Methodological concerns in the study of musculoskeletal disorders and stress among smartphone eSports athletes

Dear Editor,

I read with great interest the article “Musculoskeletal Disorders, Perceived Stress, and Ergonomic Risk Factors Among Smartphone eSports Athletes: A Cross-Sectional Study,” which was recently published on June 12, 2024, in the Journal of Musculoskeletal Surgery and Research.^[1] While the study addresses a critical and timely topic, several methodological concerns warrant attention, and I am writing to provide constructive feedback.

First, the authors assert that mobile eSports players predominantly maintain a forward head posture, making them more prone to musculoskeletal issues such as neck stiffness and backache. However, this claim needs appropriate references to support it. It is essential to provide citations from relevant literature to substantiate such statements, as this would strengthen the argument and provide a basis for comparison with existing research.

Moreover, as described by the authors, the sample size calculation utilized Cochran’s formula with a 95% confidence level and an 8% margin of error, resulting in an original sample size of 150. The authors then adjusted this to 158 to account for a 5% anticipated non-response rate. However, there is no mention of previous studies or empirical data used to inform the parameters of this calculation. Justification for the chosen confidence level, margin of error, and expected non-response rate should be based on prior research or pilot studies to ensure the appropriateness and accuracy of the sample size determination.^[2]

The study’s inclusion criteria do not cover athletes who have had any sports injuries in the past six months, which might influence their posture. In addition, it is important to highlight that athletes with skeletal problems, such as scoliosis, are also not included. They should be excluded from the study.

The authors mentioned that they “used a pre-inclusion screening questionnaire to identify individuals who satisfied the inclusion requirements.” However, no information or data are provided about the validation of this questionnaire. Furthermore, it was unclear if the authors excluded some participants; a flowchart is required to clarify this.

Addressing these issues in future research will improve the reliability and validity of findings in this important area of study.