Association between home posture habits and low back pain in high school adolescents

Does sedentary behaviour cause spinal pain in children and adolescents? A systematic review with meta-analysis

OBJECTIVE

To evaluate whether sedentary behaviour is a risk or prognostic factor for spinal pain in children and adolescents. Specifically, to estimate the (1) direction and strength of the association; (2) risk of spinal pain onset and (3) effect on spinal pain prognosis.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Electronic searches of MEDLINE, Embase, CINAHL and Web of Science up to 23 March 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Reports estimating the effect of sedentary behaviour on spinal pain in young people (≤19 years).

RESULTS

We included 129 reports, 14 were longitudinal (n = 8 433) and 115 were cross-sectional (n > 697 590). We incorporated 86 studies into meta-analyses. (1) From cross-sectional data, we found low certainty evidence of a small positive association between sedentary behaviour and spinal pain (adjusted odds ratio 1.25 (95% CI 1.17 to 1.33), k = 44, n > 92 617). (2) From longitudinal data, we found low certainty evidence of no increased risk for the onset of spinal pain due to sedentary behaviour (adjusted risk ratio 1.07 (95% CI 0.84 to 1.35), k = 4, n = 1 292). (3) No studies assessed prognosis.

CONCLUSION

Cross-sectional data suggest minimally higher odds of spinal pain for children and adolescents who engage in greater sedentary behaviours. However, longitudinal data do not support a causal relationship, indicating that sedentary behaviour does not increase the risk for onset of spinal pain. Due to the low certainty of evidence, these findings must be interpreted with caution. We found no evidence of the effect sedentary behaviour has on spinal pain prognosis in children and adolescents, highlighting a considerable gap in the literature.

The prevalence of chronic pain in children and adolescents: a systematic review update and meta-analysis

ABSTRACT

Chronic pain, defined as persistent or recurring pain or pain lasting longer than 3 months, is a common childhood problem. The objective of this study was to conduct an updated systematic review and meta-analysis on the prevalence of chronic pain (ie, overall, headache, abdominal pain, back pain, musculoskeletal pain, multisite/general pain, and other) in children and adolescents. EMBASE, PubMed, CINAHL, and PsycINFO were searched for publications between January 1, 2009, and June 30, 2023. Studies reporting population-based estimates of chronic nondisease related pain prevalence in children or adolescents (age ≤ 19 years) were included. Two independent reviewers screened articles based on a priori protocol. One hundred nineteen studies with a total of 1,043,878 children (52.0% female, mean age 13.4 years [SD 2.4]) were included. Seventy different countries were represented, with the highest number of data points of prevalence estimates coming from Finland and Germany (n = 19 each, 4.3%). The overall prevalence of chronic pain in children and adolescents was 20.8%, with the highest prevalence for headache and musculoskeletal pain (25.7%). Overall, and for all types of pain except for back pain and musculoskeletal pain, there were significant differences in the prevalence between boys and girls, with girls having a higher prevalence of pain. There was high heterogeneity (I 2 99.9%). Overall risk of bias was low to moderate. In summary, approximately 1 in 5 children and adolescents experience chronic pain and prevalence varies by pain type; for most types, there is higher pain prevalence among girls than among boys. Findings echo and expand upon the systematic review conducted in 2011.

Prevalence and Biopsychosocial Factors Associated With a Current Episode of Low Back Pain Among Adults With a Previous History of Low Back Pain: A Cross-sectional Study of Market Traders in an African Population

Low back pain (LBP) is the leading cause of years lived with disability globally, with Nigeria having one of the greatest burdens. A current episode of LBP is important in Nigeria, but the associated factors are unknown. This cross-sectional study investigated the prevalence, biomechanical, and psychosocial factors associated with a current episode of LBP among 700 adult market traders with previous LBP in an urban Nigerian population. Descriptive, bivariate, and multivariate analyses were conducted. The prevalence of a current episode of LBP was 76.4%. Factors associated with an increased risk of a current episode of LBP in a decreasing order of importance were exposure to biomechanical factors (aggregate [total] score) (odds ratio [OR] = 1.535; 95% confidence interval [CI] = 1.398-1.685); anxiety (OR = 1.182; 95% CI = 1.089-1.282); fear-avoidance beliefs (physical activity) (OR = 1.139; 95% CI = 1.029-1.261); fear-avoidance beliefs (work) (OR = 1.105; 95% CI = 1.047-1.165); while factors associated with a reduced risk of a current episode of LBP were ability to take breaks in the job in addition to scheduled breaks (OR = .430; 95% CI = .240-.773) and ability to control the order and pace of tasks (OR = .477; 95% CI = .236-.965). Occupational biomechanical and psychosocial factors were associated with a current episode of LBP in logistic regression models explaining 52.7% and 73.1% of the variation in a current episode of LBP. Occupational biomechanical factors, particularly handling large and bulky objects at arm's length and kneeling and squatting, produced the greatest risk of a current episode of LBP. PERSPECTIVE: Occupational biomechanical factors, occupational psychosocial factors, and personal psychosocial factors such as anxiety and fear-avoidance beliefs are associated with a current episode of LBP in Nigeria. Pragmatic public health and occupational health initiatives that modify exposure to these factors may be required in Nigeria.

