A 2-year prospective longitudinal study on low back pain in primary school children

Differences in walking and running parameters in elementary school students with and without backpacks

BACKGROUND

Backpack syndrome (BS) is a term used to describe symptoms such as shoulder and back pain that are believed to be caused by carrying a backpack. Few studies have investigated the changes in walking and running parameters with and without backpacks.

OBJECTIVE

The present study aimed to investigate the differences in walking and running parameters with and without backpacks in primary school children with and without BS.

METHODS

This cross-sectional study included 51 children (average age 9.3 years, 6- 12 years). Two questions were asked beforehand: whether the respondents had shoulder or back pain when going to school and present; those who answered that they had pain in both cases were defined as the BS group, while the others were the control group. Walking and running at comfortable speeds and walking and running with a 6 kg backpack on their backs were measured.

RESULTS

During walking, there were main effects for speed, cadence, and strike angle with and without the backpack, but no interactions were identified for any of the parameters. In running, however, there were main effects for speed, stride length, strike angle, and lift-off angle, and an interaction effect was observed for speed and stride length.

CONCLUSIONS

During walking, carrying a 6 kg backpack increased cadence and walking speed. During running, carrying a backpack caused a decrease in stride length and running speed in the BS group, whereas there was no change in the control group, suggesting that the control and BS groups may respond differently.

The burden of low back pain in children and adolescents with overweight and obesity: from pathophysiology to prevention and treatment strategies

Nonspecific low back pain (LBP) is one of the most common causes of disability, affecting all individuals at least once in their lifetime. Such a condition is also becoming increasingly frequent in the pediatric population, especially in children and adolescents with overweight/obesity. Furthermore, new-onset LBP during adolescence has been demonstrated to be a strong predictor of developing LBP later in life, contributing to poorer outcomes and increasing social and medical costs. Several causes and different mechanisms have been considered for the development of LBP in pediatric individuals affected by obesity. For this reason, planning adequate prevention and treatment strategies, mainly through conservative lifestyle changes, would be crucial to anticipate the negative consequences of persisting LBP in adulthood. The aim of this narrative review was to characterize the relationship between LBP and overweight/obesity in the pediatric population, highlighting epidemiological and pathophysiological aspects. In addition, prevention and treatment approaches will be reviewed considering the need to reduce the burden of LBP on this population. According to our search, LBP was more frequent in children and adolescents with overweight and obesity and has been associated with several anthropometric and lifestyle factors, including lumbar hyperlordosis, sedentary habits, physical inactivity, carrying a heavy schoolbag, low vitamin D levels, psychosocial ill-being, and premature intervertebral disc degeneration. Most of these conditions may be addressed with conservative strategies mainly consisting of dietary adjustments, physical exercise, education programs, and physical therapy.

Thoracic Spine Pain in High School Adolescents: A One-Year Longitudinal Study

Thoracic spine pain (TSP) is a common condition in the general adult population, with a similar prevalence in children and adolescents. An in-depth understanding of risk factors can assist in the identification of potential targets for effective prevention strategies. This study aimed to determine the incidence of TSP and ongoing TSP and identify its predictors in high school students. This longitudinal study was conducted in 2017 (baseline-T1), and follow-up surveys were completed in 2018 (T2). The variable "thoracic spine pain" was observed using the Nordic questionnaire, and associated variables were observed through the Baecke questionnaire and the Strengths and Difficulties Questionnaire. Statistical association methods were used for bivariate and multivariate logistic regression analysis. Among the participants, the one-year prevalence (ongoing TSP) was 38.4%, and the one-year incidence (new TSP) was 10.1%. Significant risk factors for ongoing TSP were adolescent females (RR = 2.14), in the age group of 15 to 18 years (RR = 1.41), clinical mental health problems (RR = 3.07), borderline mental health problems (RR = 2.02), mental health problems, sitting while using a tablet (RR = 1.93), distance of the eye from cell phone screen of or more than 20 cm (RR = 1.69), distance of the eye from the PC screen of or more than 30 cm (RR = 1.53), cell phone mobile use duration of or more than 3 h (RR = 1.60), tablet use time of or more than 3 h (RR = 2.08), and semi-lying prone position while using the cell phone (RR= 1.47), and these were also significant predictors of TSP episodes. Significant risk factors for new TSP were adolescent female sex (RR = 1.88), level, clinical mental health problems (RR = 4.26), borderline mental health problems (RR = 2.07), semi-lying prone position while using cell phone (RR = 1.71) or tablet (RR = 2.31), and mobile phone use duration equal to or greater than 3 h (RR = 1.72). We conclude that there is a high prevalence of TSP in high school students, which is associated with the female sex, mental health problems, and use of electronic devices for an inappropriate duration in an improper position.

A Comparison between Different Types and Frequency of Physiotherapy Treatment for Children and Adolescents with Postural Problems and Low Back Pain

AIM

To examine the effect of a once-a-week group physiotherapy session in addition to a once-a-month individual physiotherapy treatment, in comparison to a monthly individual physiotherapy treatment.

METHODS

Fifty children and adolescents aged 10-18 years with poor back posture, some of whom had LBP, met individually with a physiotherapist once a month. The intervention group received an additional once-a-week group physiotherapy session for 12 weeks. Thorax curve angle, postural behavior, and low back pain (LBP) were measured before and after intervention.

RESULTS

The thorax curve angle decreased from 39.2 ± 9.3 to 28.2 ± 6.8 (p < 0.001) in the group + individual therapy group and from 38.9 ± 9.3 to 27.9 ± 7.8 in the individual therapy only group (p < 0.001). LBP decreased from 5.6 ± 2.2 to 1.6 ± 1.9 (p < 0.001) and from 5.5 ± 2.1 to 2.8 ± 2.0 (p < 0.001). A significantly greater improvement in postural behavior was found in the group + individual therapy group (p = 0.04). Moreover, attrition rates were lower in the experimental group.

CONCLUSION

A lower-frequency individual physiotherapy treatment for 12 weeks proved as beneficial as the same program with an additional higher-frequency group physiotherapy in improving thorax curve angle and LBP. However, the higher-frequency group physiotherapy in addition to the lower-frequency individual treatment was significantly more effective in improving postural behavior and adherence to treatment.

Incidence and factors associated with low back pain in adolescents: A prospective study

BACKGROUND

Low back pain (LBP) is a common complaint among children and adolescents and can negatively impact their physical and mental health. Although previous studies investigating the incidence of low back pain (LBP) in children and adolescents have been performed in high income countries, it is unclear whether countries such as Brazil would show similar incidence rates.

OBJECTIVE

To determine the incidence and to identify predictors of new episodes of LBP in high school students.

METHODS

This is a 1-year longitudinal study of high school students from public schools in the city of Bauru, Sao Paulo. Collected clinical data were: demographic and socioeconomic factors, information on the use of electronic devices, mental health status (the Strengths and Difficulties Questionnaires), level of habitual physical activity (Baecke Physical Activity Questionnaire), and incidence of LBP (measured with question about LBP in the past 12 months and the Nordic Musculoskeletal Questionnaire). Descriptive analysis and bivariate and multivariate logistic regressions were performed.

RESULTS

The cumulative incidence of new LBP episodes for the total cohort of 757 high school students was 18.9% (95% CI: 16.2, 21.8). The cumulative incidence was 14.8% (95% CI: 11.7, 18.5) for male students and 24.1% (95% CI: 19.8, 29.9) for female students. Being a female student (OR = 1.78; 95% CI: 1.23, 2.59), sitting posture while using tablet (OR = 4.34; 95% CI: 1.19, 16.60), daily time spent on tablet (OR = 3.21; 95% CI: 1.41, 7.30), daily time spent on mobile phone (OR =1.49; 95% CI: 1.11, 2.00), lying posture while using mobile phone (OR = 1.49; 95% CI: 1.05, 2.12), and mental health status (OR = 2.81; 95% CI: 1.76, 4.48) were identified as predictor variables.

CONCLUSION

Our findings showed that one in five high school students reported having a LBP episode over the last year. The predictors found to be associated with low back pain include those related to sex, time and posture while using electronic devices, and mental health status.

Non-specific low back pain: cross-sectional study of 11,423 children and youth and the association with the perception of heaviness in carrying of schoolbags

Background

Carrying a schoolbag is a daily activity for most children and adolescents.The perception of a schoolbag’s weight depends upon the individual and is a relevant theme in schoolchildren. Describing the association between the perception of heaviness in carrying a schoolbag and NLBP can facilitate the planning of preventive programs, quite different from those based on specific weight limits for schoolbags in children and youth.

