RESEARCH ARTICLE Open Access
Musculoskeletal symptoms and computer use
among Finnish adolescents - pain intensity and
inconvenience to everyday life: a cross-sectional
study
Paula T Hakala
1,2*
, Lea A Saarni
3
, Raija-Leena Punamäki
4,5
, Marjut A Wallenius
4
, Clas-Håkan Nygård
1
and
Arja H Rimpelä
1
Abstract
Background:
Musculoskeletal symptoms among adolescents are related to the time spent using a computer, but
little is known about the seriousness of the symptoms or how much they affect everyday life. The purpose of the
present study was to examine the intensity of musculoskeletal pain and level of inconvenience to everyday life, in
relation to time spent using a computer.
Methods:
In a survey, 436 school children (12 to 13 and 15 to 16 years of age), answered a questionnaire on
musculoskeletal and computer-associated musculoskeletal symptoms in neck-shoulder, low back, head, eyes, hands,
and fingers or wrists. Pain intensity (computer-associated symptoms) and inconvenience to everyday life
(musculoskeletal symptoms) were measured using a visual analogue scale. Based on the frequency and intensity,
three categories were formed to classify pain at each anatomic site: none, mild, and moderate/severe. The
association with time spent using the computer was analyzed by multinomial logistic regression.
Results:
Moderate/severe pain intensity was most often reported in the neck-shoulders (21%); head (20%); and
eyes (14%); and moderate/severe inconvenience to everyday life was most often reported due to head (29%),
neck-shoulders (21%), and low back (16%) pain. Compared with those using the computer less than 3.6 hours/
week, computer use of
≥
14 hours/week, was associated with moderate/severe increase in computer-associated
musculoskeletal pain at all anatomic sites (odds ratio [OR] = 2.9-4.4), and moderate/severe inconvenience to
everyday life due to low back (OR = 2.5) and head (OR = 2.0) pain.
Conclusions:
Musculoskeletal symptoms causing moderate/severe pain and inconvenience to everyday life are
common among adolescent computer users. Daily computer use of 2 hours or more increases the risk for pain at
most anatomic sites.
Background
Information and communication technology (ICT) has
become an important part of the lives of adolescents,
the majority of whom regularly use computers for surf-
ing the Internet, chatting, and playing games. At the
same time, the prevalence of neck-shoulder and low
back pain has increased among adolescents [1]. Studies
among adolescents confirm a connection between
musculoskeletal symptoms and the use of ICT, espe-
cially computers. Headache [2-4], neck-shoulder pain
and low back pain [4-7] are more common among com-
puter users than non-users. The risk of developing mus-
culoskeletal pain increases with an increase in the
amount of time spent on the computer [5]. Moreover,
computer users
’
agree that computer use causes these
symptoms. The findings of seve
ral studies indicate that
computer use induces pain and discomfort not only in
the neck-shoulder and back regions, but also in the
hands, fingers, wrists, eyes, and head [8-11]. Earlier
* Correspondence: paula.t.hakala@uta.fi
1
School of Health Sciences, FIN-33014 University of Tampere, Finland
Full list of author information is available at the end of the article
Hakala
et al
.
BMC Musculoskeletal Disorders
2012,
13
:41
http://www.biomedcentral.com/1471-2474/13/41
©
2012 Hakala et al; licensee BioMed Central Ltd. This is an Open Access
article distributed under the terms of the Creative Commons
Attribution
License (http://creativecommons.org/licenses/by/2.0), which permits
unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
studies focused mainly on examining the relationship
between pain and computer use, but there is no infor-
mation on the seriousness of these symptoms and how
much these symptoms affect the everyday lives of
adolescents.
When assessing children and
adolescents, the visual
analogue scale (VAS) [12] is often used to quantify the
intensity of musculoskeletal
pain [13-17]. Very little is
known, however, about the intensity of pain due to
computer use. Konijnenberg et al. [18] described and
quantified impairment due to chronic pain from an
unknown cause in a study with 149 children (mean age
11.8 years). They reported that children report impaired
functioning in multiple domains of daily life due to
musculoskeletal pain. Roth-Isigkeit et al. [19] investi-
gated the prevalence and characteristics of pain (e.g.
pain intensity) among 735 children and adolescents
(aged 10-18 years). Girls reported pain that was signifi-
cantly more severe than did boys, and half of the sample
reported pain lasting longer than 3 months. Among
young computer users, Breen et al. [20] investigated dis-
comfort and posture while using computers in a small
sample of 68 schoolchildren (mean age 9.5 years), find-
ing that 16% of the children reported pain, mostly in
the neck or back region, at the beginning and end of a
computer session. Pain intensity increased during the
session [20].
