A total of 1,438(73.9%) students initially responded to the study. After applying the exclusion criteria, 937 students remained for data analysis. The participants were from different majors at Guangxi Medical University, with 404 (43.1%) males and 533 (56.9%) females. The age difference between males (20.60 ± 1.98 years) and females (20.69 ± 2.175 years) was not significant (p = 0.212).
Differences between the positive and negative groups
Of the 937 students, 488 had positive Finkelstein’s test results, yielding a positivity rate of 52.1%. No statistically significant differences were observed between students with positive and negative Finkelstein’s test results concerning gender (p = 0.077) and age (p = 0.212) (Table
1).
Table 1
Investigation results of Finkelstein’s test
| n | % | n | % | |
Gender | |
Male | 197 | 40.4 | 207 | 46.1 | 0.077 |
Female | 291 | 59.6 | 242 | 53.9 |
Age | |
< 18 years old | 10 | 2 | 10 | 2.2 | 0.212 |
18<-≤20 years old | 247 | 50.6 | 231 | 51.4 |
21<-≤24 years old | 199 | 40.8 | 162 | 36.1 |
24<-≤26 years old | 28 | 5.7 | 37 | 8.2 |
>26 years old | 4 | 0.8 | 9 | 2.0 |
Usage Times | |
< 2 h/day | 6 | 1.2 | 20 | 4.4 | < 0.001 |
2<-≤4 h/day | 37 | 7.5 | 105 | 23.2 |
4<-≤6 h/day | 146 | 29.7 | 169 | 37.4 |
6<-≤8 h/day | 192 | 39.1 | 105 | 23.2 |
>8 h/day | 107 | 21.8 | 40 | 11.0 |
Average | 6.46 ± 1.86 | 5.13 ± 2.02 h | |
Uses | |
Phone Games | 163 | 16.4 | 54 | 6.4 | < 0.001 |
Social Media1 | 391 | 39.4 | 299 | 35.3 |
Leisure activities2 | 322 | 32.5 | 310 | 36.6 |
Study | 116 | 11.7 | 183 | 21.6 |
Gesture3 |
UTDP | 266 | 37.6 | 255 | 38.9 | < 0.001 |
UT-OA | 63 | 8.9 | 83 | 12.7 |
BT | 232 | 32.8 | 150 | 22.9 |
BT-HS | 86 | 12.2 | 76 | 11.6 |
UI-OA | 60 | 8.5 | 92 | 14.0 |
Screen Size (inch) |
<5.0 | 22 | 4.5 | 42 | 9.3 | 0.02 |
5.0<-≤5.5 | 186 | 38.1 | 149 | 33.2 |
5.5<-≤6.0 | 109 | 22.3 | 126 | 27.9 |
6.0<-≤6.5 | 129 | 26.4 | 92 | 20.4 |
6.5<-≤7.0 | 40 | 8.2 | 34 | |
>7.0 | 2 | 0.5 | 6 | 1.3 |
Symptoms4 |
Yes | 82 | 16.8 | 49 | 10.9 | 0.009 |
No | 406 | 83.2 | 400 | 80.1 |
A total of 26, 142, 315, 297, and 147 students used their smartphones for ≤ 2 h/day, 2-4 h/day, 4-6 h/day, 6-8 h/day, and ≥ 8 h/day, respectively. Finkelstein’s test positivity rates significantly increased with smartphone usage time, from 23.1% for ≤ 2 h/day to 72.8% for ≥ 8 h/day (p < 0.01). Students with positive Finkelstein test results had a mean usage time of 6.46 ± 1.86 h, significantly longer than that of the negative students (5.13 ± 2.02 h, p < 0.001) (Table
1).
Regarding smartphone usage purposes, statistically significant differences were observed between the positive and negative groups (p < 0.001). In the positive group, the most common purposes were phone games (16.4%), social media (39.4%), leisure activities (32.5%), and study (11.7%). In the negative group, the distribution was phone games (6.4%), social media (35.5%), leisure activities (36.6%), and study (21.6%) (Table
1).
Statistically significant differences were also found in smartphone usage gestures between the positive and negative groups (p < 0.001). In the positive group, the most common gestures were Gesture-UTDP (37.6%), Gesture-UT-OA (8.9%), Gesture-BT (32.8%), Gesture-BT-HS (12.2%), and Gesture-UI-OA (8.5%). In the negative group, the distribution was Gesture-UTDP (38.9%), Gesture-UT-OA (12.7%), Gesture-BT (22.9%), Gesture-BT-HS (11.6%), and Gesture-UI-OA (14.0%).