Objective

To determine the prevalence of non-specific low back pain (NLBP) and to analyse the association between the perception of heaviness in carrying of schoolbags and NLBP in Polish children and youth aged 10–19.

Methods

This study included 11,423 children and youth (6,252 girls and 5,171 boys) from Poland. An original questionnaire was used to assess NLBP prevalence.

Results

Among 11,423 of the respondents, 41.5% of the respondents admitted that they had experienced NLBP in the period of the last 12 months. The percentage of individuals reporting NLBP increased with age of participants, p < 0.001. Girls reported NLBP more often than boys (p < 0.001). Students with NLBP declared that their school backpack was heavy more often than students without LBP. Students who thought that their backpacks weighed too much manifested a 1.44 (95% Cl [1.33–1.55]) times higher probability to experience NLBP.

Conclusion

In the examined group of schoolchildren a frequent occurrence of NLBP (41.5%) was noted. Its occurrence was related to female sex and age. Students who thought that their backpacks weighed too much manifested higher probability to develop NLBP.

Family history of pain and risk of musculoskeletal pain in children and adolescents: a systematic review and meta-analysis

Emerging evidence suggests that musculoskeletal (MSK) pain should be viewed from a biopsychosocial perspective and consider the influence of family factors. We conducted a review with meta-analysis to provide summary estimates of effect of family history of pain on childhood MSK pain and explore whether specific family pain factors influence the strength of the association (PROSPERO CRD42018090130). Included studies reported associations between family history of pain and nonspecific MSK pain in children (age <19 years). The outcome of interest was MSK pain in children. We assessed the methodological quality using a modified version of the Quality in Prognosis Studies instrument and quality of evidence for the main analyses using the GRADE criteria. After screening of 7281 titles, 6 longitudinal and 23 cross-sectional studies were included. Moderate quality evidence from 5 longitudinal studies (n = 42,131) showed that children with a family history of MSK pain had 58% increased odds of experiencing MSK pain themselves (odds ratio [OR] 1.58, 95% confidence interval 1.20-2.09). Moderate quality evidence from 18 cross-sectional studies (n = 17,274) supported this finding (OR 2.02, 95% 1.69-2.42). Subgroup analyses showed that the relationship was robust regardless of whether a child's mother, father, or sibling experienced pain. Odds were higher when both parents reported pain compared with one ([mother OR = 1.61; father OR = 1.59]; both parents OR = 2.0). Our findings show moderate quality evidence that children with a family history of pain are at higher risk of experiencing MSK pain. Understanding the mechanism by which this occurs would inform prevention and treatment efforts.

Potential risk factors and triggers for back pain in children and young adults. A scoping review, part II: unclear or mixed types of back pain

Background

Back pain is a global problem in terms of disability and financially, with a large burden both to the individual and to society. Back pain was previously believed to be uncommon in children. However, there is a growing body of evidence that this is not the case.

Objective

Part I of this scoping review studied risk factors of incident and episodic back pain. In this part II we aimed to identify all risk factors and triggers with unclear or mixed type back pain in young people and to identify any gaps in the literature.

Methods

A scoping review design was selected to summarise the evidence, as there are many studies on "risk factors" for back pain. The scoping review followed the PRISMSA-ScR guidelines. We considered all studies that tested potential risk factors and triggers for thoracic and/or lumbar spine pain, in children, adolescents, and young adults (≤ 24 years). PubMed and Cochrane databases were searched from inception to September 2018, to identify relevant English language articles. The results regarding potential risk factors were separated into temporal precursors and bidirectional risk factors and the studies were classified by study design.

Results

Our comprehensive search strategy identified 7356 articles, of which 83 articles were considered eligible for this review (part II). There were 53 cross-sectional studies and 30 cohort studies. Potential risk factors for back pain were: female sex, older age, later pubertal status, positive family history of back pain, increased growth, and a history of back pain, most of which are temporal precursor variables. There was limited research for the illness factors, spinal posture, and muscle endurance in the development of back pain.

Conclusion

Many of the included studies approached risk factors in similar ways and found factors that were associated with back pain but were not obvious risk factors as causality was uncertain. Future research should be more rigorous and innovative in the way that risk factors are considered. This could be through statistical approaches including cumulative exposures, or longitudinal approaches including multi-trajectory methods. Additionally, data on proposed risk factors should be collected before the onset of back pain.

Back pain and its risk factors in Brazilian adolescents: a longitudinal study

Owing to the lack of longitudinal studies in Latin American countries, we aimed to evaluate back pain and its risk factors in a 3-year longitudinal study of Brazilian adolescents. We analysed data of 525 adolescents (aged 11-16 years) attending primary school (fifth to eighth grade) in Brazil. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire in 2011 and at a follow-up evaluation that was conducted 3 years later (2014). Back pain was the outcome variable; the exposure variables included exercise, behavioural, hereditary and postural factors. Generalized estimating equations were used to perform a Poisson regression model with robust variance to evaluate the risk factors for back pain. The prevalence of back pain at baseline was 56% (n = 294); this increased significantly at the 3-year follow-up evaluation to 65.9% (n = 346). The frequency of experiencing back pain also significantly increased after 3 years in both boys (p = 0.002) and girls (p = 0.001). The prevalence of back pain increased significantly in adolescents up to the age of 13 years, stabilized in those aged 14 years and older and was higher among girls. A family history of back pain (in the parents), watching television for lengthy periods and carrying a backpack asymmetrically were predictors for back pain.

Gender differences in the prevalence of low back pain associated with sports activities in children and adolescents: a six-year annual survey of a birth cohort in Niigata City, Japan

BACKGROUND

This study was conducted to determine gender differences in the relationship between extracurricular sports activities (ECSA) and low back pain (LBP) in children and adolescents.

METHODS

In a cohort analysis of a 6-year birth cohort annual survey, students were followed from the fourth to sixth grades of elementary school (E4-E6; 9-12 years old) through the first to third grades of junior high school (J1-J3; 12-15 years old). All students completed annual questionnaires on ECSA and LBP. The odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the association strength between ECSA and LBP. We also calculated the population attributable fraction (PAF), which was defined as the proportion of students with ECSA-related LBP among all students with LBP.

RESULTS

ECSA was significantly associated with LBP only in grade J3 among boys (OR: 2.00, 95% CI: 1.47-2.71). On the other hand, among girls, ECSA was significantly associated with LBP in grades E5 (OR: 1.48, 95% CI: 1.00-2.20), E6 (OR: 1.91, 95% CI: 1.33-2.75), and J3 (OR: 1.81, 95% CI: 1.26-2.61). Among boys, PAF was similar in all grades (range, 10-16%), whereas among girls, the PAF varied (- 11 to 29%) and was significantly higher in girls than in boys in grades E5 (19.0% vs. 1.1%, P < 0.01) and E6 (28.8% vs. 12.8%, P < 0.01).

CONCLUSIONS

Although there was a link between ECSA and LBP in both boys and girls, girls were more susceptible to ECSA-related LBP, especially in grades E5 and E6.

Risk Factors for Low Back Pain in Childhood and Adolescence: A Systematic Review

OBJECTIVES

To identify factors associated with low back pain (LBP) in children and adolescents.

MATERIALS AND METHODS

A systematic review was conducted (Prospero CRD42016038186). Observational studies analyzing LBP risk factors among participants aged between 9 and 16 were searched for in 13 electronic databases and 8 specialized journals until March 31, 2016, with no language restrictions. In addition, references in the identified studies were manually tracked. All identified studies that included ≥50 participants aged 9 to 16, were reviewed. Their methodological quality was assessed by 2 reviewers separately, using validated tools, which scored, from worst to best, 0 to 100 for cross-sectional and 0 to 12 for cohort studies. A sensitivity analysis only included studies that had adjusted for confounders, had ≥500 participants, and had a methodological score of ≥50%.