In the present study, we aimed to evaluate the inten-
sity of computer-associated musculoskeletal pain and
the level of inconvenience to everyday life caused by
musculoskeletal symptoms a
mong adolescent computer
users.
Methods
Subjects
This study was part of a longitudinal classroom study to
evaluate the association between ICT use, physical and
mental stress, and strain, and development in school-
aged children. The sample size was 689 children from 7
schools in a major city in Finland (5 elementary and 2
middle schools) in 2004. The follow-up survey in 2006
wasperformedinthesameschoolsandclassesasthe
baseline survey. In the present cross-sectional study, 436
respondents participated including 6
th
graders aged 12
to 13 years (n = 164, 37.6%) and 9
th
graders aged 15 to
16 years (n = 272, 62.4%). More than half of the partici-
pants (53.7%) were girls.
Instruments
Computer use was measured based on the response to
the following open question:
“
How many hours per
week do you usually use a computer?
”
The responses
were categorized according to the sample distribution
into three groups as follows: (i) 3.5 hours or less per
week (corresponding
≤
1/2 hour/day, N = 105); (ii) 3.6-
13.99 hours per week (corresponding < 2 hours/day, N
= 164); and (iii) 14 hours or more per week (corre-
sponding
≥
2 hours/day, N = 148). Those who did not
use computers at all (N = 19) were excluded from the
analysis.
The questionnaire included questions about two kinds
of pain: musculoskeletal pain and computer-associated
musculoskeletal pain. The l
atter question assessed the
participants
’
own perception whether computer use had
caused pain to them. Musculoskeletal pain was assessed
with the question:
“
During the past half year, have you
had some of the following symptoms and how often?
”
After the question six symptoms were mentioned (neck-
shoulder, low back, head, eyes, hands, and fingers or
wrists) and for each of them the following alternatives
weregiven:a)seldomornotatall,b)aboutoncea
month, c) about once a week, and d) almost daily. Parti-
cipants were asked to evaluate the level of inconveni-
ence to everyday life due to pain using the VAS [12].
The 100-mm vertical VAS scale was marked at one end
as
“
not inconvenient at all
”
and at the other end as
“
very inconvenient indeed
”
. The level of the inconveni-
ence caused by pain was assessed using the following
question:
“
If you have musculoskeletal symptoms, how
much inconvenience do they cause you in your everyday
life?
”
The respondents were asked to make a mark on
the line to indicate the level of inconvenience at the
pain sites. The means for inconvenience were: head 20.7
mm (range 0-90 mm); neck or shoulders 16.1 (0-91)
mm; low back 12.7 (0-76) mm; eyes 7.6 (0-77) mm; and
hands, fingers and/or wrists 6.7 (0-68) mm.
Computer-associated musculoskeletal pain was
assessed with the question:
“
Using a computer may
cause symptoms (pain, aches, discomfort) in the follow-
ing anatomic locations in the body. Have you experi-
enced such symptoms?
”
The symptoms in neck-
shoulder, low back, head, eyes, hands, and fingers or
wrists, were named with the response alternatives a) not
at all, b) about once a month, c) about once a week, and
d) almost daily. Participants were asked to evaluate the
pain intensity on the VAS-scale by the question:
“
If you
have had computer-associated symptoms, how severe
have they been?
”
, and to make a mark on the line to
indicate the intensity of each symptom. Here the end-
points were
“
no pain at all
”
and
“
very severe pain
”
.The
means of pain intensity were: head 15.3 mm (range 0-99
mm); neck or shoulders 15.1 (0-88) mm; eyes 10.0 (0-
100) mm; low back 10.0 (0-85) mm; and hands, fingers,
and/or wrists 5.3 (0-71) mm.
The VAS scores for pain intensity and level of incon-
venience were each stratified into 4 groups. For pain
intensity, VAS scores less than 5 mm were recorded as
0 (no pain), according to Hunfeld et al., who consider
Hakala
et al
.
