A cross-sectional study of self-reported back and neck pain among English schoolchildren and associated physical and psychological risk factors

Association of self-reported musculoskeletal pain with school furniture suitability and daily activities among primary school and university students

Students spend a considerable amount of time in school. This study aimed to determine the prevalence of musculoskeletal pain and the association between the pain and suitability of school furniture and daily activities among primary school and university students. A total of 238 primary and university students participated in the study. The adapted Nordic questionnaire was used to assess pain prevalence, the BackPEI questionnaire was used to assess school-related factors, and student furniture mismatch calculations were performed to determine the anthropometric suitability of school furniture. Most students did not have a proper body posture while sitting, did not lift objects properly, and used TV and computer frequently. A high student-furniture mismatch was found for seat and desk height. The neck, lower back, shoulders, and upper back were the most affected body parts. Our study confirmed that musculoskeletal pain occurs in primary school students and increases with age, especially lower back pain. Proper backpack wearing was found to be an important factor in alleviating neck pain. Students who sat or lifted objects properly were more likely to report upper back pain, and students whose backrest height was appropriate were more likely to report lower back pain. Further efforts should be made to establish a comparable study protocol using objective methods to obtain more valid and reliable data to study school-related risk factors for musculoskeletal pain in students using prospective study protocols.

Validation of Two Instruments for the Correct Allocation of School Furniture in Secondary Schools to Prevent Back Pain

BACKGROUND

Back pain is common in secondary school students. If we adjust the school furniture to the anthropometric characteristics of the pupils, we will improve their posture and reduce back pain. There is a high degree of mismatch between the furniture used by students and that which should be used. The objectives of this research are to discover the degree of mismatch and validate two instruments that allow a correct allocation of the furniture.

METHODS

The selected sample was 132 secondary students (14.08 ± 1.10 years). An anthropometer was used to determine the ideal height of the chair and table; data were taken from body segments. The recorded values were compared with those obtained by the two measurement instruments to be validated. Inter-measurer and intra-measurer reliability and validation were performed using t-tests and Pearson's coefficient, respectively. Different analysis techniques were used: descriptive, one-way ANOVA, t-test, and effect size. The established level of significance was ρ < 0.05.

RESULTS

The mismatch between the anthropometric dimensions of the students and the existing furniture in the classrooms was 98.5 % for the chairs and 100 % for the tables. The correlational analysis of the instruments to be validated shows an r = 0.993 in the chair and r = 0.996 in the table.

CONCLUSIONS

There is a high degree of mismatch between the furniture and the anthropometric characteristics of the students. The proposed furniture allocation instruments are adequate.

Investigating the Relationship between Body Mass Index and Pain in the Spine in Children or Adolescents: A Systematic Review

Background: Neck pain (NP), back pain (BP), and low back pain (LBP) are generally defined as "pain in the spine." With the increasing prevalence of childhood obesity, secondary problems such as pain in the spine have arisen. The purpose of this review was to investigate the relationship between body mass index (BMI) and pain in the spine in children or adolescents. Methods: Publications were searched in PubMed, Web of Science, Scopus, and Google Scholar databases up to December 12, 2020. The search strategy in the database consisted of free text words and MeSH terms. Results: Twelve studies were reviewed. It was determined that different methods were used in all 12 studies to evaluate pain. In the evaluation of overweight/obesity, these studies performed BMI assessment by dividing body weight in kilograms by height squared. Five studies showed a relationship between LBP and BMI, two studies showed a relationship between BP and BMI, and two studies showed a relationship between NP and BMI. Conclusions: The review shows that there is a relationship between BMI and pain in the spine, especially LBP. There may be factors affecting this condition such as mechanical loading and hormonal metabolic activity in childhood and adolescence. Different methods are used in the studies in literature for the assessment pain in the spine and BMI, overweight, and obesity.

Notions of "optimal" posture are loaded with meaning. Perceptions of sitting posture among asymptomatic members of the community

BACKGROUND

Notions of "optimal" posture are widespread in modern society and strongly interconnected with preconceived beliefs.

OBJECTIVES

To quantitatively evaluate spinal posture among members of the community during habitual sitting, and when asked to assume an "optimal" posture.

DESIGN

Observational study.

METHODS

Marker-based kinematic analyses of the head, spine, and pelvis were conducted on 100 individuals. Habitual sitting posture and self-perceived "optimal" posture, and whether participants believed that their habitual sitting reflected an "optimal" posture, were evaluated. The Wilcoxon signed-rank test assessed angular differences between the two postures adopted. Exploratory post-hoc analyses were conducted by using the Mann-Whitney U test to assess differences between genders.