RESULTS

A total of 5142 citations were screened and 61 studies, including 137,877 participants from 5 continents, were reviewed. Their mean (range) methodological scores were 74.56 (50 to 100) for cross-sectional studies and 7.36 (5 to 9) for cohort studies. The studies had assessed 35 demographic, clinical, biological, family, psychological, ergonomic, and lifestyle risk factors. The mean (range) prevalence of LBP ranged between 15.25% (3.20 to 57.00) for point prevalence and 38.98% (11.60 to 85.56) for lifetime prevalence. Results on the association between LBP and risk factors were inconsistent. In the sensitivity analysis, "older age" and "participation in competitive sports" showed a consistent association with LBP.

DISCUSSION

Future studies should focus on muscle characteristics, the relationship between body and backpack weights, duration of carrying the backpack, characteristics of sport practice, and which are the factors associated with specifically chronic pain.

The natural course of low back pain from childhood to young adulthood - a systematic review

Background

Taking the natural course of recurrent and fluctuating low back pain (LBP) seen in longitudinal studies of adults into consideration, the aetiology and development of LBP in children and adolescents also needs to be reflected in a long-term course. Therefore, a systematic critical literature review was undertaken to assess the natural course of LBP in the general population from childhood through adolescence to young adulthood.

Methods

A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL and PsycINFO with synonyms of search terms for 1) low back pain; 2) natural course; 3) cohort study and 4) children. Records in English, German, French, Danish, Swedish, and Norwegian were included. To assess the methodological quality of the studies, the NIH quality assessment checklist for cohort studies was adapted and risk of bias was assessed on a study level. Two authors independently reviewed selected studies, assessed quality, and extracted data. A synthesis of results in relation to the natural course of LBP was created.

Results

Totally, 3373 records were identified, eight articles were included for quality assessment, and finally, four studies of good to fair quality were included for synthesis of results. Indication of three common patterns of LBP were identified across studies and labelled as 1) ´children and adolescents with no LBP or low probability of LBP´ (49 to 53%), 2) ´children and adolescents with fluctuation of LBP´ (16 to 37%) and 3) ´children and adolescents with repeated reporting of LBP´ (< 1 to 10%).

Conclusion

Although methodological heterogeneity, mainly due to different age ranges, an indication of a natural course of LBP was seen across studies. The majority of children and adolescents repeatedly reporting no or low probability of LBP. With recall periods between one week to three months and sampling rates ranging from one to four years, a very low rate repeatedly reported LBP, and approximately one-fifth to one-third of children and adolescents had fluctuating reports of LBP. A need of future research of LBP trajectories with short reporting period lengths and narrower sampling windows in a long-term perspective is emphasized in order to study childhood influences on the development of LBP throughout life.

Prevalence of low Back pain among adolescents in relation to the weight of school bags

BACKGROUND

The association between the weight of school bag and Low Back Pain (LBP) amongst students remains under intense debate worldwide. This study aimed to estimate the prevalence of LBP amongst public high school students (14 to 19 years) in Kuwait and to investigate the association between LBP and the weight of school bags.

METHODS

An analytical cross-sectional study using multistage cluster random sampling with probability proportional to size was conducted on a total of 950 public high school students from all governorates. Data on LBP were collected through face-to-face interviews using a structured questionnaire. A 0-10 Numeric Pain Rating Scale was used to rate the intensity of LBP. The students' height and weight in addition to the weight of their school bags were measured using appropriate weight and height scales. Logistic regression was used to investigate the association between the weight of school bags and LBP while adjusting for potential confounders.

RESULTS

The estimated lifetime, 6-month, and 1-month prevalence of LBP were 70.3% (95% CI: 67.30-73.21%), 49.1% (95% CI: 45.83-52.28%), and 30.8% (95% CI: 27.81-33.78%) respectively, with significantly higher prevalence amongst females compared to males (p < 0.001). The absolute weight of school bag was not significantly associated with LBP neither in univariable nor multivariable analysis. The relative weight of school bag (as a percentage of the body weight) was significantly associated with LBP in univariable analysis but not in multivariable analysis. The perceived heaviness of school bag, however, was found to be significantly associated with LBP throughout the analysis (p < 0.001).

CONCLUSION

In conclusion, LBP amongst high school students in Kuwait seems to be very common with a prevalence resembling that of high-income countries. Our data suggest that the perceived heaviness of school bag is far more important than the actual bag weight. Current recommendations about the weight of school bags, which are not supported by evidence, should be revised to take into account the students' perceived heaviness of school bag.

Do schoolbags cause back pain in children and adolescents? A systematic review

OBJECTIVE

To investigate whether characteristics of schoolbag use are risk factors for back pain in children and adolescents.

DATA SOURCES

Electronic searches of MEDLINE, EMBASE and CINAHL databases up to April 2016.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Prospective cohort studies, cross-sectional and randomised controlled trials conducted with children or adolescents. The primary outcome was an episode of back pain and the secondary outcomes were an episode of care seeking and school absence due to back pain. We weighted evidence from longitudinal studies above that from cross-sectional. The risk of bias of the longitudinal studies was assessed by a modified version of the Quality in Prognosis Studies tool.

RESULTS

We included 69 studies (n=72 627), of which five were prospective longitudinal and 64 cross-sectional or retrospective. We found evidence from five prospective studies that schoolbag characteristics such as weight, design and carriage method do not increase the risk of developing back pain in children and adolescents. The included studies were at moderate to high risk of bias. Evidence from cross-sectional studies aligned with that from longitudinal studies (ie, there was no consistent pattern of association between schoolbag use or type and back pain). We were unable to pool results due to different variables and inconsistent results.

SUMMARY/CONCLUSION

There is no convincing evidence that aspects of schoolbag use increase the risk of back pain in children and adolescents.

Are Sleep Problems a Risk Factor for the Onset of Musculoskeletal Pain in Children and Adolescents? A Systematic Review

Study Objectives

Musculoskeletal pain is a major burden on the society. Adults with sleep problems are at higher risk of musculoskeletal pain onset, but there is no evidence for this relationship in children and adolescents. This study aimed to systematically review prospective studies on the risk of musculoskeletal pain onset in children and adolescents with sleep problems.

Methods

Five databases (MEDLINE, PsycINFO, AMED, EMBASE, and HMIC) were systematically searched to identify prospective studies that investigated if children and adolescents (aged 6-19 years) with sleep problems are at higher risk of musculoskeletal pain onset. Included studies were assessed for study quality and a best evidence synthesis was carried out on extracted data.

Results

Thirteen prospective studies were identified. Overall, evidence indicates that sleep problems (quality, quantity, and day time tiredness) are not risk factors for musculoskeletal pain onset. Further analysis on specific body regions shows strong evidence that sleep problems are a risk factor for neck pain onset (only in girls) and that sleep problems are not a risk factor for the onset of widespread pain.

Conclusions

Overall, sleep problems are not a risk factor for musculoskeletal pain onset in children and adolescents. Increased risk was found for some specific body regions and subgroups, but the evidence base was less strong and generally inconsistent. This review found a lack of quality in research methodology compared to research in adults, and further research with improved methodology is required.

Low Back Pain With Impact at 17 Years of Age Is Predicted by Early Adolescent Risk Factors From Multiple Domains: Analysis of the Western Australian Pregnancy Cohort (Raine) Study

Study Design Prospective cohort study of the Western Australian Pregnancy Cohort (Raine) Study. Background Low back pain (LBP) commonly develops in adolescence and is a significant risk factor for adult LBP. A broad range of factors have been associated with the development of adolescent LBP, but prior literature has limitations related to characterization of LBP and the scope of risk factors considered. Objective This study aimed to identify potential factors contributing to the development of LBP, with and without impact, at 17 years of age, utilizing a broad range of exposures at 14 years of age. Methods Data from 1088 participants (52.1% female) with "no LBP," "LBP with minimal impact," and "LBP with impact" at 17 years of age and a range of measures from multiple domains, including spinal pain, physical, psychological, social, and lifestyle, at 14 years of age were collected for the study. Multivariable multinomial logistic regression was used to estimate the association of potential mechanistic factors at 14 years of age with LBP at 17 years of age. Results Female sex and back pain at 14 years of age were strongly associated with LBP at 17 years of age. Potential mechanistic factors for LBP outcomes at 17 years of age included exposures from the pain (neck/shoulder pain) and physical domains (standing posture subgroup membership, back muscle endurance, throwing distance), psychological domain (somatic complaints, aggressive behavior), social domain (socioeconomic area), and lifestyle domain (exercise out of school). Conclusion The findings support the multidimensional nature of adolescent LBP and highlight the challenge this presents for epidemiological research, clinical practice, and prevention initiatives in the general population. Level of Evidence Prognosis, level 1b. J Orthop Sports Phys Ther 2017;47(10):752-762. doi:10.2519/jospt.2017.7464.

