Clinically significant neck pain and tablet tilt angles in real-world educational settings: A nationwide cross-sectional study of university students.

INTRODUCTION: Tablet use has been steadily increasing, particularly among students. However, the long-term effects of tablet tilt on neck pain remain underexplored. PURPOSE: This study examined tablet tilt angles and factors associated with neck pain (Numeric Pain Rating Scale; NRS ≥ 4) among university students. METHODS: A cross-sectional survey was conducted among undergraduate students using a self-administered questionnaire. RESULTS: A total of 328 responses were collected from 17 universities, with 95% being complete. Participants were predominantly female, aged 21 (20,22) years old. The prevalence of tablet-related neck pain (NRS ≥ 4) was 42.17%. Fourth-year students had lower risk (aOR = 0.30, 95% CI: 0.14-0.66), whereas 10° and 60° tablet tilt angles increased the risk (aOR = 3.93, 95% CI: 1.83-8.46; aOR = 2.94, 95% CI: 1.15-7.51) with moderate predictive ability (AUC = 0.69, 95% CI: 0.63-0.75). CONCLUSIONS: Tablet tilt angles of 10° and 60° were associated with increased neck pain. Proper tablet positioning and posture are essential to reduce musculoskeletal strain.