Reducing Smartphone Addiction and Improving Fibromyalgia Outcomes: A Randomized Controlled Trial

Öz

Aim: Smartphone overuse may worsen pain and disability in fibromyalgia. Health education about potential negative effects of smartphone addiction on fibromyalgia may help decrease this overuse. The aim of this study is to examine the relationship between smartphone addiction (SA), and total fibromyalgia impact (TFI) in patients with fibromyalgia, and to assess the effects of health education on decreasing pain and disability. Material and Methods: Study was designed as a randomized controlled trial, and was conducted in the physiatry clinic of a state hospital. Patients were randomized into intervention and control groups and followed for 21 days. 83 patients (42 intervention group mean age 40.36 ± 6.54 years; 41 control group mean age 40.90 ± 9.42 years) were included. The intervention group received one-time health education session on negative effects of SA, alongside self-monitoring with an exercise diary. The control group engaged in self-monitoring only, using the same diary. The study compared education plus self-monitoring versus self-monitoring alone. Primary outcomes included SA (measured by the Smartphone Addiction Scale-Short Version, SAS-SV) and TFI (measured by the revised Fibromyalgia Impact Questionnaire, FIQR) at baseline and on day 21. Secondary outcomes included daily smartphone screen time (DSST) and daily exercise time (DET) tracked during the 20-day period. Results: Young and single fibromyalgia patients exhibited higher SA levels. Both groups showed improvements in DSST, DET, SA, and TFI after 21 day period. Improvements were greater in the intervention group, however between-group differences were not statistically significant. Reductions in SA scores correlated positively with reductions in TFI scores. Self-monitoring with or without patient education, improved SA and TFI. Conclusion: Self-monitoring with physician follow-up was sufficient to promote behavior change. Decreased SA was linked to reduced symptom burden in patients. Findings suggest that self-monitoring may be an underused yet effective behavioral strategy in fibromyalgia care. This study was retrospectively registered at ClinicalTrials.gov (NCT06239779) on 26 January 2024.

Anahtar Kelimeler

• Behavioral medicine
• fibromyalgia
• health education
• pain management
• self monitoring
• technology addiction

Akıllı Telefon Bağımlılığının Azaltılması ve Fibromiyalji Sonuçlarının İyileştirilmesi: Randomize Kontrollü Bir Çalışma

Öz

Amaç: Akıllı telefonların aşırı kullanımı fibromiyaljide ağrı ve sakatlığı kötüleştirebilir. Akıllı telefon bağımlılığının fibromiyalji üzerindeki olası olumsuz etkileri hakkında sağlık eğitimi, bu aşırı kullanımın azaltılmasına yardımcı olabilir. Bu çalışmanın amacı, fibromiyaljili hastalarda akıllı telefon bağımlılığı (SA) ile toplam fibromiyalji etkisi (TFI) arasındaki ilişkiyi incelemek ve sağlık eğitiminin ağrı ve sakatlığı azaltmadaki etkilerini değerlendirmektir. Gereç ve Yöntem: Çalışma, randomize kontrollü bir çalışma olarak tasarlanmış ve bir devlet hastanesinin fizyoterapi kliniğinde yürütülmüştür. Hastalar müdahale ve kontrol gruplarına randomize edilmiş ve 21 gün boyunca takip edilmiştir. 83 hasta (müdahale grubunda 42 hasta ortalama yaş 40,36±6,54 yıl; kontrol grubunda 41 hasta ortalama yaş 40,90±9,42 yıl) çalışmaya dahil edilmiştir. Müdahale grubuna, egzersiz günlüğüyle öz izlemenin yanı sıra, SA'nın olumsuz etkileri hakkında tek seferlik bir sağlık eğitimi seansı verildi. Kontrol grubu ise aynı günlüğü kullanarak yalnızca öz izleme yaptı. Çalışma, eğitim artı öz izlemeyi, yalnızca öz izlemeyle karşılaştırdı. Birincil sonuçlar, başlangıçta ve 21. günde SA (Akıllı Telefon Bağımlılığı Ölçeği-Kısa Versiyon, SAS-SV ile ölçülmüştür) ve TFI'yi (gözden geçirilmiş Fibromiyalji Etki Anketi, FIQR ile ölçülmüştür) içeriyordu. İkincil sonuçlar, 20 günlük süre boyunca izlenen günlük akıllı telefon ekran süresi (DSST) ve günlük egzersiz süresi (DET) idi. Sonuçlar: Genç ve bekar fibromiyalji hastaları daha yüksek SA seviyeleri gösterdi. Her iki grup da 21 günlük sürenin ardından DSST, DET, SA ve TFI'da iyileşme gösterdi. İyileşmeler müdahale grubunda daha fazlaydı, ancak gruplar arası farklılıklar istatistiksel olarak anlamlı değildi. SA puanlarındaki düşüşler, TFI puanlarındaki düşüşlerle pozitif korelasyon gösterdi. Hasta eğitimiyle veya eğitimsiz öz izleme, SA ve TFI'yi iyileştirdi. Sonuç: Hekim takibiyle öz izleme, davranış değişikliğini teşvik etmek için yeterliydi. SA'nın azalması, hastalarda semptom yükünün azalmasıyla ilişkilendirildi. Bulgular, öz izlemenin fibromiyalji bakımında yeterince kullanılmayan ancak etkili bir davranış stratejisi olabileceğini düşündürmektedir. Bu çalışma, 26 Ocak 2024 tarihinde ClinicalTrials.gov (NCT06239779) adresinde retrospektif olarak kaydedildi.