Spinal pain and co-occurrence with stress and general well-being among young adolescents: a study within the Danish National Birth Cohort

This study aims to describe the patterns in low back, mid back, and neck pain complaints in young adolescents from the Danish National Birth Cohort (DNBC) and to investigate the co-occurrence of spinal pain and stress and general well-being, respectively. Cross-sectional data from the 11-year follow-up of DNBC were used. As part of a web-based survey, a total of 45,371 young adolescents between 10 and 14 years old completed the Young Spine Questionnaire, the Stress in Children Questionnaire, and a one-item question on general well-being. Associations between spinal pain and, respectively, stress and general well-being were estimated by means of multiple logistic regression models. Almost one fifth of boys and one quarter of girls reported spinal pain. Compared with adolescents who reported no stress, adolescents reporting medium and high values of stress had odds ratios (OR) of 2.19 (95% CI 2.08-2.30) and 4.73 (95% CI 4.28-5.23), respectively, of reporting spinal pain (adjusted for age, gender, and maternal education). Adolescents who reported poor general well-being had an OR of 2.50 (95% CI 2.31-2.72) for reporting spinal pain compared to adolescents with good general well-being.

CONCLUSION

Spinal pain is a common complaint among young adolescents and co-occurs with stress and poor general well-being. The mutual dependency between the factors remained to be explained. What is Known: • The prevalence of spinal pain increases rapidly during childhood and adolescence, but different measurement instruments result in great variation in the estimates of spinal pain in children and adolescents. • Some studies have shown that different psychosocial measures are associated with spinal pain in children and adolescents. What is New: • Spinal pain, as measured by the newly developed and validated Young Spine Questionnaire, is a common complaint in young adolescents aged 10-14 years. • Spinal pain in young adolescents co-occurs with stress and poor general well-being.

Predicting the occurrence of headache and back pain in young adults by biopsychological characteristics assessed at childhood or adolescence

The aim of the current study was to identify predictors of recurrent headache and back pain in young adults (aged 18–27 years) from data assessed in childhood or adolescence, i.e., 9 years before the final survey. Our interest was whether psychological characteristics contribute to the risk of pain prevalence in adult age when controlling for already empirically supported risk factors such as parental pain, pediatric pain and sex. The study was part of a five-wave epidemiological investigation of >5000 families with children aged between 7 and 14 years when addressed first. In a multiple hierarchical regression analysis, the abovementioned three variables (Block-I variables) were entered first followed by five psychological trait variables (Block-II variables: internalizing, anxiety sensitivity, somatosensory amplification, catastrophizing and dysfunctional stress coping) to find out the extent of model improvement. The multivariable hierarchical regression analysis confirmed the hypothesis that the Block-I variables significantly enhance the risk of future pain at young adult age. None of the psychological variables did so. Thus, the hypothesis of a significant surplus predictive effect was not confirmed. The amount of total explained variance differed strongly between headache and back pain. In particular, a valid prediction of back pain was not possible. When analyzed separately in simple regression analysis, psychological variables turned out to be significant predictors, however, of very low effect size. The inclusion of Block-I variables in the model clearly reduced the impact of the psychological variables. This risk profile is discussed in the context of the different trajectories of headache and back pain from childhood to adult age, which were proposed by various studies. We propose that a biopsychological characteristic denoted as emotional negativity, especially regarding self-reference, might be a common factor behind all selected variables. Risk research in recurrent pain is a field where much more multidisciplinary research is needed before progress can be expected.

Content validity and test-retest reliability of a low back pain questionnaire in Zimbabwean adolescents

BACKGROUND

In Zimbabwe, a recent increase in the volume of research on recurrent non-specific low back pain (NSLBP) has revealed that adolescents are commonly affected. This is alarming to health professionals and parents and calls for serious primary preventative strategies to be developed and implemented forthwith. Early identification initiatives should be prioritised in order to curtail the condition and its progression. In an attempt to be proactive in minimising the prevalence of recurrent NSLBP, this study was conducted to evaluate the content validity and test-retest reliability of a survey questionnaire with the aim of proffering a valid and reliable questionnaire which can be used in non-clinical settings to identify adolescents with recurrent NSLBP in Harare, Zimbabwe and determine the possible factors associated with the condition.

METHODS

The study was conducted in two parts. The first part assessed content validity of the questionnaire using four experts derived from academia and clinical practice. The second part evaluated the reliability of the questionnaire among 125 high school-children aged between 13 and 19 years in a test-retest study.

RESULTS

Twenty-six (26) out of thirty questions in the questionnaire had an Item Content Validity index of 1.00, demonstrating complete agreement among content experts. Overall, the Scale Content Validity Index for the questionnaire was 0.97. Item completion for the reliability study was satisfactory. The questionnaire items had kappa values ranging from 0.17 (slight agreement) to 1 (perfect agreement). High levels of reliability were found for the questions on school bag use (k=0.94), sports participation (k=0.97), and lifetime prevalence (k=0.89).

CONCLUSION

Excellent content validity and slight to perfect test-retest reliability was found for the Low Back Pain (LBP) questionnaire. These results are comparable to findings of other studies evaluating the psychometric properties of LBP questionnaires. Cognisant of the limitations of the study, the results of this study suggest that the LBP questionnaire could be used in local studies investigating LBP among adolescents although questions enquiring on functional limitations and sciatica may need further consideration.

Multivariable modeling of factors associated with spinal pain in young adolescence

PURPOSE

To investigate the factors related to the 1-month period prevalence of low back pain (LBP), neck pain (NP) and thoracic spine pain (TSP) in young adolescents, thereby considering potential correlates from the physical, sociodemographic, lifestyle, psychosocial and comorbid pain domains.

METHODS

In this cross-sectional baseline study, 69 factors potentially associated with spinal pain were assessed among 842 healthy adolescents before pubertal peak growth. With consideration for possible sex differences in associations, multivariable analysis was used to simultaneously evaluate contributions of all variables collected in the five domains.

RESULTS

A significantly higher odds of LBP was shown for having high levels of psychosomatic complaints (odds ratio: 4.4; 95 % confidence interval: 1.6-11.9), a high lumbar lordotic apex, retroversed pelvis, introverted personality, and high levels of negative over positive affect. Associations with a higher prevalence and odds of NP were found for psychosomatic complaints (7.8; 2.5-23.9), TSP in the last month (4.9; 2.2-10.8), backward trunk lean, high levels of negative over positive affect and depressed mood. Having experienced LBP (2.7; 1.3-5.7) or NP (5.5; 2.6-11.8) in the preceding month was associated with a higher odds of TSP, as were low self-esteem, excessive physical activity, sedentarism and not achieving the Fit-norm.

CONCLUSIONS

Psychosomatic symptoms and pain comorbidities had the strongest association with 1-month period prevalence of spinal pain in young adolescents, followed by factors from the physical and psychosocial domains. The role that "physical factors" play in non-adult spinal pain may have been underestimated by previous studies.

Differences in personal and lifestyle characteristics among Zimbabwean high school adolescents with and without recurrent non-specific low back pain: a two part cross-sectional study

BACKGROUND

Recurrent non-specific low back pain (NSLBP) is increasingly becoming common among adolescents worldwide. A recent study in Zimbabwe showed a relatively high prevalence (28.8 %) among high school students. Influential associated factors, however, remain unclear. This is a significant shortcoming. The aim was to determine personal or lifestyle-related factors associated with recurrent NSLBP among high school adolescents in Harare, Zimbabwe.

METHODS

This study was part of a large epidemiological study conducted in two continuous parts. Part one sought to determine self-reported associated factors among 532 participants (mean age =16 ± 1.72 years) drawn randomly from selected government schools using a reliable and content-validated questionnaire (Kappa coefficient, k = 0.32-1). Part two purposively identified adolescents (N = 64, median age =17 years, interquartile range, IQR = 15-18 years) with a history of 'severe' recurrent NSLBP from part one based on a specific eligibility criteria and compared body mass index, relative school bag weight and hamstring flexibility with matched adolescents without NSLBP. Data was analysed using Statistica version 11. Independent t-tests or χ2 tests of association were used for continuous and categorical data, respectively. The statistical significance was set at p < .05.