BMC Musculoskeletal Disorders
2012,
13
:41
http://www.biomedcentral.com/1471-2474/13/41
Page 2 of 7
only a score of 5 mm or above to indicate the presence
of pain [15,21,22]. For pain intensity and level of incon-
venience symptom groups, scores of 51 mm or more
were considered to indicate severe pain or severe incon-
venience to everyday life; 26 to 50 mm indicated moder-
ate pain or moderate inconvenience to everyday life; and
5 to 25 mm indicated mild pa
in or mild inconvenience
to everyday life, respectively. Because of the small num-
ber of cases with severe pain and severe inconvenience
to everyday life, the categories
“
severe
”
and
“
moderate
”
were combined into one variable
“
moderate/severe pain
”
and
“
moderate/severe inconvenience to everyday life
”
.
New variables were formed by combining groups
according to pain occurrence and pain intensity or level
of inconvenience, as follows:
“
intensity of computer-
associated pain
”
for computer-associated pain and their
VAS categories, and
“
level of inconvenience to everyday
life caused by musculoskeletal pain
”
for musculoskeletal
pain and their VAS categories. These alternative groups
were: a) seldom/no pain, no inconvenience to everyday
life, b) mild pain, mild inconvenience to everyday life,
and c) moderate/severe pain, moderate/severe inconve-
nience to everyday life. Those who reported having no
or rare pain, but who evaluated their pain as mild, were
classified as category b.
Procedure
The Ethics Committee of Pirkanmaa Hospital District
approved the study (Code N
r. R04013). Permission was
also obtained from the school principals. An informa-
tion meeting was held separately at each school for each
participating class, during which the purpose of the
study was explained and an information letter was deliv-
ered both to the schoolchildren and their parents. Writ-
ten consent to participate was obtained from all
children and their parents/guardians. The participants
completed questionnaires during school hours in the
spring 2006, guided by the authors and research
assistants.
Statistical analysis
Data were analyzed using SPSS for Windows, version
15.0. In the multinomial logistic regression model, vari-
ables
“
intensity of computer-associated pain
”
and
“
level
of inconvenience to everyday life caused by musculoske-
letal pain
”
were outcome variables with three different
categories. Time spent on the computer was a predictor
variable, and sex and school grade (aged 12-13 and, 15-
16 years) were considered potential confounders and
treated as covariates. We calculated the odds ratios and
95% confidence intervals, and used P-values to show the
differences between the age and sex groups. The statisti-
cal differences between the groups were tested using the
chi-square test. A p-value of less than 0.05 was consid-
ered statistically significant.
Results
Severe pain intensity and severe inconvenience to every-
daylifewerereportedmostcommonlyforthehead,
neck-shoulders, and eyes, and least commonly for the
hands, fingers, and/or wrists. The prevalence of moder-
ate/severe pain was 20.7% for neck-shoulders, 19.7% for
head, and 13.8% for eyes. The prevalence of moderate/
severe inconvenience to eve
ryday life was 28.3% due to
head pain, 20.7% due to neck-shoulder pain, and 15.4%
due to low back (Table 1). Pain intensity was reported
as follows: girls reported more moderate/severe compu-
ter-associated pain than boys at all anatomic sites,
except the low back, for which the prevalence was
higher among the boys. Pain intensity in the neck-
shoulders (p = 0.0001) and head (p = 0.0001) differed
significantly between the sexes. Pain intensity at all ana-
tomic sites increased with age, except in the eyes, for
which the pain intensity decreased with age. The results
were statistically significant in the neck-shoulders (p =
0.0001) and head (p = 0.0001) within age groups among
both sexes. Level of inconvenience to everyday life was
reported as follows: girls reported more moderate/severe
inconvenience to everyday life caused by musculoskele-
tal pain than boys; head (p = 0.0001), neck-shoulders (p
= 0.0001), and low back (p = 0.034) were the most pre-
valent sites for pain causing moderate/severe inconveni-
ence. The 9
th
grade pupils reported moderate/severe
inconvenience to everyday life more often than the 6
th
graders, and the results were s
tatistically significant for
head (p = 0.011), neck-shoulders (p = 0.0001), and low
back (p = 0.0001) pain (data not shown).
