Wednesday May 25 2011
The Sun warned today that “kids as young as eight are suffering crippling arthritis-like pain from using consoles and phones.” It said that experts have called for warnings to be shown on gaming boxes.
The news reports are based on a study presented at a conference on rheumatism in London this week. The abstract of that conference report states that the researchers surveyed students aged nine to fifteen from two schools in the US and found that longer duration of play on games devices was associated with greater joint pain.
Limited information was available about the methods and results of this study and until it is fully published in a peer-reviewed journal, the results should be treated cautiously. The available results seem to suggest that the study found that average levels of pain were low, although the average duration of game use was not clear. It is not possible to say from the study whether this pain only started after device usage started, and whether it persisted after usage stopped.
It seems plausible that repetitive use of any joint could potentially result in pain. However, with regards to wrist and finger joint pain this would need to be further investigated in cohort studies that follow children up over time, to confirm that the joint pain was not present before the game or mobile use, or that it worsens over time with increasing use of these devices.
Where did the story come from?
The study was carried out by researchers from Rossman Elementary School in Missouri, New York University, and the University of Medical Sciences. Funding was not reported, but the authors declared that they had no conflicts of interest.
The study is being presented as a talk at the European League Against Rheumatism conference in London this week.
The Sun and The Daily Telegraph covered this study. The title of the Telegraph’s article referred to gaming being related to ‘joint pain’, which is a better reflection of the study than the Sun’s headline, which suggested that the children are getting arthritis.
What kind of research was this?
This was a cross-sectional study looking at wrist and finger joint pain and use of games consoles and mobile phones. It assessed both factors (in this case joint pain and game and mobile use) at the same time. This means that we cannot be sure which factor came first, the pain, or the game and mobile use.
The study indicated a potential link between the two factors that can be further investigated in studies following children up over time. This is to confirm that the joint pain was not present before the game and mobile use, or that it worsened over time with increasing use of these devices.
What did the research involve?
The researchers carried out a survey of game or mobile use in children aged between nine and fifteen in two schools in the US. They then looked at whether those with extensive game and mobile use had greater levels of wrist and finger pain.
Participants completed a questionnaire about their use of game consoles, hand-held devices and mobile phones, and the amount of time they used them. The questionnaire also asked the children to indicate how much pain they had in their wrist or fingers. This was done using a standard method for assessing pain, called a visual analogue scale (VAS).
In a VAS the person is shown a 10cm line where one end of the line signifies no pain, and the other end signifies the worst pain. The person is then asked to mark on the line how severe they think their pain is. It was not clear whether the study asked the children to report their pain specifically when using each device, but the results imply that this was the case.
The researchers compared device usage and pain levels between the two schools, and looked at whether the level of pain differed between different devices.
What were the basic results?
The researchers say that 257 students responded to the survey. Participants at school one were younger than those at school two (11 years versus 13 years). Pupils from school one reported using Gameboys (44%) and Wiis (80%) more than school two (20% and 66% respectively). Those from school two, however, reported more mobile usage (92% compared to 40% in school one). Students at school two who used mobile phones were more likely than those at school one to use text messaging, and to send more text messages a day.
When comparing pain between schools, only finger pain related to iPhone usage differed between schools, with school one reporting more finger pain.
When the researchers looked at all game systems, the highest pain levels were associated with the Xbox, Gameboy and Gameboy Advanced systems. In an analysis that took into account age, gender, school, and duration of game play for each device, the researchers found that the Xbox, Gameboy and Gameboy Advanced were associated with significantly higher levels of pain than the iPhone.
Increasing length of play was also associated with greater likelihood of having pain. The odds of a child reporting pain were twice as high with each additional hour of play (odds ratio 2, 95% confidence interval 1.50 to 2.89).
Pain attributed to mobile phone use was associated with sending text messages, number of texts sent, use of text abbreviations, and type of keyboard. These analyses took into account age, gender and school.
They say that females reported twice as much pain as males (0.37 compared with 0.15; the abstract does not clearly report what these figures represent, but they may represent average pain scores on the pain scale in cm). Gender was the only factor that was independently associated with pain with mobile phone usage, and this association remained even if children with unusually high pain levels (at or above 3cm on the pain line) were removed from the analysis.
How did the researchers interpret the results?
The researchers conclude that, “in this group of young children, longer use of gaming devices was associated with more pain”. They say that girls used mobile phones more than boys.
The researchers say their findings “may have implications for which age children should start playing with gaming consoles, handheld devices and mobile phones and possibly some limits in the hours they play”.
Limited information was available on the methods of this study, as it was reported as an abstract at a conference. Therefore, it is difficult to fully assess its quality. However, there are some points to note:
- Studies presented at conferences do not generally have to go through the same peer review (quality control) process as when they are published in peer-reviewed journals. Sometimes results published in abstract form never reach full publication, or results and analyses may change in the final publication.
- The study assessed joint pain and game and mobile use at the same time. This means we cannot be sure which factor came first: the pain, or the game and mobile use.
- The study did not report the average levels of pain seen with each device, although the results suggested that most children had quite low levels of pain (marking their pain at less than 3cm along the 10cm pain severity line).
- For the analyses looking at the odds of a child experiencing pain with increasing use of the device, the abstract did not report what threshold was used to define having pain (for example, whether it was any score above 0cm on the pain line), or how many children had pain. The threshold should have been selected in advance before carrying out the analysis.
- It is not possible to say that this pain is ‘arthritis-like’ as the nature of the children’s pain had not been assessed. For example, the abstract did not state whether the study assessed if the pain was constant or only occurred when the devices were being used. It is not possible to say whether the pain is lasting or if it lessens if the children reduce their device usage.
- It is not clear what proportion of pupils who were asked to participate in the study agreed to do so. If only a small proportion agreed, they may not be representative of this age group as a whole. For example, it is possible that those with higher levels of game use or those who had experienced joint pain were more likely to participate.
- Although there were gender differences in the level of pain, this may be to do with how boys and girls report pain rather than how severe the pain is.
Overall, the study’s results should be seen as preliminary and interpreted cautiously. It does not seem to suggest that most children using gaming devices and mobile phones have ‘crippling arthritis-like pain’, as the levels of pain seem to be low. It is also not possible to say whether this pain is only felt when using the devices or whether it remains afterwards, and whether there are any long-term effects.
It seems plausible that heavy use of joints in any fashion could potentially lead to pain in these joints. Studies such as this may indicate whether they could be a link between the two factors. However, this would need to be further investigated in cohort studies that follow children up over time to confirm that the joint pain was not present before the game and mobile use, or that it worsens over time with increasing use of these devices.