RESULTS

Recurrent NSLBP was associated with self-reported factors such as perceptions of a heavy school bag [χ2 (1) = 85.9, p < 0.001]. A significant proportion of adolescents with recurrent NSLBP spent over 30 min carrying the school bag to and from school [χ2 (1) =32.2, p < 0.001]. It was also associated with prolonged sitting (p < 0.001), not playing sports [χ2 (1) =5.85, p = 0.02] and tight hamstrings [χ2 (1) =7.6, p = 0.006].

CONCLUSIONS

Although conclusions from this study are hesitant because of the cross-sectional nature of the study and the relatively small sample size in follow-up study, recurrent NSLBP is associated with perceptions of a heavy school bag, duration of school bag carriage, no sports participation, prolonged sitting on entertainment activities, and tight hamstrings. These findings add to the importance of promoting physical activity at school or home especially aimed at improving muscle flexibility.

Schoolbag carriage and schoolbag-related musculoskeletal discomfort among primary school children

Schoolbag carriage is a common occurrence and has been associated with musculoskeletal discomfort in children. The current study investigated the relationship between schoolbag-related musculoskeletal discomfort and individual, physical and psychosocial risk factors in primary school children in Ireland. A cross-sectional survey and pretest-posttest quasi-experimental design was used. The site and intensity of musculoskeletal discomfort was assessed before and after schoolbag carriage to provide a dose-response assessment of schoolbag-related discomfort for the first time. Objective measurements of the children, schoolbags and other additional items were made, and a researcher assisted questionnaire was completed on arrival at school. A total of 529 children (male 55.8%: female 44.2%) with a mean age of 10.6 years ± 7.14 months were included. The majority had backpacks (93.8%) and 89.7% (n = 445) carried the backpack over 2 shoulders. The mean schoolbag weight (4.8 ± 1.47 kgs) represented a mean % body weight (%BW) of 12.6 ± 4.29%. Only 29.9% carried schoolbags that were ≤10%BW. A significantly greater proportion of normal weight children carried schoolbags that were >10%BW compared to overweight/obese children (p < 0.001). The mean %BW carried was 18.3 ± 5.03 for those who had an additional item. The majority (77.5%) carried schoolbags to school for ≤10 min. The prevalence of baseline musculoskeletal discomfort was high (63.4%). Schoolbag-related discomfort was reported more frequently in the shoulders (27.3%) than in the back (15%). The dose-response assessment indicated that both statistically and meaningfully significant increases in discomfort were observed following schoolbag carriage. Multiple logistic regression models indicated that psychosocial factors and a history of discomfort were predictors of schoolbag-related back discomfort, while gender (being female) and a history of discomfort were predictors of schoolbag-related shoulder discomfort. None of the physical factors (absolute/relative schoolbag weight, carrying an additional item, duration of carriage, method of travel to school) were associated with schoolbag-related discomfort. This study highlights the need to consider the multi-factorial nature of schoolbag-related discomfort in children, and also the need to identify background pain as its presence can inadvertently influence the reporting of 'schoolbag-related' discomfort if it is not accounted for.

The prevalence of degenerative or incidental findings in the lumbar spine of pediatric patients: a study using magnetic resonance imaging as a screening tool

PURPOSE

Several studies using magnetic resonance imaging (MRI) to evaluate the lumbar spine in adults have shown a large prevalence of degenerative changes in asymptomatic subjects; however, studies in pediatric patients are scarce. Those studies have suggested a lower rate of degenerative findings in adolescents than in adults, but the actual prevalence of MRI findings in the pediatric population has not yet been determined. We aimed to determine the prevalence of degenerative changes in the lumbar spine of pediatric patients using abdominal and pelvic MRI as the screening tool.

METHODS

We studied 103 patients (mean age 6.6 years) who were evaluated with abdominal and pelvic MRI for indications that were not spine related. The entire lumbo-sacral spine was evaluated to detect the presence of disc degeneration (DD), disc displacement, anular rupture with high-intensity zone (HIZ) and Modic changes.

RESULTS

In our population, 10.7 % [4.9-16.5] had at least one disc classified as Pfirrmann 2, and no patients presented discs classified as Pfirrmann 3, 4 or 5; patients exhibiting discs classified as Pfirrmann 2 were significantly older than patients who had only Pfirrmann 1 discs. The prevalence of disc bulging was 1 % [0-2.9]. No patients presented disc herniation (including protrusion or extrusions); additionally, no patients exhibited HIZ or Modic changes.

CONCLUSIONS

Incidental findings related to DD are very uncommon at this early age, in contrast to findings described in adults or later in adolescence.

Effect of backpack position on foot weight distribution of school-aged children

[Purpose] In the present study, we aimed to determine the effects of backpack position on foot weight distribution of standing school-aged children. [Subjects] Thirty school-aged children volunteered to participate in this study. [Methods] The subjects randomly performed four types of carrying a backpack: no backpack (condition-1), carrying a backpack at C7 (condition-2), carrying a backpack at 10 cm below C7 (condition-3), and carrying a backpack at 20 cm below C7 (condition-4). [Results] Statistically significant differences were noted in the anterior and posterior pressure values, and in the anterior-to-posterior ratio, among the four conditions (p < 0.05). Post-hoc analysis indicated that the pressure value of condition-4 was significantly lower in the anterior foot region and higher in the posterior foot region than in condition-2 and condition-3. In addition, the anterior-to-posterior ratio was lower in condition-4 than in condition-2 and condition-3. [Conclusion] These findings suggest that carrying a backpack in a higher position, with fastening of the shoulder strap, may be more favorable for normalizing the foot weight distribution.

Is objectively measured sitting time associated with low back pain? A cross-sectional investigation in the NOMAD study

Background

Studies on the association between sitting time and low back pain (LBP) have found contrasting results. This may be due to the lack of objectively measured sitting time or because socioeconomic confounders were not considered in the analysis.

Objectives

To investigate the association between objectively measured sitting time (daily total, and occupational and leisure-time periods) and LBP among blue-collar workers.

Methods

Two-hundred-and-one blue-collar workers wore two accelerometers (GT3X+ Actigraph) for up to four consecutive working days to obtain objective measures of sitting time, estimated via Acti4 software. Workers reported their LBP intensity the past month on a scale from 0 (no pain) to 9 (worst imaginable pain) and were categorized into either low (≤5) or high (>5) LBP intensity groups. In the multivariate-adjusted binary logistic regression analysis, total sitting time, and occupational and leisure-time sitting were both modeled as continuous (hours/day) and categorical variables (i.e. low, moderate and high sitting time).

Results

The multivariate logistic regression analysis showed a significant positive association between total sitting time (per hour) and high LBP intensity (odds ratio; OR=1.43, 95%CI=1.15-1.77, P=0.01). Similar results were obtained for leisure-time sitting (OR=1.45, 95%CI=1.10-1.91, P=0.01), and a similar but non-significant trend was obtained for occupational sitting time (OR=1.34, 95%CI 0.99-1.82, P=0.06). In the analysis on categorized sitting time, high sitting time was positively associated with high LBP for total (OR=3.31, 95%CI=1.18-9.28, P=0.03), leisure (OR=5.31, 95%CI=1.57-17.90, P=0.01), and occupational (OR=3.26, 95%CI=0.89-11.98, P=0.08) periods, referencing those with low sitting time.

Conclusion

Sitting time is positively associated with LBP intensity among blue-collar workers. Future studies using a prospective design with objective measures of sitting time are recommended.

Back pain in children surveyed with weekly text messages - a 2.5 year prospective school cohort study

BACKGROUND

Back pain is reported to occur already in childhood, but its development at that age is not well understood. The aims of this study were to describe BP in children aged 6-12 years, and to investigate any sex and age differences.

METHODS

Data on back pain (defined as pain in the neck, mid back and/or lower back) were collected once a week from parents replying to automated text-messages over 2.5 school years from 2008 till 2011. The prevalence estimates were presented as percentages and 95% confidence intervals. Differences between estimates were considered significant if confidence intervals did not overlap. A test for trend, using a multi-level mixed-effects logistic regression extended to the longitudinal and multilevel setting, was performed to see whether back pain reporting increased with age.

RESULTS

Depending on the age group, 13-38% children reported back pain at least once per survey year, and 5-23% at least twice per survey year. The average weekly prevalence estimate ranged between 1% and 5%. In the final survey year more girls than boys reported back pain at least twice. The prevalence estimates did not increase monotonically with age but showed a greater increase in children younger than 9/10, after which they remained relatively stable up to the age of 12 years.