A third (35.4%) of the respondents reported that they
spend 14 or more hours a week using computers. Boys
used computers more often than girls (p = 0.0001); half
of the boys (50%, N = 98) and almost a quarter of the
girls(23%,N=51)usedcomputersfor14hoursor
more per week, which corresponds to 2 hours or more
of daily use. The time spent using computers increased
with age (p = 0.0001) among both sexes.
In the multinomial regression analysis, moderate/
severe computer-associated musculoskeletal pain was
significantly related to all anatomic sites when computer
use was 14 hours or more hours/week. Moderate/severe
pain in the neck-shoulders and head were statistically
significantly related to computer use 3.6 to 13.99 hours/
week. Moderate/severe inconvenience to everyday life
due to musculoskeletal pain in the lower back and head
was significantly related to computer use of 14 or more
hours/week; and head pain was significantly related to
computer use of 3.6 to 13.99 hours/week (Table 2).
Hakala
et al
.
BMC Musculoskeletal Disorders
2012,
13
:41
http://www.biomedcentral.com/1471-2474/13/41
Page 3 of 7
Table 1 Level of inconvenience to everyday life caused by musculoskeletal pain, and intensity of computer-associated
musculoskeletal pain, by sex and grade (%)
Symptoms Boys Girls Total
6
th
grade 9
th
grade 6
th
grade 9
th
grade
(70) (128) (90) (135) (423)
Neck-shoulder
Level of inconvenience to everyday life
Severe 1.4 2.4 5.6 19.3 7.2
Moderate 8.6 12.6 8.9 23.7 13.5
Mild 30.0 25.2 33.3 27.4 29.0
Pain intensity
Severe 4.3 3.1 6.7 15.6 7.4
Moderate 10.0 11.8 10.0 21.5 13.3
Mild 22.9 26.0 33.3 24.4 26.7
Low back
Level of inconvenience to everyday life
Severe 0.0 4.7 1.1 11.1 4.2
Moderate 7.4 13.3 5.7 18.5 11.2
Mild 11.8 23.4 21.6 26.7 20.9
Pain intensity
Severe 2.9 5.5 1.1 5.9 3.9
Moderate 7.1 12.6 5.6 12.6 9.5
Mild 12.9 19.7 23.6 22.2 19.6
Head
Level of inconvenience to everyday life
Severe 5.8 5.5 7.8 25.4 11.1
Moderate 15.9 10.9 14.4 27.6 17.2
Mild 30.4 32.8 34.4 29.1 31.7
Pain intensity
Severe 7.2 3.9 3.4 15.7 7.6
Moderate 7.2 9.4 14.6 17.2 12.1
Mild 17.4 21.9 28.1 22.4 22.5
Eyes
Level of inconvenience to everyday life
Severe 4.3 1.6 4.4 8.9 4.8
Moderate 5.8 8.7 3.3 7.4 6.3
Mild 15.9 18.1 14.4 17.0 16.4
Pain intensity
Severe 5.8 3.9 3.4 5.9 4.8
Moderate 8.7 7.8 11.2 8.1 9.0
Mild 13.0 23.4 25.8 26.7 22.2
Hands, fingers, wrists
Level of inconvenience to everyday life
Severe 0.0 1.6 3.4 6.0 2.8
Moderate 1.5 4.7 1.1 6.7 3.5
Mild 16.4 18.9 19.1 14.9 17.3
Pain intensity
Severe 1.4 1.6 1.1 5.2 2.3
Moderate 2.9 3.1 4.5 7.4 4.5
Mild 18.8 11.0 21.3 14.1 16.3
Hakala
et al
.
BMC Musculoskeletal Disorders
2012,
13
:41
http://www.biomedcentral.com/1471-2474/13/41
Page 4 of 7
Table 2 Odds ratios (OR) and 95% confidence intervals (Cl) for multivariate associations between computer use/week
and level of inconvenience to everyday life caused by musculoskeletal pain, and intensity of computer-associated
musculoskeletal pain.