Associations between sedentary behavior and health and the moderating role of physical activity in young people within a cross-sectional investigation

The purpose of this study was to determine the influence of sedentary behavior (SB) on the frequency of health complaints (fHC) as well as on self-rated health (SRH) and body mass index (BMI), and to determine whether physical activity (PA) moderated this influence. Data were obtained from the Youth Survey Luxembourg 2019 (N = 2,802), a nationally representative stratified random sample of all youths aged 16 to 29 years who were living in Luxembourg. fHC is a composite measure of eight common psychosomatic health complaints, SRH was measured on a five-point scale, and BMI was calculated by dividing participants' body weight by the square of their body height (kg/m2). PA and SB values were obtained from factor analyses of the relevant questionnaire items. SB was evaluated as both leisure-time SB and gaming-associated SB. Multiple regression analyses adjusted for age, sex, socioeconomic status, and migration status were used to determine the association between SB, fHC, BMI, and SRH. We found that leisure-time SB was positively associated with fHC, but not with SRH or BMI. Gaming-associated SB was positively associated with fHC and BMI but was negatively associated with SRH. PA was negatively associated with fHC, BMI and SRH. No statistically significant moderating effects were observed. We found that both leisure-time and gaming-associated SB showed statistically significant impacts on health. Although PA is known to be beneficial to health, we conclude that its potential to mitigate the negative effects of SB is limited in young people.

Certainty of the Global Burden of Disease 2019 Modelled Prevalence Estimates for Musculoskeletal Conditions: A Meta-Epidemiological Study

Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prevalence evidence. Methods: Primary studies were identified using the GBD Data Input Sources Tool and their risk of bias was assessed using a validated tool. We rated the certainty of modelled prevalence estimates based on the GRADE Guidelines 30-the GRADE approach for modelled evidence. Results: Seventy-two primary studies (LBP: 67, NP: 2, knee OA: 3) underpinned the GBD estimates. Most studies had limited representativeness of their study populations, used suboptimal case definitions and applied assessment instruments with unknown psychometric properties. The certainty of modelled prevalence estimates was low, mainly due to risk of bias and indirectness. Conclusion: Beyond the risk of bias of primary input studies for LBP, NP, and knee OA in GBD 2019, the certainty of country-specific modelled prevalence estimates still have room for improvement.

Dose-response relationship between daily screen time and the risk of low back pain among children and adolescents: a meta-analysis of 57831 participants

BACKGROUND

The risk of low back pain (LBP) increases steeply during adolescence, and adolescents with LBP are more likely to have low back pain in their adult years. This study aimed to investigate the dose-response relationship between daily screen time and the risk of low back pain among children and adolescents.

METHODS

PubMed, the Cochrane Library, Embase, and Web of Science were searched to collect relevant studies on daily screen time and the risk of low back pain from the establishment of the database up to December 2022. Two investigators independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata16.0 was used to perform a dose-response meta-analysis and the methodological quality evaluation of the included studies.

RESULTS

The results of the meta-analysis showed that there is a positive correlation between daily computer time (OR = 1.32, 1.05-1.60), daily mobile phone time (OR = 1.32, 1.00-1.64), daily TV watching (OR = 1.07, 1.04-1.09) and the risk of low back pain, separately. The dose-response meta-analysis showed that there is a linear relationship between daily computer use and low back pain. The risk of low back pain increased by 8.2% for each 1-hour of daily computer use.

CONCLUSIONS

Screen time is related to the risk of low back pain, and there is a linear relationship between daily computer use and the risk of low back pain. A number of strategic measures should be taken to prevent adolescents from developing severe low back pain.

Factors affecting chronic low back pain among high school baseball players in Japan: A pilot study

The prevalence of chronic lower back pain (CLBP) among baseball players is high. CLBP is associated with reduced participation in practice and games. This pilot study examined the factors associated with CLBP among high school baseball players in Fukui, Japan. The participants underwent two health examinations in high school: (1) as first-grade baseball players (baseline) and (2) as second-grade baseball players (follow-up); a total of 59 players who could be followed-up a year later were included in the study. Players were divided into three groups based on whether they had no lower back pain (LBP) (n = 30), improved LBP (n = 17), or CLBP (n = 12) after 1 year of follow-up. Players were evaluated on the physical and cognitive aspects of pain. The Number Rating System, Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Central Sensitization Inventory (CSI), body characteristics (age, height, weight, body mass index, and skeletal mass index), and a medical history questionnaire regarding spondylolysis and baseball loads were used to evaluate the players. Inventory scores were highest in the CLBP group, which indicated that this group had significant pain that affected their willingness to engage in baseball-related activities. The TSK scores in the CLBP group were worse on follow-up. High school baseball players with CLBP were more likely to have lumbar spondylolysis and kinesiophobia, which are also factors related to pain chronicity. Kinesiophobia and the presence of lumbar spondylolysis should be considered when creating an exercise program for high school baseball players with CLBP.

Young people's low back pain and awareness of postural habits: A cross-sectional study

BACKGROUND

Young people tend to spend most of their time in activities involving inappropriate positions, which can promote musculoskeletal alterations and disorders.

OBJECTIVE

To investigate the prevalence of low back pain (LBP) in young people and analyse its associations with daily postural habits.

METHODS

Cross-sectional and retrospective study evaluating 679 Brazilian young people (15 to 18 years old), using questionnaires about LBP and awareness of postural habits. The prevalence values were calculated for the present moment, the last three months and throughout life. The Mann-Whitney U test and the Chi-square test were applied.

RESULTS

The prevalence of LBP at the present moment was 27.2%, 57.7% over the last three months and 73.9% throughout life. Boys and girls presented significantly different values, a larger number of girls manifesting pain for the three moments. The associated postural habits were: turning the body, reduction of lumbar lordosis when seated, not placing the feet on the floor, crossing the legs when sitting in the classroom and at home, sitting or lying in an inappropriate position, and distributing the body asymmetrically on the legs when standing.

