Text neck: conceptual definition and cutoff point for quantitative evaluation

Abstract

Introduction: Text neck is proposed to be one of the causes of neck pain. However, there is a lack of consensus concerning the definitions of text neck which challenges researchers and clinicians as well as a lack of definition of the cutoff value to discriminate against individuals with text neck. Objective: To investigate how text neck is defined in peer-reviewed articles and a study to develop and validate a cut-off value for cervical flexion angle to discriminate individuals with text neck posture classified by physiotherapists
Methods: We conducted a scoping review to identify all articles using the terms “text neck” or “tech neck”. EMBASE, Medline, CINAHL, PubMed and Web of Science were searched from inception to 30th April 2022. No limitation was applied for language or study design. Data extraction included study characteristics and the primary outcome relating to text neck definitions. This is a scoping review that followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. To develop and validate a cut-off value for cervical flexion angle to discriminate, a total of 562 participants wearing the inclinometer (index test) were photographed in lateral view while texting using a smartphone. Three physiotherapists made the classification of text neck posture (reference standard). Results: 41 articles were included in the scoping review. Text neck definitions varied across studies. The most frequent components of definitions were grouped into five basis for definition: Posture (n=38; 92.7%), with qualifying adjectives meaning incorrect posture (n=23; 56.1%) and posture without a qualifying adjective (n=15; 36.6%); Overuse (n=26; 63.4%); Mechanical stress or tensions (n=17; 41.4%); Musculoskeletal symptoms (n=15; 36.6%) and; Tissue
damage (n=7; 17.1%). In development and validate a cut-off value study, receiver operating characteristics curve identified the cutoff of 37° of the cervical flexion angles in the standing position and 41° in the sitting position of a training sample (n = 393; 70%) [AUC of 0.89 (95% CI 0.85 to 0.92) and 0.89 (0.86 to 0.92)], respectively. In the testing sample (n = 168; 30%), the same cutoffs provided high sensitivity and specificity values for standing and sitting postures. Conclusion: The scoping review showed that posture is the defining characteristic of text neck in academic literature. For research purposes, it seems that text neck is a habit of texting on the
smartphone in a flexed neck position. Since there is no scientific evidence linking text neck with neck pain regardless of the definition used, adjectives like inappropriate or incorrect should be avoided when intended to qualify posture. And the cervical flexion angle accurately discriminates individuals classified as text neck by the physiotherapists through subjective photography assessment, however text neck was not associated with neck pain.