CONCLUSIONS

We found that back pain was not a common problem in this age group and recommend health professionals be vigilant if a child presents with constant or recurring back pain. Our results need to be supplemented by a better understanding of the severity and consequences of back pain in childhood. It would be productive to study the circumstances surrounding the appearance of back pain in childhood, as well as, how various bio-psycho-social factors affect its onset and later recurrence. Knowledge about the causes of back pain in childhood might allow early prevention.

Time trends in single versus concomitant neck and back pain in Finnish adolescents: results from national cross-sectional surveys from 1991 to 2011

Background

Previous studies, in late 20th century, suggest an increase in the prevalence of neck pain and low back pain among children and adolescents, when neck and low back pain were studied separately. This study investigated time trends in adolescent spinal pain between 1991 and 2011 by classifying pain into the following three classes: neck pain alone, low back pain alone, and concomitant neck and low back pain.

Methods

Representative samples of 12 to 18-year-old Finns were sent a questionnaire in 1991, 1999, 2001, 2003, 2005, 2007, 2009 and 2011. Information was gathered about the frequency of neck and low back pain with a six-month recall period. Statistical methods used included descriptive analysis, and generalized linear models.

Results

The total number of respondents in these eight comparable cross-sectional surveys was 51 044 with a response proportion of 64%. The prevalence of concomitant neck and low back pain showed a steady increase from 1991 to 2009/2011; the prevalence almost quadrupled among 12-14-year-olds girls (from 2% to 7.5%), and more than doubled among 12-14-year-old boys (from 1.6% to 3.8%), and among 16-18-year old boys (from 4.2 to 9.9%) and girls (6.9% to 15.9%). The prevalence of neck pain alone only increased in the 1990s (e.g. among 16-18-year-old girls 22.9% in 1991, 29.2% in 1999, and 29.5% in 2011), while the prevalence of low back pain alone remained relatively constant during the last two decades (e.g. among 16-18-year-old girls 4% in 1991, 3.1% in 1999, and 3.7% in 2011).

Conclusions

Concomitant neck and low back pain has constantly increased in the last two decades among adolescents, while single neck pain has only increased in the 1990s. Single low back pain has remained relatively constant. Thus, earlier detected increase in low back pain in the 1990s was explained by the increase in concomitant neck and low back pain. Differences in the time trends in the three pain conditions might suggest, at least partly, different risk factors and aetiology for single- and multisite spinal pain among adolescents. This hypothesis needs further investigations.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-296) contains supplementary material, which is available to authorized users.

Primary prevention of disc degeneration-related symptoms

INTRODUCTION

It has been shown previously that a history of low back pain often begins in childhood or adulthood. Indeed, the prevalence of severe back symptoms among schoolchildren is not insignificant. Possibilities for the primary prevention of intervertebral disc degeneration-related conditions are poorly reported in the literature despite the assumed socio-economical impact of the prevention of these conditions.

METHODS

In this review, the authors have collated published data on the prevalence and risk factors of childhood low back pain as well as the structure and results of published primary prevention programs.

RESULTS

The prevalence of self-reported low back pain is 7-65% among children and it increases with age. Several lifestyle factors have been reported as significant risk factors for back pain, many of which are related to the schools. Current educational primary prevention programs in schools show no clear or long-term stable effect.

CONCLUSION

Considering the growing evidence about the importance of normal and bad posture, an exercise-based posture correction program is suggested as a school-based primary prevention of disc degeneration-related symptoms. Further, prospective randomized studies with more than 20 years follow-up, however, are strongly required to confirm it.

Epidemiology of back pain in children and youth aged 10-19 from the area of the southeast of Poland

OBJECTIVE

The aim of this work was to define the prevalence of back pain in children and youth aged 10-19 from the southeast of Poland.

MATERIAL AND METHODS

The cross-sectional study included 1089 students (547 girls and 542 boys) aged 10-19. The prevalence of back pain, its intensity, location, and situations in which it occurred were assessed with a questionnaire.

RESULTS

Among 1089 respondents, 830 (76.2%) admitted that they had experienced back pain at various frequencies within the year preceding the study. Back pain was located mainly in the lumbar segment (74.8%). Mild pains were dominant, which was declared by 44.7% of the respondents. Girls experienced back pain significantly more frequently than boys (52.2% versus 47.8%, P < 0.05).

CONCLUSIONS

The research revealed that back pain is a common phenomenon. The prevalence of back pain in children and youth living in southeast Poland is similar to the frequency of occurrence of such complaints occurring in peers in other countries. It seems significant to monitor the remaining regions of Poland in order to define the scale of the problem and to look for the risk factors of back pain in children and youth to undertake efficient prophylactic actions.

Classification system of the sagittal standing alignment in young adolescent girls

PURPOSE

The purpose of this cohort study was to classify sagittal standing alignment of pre-peak height velocity (pre-PHV) girls, and to evaluate whether identified subgroups were associated with measures of spinal pain. This study further aimed at drawing attention to similarities and differences between the current postural classification and a previous system determined among pre-PHV boys.

METHODS

557 pre-PHV girls [mean age, 10.6 years (SD, 0.47 years)] participated in the study. Three gross body segment orientation parameters and five specific lumbopelvic characteristics were quantified during habitual standing. Postural subgroups were determined by cluster analysis. Logistic regression was applied to assess the relationship between postural subgroups and spinal pain measures (pain and seeking care, assessed by self-administered questionnaire). Chi-square statistics, independent samples T test, and distribution-based methods were used for comparison with postural categorization in pre-PHV boys.

RESULTS AND CONCLUSION

Among pre-PHV girls, clinically meaningful posture clusters emerged both on the gross body segment and specific lumbopelvic level. The postural subtypes identified among pre-PHV girls closely corresponded to those previously described in pre-PHV boys, thereby allowing the use of the same, working nomenclature. In contrast to previous findings among pre-PHV boys, no associations between posture clusters and spinal pain measures were significant in girls at pre-PHV age. When comparing discrete 'global' alignment scores across corresponding posture types, some intriguing differences were found between genders which might involve different biomechanical loading patterns. Whether habitual posture forms a risk factor for developing spinal pain up to adulthood needs evaluation in prospective multifactorial follow-up research.

Schoolbag weight limit: can it be defined?

BACKGROUND

Carrying a schoolbag is a daily activity for most children and much research has been conducted in an effort to identify a safe load limit for children to carry in their schoolbags. Despite this, there is still no consensus about guideline weight and other factors associated with carrying a schoolbag. The objective of this article is to review the literature on schoolbags with particular emphasis on the load limit guidelines and schoolbag-related musculoskeletal pain, and to suggest directions for school health and future research.

METHODS

Science Direct, PubMed, AMED, CINAHL, OVID, EMBASE, and Scopus were searched for peer-reviewed articles using combinations of the following key words: schoolbag, backpack, rucksack, knapsack, satchel, book bag, book pack and included combinations of children, pain, gait, and posture. Article references were also checked for further citations. All are in English, with the exception of one which is in German but is widely cited.

RESULTS

There are conflicting findings in the literature. The recommended load limit for schoolchildren to carry varies from 5% to 20% of their body weight, and the evidence linking backpack weight and back pain is inconclusive.

CONCLUSIONS

The shortcomings in the current literature should be addressed so that evidence-based guidelines can be provided to schoolchildren, parents, and teachers. It is suggested that general guidance may be more appropriate than a single load limit guideline.