CONCLUSIONS

Young people from 15 to 18 years of age show a high prevalence of low back pain. Inadequate postural habits adopted during everyday activities are associated with this complaint. These findings could contribute to the implementation of prevention and rehabilitation strategies.

Tools for Assessing Knowledge of Back Health in Adolescents: A Systematic Review Protocol

Back pain is common in adolescents as a result of their typical daily activities. There is a critical need for developing instruments that can assess the adolescents' knowledge of proper posture, because adequate postural habits are essential for preventing back pain and facilitating physical well-being. Unfortunately, there is insufficient understanding about appropriate back health in the general public, even though this knowledge is decisive in the development of physical skills and attainment of health literacy. Furthermore, relevant substantive literature is scarce. Therefore, the proposed systematic review aims to identify instruments that are used for assessing knowledge of back health in adolescents. Relevant search terms and descriptors will be combined, and searches will be carried out in a uniform sequence within the PubMed, Embase, CINAHL, and Cochrane Library databases. Eligible articles must present data on the assessment of the adolescents' knowledge of back health and describe the applied instrumentation. Articles will be selected by two reviewers independently; all disagreements will be resolved by a third reviewer. Mendeley and the Rayyan software will be used for the systematic review, and the checklist proposed by Brink and Louw will be used to verify the methodological quality of the included studies. Our findings may confirm the relevance of constructing and validating back health instruments for use in Brazil and other countries.

Paediatric chronic pain prevalence in low- and middle-income countries: A systematic review and meta-analysis

BACKGROUND

Chronic pain is a leading cause of morbidity in children and adolescents globally, with a significant impact on quality of life. This is the first systematic review and meta-analysis on paediatric chronic pain in low- and middle-income countries (LMICs).

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE (via PubMed), Embase, CINAHL, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, and the WHO Global Index Medicus for all studies published prior to January 7, 2022. Articles published in all languages that included populations age 19 years and under living in LMICs were considered. Chronic pain was defined as persistent or recurrent pain that is present for ≥3 months, per the International Classification of Diseases (ICD-11) definition. Summary data were extracted from published reports and evaluated with mixed-effects regression analysis. PROSPERO Record ID: CRD42021227967.

FINDINGS

Of the 2875 studies identified, 70 articles were reviewed, with 27 studies representing 20 LMICs eligible for analysis. The average prevalence for each pain type reported with 95% confidence interval is as follows: general/multi-site/any 20% (16-25), musculoskeletal (MSK) pain 9% (7-13), abdominal pain 7% (5-10), headache 4% (2-10), and fibromyalgia per American College of Rheumatology or Yunus and Masi criteria 3% (1-10). Overall, a pooled mean of 8% chronic pain was estimated across all studies. A significantly high level of heterogeneity was found across all studies (I2  >90%). Chronic headache (OR=1·65, 95% CI 1·39-1·96), abdominal pain (OR=1·36, 95% CI 1·22-1·51), and generalized/multi-site pain (OR=1·54, 95% CI 1·31-1·81) were significantly more prevalent in females than males.

INTERPRETATION

The characterization of paediatric chronic pain in low- and middle-income countries suffers from a paucity of data and significant heterogeneity in the assessment methods. Understanding the global burden of chronic pain in this group should be prioritized.

FUNDING

None.

Prevalence and Characteristics of Back Pain in Children and Adolescents from the Region of Murcia (Spain): ISQUIOS Programme

Puberty is a vulnerable period for musculoskeletal disorders due to the existence of a wide inter-individual variation in growth and development. The main objective of the present study was to describe the prevalence of back pain (BP) in the past year and month in school-aged children according to sex, age, maturity status, body mass index (BMI) and pain characteristics. This study involved 513 students aged between 9 and 16 years. Anthropometric measures were recorded to calculate the maturity stage of the students using a regression equation comprising measures for age, body mass, body height, sitting height and leg length. An ad hoc questionnaire composed of eight questions was used to describe BP prevalence in school-aged children. The results showed that the prevalence of BP in school-aged children was observed in 35.1% over the last year (45% boys and 55% girls), and 17.3% (40.4% boys and 59.6% girls, with an association found between female sex and BP) in the last month. The prevalence of back pain in the past year and month was higher the older the students were, or the more pubertal development they had experienced. The prevalence of BP in the last year was also higher in those with overweight or obesity. After adjustment for sex, there was an association between BP and older age and higher BMI in boys and an association between BP and higher pubertal development in girls. In summary, the present study showed that the prevalence of BP was related to the maturity stage and weight of the participants, with different prevalence patterns found according to sex.

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.

Increased Computer Use is Associated with Trunk Asymmetry That Negatively Impacts Health-Related Quality of Life in Early Adolescents

PURPOSE

This study aimed to investigate the effects of trunk asymmetry on the health-related quality of life of early adolescents and to identify daily activities that were associated with trunk asymmetry in this cohort.

METHODS

This study included 200 early adolescents (52 male and 148 female) aged 10 to 14 years in Hong Kong. Among them, 100 adolescents were considered to have trunk asymmetry with angle of trunk rotation ≥5° and one or more physical signs on visual inspection. The 36-Item Short Form Health Survey was used to measure the eight scales under the physical and mental domains of the health-related quality of life. The adolescents reported their average daily durations spent (1) using a computer; (2) using a smartphone; (3) watching television, videos or DVDs; (4) doing homework; and (5) doing physical exercise. Independent samples t-tests, chi-square (χ 2) tests or Mann-Whitney U-tests were performed to compare the health-related quality of life and the average daily duration of daily activities between early adolescents with and without trunk asymmetry. Logistic regression was performed to investigate the odds ratios of daily activities for trunk asymmetry.