Anahtar Kelimeler

• Davranışsal tıp
• fibromiyalji
• sağlık eğitimi
• ağrı yönetimi
• öz izleme
• teknoloji bağımlılığı

Kaynakça

1. Jurado-Priego LN, Cueto-Ureña C, Ramírez-Expósito MJ, Martínez-Martos JM. Fibromyalgia: a review of the pathophysiological mechanisms and multidisciplinary treatment strategies. Biomedicines 2024;12(7):1543.
2. Marques AP, Santo ASDE, Berssaneti AA, Matsutani LA, Yuan SLK. Prevalence of fibromyalgia: literature review update. Rev Bras Reumatol Engl Ed. 2017;57(4):356-363.
3. Sarzi-Puttini P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol 2020;16(11):645-660.
4. Di Carlo M, Farah S, Bazzichi L, et al. Fibromyalgia severity according to age categories: results of a cross-sectional study from a large national database. Clin Exp Rheumatol 2022;40(6):1084-1090.
5. Jiao J, Cheng Z, Wang W, Zhao Y, Jiang Q. Demographic Characteristics and Clinical Features of Fibromyalgia in China: A Cross-Sectional Study. Rheumatol Ther 2021;8(2):817-831.
6. Amsterdam D, Buskila D. Etiology and triggers in the development of fibromyalgia. In: Ablin JN, Shoenfeld Y (eds). Fibromyalgia Syndrome. Springer International Publishing, Cham, Switzerland, 2021, pp 17-31.
7. Clauw DJ. From fibrositis to fibromyalgia to nociplastic pain: how rheumatology helped get us here and where do we go from here?. Ann Rheum Dis 2024;83(11):1421-1427.
8. Jones EA, Asaad F, Patel N, Jain E, Abd-Elsayed A. Management of Fibromyalgia: An Update. Biomedicines 2024; 12(6), 1266.