Symptoms Computer use time/week
< 3.6 hours 3.6 - 13.99 hours
≥
14 hours
n* OR**(95%Cl) n OR (95%Cl) n OR (95%Cl)
Neck or shoulder
Level of inconvenience to everyday life
Severe/moderate 27 1.0 40 1.3 (0.7-2.5) 31 1.1 (0.5-2.2)
Mild 29 1.0 50 1.3 (0.7-2.3) 39 1.1 (0.6-2.1)
Pain intensity
Severe/moderate 17 1.0 42
2.6 (1.3-5.3)
35
2.9 (1.4-6.1)
Mild 26 1.0 44 1.6 (0.9-2.9) 41 1.9 (1.0-3.6)
Low back
Level of inconvenience to everyday life
Severe/moderate 15 1.0 26 1.5 (0.7-3.2) 34
2.5 (1.2-5.5)
Mild 18 1.0 39 1.8 (0.9-3.5) 33
2.1 (1.0-4.3)
Pain intensity
Severe/moderate 9 1.0 19 1.6 (0.7-3.8) 32
3.5 (1.5-8.3)
Mild 14 1.0 37
2.4 (1.2-4.8)
34
3.1 (1.5-6.7)
Head
Level of inconvenience to everyday life
Severe/moderate 26 1.0 55
2.0 (1.0-3.8)
44
2.0 (1.0-4.1)
Mild 37 1.0 50 1.0 (0.6-1.9) 45 1.0 (0.5-1.9)
Pain intensity
Severe/moderate 16 1.0 36
2.4 (1.2-4.8)
34
3.4 (1.6-7.2)
Mild 16 1.0 42
2.6 (1.3-5.0)
37
3.0 (1.5-6.3)
Eyes
Level of inconvenience to everyday life
Severe/moderate 12 1.0 16 1.1 (0.5-2.6) 21 1.9 (0.8-4.5)
Mild 12 1.0 27 1.6 (0.7-3.3) 30
2.2 (1.0-4.8)
Pain intensity
Severe/moderate 11 1.0 22 1.8 (0.8-4.2) 25
3.3 (1.4-7.8)
Mild 16 1.0 38
2.0 (1.0-3.9)
44
3.6 (1.8-7.3)
Hands, fingers or wrists
Level of inconvenience to everyday life
Severe/moderate 7 1.0 10 1.5 (0.5-4.7) 14 2.7 (0.9-8.3)
Mild 15 1.0 31 1.4 (0.7-2.7) 24 1.2 (0.6-2.5)
Pain intensity
Severe/moderate 4 1.0 12 2.3 (0.7-7.3) 15
4.4 (1.3-14.5)
Mild 18 1.0 21 0.9 (0.4-1.8) 27 1.7 (0.8-3.6)
Multinominal logistic regression analysis, adjusted for grade and sex
*n = Number of cases
**The
reference category (no pain/no inconvenience) is indicated by an odds
ratio (OR) of 1.0. Odds ratios are given in bold when they indicate a
statis
tically
significant difference from the odds of the reference category at 95% confidence level (CI).
Hakala
et al
.
BMC Musculoskeletal Disorders
2012,
13
:41
http://www.biomedcentral.com/1471-2474/13/41
Page 5 of 7
Mild pain in the lower back, head, and eyes was signif-
icantly related to computer use of 14 or more hours/
week and 3.6 to 13.99 hours/week. Mild inconvenience
to everyday life was significantly associated with pain in
the low back and eyes when computer use was 14 or
more hours per week (Table 2).
Discussion
The responses to two independent questions indicated that
adolescents experience a low level of musculoskeletal pain
with little effect on everyday life. On the other hand, our
findings indicate that computer use of 14 or more hours/
week (corresponding
≥
2 hours/day) is related to moderate/
severe computer-associated pain at all measured anatomic
sites. Moreover, computer use of 14 or more hours/week
was related to moderate/severe pain in the lower back and
head, which affected the everyday lives of adolescents. Girls
reported greater pain intensity and more inconvenience to
everyday life due to pain at all anatomic sites than boys,
and the prevalence rates increased with age.
To the best of our knowledge, this is the first study to
evaluate pain intensity and level of perceived negative
impact on everyday life related to computer use in ado-
lescents. Our results suggest that computer use of 14 or
more hours/week (estimated
≥
2 hours/day) is related to
severe or moderate pain. Computer use exceeding 2
hours/day is suggested to be a threshold for neck-
shoulder pain [5] neck-shoul
der pain is associated with
1 or more hours/day spent on the computer [11,23].
In our study, the pain intensity was lower than that
reported in some previous studies [18,19,24], but
approximately the same level as in the Finnish follow-up
study by Saarni et al. with
88 participants [17]. Our
results confirm earlier findings, that girls report more
severe pain than do boys [18,19].