RESULTS

Compared with early adolescents without trunk asymmetry, those with trunk asymmetry had a lower health-related quality of life in some of the physical domains, namely, bodily pain and general health, and all mental domains, namely, vitality (energy/fatigue), social functioning, role limitation due to emotional problems and mental health (p < 0.05). Use of computer was found to be significantly associated with trunk asymmetry in early adolescents (OR = 1.63, 95% CI [1.23, 2.14]).

CONCLUSION

Our results indicate that increased computer use is associated with trunk asymmetry, which negatively impacts the health-related quality of life in early adolescents.

The burden of neck pain in Brazil: estimates from the global burden of disease study 2019

Background

This study analyzed neck pain estimates in Brazil and its states between 2000 and 2019, in view of the country’s lacking epidemiological data.

Methods

An analysis was performed of the GBD 2019 estimates by location, sex, and age, per 100,000 population, with uncertainty intervals (95% UI). Brazilian estimates were compared to global, Mexican, English, and American rates.

Results

Global, Brazilian, and Mexican prevalence numbers were statistically homogeneous and stable in the period. Throughout the period analyzed in the study, Brazilian neck pain prevalence (2241.9; 95%UI 1770.5–2870.6) did not show statistical differences when compared to global (2696.5; 95%UI 2177.0–3375.2) or Mexican (1595.9; 95%UI 1258.9–2058.8) estimates. Estimates observed in the USA (5123.29; 95%UI 4268.35–6170.35) and England (4612.5; 95%UI 3668.8–5830.3) were significantly higher. In 2019, when compared to the USA and England, age-standardized prevalences were lower globally, in Brazil, and in Mexico. Prevalences in Brazilian states were similar, being that Roraima (1915.9; 95%UI 1506.5–2443.1) and the Federal District (1932.05; 95%UI 1515.1–2462.7) presented the lowest and highest values respectively. The exception was the state of São Paulo (3326.5; 95%UI 2609.6–4275.5). There was no statistical difference by sex, but the prevalence tended to increase with aging. In 2019, the Brazilian prevalence was 2478.6 (95% UI 1791.0–3503.8), 5017.2 (95%UI 3257.26–7483.8), and 4293.4 (95% UI 2898,8–6343.9), for those aged 15 to 49, 50 to 69, and 70+ years. There was no statistical difference among the YLDs in all locations and times.

Conclusions

Brazil is going through a fast-paced process of populational aging; a higher prevalence of neck pain in middle-aged individuals and the elderly highlights the need for lifelong prevention initiatives. The higher rates observed among higher-income populations and the homogeneity of the Brazilian estimates suggest a lack of robust epidemiological data in lower-income countries.

Prevalence of Low Back Pain and Associated Risks in School-Age Children

BACKGROUND

Low back pain (LBP) is highly prevalent in children and adolescents, while psychosocial, anthropometric, developmental, and lifestyle factors have been associated. However, the evidence is inconsistent from a biological point of view, so identifying predictors of LBP in the 6-12 years children through physical examination should be appropriate.

AIMS

To estimate the prevalence of LBP and associated factors in schoolchildren in a Brazilian population.

DESIGN

Cross-sectional study.

SETTING

Three schools in Botucatu, Brazil.

PARTICIPANTS/SUBJECTS

377 students from 6-12 years.

METHODS

Data collection consisted of questions regarding personal history, socioeconomic and anthropometric information, kinesiologic evaluation with anthropometry, lumbar biophotogrammetry, and backpack weight and use. Descriptive analyses were performed, and simple and multiple logistic regression models were used for risk factors.

RESULTS

The prevalence of LBP was 27.32% (confidence interval [CI] 95% = 23.07-32.03). The mean age was 8.85 years (± 1.83) in the group with LBP and 8 years (± 1.76) in the group without LBP (p = .006). Variables such as backpack weight (odds ratio [OR] = 1.45, CI 95% = 1.018-2.064) and exceeding 3 hours per day in front of the television (OR = 7.97, CI 95% = 1.957-32.515) increased the chance of LBP in these students.

CONCLUSION

LBP is prevalent in younger schoolchildren, and the factors associated with this outcome can be effectively addressed through the promotion of health measures. LBP in schoolchildren is a musculoskeletal discomfort that negatively affects the quality of life of these individuals and persists in adulthood.

Cross-Cultural Adaptation and Reliability of the Back Pain and Body Posture Evaluation Instrument (BackPEI) to the Spanish Adolescent Population

The prevalence of back pain (BP) among children and adolescents has increased over recent years. Some authors advocate promoting back-health education in the school setting. It is therefore important to adopt a uniform suite of assessment instruments to measure the various constructs. The present study aimed to perform a cultural adaptation of a validated measurement instrument (BackPEI), beginning with a translation and cultural adaptation phase, followed by a second phase to test reliability using a test-retest design. The translation and cross-cultural adaptation were performed based on the guidelines. Reliability was tested by applying the questionnaire to 224 secondary school students, at two different times with a 7-day interval between the tests. In general, the Spanish version presented adequate agreement for questions 1-20, with only question 9 achieving a low Kappa range of 0.312 (-0.152-0.189). The question about pain intensity did not show differences between the test means (4.72 ± 2.33) and re-test (4.58 ± 2.37) (p = 0.333), and the responses for these two tests obtained a high correlation (ICC = 0.951 (0.928-0.966); p = 0.0001). Psychometric testing indicated that the Spanish version of the BackPEI is well-adapted and reliable, based on the test-retest design, providing similar results to the original Brazilian version.

Prevalence of low back pain in young Brazilians and associated factors: Sex, physical activity, sedentary behavior, sleep and body mass index

BACKGROUND

Low back pain (LBP) has become increasingly common, but the prevalence of this complaint and associated factors in young people remains controversial.