9. Olson JA, Sandra DA, et al. Smartphone addiction is increasing across the world: A meta-analysis of 24 countries. Comput Human Behav 2022;129:107138.
10. Alotaibi MS, Fox M, Coman R, Ratan ZA, Hosseinzadeh H. Smartphone addiction prevalence and its association on academic performance, physical health, and mental well-being among university students in Umm Al-Qura University (UQU), Saudi Arabia. Int J Environ Res Public Health 2022;19(6):3710.
11. De-Sola Gutiérrez J, Rodríguez de Fonseca F, Rubio G. Cell-phone addiction: a review. Front Psychiatry 2016;7:175.
12. Huang Q, Li Y, Huang S, et al. Smartphone Use and Sleep Quality in Chinese College Students: A Preliminary Study. Front Psychiatry 2020;11:352.
13. Lepp A, Barkley JE, Karpinski AC. The relationship between cell phone use, academic performance, anxiety, and satisfaction with life in college students. Comput Hum Behav 2014; 31:343–350.
14. Zirek E, Mustafaoglu R, Yasaci Z, Griffiths MD. A systematic review of musculoskeletal complaints, symptoms, and pathologies related to mobile phone usage. Musculoskelet Sci Pract 2020;49:102196.
15. Ali M, Asim M, Danish SH, Ahmad F, Iqbal A, Hasan SD. Frequency of De Quervain's tenosynovitis and its association with SMS texting. Muscles Ligaments Tendons J 2014; 4(1):74-78.
16. Banadaki, F.D., Rahimian, B., Moraveji, F. et al. The impact of smartphone use duration and posture on the prevalence of hand pain among college students. BMC Musculoskelet Disord. 2024; 25:574.
17. Ahmed S, Akter R, Pokhrel N, Samuel AJ. Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: a cross-sectional survey study. J Public Health (Berl). 2012; 29:411-416.
18. Yaşarer Ö, Mete E, Kaygusuz Benli R, Kılıç BB, Doğan H, Sarı Z. Association between smartphone addiction and myofascial trigger points. BMC Musculoskelet Disord. 2024; 25(1):254.
19. Loftus N, Dobbin N, Crampton JS. The effects of a group exercise and education programme on symptoms and physical fitness in patients with fibromyalgia: a prospective observational cohort study. Disabil Rehabil. 2022; 44(15):3860–3867.
20. Gowans SE, deHueck A, Voss S, Richardson M. A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res. 1999; 12(2):120-128.
21. Bulthuis Y, Drossaers-Bakker KW, Taal E, et al. Arthritis patients show long-term benefits from 3 weeks intensive exercise training directly following hospital discharge. Rheumatology (Oxford). 2007; 46(11):1712–1717.
22. D'Lima D, Lorencatto F, Michie S. The behaviour change wheel approach. In: Nilsen P, Birken SA (eds). Handbook on Implementation Science. Edward Elgar Publishing, Cheltenham, 2020, pp 168-214.
23. Salaffi F, Di Carlo M, Bazzichi L, et al. Definition of fibromyalgia severity: findings from a cross-sectional survey of 2339 Italian patients. Rheumatology (Oxford). 2021; 60(2):728-736.
24. Wolfe F, Clauw DJ, Fitzcharles MA, et al. American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010; 62(5):600-610.
25. Wolfe F, Clauw DJ, Fitzcharles MA, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46(3):319-329.
26. Bennett RM, Friend R., Jones KD, Ward R, Han BK, Ross RL. The Revised Fibromyalgia Impact Questionnaire (FIQR): validation and psychometric properties. Arthritis Res Ther 2009; 11(4):R120.
27. Kwon M, Kim DJ, Cho H, Yang S. The Smartphone Addiction Scale: Development and Validation of a Short Version for Adolescents. PLoS One 2013; 8(12), e83558.
28. Ediz L, Hiz O, Toprak M, Tekeoglu I, Ercan S. The validity and reliability of the Turkish version of the Revised Fibromyalgia Impact Questionnaire. Clin Rheumatol 2011; 30(3):339-346.
29. Akın A, Altundağ Y, Turan ME, Akın U. The validity and reliability of the Turkish version of the smartphone addiction scale-short form for adolescents. Procedia-Social and Behavioral Sciences 2014; 152:74-77.