Instrumentos de avaliação da postura dinâmica: aplicabilidade ao ambiente escolar

INTRODUÇÃO: Para que a avaliação da postura dinâmica seja efetivada é necessário, primeiramente, conhecer os diversos instrumentos, disponíveis e validados na literatura, apropriados para esse fim. OBJETIVO: O objetivo deste artigo de revisão sistemática foi descrever, sintetizar e analisar criticamente os instrumentos encontrados na literatura que objetivem avaliar a postura dinâmica, tanto em adultos quanto em escolares, e refletir sobre a possibilidade de utilização desses métodos no ambiente escolar. MATERIAIS E MÉTODOS: Foi realizada uma busca sistemática de artigos em bases de dados (Scopus, ScienceDirect, PubMed, SciELO) publicados a partir da década de 1980 e no Banco de Teses e Dissertações da Capes. As palavras-chave utilizadas na busca pelos artigos foram back, spine, back injuries, school, back school, postural hygiene program, education, child, student, posture, em combinação com as palavras-chave evaluation, assessment, measurement, e os respectivos termos em português. Os instrumentos propostos deveriam preencher os seguintes critérios: (a) avaliar a postura corporal durante a realização de atividades da vida diária (AVDs); (b) utilizar critérios pré-definidos de avaliação da postura dinâmica; e (c) avaliar a postura a partir de observação, direta ou a partir de filmagem. RESULTADOS: Foram identificados oito artigos originais que apresentam instrumentos de avaliação da postura dinâmica, avaliando a execução de AVDs a partir de critérios biomecânicos pré-definidos por escalas numéricas; destes, apenas quatro instrumentos foram elaborados com o propósito de avaliar a execução de AVDs de escolares. CONSIDERAÇÕES FINAIS: Em geral, os instrumentos apresentam algumas limitações metodológicas, embora sejam de fácil aplicabilidade.

Recurrent pain and discomfort in relation to fitness and physical activity among young school children

As an increase in pain symptoms among children has been shown in the last decades, the aim of this study was to describe perceptions of recurrent pain, measured physical fitness and levels of reported physical activity (PA) in children, and to investigate if any associations between PA, fitness and recurrent pain could be identified. A school-based study comprised 206 Swedish children 8-12 years old, 114 boys, 92 girls. A questionnaire with questions about perceived pain, self-reported PA and lifestyle factors was used. Health-related fitness was assessed by 11 physical tests. A physical index was calculated from these tests as a z score. High physical index indicated high fitness and low physical index indicated low fitness. ANOVA test, chi-square test and logistic regression analysis were used to compare active and inactive children. The prevalence of one pain location (head, abdomen or back) was 26%, two 11% and three 4% (n=206). Female gender, living in single-parent families, low PA and low subjective health were associated with reported recurrent pain. Children reporting high levels of PA had high physical index and reported low prevalence of pain symptoms. The physical index and level of self-reported PA decreased gradually the more pain locations. Physically active children had higher fitness levels and reported less pain symptoms than inactive peers. Coping with pain is an integral part of PA, and active children learn to cope with unpleasant body sensations which together with high fitness may reduce the perception of pain.

Prevalence of low back pain in children and adolescents: a meta-analysis

BACKGROUND

Low back pain (LBP) is common in children and adolescents, and it is becoming a public health concern. In recent years there has been a considerable increase in research studies that examine the prevalence of LBP in this population, but studies exhibit great variability in the prevalence rates reported. The purpose of this research was to examine, by means of a meta-analytic investigation, the prevalence rates of LBP in children and adolescents.

METHODS

Studies were located from computerized databases (ISI Web of Knowledge, MedLine, PEDro, IME, LILACS, and CINAHL) and other sources. The search period extended to April 2011. To be included in the meta-analysis, studies had to report a prevalence rate (whether point, period or lifetime prevalence) of LBP in children and/or adolescents (≤ 18 years old). Two independent researchers coded the moderator variables of the studies, and extracted the prevalence rates. Separate meta-analyses were carried out for the different types of prevalence in order to avoid dependence problems. In each meta-analysis, a random-effects model was assumed to carry out the statistical analyses.

RESULTS

A total of 59 articles fulfilled the selection criteria. The mean point prevalence obtained from 10 studies was 0.120 (95% CI: 0.09 and 0.159). The mean period prevalence at 12 months obtained from 13 studies was 0.336 (95% CI: 0.269 and 0.410), whereas the mean period prevalence at one week obtained from six studies was 0.177 (95% CI: 0.124 and 0.247). The mean lifetime prevalence obtained from 30 studies was 0.399 (95% CI: 0.342 and 0.459). Lifetime prevalence exhibited a positive, statistically significant relationship with the mean age of the participants in the samples and with the publication year of the studies.

CONCLUSIONS

The most recent studies showed higher prevalence rates than the oldest ones, and studies with a better methodology exhibited higher lifetime prevalence rates than studies that were methodologically poor. Future studies should report more information regarding the definition of LBP and there is a need to improve the methodological quality of studies.

Inculcating the ergonomic culture in developing countries: national healthy schoolbag initiative in Sri Lanka

OBJECTIVE

The aim of this article is to describe a survey on ergonomic factors of classroom environments of school children, their influence on health, and use of research outcomes to launch a healthy schoolbag initiative.

BACKGROUND

Ergonomics have not yet well penetrated relevant fields in industrially developing countries, such as Sri Lanka. One of the crucial parameters of the school environment is ergonomics. Available evidence suggests ergonomic mismatches in classroom settings. Good practice examples in child ergonomic interventions are few in resource-poor contexts.

METHOD

A school-based cross-sectional study was conducted in a district in Sri Lanka with a sample of 1,607 children in Grades 6 to 8 with the use of a stratified multistage cluster sampling method.

RESULTS

Many children did experience discomfort related to substandard seating arrangements in the classroom. A significant proportion had to turn their necks to see the blackboard. For many children, seating locations were not changed. There were widespread incompatibilities of classroom furniture with anthropometric dimensions of children. A majority of children perceived discomfort contributed by mismatched classroom furniture. Carriage of school materials was not healthy. Deficiencies were noted in weight, model, ergonomic features, and carrying behavior of bags. Children experienced several negative effects, in part attributable to mismatched ergonomic factors.

APPLICATION

The schoolbag was considered a priority issue. Findings were disseminated to stakeholders and to media. Solutions were contemplated on bag weight reduction, healthy schoolbag introduction, and behavior change in a collaborative initiative with the Education Ministry. Political, administrative, and business stakeholders were successfully engaged to inculcate an ergonomic culture in an industrially developing country.

Sagittal standing posture and its association with spinal pain: a school-based epidemiological study of 1196 Flemish adolescents before age at peak height velocity

STUDY DESIGN

Cross-sectional baseline data set on the sagittal standing posture of 1196 adolescents.

OBJECTIVE

To describe and quantify common variations in the sagittal standing alignment in boys and girls who are in the same phase of growth and to explore the association between habitual standing posture and measures for spinal pain.

SUMMARY OF BACKGROUND DATA

Data on postural characteristics and spinal pain measures in adolescence are sparse, especially when somatic and biological maturity status is to be considered. Our understanding of the relationship between standing posture in the sagittal plane and spinal pain is also deficient.

METHODS

A total of 639 boys (age [mean ± SD], 12.6 ± 0.54 yr) and 557 girls (10.6 ± 0.47 yr), with predicted years from peak height velocity (PHV) being 1.2 ± 0.71 and 1.2 ± 0.59 pre-PHV, respectively, were studied. Postural examination included the assessment of global alignment and local spinopelvic characteristics, using post hoc analyses of digital images and direct body measurements (palpation, digital inclinometry, and wheeled accelerometry). Spinal pain experience was assessed by questionnaire.

RESULTS

A wide interindividual variation in sagittal posture characteristics was observed. Logistic regression analyses yielded global alignment parameters to be associated with low back pain (lifetime prevalence), neck pain (lifetime prevalence, 1-mo prevalence, and doctor visit), and thoracic spine pain (doctor visit) outcome measures. None of the included local spinopelvic parameters could be identified as an associated factor with measures of spinal pain.

CONCLUSION

The orientation of gross body segments with respect to the gravity line seems superior to local spinopelvic features in terms of clinical importance, at least in the current pre-PHV cohort. Opportunities may exist for postural subgrouping strategies to begin with global alignment parameters in order to gain further insight into the relationship between sagittal alignment and the relative risk of developing spinal pain/seeking medical consultation for this pain.

Preventive physiotherapy interventions for back care in children and adolescents: a meta-analysis

BACKGROUND

Preventive interventions improve healthy behaviours and they also increase knowledge regarding back care in children and adolescents, but studies exhibit great variability in their contents, duration and number of sessions, and in the assessment methods. The purpose of this study was to review the empirical evidence regarding preventive physiotherapy interventions for back care in children and adolescents, and to ascertain the most efficacious treatments, in what way and under which circumstances.