RESULTS

None of the participants stated that their habitual sitting was "optimal". Statistically significant differences were observed in most of the measured angles (p < 0.001) between habitual and self-perceived "optimal" posture. In habitual sitting posture, a significant interaction with gender was found only in the thoracolumbar (p < 0.05) and pelvic (p < 0.001) angles, with small effect sizes. In self-perceived "optimal" posture females were more extended in the head, upper thoracic, lower thoracic, lumbar and pelvic (p < 0.01) regions, than the males.

CONCLUSIONS

A group of young, asymptomatic participants, consistently changed their habitual sitting posture to a more upright posture when asked to assume an "optimal" sitting posture, although the amount of change observed varied between spinal regions. These findings also highlight gender differences in not just habitual sitting posture, but also the degree to which habitual sitting posture is modified when trying to assume an "optimal" sitting posture.

Musculoskeletal Pain, Related Factors, and Posture Profiles Among Adolescents: A Cross-Sectional Study From Turkey

PURPOSE

The aim of the study was to evaluate musculoskeletal pain due to mechanical reasons and related risk factors in adolescents and to define posture profiles of adolescents.

DESIGN

A cross-sectional study.

METHODS

The study was conducted with 2221 adolescents between February 2015 and May 2015. The questionnaire used to collect data consisted of three parts: (1) descriptive characteristics of the participants, (2) pain assessment of 14 parts of the body, and (3) Back Pain and Body Posture Evaluation Instrument (BackPEI).

RESULTS

The prevalence of low back pain among the participants was 73.3% (n = 1,343), while the prevalence of back pain was 68.4% (n = 1,254). The participants attributed their pain to their poor sitting postures at school (38.1%, n = 847) and carrying school backpacks (84.1%, n = 1,713). There was a statistically significant difference in the physical activities of adolescents and the BackPEI score (z = 4.40; p = .001). Posture factors of the BackPEI score increased while school desk comfort score increased (Spearman's rho = 0.148; p = .001), but it decreased while the school grades of the adolescents increased (Spearman's rho [ρ] = -0.161; p = .001).

CONCLUSIONS

According to this study, body posture was related to musculoskeletal pain and was correlated with physical activities, school desk comfort, and school grades of the adolescents. It is suggested that correct posture and ergonomic positions should be taught to adolescents when using computers, carrying school backpacks, and sitting in school chairs to prevent musculoskeletal pain.

Exploring Teachers' Back Pain Concerning Their Habits, Rules, Leisure Activities, and Physical Activity Breaks at Work

The role of a teacher in the Faculty of Health Sciences involves teaching students, preparing lessons, and participating in other activities such as research projects and management processes. Professional participation is part of their involvement in daily occupations, which are taking place in teachers' socio-cultural context and are necessary for their well-being. Teachers' work performance can be enabled or constrained by their professional habits, including habits while using computers. We investigated awareness of and adherence to recommendations on ergonomics and preventive measures for back pain among the Faculty of Health Sciences employees. This study was aimed at investigating the relationship between the influence of their habits during computer use and back pain. An online questionnaire was sent to the teaching staff of the Faculty of Health Sciences (n = 115). 73% of the staff opened the online questionnaire, 43% fully completed the questionnaire. Data were processed using SPSS statistical program, version 20.0. Descriptive statistics, Pearson's correlation coefficient, and factor analysis were calculated. Analysis of the results showed a significant statistical association between the professional habits and roles [daily computer use (r = .443, P < .01); position of different body parts during computer use [head (r = .669, P < .001), shoulder (r = .446, P < .01), legs and feet (r = .483, P < .01), screen inclination (r = .577, P < .01), adjusting chair settings (r = .608, P < .01), distance between eyes and screen (r = .766, P < .01)]; physical activities break at work [r = .758, P < .01], and back pain. Considering ergonomic principles when designing the work environment can have a major impact on employees' health and quality of work. As experts in the field of health sciences, faculty members are not sufficiently aware of the impact of an improperly designed work environment on employee health, which affects work habits.

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.

Factors associated with non-specific low back pain in children aged 10-12 from Bucaramanga, Colombia: A cross-sectional study

BACKGROUND

There are no Colombian studies published that assess non-specific low back pain (NSLBP) risk factors in children.

OBJECTIVE

To determine the factors associated with NSLBP in 73 children (19.2% girls) aged 10-12 years in one military school in Bucaramanga, Colombia.

METHODS

A questionnaire was used to obtain information of risk factors. Subsequently, children's weight and height were measured. The backpack was weighed at the beginning of each day from Monday to Friday. Crude and adjusted prevalence ratios were calculated, with their respective 95% confidence interval (CI).