A total of 64, 335, 235, 321, 74, and 8 students used smartphones with screen sizes ≤ 5.0 inches, 5-5.5 inches, 5.5-6 inches, 6-6.5 inches, 6.5-7 inches, and ≥ 7.0 inches, respectively. Finkelstein’s test positivity rates were 34.4%, 55.5%, 46.4%, 58.4%, 54.1%, and 25%, respectively, and were statistically different between the positive and negative groups (p = 0.02).
Furthermore, a significantly higher number of students in the positive group (82 or 16.8%) experienced symptoms before the test in the past 14 days compared to the negative group (49 or 10.9%, p = 0.009) (Table
1).
Associations between smartphone usage behaviors and DQT
Logistic regression analysis of the factors (usage time, purpose of smartphone, gestures, screen size, and symptoms) (Table
2)revealed that usage time (6-8 h/day, p = 0.004, OR = 4.454, 95% CI: 1.662–12.229; ≥8 h/day, p = 0.004, OR = 4.524, 95% CI: 1.596–12.811), the purpose of the smartphone (phone games, p = 0.001, OR = 1.997, 95% CI: 1.312–3.040; social media, p < 0.001, OR = 2.263, 95% CI: 1.795–3.833; leisure activities, p = 0.009, OR = 1.679, 95% CI: 1.140–2.475), gestures (Gesture-BT, p = 0.001, OR = 1.90, 95% CI: 1.281–2.817; Gesture-BT-HS, p = 0.003, OR = 1.872, 95% CI: 1.244–2.818), and screen size (5-5.5 inches, p = 0.022, OR = 2.064, 95% CI: 1.018–3.846; 6-6.5 inches, p = 0.021, OR = 2.413, 95% CI: 1.125–4.083) were statistically significantly associated with increased DQT.
Table 2
Association between gender, ages, uses gestures, screen size activity and symptoms risk of DQT (n = 937)
Usage Times | | | | | |
< 2 h/day | 6 | Ref | | | |
2<-≤4 h/day | 37 | 0.937 | 0.326–2.697 | 0.904 | |
4<-≤6 h/day | 146 | 2.003 | 0.732–5.480 | 0.176 | |
6<-≤8 h/day | 192 | 4.454 | 1.662–12.229 | 0.004 | |
>8 h/day | 107 | 4.521 | 1.596–12.811 | 0.004 | |
Uses | | | | | |
Phone Games | 163 | 1.997 | 1.312–3.040 | 0.001 | |
Social Media | 391 | 2.263 | 1.795–3.833 | < 0.001 | |
Leisure Activities | 322 | 1.679 | 1.140–2.475 | 0.009 | |
Study | 116 | | | | |
Gestures | | | | | |
UTDP | 266 | 1.156 | 0.786–1.702 | 0.461 | |
UT-OA | 63 | 0.892 | 0.559–1.422 | 0.630 | |
BT | 232 | 1.900 | 1.281–2.817 | 0.001 | |
BT-HS | 86 | 1.872 | 1.244–2.818 | 0.003 | |
UI-OA | 60 | 0.835 | 0.536–1.299 | 0.423 | |
Screen Size (inch) | | | | | |
<5.0 | 22 | Ref | | | |
5.0<-≤5.5 | 186 | 2.064 | 1.108–3.846 | 0.022 | |
5.5<-≤6.0 | 109 | 1.591 | 0.840–3.016 | 0.154 | |
6.0<-≤6.5 | 129 | 2.413 | 1.125–4.083 | 0.021 | |
6.5<-≤7.0 | 40 | 1.725 | 0.810–3.673 | 0.158 | |
>7.0 | 2 | 0.766 | 0.126–4.653 | 0.773 | |
Symptoms | 82 | 1.387 | 0.905–2.126 | 0.133 | |
Differences and associations between unilateral and bilateral DQT
Among the students with positive Finkelstein’s test results, 42.21% exhibited bilateral DQT. In terms of gender, 119 (52.7%) bilateral DQT students were male, compared to unilateral DQT students, with a statistically significant difference (p = 0.01). Among the unilateral positive group, 54.4% were aged 18–20 years, compared to 46.5% in the bilateral group (p = 0.026). Gesture-BT (33.6%) and Gesture-BT-HS (23.1%) were more commonly used by the bilateral DQT group than the unilateral group (Gesture-BT: 26.7%, Gesture-BT-HS: 15.0%), with a statistically significant difference (p = 0.04) (Table
3).
