW. Influence of smartphone use styles on typing performance and biomechanical exposure. Ergonomics 2016;59:821-828.  Back to cited text no. 12
    
13.
Trudeau MB, Asakawa DS, Jindrich DL, Dennerlein JT. Two-handed grip on a mobile phone affords greater thumb motor performance, decreased variability, and a more extended thumb posture than a one-handed grip. Appl Ergon 2016;52:24-28.  Back to cited text no. 13
    
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Oberoi M. Effect of smartphone addiction on gross hand dexterity. Int J Soc Sci Humanit Invent 2019;8:64-67.  Back to cited text no. 14
    


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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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