In the present study, the intensity of pain and inconveni-
ence to everyday life were measured using the well-docu-
mented visual analogue scale, VAS. The VAS has been
extensively studied and has
shown good acceptability,
responsivity, and validity for most children aged 8 years
and older [25]. Before analysis of the data, pain intensity
categories were defined based on the findings of Collins et
al. [26]. Musculoskeletal s
ymptoms in five anatomical
locations were evaluated by t
wo independent questions.
These anatomical sites had been related to computer use
in previous studies. The first question measured musculos-
keletal symptoms in general with no reference to compu-
ter use. The second one measured musculoskeletal pain
that children themselves attributed to their computer use.
Using two different questions gives a more reliable picture
and a wider perspective to the association between muscu-
loskeletal symptoms and computer use. The questions and
their VAS categories were stated in different sections of
the questionnaire; computer-associated pain was stated in
the ICT-section and musculoskeletal pain in the section
concerning health status.
There are some limitations to the present study. The
convenience sample of the present study does not necessa-
rily represent the entire population of that age, although it
is unlikely that this would influence the studied relation-
ships. Due to the cross-sect
ional design of the study, we
are restricted to investigating the contemporary relations
in our data, and thus causal inferences cannot be made
based on this study alone. As the questions used in the
study measured the respondents
’
perception of the inten-
sity of computer-associated pain, it was a subjective mea-
sure. Thus it was left to the respondents to report whether
these symptoms were due speci
fically to computer use.
Being a questionnaire survey, the rate of occurrence of
computer -associated and musculoskeletal symptoms, the
pain intensity and inconvenience to everyday life were
based on self-reports, and therefore memory bias is possi-
ble and differences between individuals
’
interpretations
cannot be ruled out [27]. Respondents reported the weekly
duration of computer use in response to an open question.
There may be misreporting and overestimation of the
duration of adolescents
’
computer use especially if there
are different procedures to measure computer time [10].
In adults, the use of self-reports can lead to the misclassifi-
cation of computer exposure for more than 80% of
respondents [28]. In a previous study of adults self-
reported duration of computer use but not recorded com-
puter exposure, was positively associated with upper extre-
mity symptoms [29]. A stud
yusingacomputer-based
program showed that the use of a computer mouse pre-
dicted acute neck-shoulder pain, but not chronic neck-
shoulder pain [30]. Overall, based on an overview of sys-
tematic reviews, computer work has been associated with
upper extremity musculoskeletal symptoms, but the causal
relationship between computer work and symptoms
shows a more mixed level of evidence [31]. We also do
not know either if the mechanisms by which computer
use elicits pain differ between adults and adolescents.
Future studies with longitudinal designs are needed to
examine the persistence of m
usculoskeletal symptoms,
with accurate measurements of computer use and to eval-
uate the changes between symptoms and computer use.
Conclusion
The findings of the present study suggest that musculoske-
letal symptoms causing moderate and severe pain as well
as inconvenience to everyday life are common among ado-
lescent computer users. Daily computer use of 2 hours or
more increases the risk at most anatomic sites.
Acknowledgements
We wish to thank Lasse Pere for data management and SciTechEdit
International for revising the language. This study was supported by the
Hakala
et al
.
BMC Musculoskeletal Disorders
2012,
13
:41
http://www.biomedcentral.com/1471-2474/13/41
Page 6 of 7
grant from the Academy of Finland; the Information Society Institute of the
University of Tampere and the Tampere University of Technology; the
Ministry of Social Affairs and Health, Health Promotion Research Programme
of the Academy of Finland; Competitive Research Funding of Pirkanmaa
Hospital District; and the Vaasa University of Applied Sciences.
Author details
1
School of Health Sciences, FIN-33014 University of Tampere, Finland.
2
Tampere University Hospital, PO Box 2000, FIN-33421 Tampere, Finland.
3
Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere,
Finland.
4
School of Humanities and Social Sciences, FIN-33014 University of
Tampere, Finland.
5
Helsinki Collegium for Advanced Studies, FIN-00014
University of Helsinki, Finland.
