Musculoskeletal disorders in smartphone play to earn gamers: A comparative study

Background Play-to-earn (P2E) games are a growing category of smartphone games that require repetitive tapping and prolonged gaming in poor postures, increasing the risk of musculoskeletal disorders (MSDs). Objective This study aimed to assess the prevalence of MSDs among smartphone P2E gamers and compare it with non-P2E gamers among students and staff at Zanjan University of Medical Sciences. Methods A cross-sectional study was conducted in 2024 on 938 students and staff. Data were collected using a demographic questionnaire and the standardized Nordic Musculoskeletal Questionnaire. Descriptive statistics, independent sample t-tests, and Chi-square tests were used for data analysis. Results The one-year and seven-day prevalence of MSDs among P2E gamers were 80% and 70.3%, respectively, both higher than those observed in non-P2E gamers. The upper back had the highest prevalence of pain, followed by the neck and lower back. The seven-day prevalence of MSDs in the wrists/hands and upper back was significantly higher in P2E gamers. A history of gaming and the frequency of unlocking the smartphone touchscreen were associated with increased MSD prevalence. Conclusion As P2E games may increase the probability of MSDs, developing guidelines for smartphone P2E gamers may help raise awareness and prevent MSDs.