SMARTPHONE-BASED APPLICATIONS FOR CRANIOVERTEBRAL ANGLE ASSESSMENT IN YOUNG ADULTS: A SYSTEMATIC REVIEW

Abstract

Background: Forward head posture (FHP) has become increasingly prevalent among young adults because of prolonged smartphone use and sedentary lifestyles. Accurate assessment of the craniovertebral angle (CVA) is essential for identifying postural abnormalities and monitoring treatment outcomes. Smartphone-based applications have emerged as accessible and cost-effective alternatives to conventional posture assessment methods; however, their measurement properties and clinical applicability require comprehensive evaluation. Methods: A systematic review was conducted according to the PRISMA 2020 guidelines. Electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and ScienceDirect, were searched for studies published between January 2021 and December 2026.. Electronic databases were searched to identify studies evaluating smartphone based applications for CVA assessment and related postural outcomes. Eligible studies included reliability, validity, cross sectional, randomized controlled, and observational studies involving young adults or individuals with neck pain. Data on study characteristics, methodological quality, measurement properties, and clinical outcomes were extracted and synthesized descriptively. Risk of bias was assessed using standardized quality assessment criteria. Results: Fifteen studies involving 1,954 participants met the inclusion criteria. Craniovertebral angle was the most frequently assessed outcome (80.0%). Eight studies (53.3%) were classified as high quality with a low risk of bias, while seven (46.7%) demonstrated moderate methodological quality. Reliability studies consistently reported excellent intra- and inter-rater reliability (ICC ranging from 0.865 to 0.991), with low SEM and MDC values. Validity studies demonstrated strong agreement with reference measurement methods (ICC up to 0.944; correlation coefficient up to 0.95). Six of seven observational studies reported a significant association between prolonged smartphone use and reduced CVA, indicating increased forward head posture. All intervention studies demonstrated significant improvements in posture, pain, and functional disability following smartphone-assisted rehabilitation. No conflicting evidence was identified across the included studies. Conclusion: Current evidence indicates that smartphone-based applications are reliable, valid, and clinically useful tools for assessing craniovertebral angle and forward head posture in young adults. These applications offer an inexpensive, portable, and practical alternative for clinical practice and research. Nevertheless, additional large-scale, high-quality studies are recommended to further establish diagnostic accuracy, responsiveness, and long-term clinical utility.