OBJECTIVE

This study aimed to identify the prevalence of LBP and to explore the existence of associated factors (sex, physical activity, sedentary lifestyle, sleep, body mass index and waist circumference).

METHODS

This study considered all complaints of the lumbar region (acute or chronic) as LBP, which can irradiate to the backside and legs, lasting a minimum of 24 hours. Youngsters aged 15 to 18 years from a school in the south of Brazil were evaluated. Descriptive statistics was used, in particular Chi-square, Mann-Whitney U tests and binary logistic regression. A significance level of p< 0.05 was adopted.

RESULTS

A total of 330 youngsters answered a questionnaire and had their anthropometric measurements measured (response rate 84%). The prevalence of LBP in the present was 30%, quarterly 63% and throughout life 77%. There was a significant association between LBP and sex: girls have an increased risk of LBP in the last three-month period (PR = 1.3, 95% CI 1.06-1.56) and throughout life (PR = 1.2, 95% CI 1.04-1.43). The practice of physical activities was also associated with LBP, but as a protection factor in the present and in the last three-month period (PR = 0.7, 95% CI 0.47-0.90). Physical education at school has demonstrated a protective factor regarding LBP throughout life (PR = 0.9, 95% CI 0.77-0.97). Most of the students did not comply with recommendations related to sleep and time spent doing activities in front of a screen, and no association of these factors with LBP was detected. This exposure (physical activity, sleep time, sedentarism) did not present significant association with LBP when adjusted by the confusion factors (sex, age, BMI).

CONCLUSIONS

Youngsters reported a high prevalence of LBP. Girls were at greater risk of LBP than boys. It is recommended that prevention strategies focus on the practices of physical activities and scholar physical education. No association of LBP with sedentary lifestyle (TV and computer use time, sleep time), anthropometric measures and sleeping duration was observed.

Do changes in psychosocial factors, lifestyle factors and sitting posture influence the likelihood of musculoskeletal pain in high school computer users?

OBJECTIVES

Adolescents regularly engage in screen-based activities. Complex factors influence adolescents' growth, and habitual sitting posture. The association between over-time changes in their sitting posture, and upper quadrant musculoskeletal pain (UQMP) is poorly understood. This study tested the association between change over 12 months in seated posture angles (neck flexion [NF]; craniocervical angle [CCA] into flexion and extension; and thoracic flexion [TF]), UQMP, and predictor variables (anxiety and depression; sport activity, music participation; computer use).

METHODS

A one-year prospective longitudinal study enrolled 211 asymptomatic 15-18-year students. 3D motion analysis captured postural angles while students worked on desktop computers, at baseline and 12 months later. Height, weight, computing time, sport and music participation, and depression and anxiety were measured at both time periods. UQMP in the previous month was captured at 12 months. The association between over-time change in sitting posture angles and predictor variables was determined using linear regression analysis (r² ; p-values). The association between predictor variables with UQMP, and predictor variables on the association between postural angles and UQMP was assessed using logistic regression models (Odds Ratios [95%CI]). Significant confounding effects were determined when the addition of a predictor variable to the posture-UQMP model significantly changed the Likelihood Ratio chi square value.

RESULTS

N = 153 students (72%) completed the study (48 with UQMP). Significant associations occurred between head flexion (HF) and body mass index (BMI) (r²⁼ 4.20, p = .01); NF and computer use (r²⁼ 2.87, p = .036) and CCA and music participation (r²⁼ 9.99, p = .047). Music participants and non-participants in sport or music had increased risk of UQMP with CCA changes into flexion (OR 12.0) and TF changes into extension (OR 7.6) respectively.

CONCLUSION

The association between over-time-change in sitting posture angles and UQMP is not influenced by anthropometrics, psychosocial factors or time spent computing. Music students, and students not participating in sport, require further postural analysis.

Back pain in elementary schoolchildren is related to screen habits

PURPOSE

Verify the influences of physical activity level, nutritional status and screen habits on the prevalence of back pain in Brazilian students.

METHODS

The sample consisted of 577 schoolchildren (female = 274; male = 303) aged between 10 and 16 years old, regularly enrolled in the 6th grade of elementary school living in the metropolitan area of the Alto Tietê of the state of São Paulo, Brazil. The prevalence, intensity and frequency of pain was verified with the Back Pain Assessment Instrument. The usual practice of physical activity was verified with the Physical Activity Questionnaire for Older Children/Adolescent. Nutritional status was analyzed using Body Mass Index. Screen habits were obtained through a previously structured questionnaire.

RESULTS

The Chi-square test indicated that pain complaint and its prevalence in the cervical region are significantly higher in females (p < 0.05). The multiple logistic regression test revealed that watching television influences the prevalence of cervical pain and that the use of more than one screen increases the occurrence of low back pain in male students (p < 0.05).

CONCLUSION

Female students were the most affected by back pain complain, especially in the cervical region. However, factors associated with the prevalence of back pain were found only in males.