METHODS

Studies were located from computerized databases (Cochrane Library, Medline, PEDro, Web of Science and IME) and other sources. The search period extended to May 2012. To be included in the meta-analysis, studies had to use physical therapy methodologies of preventive treatment on children and adolescents, and to compare a treatment and a control group. Treatment, participant, methodological, and extrinsic characteristics of the studies were coded. Two researchers independently coded all of the studies. As effect size indices, standardized mean differences were calculated for measures of behaviours and knowledge, both in the posttest and in the follow-up. The random and mixed-effects models were used for the statistical analyses and sensitivity analyses were carried out in order to check the robustness of the meta-analytic results.

RESULTS

A total of 19 papers fulfilled the selection criteria, producing 23 independent studies. On average, the treatments reached a statistically significant effectiveness in the behaviours acquired, both in the posttest and in the follow-up (d+ = 1.33 and d+ = 1.80, respectively), as well as in measures of knowledge (posttest; d+ = 1.29; follow-up: d+ = 0.76). Depending on the outcome measure, the effect sizes were affected by different moderator variables, such as the type of treatment, the type of postural hygiene, the teaching method, or the use of paraprofessionals as cotherapists.

CONCLUSIONS

The interventions were successful in significantly increasing the behaviours and knowledge acquired both in the posttest and in the follow-up. The combined treatment of postural hygiene with physiotherapy exercise exhibited the best results. The small number of studies limits the generalizability of the results.

Prevalence of musculoskeletal disorders and ergonomic assessments of cleaners

BACKGROUND

Professional cleaning has emerged as a new industry in Taiwan in the past few years. However, information about the workload and prevalence of musculoskeletal disorders (MSDs) among these workers is still limited. This study investigated the prevalence of musculoskeletal discomforts and the characteristics of musculoskeletal activities of cleaning workers in Taiwan.

METHODS

Face-to-face interviews to collect basic information and to administer the Chinese version of the Standardized Nordic Musculoskeletal Questionnaire were conducted on 180 cleaners. Biaxial electrogoniometers and electromyography were used to characterize the motion and forceful exertion of 56 cleaners during work.

RESULTS

Nearly 90% of the participants reported musculoskeletal discomfort in at least one body part due to work. Of the nine body parts examined, hand/wrist (41.7%), shoulder (41.1%), low back (37.8%), and elbow (33.3%) were most frequently reported to exhibit discomfort. Additionally, time pressure as a psychosocial risk factor was found to be associated with discomfort in several body parts. Measurements of electrogoniometry showed that wrists of many cleaners were frequently held in extreme angles of ulnar/radial deviation, leading to an increased risk of developing carpal tunnel syndrome. Motion repetitiveness and force output during mopping and sweeping tasks were considered less influential in developing hand/wrist discomfort.

CONCLUSIONS

Cleaners in Taiwan are a high-risk group for developing MSDs, and solutions are needed to avoid extreme motion angles of the wrists when performing cleaning tasks. Moreover, both psychosocial stress and the welfare of this group of workers deserve immediate attention from management and the government.

Computer use and musculoskeletal complaints in the Lithuanian adolescent population

The purpose of this study was to evaluate self-rated musculoskeletal complaints and their association with computer use time in the adolescent population in Lithuania. The cross-sectional study done in 2008–2009 in Lithuania. 1806 students aged 13–18 years from randomly selected schools were questioned (response rate 95.8%). Logistic regression analysis results show that musculoskeletal complaints in adolescence are associated with duration of computer use as related to age and gender. Compared with adolescents using computer <2 hours daily, a statistically significant probability of experiencing back pain was determined for younger boys and girls groups (13–15 years) who reported working on a computer >4 hours (OR=2.36 and OR=2.50, respectively) in older age groups (16–18 years); in girls only the ORs of back pain significantly increased with increased time of computer use. the probability of experiencing the neck-shoulder pain was determined only in girls aged 16–18 years who reported working on a computer 2–4 hours (OR=1.62, p=0.020). Musculoskeletal complaints in adolescence are related to duration of computer use. Increasing the time spent at the computer increased complaints of musculoskeletal pain among Lithuanian adolescents. The main guidelines for prevention point to restriction of time of computer use.

Acute low back pain in high school adolescents in Southern Brazil: prevalence and associated factors

PURPOSE

The aim of this study was to investigate the prevalence of acute low back pain (ALBP) and associated factors in high school students from a Southern Brazilian city.

METHODS

The study was cross-sectional and interviewed 1,233 students 13- to 19-year-olds, attending high schools. A total of 25 schools were included in the sample (15 state institutions, 7 private, 2 federal and 1 municipal). The ALBP was evaluated using two questions. The outcome was LBP in the previous 30 days.

RESULTS

The prevalence of ALBP was 13.7%. Non-white students, who commuted to school walking, showed a higher prevalence of ALBP. The prevalence of ALBP is relatively high.

CONCLUSIONS

Further studies with follow-ups to adulthood are needed to investigate whether physical cumulative loads on the lumbar spine (for example, duration/transport, school bags and inadequate school furniture) during adolescence, may influence the development of ALBP later in life.

School Bag Weight and the Occurrence of Shoulder, Hand/Wrist and Low Back Symptoms among Iranian Elementary Schoolchildren

BACKGROUND

Schoolchildren usually use school bags to carry their school materials. Carry-ing heavy school bags can cause several problems such as musculoskeletal problems among schoolchildren. The aim of this study was to investigate the association between the weight of school bags and the occurrence of low back, shoulder and hand/wrist symptoms among pri-mary school children.

METHOD

This cross-sectional, descriptive-analytical study was conducted among a sample of 307 elementary school children in Tabriz, Iran. Data were collected using a questionnaire and from measurement of the school bag weight, body weight and height of each participant. Data were analysed using SPSS software.

RESULTS

The average load carried by schoolchildren was 2.9 kg, representing approximately 10% of the children's body weight. Girls and lower grade children carried a greater percent-age of their body weights. Approximately 86% of the children reported some kind of muscu-loskeletal symptoms. The occurrence of shoulder, wrists/hands, and low back pain among school-children was 70%, 18.5% and 8.7%, respectively. The results of binary logistic regres-sion indicated that the school bag weight (expressed as a percentage of body weight) was only significantly associated with hand/wrist symptoms (P<0.05). Girls were more likely to com-plaint from low back pain than boys were. Age was significantly negatively associated with hand/wrist symptoms. Body mass index was also significantly associated with shoulder symptoms.

CONCLUSION

The results indicate a high prevalence of musculoskeletal symptoms among elemen-tary schoolchildren. Preventive measures and appropriate guidelines with regard to safe load carriage in schoolchildren are therefore needed to protect this age group.

Prevalence and tracking of back pain from childhood to adolescence

Background

It is generally acknowledged that back pain (BP) is a common condition already in childhood. However, the development until early adulthood is not well understood and, in particular, not the individual tracking pattern. The objectives of this paper are to show the prevalence estimates of BP, low back pain (LBP), mid back pain (MBP), neck pain (NP), and care-seeking because of BP at three different ages (9, 13 and15 years) and how the BP reporting tracks over these age groups over three consecutive surveys.

Methods

A longitudinal cohort study was carried out from the years of 1997 till 2005, collecting interview data from children who were sampled to be representative of Danish schoolchildren. BP was defined overall and specifically in the three spinal regions as having reported pain within the past month. The prevalence estimates and the various patterns of BP reporting over time are presented as percentages.

Results

Of the 771 children sampled, 62%, 57%, and 58% participated in the three back surveys and 34% participated in all three. The prevalence estimates for children at the ages of 9, 13, and 15, respectively, were for BP 33%, 28%, and 48%; for LBP 4%, 22%, and 36%; for MBP 20%, 13%, and 35%; and for NP 10%, 7%, and 15%. Seeking care for BP increased from 6% and 8% at the two youngest ages to 34% at the oldest. Only 7% of the children who participated in all three surveys reported BP each time and 30% of these always reported no pain. The patterns of development differed for the three spinal regions and between genders. Status at the previous survey predicted status at the next survey, so that those who had pain before were more likely to report pain again and vice versa. This was most pronounced for care-seeking.

Conclusion

It was confirmed that BP starts early in life, but the patterns of onset and development over time vary for different parts of the spine and between genders. Because of these differences, it is recommended to report on BP in youngsters separately for the three spinal regions, and to differentiate in the analyses between the genders and age groups. Although only a small minority reported BP at two or all three surveys, tracking of BP (particularly NP) and care seeking was noted from one survey to the other. On the positive side, individuals without BP at a previous survey were likely to remain pain free at the subsequent survey.