30. Llàdser AN, Montesó-Curto P, López C, et al. Multidisciplinary rehabilitation treatments for patients with fibromyalgia: a systematic review. Eur J Phys Rehabil Med 2022; 58(1):76-84.
31. Bair MJ, Krebs EE. Fibromyalgia. Ann Intern Med 2020; 172(5):ITC33-ITC48.
32. Tran D. Classifying nomophobia as smartphone addiction disorder. UC Merced Undergrad Res J 2016; 9(1):1–5.
33. Chaput JP, Willumsen J, Bull F, et al. 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years: summary of the evidence. Int J Behav Nutr Phys Act 2020;17(1):141.
34. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54(24):1451–1462.
35. Luk TT, Wang MP, Shen C, et al. Short version of the Smartphone Addiction Scale in Chinese adults: Psychometric properties, sociodemographic, and health behavioral correlates. J Behav Addict 2018; 7(4):1157-1165.
36. Aljomaa SS, Al Qudah MF, Albursan IS, Bakhiet SF, Abduljabbar AS. Smartphone addiction among university students in the light of some variables. Computers in Human Behavior 2016; 61:155–164.
37. García-Ríos MC, Navarro-Ledesma S, Tapia-Haro RM, et al. Effectiveness of health education in patients with fibromyalgia: a systematic review. Eur J Phys Rehabil Med. 2019; 55(2):301-313.
38. Atkins L, Michie S. Designing interventions to change eating behaviours. Proc Nutr Soc 2015; 74(2):164-170.
39. Johnson F, Wardle J. The association between weight loss and engagement with a web-based food and exercise diary in a commercial weight loss programme: a retrospective analysis. Int J Behav Nutr Phys Act 2011; 8:83.
40. Jimoh F, Lund EK, Harvey LJ, et al. Comparing diet and exercise monitoring using smartphone app and paper diary: a two-phase intervention study. JMIR Mhealth Uhealth 2018; 6(1):e17.
41. Blanson Henkemans OA, van der Boog PJ, Lindenberg J, van der Mast CA, Neerincx MA, Zwetsloot-Schonk BJ. An online lifestyle diary with a persuasive computer assistant providing feedback on self-management. Technol Health Care 2009; 17(3):253-67.
42. Lahham A, McDonald CF, Mahal A, Holland AE. Acceptability and validity of a home exercise diary used in home-based pulmonary rehabilitation: a secondary analysis of a randomised controlled trial. Clin Respir J 2018; 12(6):2057-2064.
43. Wilde MH, Garvin S. A concept analysis of self-monitoring. J Adv Nurs 2007; 57(3):339–350.
44. Rooksby J, Asadzadeh P, Rost M, Morrison A, Chalmers M. Personal tracking of screen time on digital devices. In: Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems. ACM, San Jose, CA, 2016, pp 284-296.
45. Jakowski S. Self-tracking via smartphone app: Potential tool for athletes’ recovery self-management? A survey on technology usage and sleep behaviour. Ger J Exerc Sport Res 2022; 52(2):253–61.
46. Collinge W, Yarnold P, Soltysik R. Fibromyalgia symptom reduction by online behavioral self-monitoring, longitudinal single subject analysis and automated delivery of individualized guidance. N Am J Med Sci 2013; 5(9):546-553.
47. Zhang J, Zhang X, Zhang K, Lu X, Yuan G, Yang H, et al. An updated meta-analysis on the relationship between mobile phone addiction and sleep disorder. J Affect Disord 2022; 305:94–101.
48. Sullivan AB, Covington E, Scheman J. Immediate benefits of a brief 10-minute exercise protocol in a chronic pain population: a pilot study. Pain Med 2010; 11(4):524-9.
49. La Rovere MT, Mortara A, Sandrone G, Lombardi F. Autonomic nervous system adaptations to short-term exercise training. Chest 1992; 101(5 Suppl):299S–303S.
50. Rendi M, Szabo A, Szabó T, Velenczei A, Kovács Á. Acute psychological benefits of aerobic exercise: A field study into the effects of exercise characteristics. Psychol Health Med 2008; 13(2):180-184.
51. Dewald-Kaufmann JF, Oort FJ, Meijer AM. The effects of sleep extension and sleep hygiene advice on sleep and depressive symptoms in adolescents: a randomized controlled trial. J Child Psychol Psychiatry 2014; 55(3):273–283.