Sitting Posture, Sagittal Spinal Curvatures and Back Pain in 8 to 12-Year-Old Children from the Region of Murcia (Spain): ISQUIOS Programme

To explore sagittal spinal alignment and pelvic disposition of schoolchildren in a slump sitting position is needed in order to establish preventive educational postural programs. The purposes of this study were to describe sagittal spinal alignment and pelvic tilt (LSA) in a slump sitting position and to explore the association of sagittal spine and pelvic tilt with back pain (BP) among 8-12-year-old children. It was a cross-sectional study. Sagittal spinal curvatures, BP and pelvic tilt were assessed in 582 students from 14 elementary schools. It was found that 53.44% of children had slight thoracic hyperkyphosis and that 48.80% presented moderate lumbar hyperkyphosis and 38.66% presented slight lumbar hyperkyphosis. Those who did not suffer from BP in any part of the back had a higher lumbar kyphosis (24.64 ± 7.84) or a greater LSA (107.27 ± 5.38) than children who had some type of BP in the previous year or week (lumbar kyphosis: 23.08 ± 8.06; LSA: 105.52 ± 6.00), although with no clinically relevant differences. In fact, neither sufferers nor those who did not have BP presented normal mean values for lumbar kyphosis or LSA according to normality references. This study demonstrates the need to assess sagittal morphotype in childhood since schoolchildren remain incorrectly seated for many hours and it greatly affects their spinal curvatures.

Potential risk factors and triggers for back pain in children and young adults. A scoping review, part I: incident and episodic back pain

Background

The one-month prevalence of back pain in children and adolescents has been reported at 33, 28 and 48% at ages 9, 13 and 15 respectively. There are many suspected risk factors and triggers of back pain in young people.

Objective

The purpose of this scoping review was to identify potential risk factors and potential triggers for back pain in young people. The purpose of part I was to identify potential risk factors for incident and episodic back pain in young people. Part II included all eligible studies with unclear or mixed types of back pain.

Methods

Due to the vast number of studies on "risk factors" for back pain, a two-part scoping review of the literature was chosen as the best way to summarise the evidence. We adhered to the PRISMA-ScR guideline for scoping reviews. General potential risk factors and triggers for back pain in children and young adults (≤ 24 years) were included, incorporating physical, environmental, and/or physiological factors. A search was conducted using PubMed and Cochrane databases from inception to September 2018, limited to the English language. Within part I, and because of their importance, only the results of the studies that investigated risk factors of incident back pain and back pain episodes are presented.

Results

The search identified 7356 articles, of which 91 articles were eligible for this scoping review. The majority of the eligible articles had an unclear definition of back pain (results presented in scoping review part II). There were 7 inception cohort studies included and 1 cohort study that met the criteria for part I. The most consistent risk factors for incident and episodic back pain are female sex and older age.

Conclusion

Due to inconsistent ways of reporting on the type of back pain, no definitive risk factor for back pain has been identified. In general, females often report more symptoms, also for other diseases, and older age is not a useful risk factor as it merely indicates that the onset may not be in childhood. Clearly, the time has come to study the causes of back pain from different angles.

Neck posture and muscle activity in a reclined business class aircraft seat watching IFE with and without head support

The purpose of this study is to research if a headrest benefits the comfort of the passenger and lowers muscle activity in the neck when sitting in a reclined (slouched) posture while watching in flight entertainment (IFE) in an aircraft business class seat. No significant differences in muscle activity in the musculus sternocleidomastoid and musculus trapezius pars descendant were found between the conditions with headrest and without headrest. A significant difference in expected comfort rating was found. Subjects indicated they expect to experience more comfort with a headrest when watching IFE for a duration of two movies during a long-haul flight. This study also found a significant difference in posture. In the condition without headrest the head was more upright compared to the condition with headrest. The lack of significant difference in muscle activity and the significant difference in posture may indicate that humans tend to look for a head position that is neutral, in the sense of minimal muscle effort. This study shows that the use of a headrest may benefit the comfort experience of the passenger during flight. However, further research is necessary on the design of the headrest and the long-term effects of head support on comfort, discomfort, muscle activity and fatigue for watching IFE in a slouched posture.

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.

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.

Classroom Furniture Mismatch and Back Pain Among Adolescent School-Children in Abha City, Southwestern Saudi Arabia

Objective: To explore the potential classroom furniture mismatch with students’ anthropometric measurements and back pain related to sitting for extended periods. Methods: This cross-sectional study was carried out on all twelve male and female intermediate and secondary schools located in Abha city. Anthropometric and classroom furniture measurements were assessed, and the mismatch was determined using standardized methods. Students were also screened for back pain related to long sitting at school. Results: A total number of 879 students was selected. The study revealed seat height mismatch in both intermediate, and secondary school of 84.3%, and 75.6%, respectively. Seat depth mismatch was 74.0% in intermediate schools and reached 84.5% in secondary schools. The desk height was improper for 94.1%, and 82.3% of students in intermediate, and secondary schools, respectively. The levels of mismatch differ significantly by grade level and gender. A prevalence of 10.8% of back pain related to long sitting at school was found. In multivariable logistic regression, males, intermediate school children, and the presence of buttock-popliteal length/seat depth mismatch were significantly associated with pain. On the other hand, practicing exercise was a significant protective factor. Conclusions: There is a prevalent mismatch between students’ dimensions and existing schools’ furniture. School furniture providers should take in consideration the average Saudi students’ dimensions, while designing school furniture especially for males, and at intermediate schools, or provide schools with adjustable seats and desks.

Knee pain is associated with lower back pain in young baseball players: a cross-sectional study

PURPOSE

Considerable research has focused on shoulder and elbow injuries among baseball players; however, although lumbar spine and knee injuries are commonly experienced, they are less frequently studied. During common motions in baseball, such as throwing, hitting, and running, energy is transferred from the lower extremities through the lower back to the upper body. Lower extremity pain, as well as lower back pain (LBP), can disrupt the kinematic chain, and it is important to understand the association between lower extremity complaints and LBP. The purpose of this study was to elucidate the association between knee pain and LBP among young baseball players.

METHODS

A cross-sectional study was conducted with young baseball players (aged 6-15 years, n = 1,609) using a self-reported questionnaire. Multivariate logistic regression models were used for analyses. Variables considered in the models were sex, age, body mass index, team levels, number of days of training per week, number of hours in practice per day on weekdays and weekend, frequency of participation in games, practice intensity, and player position.