Authors
’
contributions
AHR, R-LP, MAW, and C-HN initiated and designed the study, and LAS
provided critical input in all phases. PTH and AHR performed the main
analysis, drafted the paper, and coordinated subsequent revisions with the
other authors. All authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 7 August 2011 Accepted: 22 March 2012
Published: 22 March 2012
References
1. Hakala P, Rimpelä A, Salminen JJ, Virtanen SM, Rimpelä M:
Back, neck, and
shoulder pain in Finnish adolescents: national cross sectional surveys.
Br
Med J
2002,
325
:743-745.
2. Alexander LM, Currie C:
Young people
’
s computer use: implications for
health education.
Health Educ
2004,
4
:254-261.
3. Oksanen A, Metsähonkala L, Anttila P, Aromaa M, Jäppilä E, Viander S,
Salminen J, Helenius H, Sillanpää M:
Leisure activities in adolescents with
headache.
Acta Paediatr
2005,
94
:609-615.
4. Torsheim T, Eriksson L, Schnohr CH, Hansen F, Bjarnason T, Välimaa R:
Screen-based activities and physical complaints among adolescents
from the Nordic countries.
BMC Public Health
2010,
10
:324[http://www.
biomedcentral.com/1471-2458/10/324.], Accessed June 9, 2010.
5. Hakala PT, Rimpelä AH, Saarni LA, Salminen JJ:
Frequent computer-related
activities increase the risk of neck-shoulder and low back pain in
adolescents.
Eur J Public Health
2006,
16
:536-541.
6. Zapata AL, Moraes AJP, Leone C, Doria-Filho U, Silva CAA:
Pain and
musculoskeletal pain syndromes related to computer and video game
use in adolescents.
Eur J Pediatr
2006,
165
:408-414.
7. Smith L, Louw Q, Crous L, Grimmer-Somers K:
Prevalence of neck pain
and headaches: impact of computer use and other associative factors.
Cephalalgia
2008,
29
:250-257.
8. Burke A, Peper E:
Cumulative trauma disorder risk for children using
computer products: Results of a pilot investigation with a student
convenience sample.
Public Health Rep
2002,
117
:350-357.
9. Szeto GPY, Lau JCC, Siu AYK, Tang MY, Tang TWY, Yiu AOY:
A study of
physical discomfort associated with computer use in secondary school
student.
Proc CybErg 2002;[http://cyberg.wits.ac.za/].
10. Palm P, Hansson Risberg E, Mortimer M, Palmerud G, Toomingas A,
Wigaeus Tornqvist E:
Computer use, neck and upper-extremity
symptoms, eyestrain and headache among female and male upper
secondary school students.
Scand J Work Environ Health Suppl
2007,
3
:33-41.
11. Hakala PT, Saarni LA, Ketola RL, Rahkola ET, Salminen JJ, Rimpelä AT:
Computer-associated health complaints and sources of ergonomic
instructions in computer-related issues among Finnish adolescents: A
cross-sectional study.
BMC Public Health
2010,
10
:11[http://biomedcentral.
com/1471-2458/10/11], Accessed January 11, 2010.
12. Revill SI, Robinson JO, Rosen M, Hogg MIJ:
The reliability of a linear
analogue for evaluating pain.
Anaesthesia
1976,
31
:1191-1198.
13. Perquin CW, Hazebroek-Kampschreur AAJM, Hunfeld JAM, Bohnen AM, van
Suijlekom-Smith LW, Passchier J, van der Wouden JC:
Pain in children and
adolescents: a common experience.
Pain
2000,
87
:51-58.
14. Bandell-Hoekstra IENG, Huijer Abu-Saad H, Passchier J, Frederics CMA,
Feron FMJ, Knipschild P:
Prevalence and characteristics of headache in
Dutch schoolchildren.
Eur J Pain
2001,
5
:145-153.
15. Hunfeld JAM, Perquin CW, Bertina W, Hazebroek-Kampschreur AAJM, van
Suijlekom-Smit LWA, Koes BW, van der Wouden JC, Passchier J:
Stability of
pain parameters and pain-related quality of life in adolescents with
persistent pain: A three-year follow-up.
Clin J Pain
2002,
18
:99-106.
16. Guite JW, Logan DE, Sherry DD, Rose JB:
Adolescent Self-Perception:
Associations with chronic musculoskeletal pain and functional disability.
J Pain
2007,
8
:379-386.