Table 3
Investigation results of Unilateral and Bilateral DQT
Gender | |
Male | 89 | 34.1 | 119 | 52.7 | 0.01 |
Female | 172 | 65.9 | 108 | 47.3 |
Age | |
< 18 years old | 3 | 1.1 | 7 | 3.1 | 0.026 |
18<-≤20 years old | 142 | 54.4 | 105 | 46.5 |
21<-≤24 years old | 97 | 37.2 | 102 | 45.1 |
24<-≤26 years old | 20 | 7.3 | 8 | 3.5 |
>26 years old | 1 | | 3 | 1.8 |
Usage Times | |
< 2 h/day | 3 | 1.1 | 3 | 1.3 | 0.143 |
2<-≤4 h/day | 13 | 5.0 | 24 | 10.6 |
4<-≤6 h/day | 76 | 28.7 | 70 | 31.0 |
6<-≤8 h/day | 109 | 41.8 | 83 | 36.7 |
>8 h/day | 41 | 23.4 | 46 | 20.4 |
Uses | |
Phone Games | 66 | 13.3 | 81 | 17.8 | 0.105 |
Social Media | 216 | 43.6 | 174 | 38.2 |
Leisure Activities | 150 | 30.3 | 151 | 33.2 |
Study | 63 | 12.7 | 49 | 10.8 |
Gesture |
UTDP | 161 | 41.4 | 104 | 28.0 | 0.04 |
UT-OA | 35 | 8.9 | 28 | 7.5 |
BT | 104 | 26.7 | 125 | 33.6 |
BT-HS | 58 | 15.0 | 86 | 23.1 |
UI-OA | 31 | 8.0 | 29 | 7.8 |
Screen Size (inch) |
<5.0 | 15 | 5.7 | 7 | 3.1 | 0.09 |
5.0<-≤5.5 | 100 | 38.3 | 86 | 38.1 |
5.5<-≤6.0 | 67 | 25.7 | 42 | 18.6 |
6.0<-≤6.5 | 57 | 21.8 | 72 | 31.4 |
6.5<-≤7.0 | 21 | 8.0 | 19 | 8.4 |
>7.0 | 1 | 0.04 | 1 | 0.4 |
Symptoms |
Yes | 41 | 84.3 | 41 | 81.9 | 0.474 |
No | 220 | 15.7 | 186 | 18.1 |
Logistic regression analysis incorporating factors (gender, age, usage time, purpose of smartphone, gestures, screen size, and symptoms) (Table
4) revealed that Gesture-BT (p = 0.002, OR = 2.221, 95% CI: 1.324–3.375) was statistically significantly associated with increased bilateral DQT.
Table 4
Association between gender, age, gestures, screen size activity, and symptoms risk of Bilateral DQT (n = 488)
Gender | | 1.575 | 1.048–2.366 | 0.029 |
Usage Times | | | | |
< 2 h/day | 3 | Ref | | |
2<-≤4 h/day | 13 | 2.022 | 0.357–11.438 | 0.426 |
4<-≤6 h/day | 76 | 2.204 | 0.955–5.085 | 0.064 |
6<-≤8 h/day | 109 | 1.235 | 0.714–2.133 | 0.450 |
>8 h/day | 41 | 1.029 | 0.619–1.712 | 0.911 |
Uses | | | | |
Phone Games | 66 | 1.395 | 0.768–2.531 | 0.274 |
Social Media | 216 | 0.739 | 0.416–1.314 | 0.303 |
Entertainment- Activities | 150 | 1.335 | 0.782–2.278 | 0.289 |
Gestures | 63 | | | |
UTDP | 161 | 0.704 | 0.417–1.186 | 0.187 |
UT-OA | 35 | 0.982 | 0.494–1.951 | 0.959 |
BT | 104 | 2.221 | 1.324–3.375 | 0.002 |
BT-HS | 58 | 1.632 | 0.978–2.271 | 0.061 |
UI-OA | 31 | 1.518 | 0.776–2.969 | 0.223 |
Screen Size (inch) | | | | |
<5.0 | 15 | Ref | | |
5.0<-≤5.5 | 100 | 0.548 | 0.028–10.853 | 0.693 |
5.5<-≤6.0 | 67 | 0.952 | 0.055–16.425 | 0.973 |
6.0<-≤6.5 | 57 | 0.720 | 0.041–12.567 | 0.822 |
6.5<-≤7.0 | 21 | 1.368 | 0.079–23.705 | 0.830 |
>7.0 | 1 | 0.892 | 0.049–16.216 | 0.938 |
Symptoms | 41 | 1.306 | 0.620–1.731 | 0.894 |