RESULTS

The point prevalence of LBP and knee pain was 8.4% and 13.1%, respectively. Knee pain was significantly associated with LBP. Using the absence of knee pain as a reference, the adjusted odds ratio (95% confidence interval) for LBP was 5.83 (3.93-8.65) (p < 0.001) in the presence of knee pain.

CONCLUSIONS

Knee pain was associated with LBP among young baseball players. Clinicians should pay attention to knee complaints to prevent and treat LBP among young baseball players.

LEVEL OF EVIDENCE

III.

Is Health-related Quality of Life Decreased in Adolescents With Back Pain?

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To evaluate the association between back pain and health-related quality of life (HRQoL) among adolescents.

SUMMARY OF BACKGROUND DATA

The prevalence of back pain has been increasing not only in the adult population but also among children and adolescents. The better knowledge about the association between back pain and health-related quality of life could facilitate the implementation of new intervention strategies on prevention and treatment of back pain.

METHODS

A sample of 350 students from the fifth to ninth grades of one public school in Niterói, Rio de Janeiro, Brazil. Anthropometric measures and information regarding sociodemographic, lifestyle, frequency and intensity of neck (NP), thoracic (TP), and low back pain in the previous month were collected using a personal digital assistant. HRQoL was assessed by KIDSCREEN-27. Multiple linear regression analyses were performed to investigate the association between back pain and HRQoL by sex.

RESULTS

The mean age of participants was 12.7 (±1.6) years. Frequency of NP, TP, and low back pain was 34.3, 27.1, and 13.1%, respectively. The mean intensity of pain was 2.3 (±0.2) for neck, 2.0 (±0.2) for thoracic, and 1.3 (±0.1) for low back pain. The presence of two/three painful sites was reported by 21.7% of the adolescents. The frequency and severity of neck pain were inversely associated with global HRQoL in both the sexes. There is a strong inverse association between the number of painful sites and global HRQoL and domains.

CONCLUSION

The presence and intensity of cervical pain and the number of painful regions were associated with lower HRQoL in adolescents, which is worrying due to the important relationship between back pain in the adolescence and in the adulthood.

LEVEL OF EVIDENCE

3.

Association between home posture habits and neck pain in High School adolescents

BACKGROUND

Neck pain (NP) in adolescence is as frequent as in adulthood. However, the relationship between home posture habits and neck pain is still unknown.

OBJECTIVE

To investigate the prevalence of NP and the association with home posture habits (HPH) in adolescents.

METHODS

Cross-sectional study with High School adolescents. Students answered questions regarding sociodemographic variables, lifestyle, HPH (illustration in the questionnaire), time (TV, computer, video-game) and the presence of NP. Multivariate logistic regression was used to investigate the association between HPH and NP.

RESULTS

The prevalence of NP was 48.9%. The ones who watched TV lying supine in bed for 2 hours or more a day yielded an odds ratio (OR) of 6.21 (1.45-26.52) for acute neck pain (ANP). Who watched TV and used the desktop in the slump posture yielded, respectively, an OR of 4.0 (1.63-9.85), and 2.03 (1.23-3.34) for chronic neck pain (CNP). The ones who frequently changed their positions while using the desktop and used it for 2 hours or more a day yielded an OR of 0.34 (0.14-0.85) for ANP.

CONCLUSION

Our findings support the high prevalence of NP in adolescence and raise the association between some HPH and neck pain.

Three-dimensional evaluation of pelvic posture in adolescents with and without a history of low back pain

Background/aim: This study aimed to evaluate the three-dimensional (3D) profile of pelvic posture and postural displacements of the pelvis in adolescents with and without a history of low back pain (LBP). Materials and methods: Thirty-two adolescents participated in this study. Participants were asked if they had ever suffered LBP at some point in their lives. Participants were divided into two groups: with a history of LBP (LBP group) and without a history of LBP (control group). For 3D evaluation of pelvic posture, the PosturePrint system was used. Three digital photographs were obtained in an upright stance (anteroposterior, left-right lateral) and analyzed. Postural displacements of the pelvis were calculated as rotations in degrees and translations in millimeters. The posture index, which is the total postural displacements score, was recorded. Results: Overall, 40.6% of the participants reported a history of LBP, while 59.4% of the participants did not. Although the 3D profile of pelvic posture, postural displacements of pelvis, and posture index score were similar between groups, the majority of participants in both groups had altered pelvic and total body posture. Conclusion: The findings suggest that adolescents with LBP have a profile of pelvic posture similar to those of healthy adolescents without a history of LBP.

High prevalence of inadequate sitting and sleeping postures: a three-year prospective study of adolescents

There is a paucity of information regarding the development of body posture during adolescence. This three-year prospective study aimed to evaluate sitting and sleeping postures among adolescents, and to determine whether these postures are associated with age and sex. We assessed 525 adolescents aged 11-16 years from the fifth to eighth grades. These adolescents were reassessed three years later. The Back Pain and Body Posture Evaluation Instrument was used to evaluate the sleeping posture and three sitting positions: sitting to write, to use a computer, and during leisure activities. Our findings indicated a low prevalence of adequate sleeping and sitting postures at baseline, with a decrease in prevalence observed after three years for all postures. These changes were similar for both sexes. Moreover, we found a strong reduction of adequate posture prevalence for younger adolescents, but the oldest adolescents demonstrated no significant differences after three years. Early, rather than late, adolescence is a critical period for establishing inadequate sitting and sleeping postures. This has implications for posture throughout adulthood; hence, interventions targeted at this age group are needed.