17. Saarni LA, Rimpelä AH, Nummi TH, Kaukiainen A, Salminen JJ, Nygård C-H:
Do ergonomically designed school workstations decrease
musculoskeletal symptoms in children? A 26-month prospective follow-
up study.
Appl Erg
2009,
40
:491-499.
18. Konijnenberg AY, Uiterwaal CSPM, Kimpen JLL, van der Hoeven J,
Buitelaar JK, de Graeff-Meeder ER:
Children with unexplained chronic pain:
substantial impairment in everyday life.
Arch Dis Child
2005,
90
:680-686.
19. Roth-Isigkeit A, Thyen U, Raspe HH, Stöven H, Schmucker P:
Reports of
pain among German children and adolescents: an epidemiological
study.
Acta Paediatr
2004,
93
:258-263.
20. Breen R, Pyper S, Rusk Y, Dockrell S:
An investigation of children
’
s posture
and discomfort during computer use.
Ergonomics
2007,
50
:1582-1592.
21. Hunfeld JAM, van der Wouden JC, den Deurwaarder ESG, van Suijlekom-
Smit LWA, Hazebroek-Kampschreur AJJM:
Measuring chronic pain in
children, an exploration.
Percept Mot Skills
1997,
84
:1176-1178.
22. Hunfeld JAM, Passchier J, Perquin CW, Hazebroek-Kampschreur AAJM, van
Suijlekom-Smit LWA, van der Wouden JC:
Quality of life in adolescents
with chronic pain in the head or at other locations.
Cephalalgia
2001,
21
:201-206.
23. Smith L, Louw Q, Crous L, Grimmer-Somers K:
Prevalence of neck pain
and headaches: impact of computer use and other associative factors.
Cephalalgia
2008,
29
:250-257.
24. Astfalck RG, O
’
Sullivan PB, Straker LM, Smith AJ:
A detailed characterization
of pain, disability, physical and psychological features of a small group
of adolescents with non-specific chronic low back pain.
Man Ther
2010,
15
:240-247.
25. Stinson JN, Kavanagh T, Yamada J, Gill N, Stevens B:
Systematic review of
the psychometric properties, interpretability and feasibility of self-report
pain intensity measures for use in clinical trials in children and
adolescents.
Pain
2006,
125
:143-157.
26. Collins SL, Moore RA, McQuay HJ:
The visual analogue pain intensity
scale: what is moderate pain in millimeters?
Pain
1997,
72
:95-97.
27. Eich E, Reeves JL, Jaeger B, Graff-Radford SB:
Memory for pain: Relation
between past and present pain intensity.
Pain
1985,
23
:375-379.
28. IJmker S, Leijssen JNM, Blatter BM, van der Beek AJ, van Mechelen W,
Bongers PM:
Test-retest reliability and validity of self-reported duration
of computer use at work.
Scand J Work Environ Health
2008,
34
:113-119.
29. IJmker S, Huysmans MA, van der Beek AJ, Knol DL, van Mechelen W,
Bongers PM, Blatter BM:
Software-recorded and self-reported duration of
computer use in relation to the onset of severe arm-wrist-hand pain
and neck-shoulder pain.
Occup Environ Med
2011,
68
:502-509.
30. Andersen JH, Harhoff M, Grimstrup S, Vilstrup I, Lassen CF, Brandt LP,
Kryger AI, Overgaard E, Hansen KD, Mikkelsen S:
Computer mouse use
predicts acute pain but not prolonged or chronic pain in the neck and
shoulder.
Occup Environ Med
2008,
65
:126-131.
31. Andersen JH, Fallentin N, Thomsen JF, Mikkelsen S:
Risk factors for neck
and upper extremity disorders among computers users and the effect of
interventions: An overview of systematic reviews.
PLoS One
2011,
6(5)
:
e19691.
Pre-publication history
The pre-publication history for this paper can be accessed here:
http://www.biomedcentral.com/1471-2474/13/41/prepub
doi:10.1186/1471-2474-13-41
Cite this article as:
Hakala
et al
.:
Musculoskeletal symptoms and
computer use among Finnish adolescents - pain intensity and
inconvenience to everyday life: a cross-sectional study.
BMC
Musculoskeletal Disorders
2012
13
:41.
Hakala
et al
.
BMC Musculoskeletal Disorders
2012,
13
:41
http://www.biomedcentral.com/1471-2474/13/41
Page 7 of 7