Occupational injuries among pediatric orthopedic surgeons: How serious is the problem?

In this cross-sectional study, we surveyed all pediatric orthopedic surgeons in Saudi Arabia using an anonymous electronic questionnaire composed of 23 items to identify the rate of occupational injuries and obtain other relevant information. Thirty-nine participants completed the questionnaire (response rate: 83%). Participants who sustained occupational injuries throughout their careers represented 82.5%. The most injured areas were the hands, eyes, and back by 54.5%, 24.2%, and 15.2%, respectively. Approximately 11.1% were injured while operating on infected patients. Approximately 30.3% reported their injuries to their institution. We concluded that the rate of occupational injuries among pediatric orthopedic surgeons is very high and underreported.

Evaluation of factors associated with severe and frequent back pain in high school athletes

Several studies have shown that half of all young athletes experience back pain (BP). However, high intensity and frequency of BP may be harmful, and the factors associated with BP severity have not been investigated in detail. Here, we investigated the factors associated with a high intensity and high frequency of BP in high school athletes. We included 251 athletes (173 boys and 78 girls [14-20 years old]) in this cross-sectional study. The dependent variables were a high frequency and high intensity of BP, and the independent variables were demographic, socioeconomic, psychosocial, hereditary, anthropometric, behavioural, and postural factors and the level of exercise. The effect measure is presented as prevalence ratio (PR) with 95% confidence interval (CI). Of 251 athletes, 104 reported BP; thus, only these athletes were included in the present analysis. Results of multivariable analysis showed an association between high BP intensity and time spent using a computer (PR: 1.15, CI: 1.01-1.33), posture while writing (PR: 1.41, CI: 1.27-1.58), and posture while using a computer (PR: 1.39, CI: 1.26-1.54). Multivariable analysis also revealed an association of high BP frequency with studying in bed (PR: 1.19, CI: 1.01-1.40) and the method of carrying a backpack (PR: 1.19, CI: 1.01-1.40). In conclusion, we found that behavioural and postural factors are associated with a high intensity and frequency of BP. To the best of our knowledge, this study is the first to compare different intensities and frequencies of BP, and our results may help physicians and coaches to better understand BP in high school athletes.

Back pain prevalence and associated factors in children and adolescents: an epidemiological population study

OBJECTIVE

To identify the prevalence of back pain among Brazilian school children and the factors associated with this pain.

METHODS

All 1,720 schoolchildren from the fifth to the eight grade attending schools from the city of Teutonia, RS, Southern Brazil, were invited to participate in the study. From these, 1,597 children participated. We applied the Back Pain and Body Posture Evaluation Instrument. The dependent variable was back pain, while the independent one were demographic, socioeconomic, behavior and heredity data. The prevalence ratio was estimated by multivariate analysis using the Poisson regression model (α = 0.05).

RESULTS

The prevalence of back pain in the last three months was 55.7% (n = 802). The multivariate analysis showed that back pain is associated with the variables: sex, parents with back pain, weekly frequency of physical activity, daily time spent watching television, studying in bed, sitting posture to write and use the computer, and way of carrying the backpack.

CONCLUSIONS

The prevalence of back pain in schoolchildren is high and it is associated with demographic, behavior and heredity aspects.

Back Pain Prevalence and Its Associated Factors in Brazilian Athletes from Public High Schools: A Cross-Sectional Study

Most studies on the prevalence of back pain have evaluated it in developed countries (Human Development Index--HDI > 0.808), and their conclusions may not hold for developing countries. The aim of this study was to identify the prevalence of back pain in representative Brazilian athletes from public high schools. This cross-sectional study was performed during the state phase of the 2015 Jogos dos Institutos Federais (JIF), or Federal Institutes Games, in Brazil (HDI = 0.744), and it enrolled 251 athletes, 173 males and 78 females (14-20 years old). The dependent variable was back pain, and the independent variables were demographic, socioeconomic, psychosocial, hereditary, exercise-level, anthropometric, strength, behavioral, and postural factors. The prevalence ratio (PR) was calculated using multivariable analysis according to the Poisson regression model (α = 0.05). The prevalence of back pain in the three months prior to the study was 43.7% (n = 104), and 26% of the athletes reported feeling back pain only once. Multivariable analysis showed that back pain was associated with demographic (sex), psychosocial (loneliness and loss of sleep in the previous year), hereditary (ethnicity, parental back pain), strength (lumbar and hand forces), anthropometric (body mass index), behavioral (sleeping time per night, reading and studying in bed, smoking habits in the previous month), and postural (sitting posture while writing, while on a bench, and while using a computer) variables. Participants who recorded higher levels of lumbar and manual forces reported a lower prevalence of back pain (PR < 0.79), whereas feeling lonely in the previous year, obesity, and ethnicity exhibited the highest prevalence ratio (PR > 1.30). In conclusion, there is no association between exercise levels and back pain but there is an association between back pain and non-exercise related variables.

Layout for Assessing Dynamic Posture: Development, Validation, and Reproducibility

PURPOSE

To determine the psychometric properties of the layout for assessing dynamic posture (LADy).

METHODS

The study was divided into 2 phases: (1) development of the instrument and (2) determination of validity and reproducibility. The LADy was designed to evaluate the position adopted in 9 dynamic postures.

RESULTS

The results confirmed the validity and reproducibility of the instrument. From a total of 51 criteria assessing 9 postures, 1 was rejected. The reproducibility for each of the criteria was classified as moderate to excellent.

CONCLUSIONS

The LADy constitutes a valid and reproducible instrument for the evaluation of dynamic postures in children 11 to 17 years old. It is low cost and applicable in the school environment.