RESULTS

The one-month prevalence of NSLBP was 39.7% (95% CI 28.4-51.9). In the multivariate analysis, carrying backpacks wearing between 12% and 20% of body weight, having a perception that the backpack is very heavy, and being a passive smoker increase the likelihood of NSLBP, while being 11-year-old compared to 10-year-old decreases the likelihood of having NSLBP, adjusted for gender, body mass index, and history of LBP in parents.

CONCLUSIONS

High prevalence of low back pain was found in children between 10 and 12 years old. The study of the decisive factors of low back pain is important to identify children at risk, as well as to develop efficient primary prevention programs.

Evidence- based Management Options for Nonspecific Musculoskeletal Pain in Schoolchildren

Introduction:

Children of school age (8-15 years) have a significant prevalence of non-specific musculoskeletal pain (from 11 to 38%, in our country as much as 48%), which represents a neglected public health problem without adequate preventive interventions. Health workers have little empirical evidence to support their clinical practice in deciding on intervention measures and treating this pain.

Aim:

The aim of this review article is to expand knowledge of the management of nonspecific musculoskeletal pain in school children based on the evidence.

Material and Methods:

The systematic review of literature was carried out at Biomed Central, PubMed, Scopus and Web of Science databases in search of relevant evidence supporting the research goal.

Results:

A total of 564 publications were reviewed and 523 were considered irrelevant. The remaining 47 publications were assessed as potentially relevant, and among them 39 did not meet the criteria for inclusion and exclusion. Therefore, 9 publications met the necessary criteria for further analysis.

Conclusion:

There is little evidence to create an integrative program of intervention measures and treatment of musculoskeletal pain in school children. Based on scarce number of proofs shown in this research, no conclusive solutions have been reached, necessitating a need for further research.

Neck and shoulder pain among elementary school students: prevalence and its risk factors

Background

Neck and shoulder pain is relatively common among children and teenagers and has a negative impact on their physical and psychological health. This study was carried out to assess the prevalence of neck and shoulder pain among elementary school students, and to investigate the relationship between this pain and its risk factors.

Methods

In this cross-sectional study, 693 elementary school students aged 7 to 12 years from Hamadan city, located in western Iran, were selected through the multistage cluster random sampling method. Data were collected through interviews and questionnaires. For the social and psychological variables, the parent version of the Strengths and Difficulties Questionnaire (SDQ) was used. For assessing each student’s posture, an observational checklist, the Rapid Upper Limbs Assessment (RULA), was used. The data was analyzed using the unadjusted (univariate) and adjusted (multivariate) logistic regression.

Results

The prevalence of the neck pain was slightly higher than that of shoulder pain. The prevalence reported over a month was 35.8 and 30.9% for neck and shoulder pain, respectively. The logistic regression analyses showed that, very high desk height (odds ratio (OR) =1.96, 95% confidence interval CI: 1.02–3.74), backward seat pan inclination (OR = 2.10, 95% CI: 1.37–3.24), forward seat pan inclination (OR = 3.12, 95% CI:1.46–6.68), difficulty in viewing the board (OR = 2.54, 95% CI: 1.10–5.84), too much homework (OR = 2.59, 95% CI: 1.49–4.51), RULA score at level III (OR = 2.88, 95% CI:1.64–5.05), and RULA score at level IV (OR = 3.12, 95% CI: 1.72–5.63) increased the risk of neck pain independently. On the other hand, sitting on desk and seat (OR = 0.59, 95% CI: 0.39–0.91) and laying position for doing homework (OR = 0.53, 95% CI: 0.34–0.81) reduced the related risk. Very short desk height (OR = 2.41, 95% CI: 1.26–4.61) and too much homework (OR = 1.94, 95% CI: 1.10–3.42) increased the risk of shoulder pain.

Conclusion

The elementary school students reported a high prevalence of shoulder and neck pain. This study found that improper sitting positions, as well as physical factors such as the school furniture, too much homework, and difficulty in viewing the classroom board, were associated with pain. Proper interventions considering the risk factors assessed in this study, are suggested.

Back pain and school bag weight - a study on Indian children and review of literature

Back pain in children is a complex phenomenon, which has been shown to be associated with physical and psychosocial factors. None of the studies on Indian children have investigated the possible association between back pain and psychosocial factors. We decided to determine the prevalence of back pain in students and association with both physical and psychosocial factors. A cross-sectional study was conducted on 163 students from two city schools. Physical factors were evaluated using a structured questionnaire. Strengths and difficulties questionnaire was used to assess psychosocial factors. The studied sample consisted of 49.7% boys and 50.3% girls. Mean school bag weight was 6.1±2.4 kg (range: 2.2-15.6 kg). Mean weight of school bag as a percentage of body weight was 13.5±6.2%. Approximately 76% students carried more than 10% of their body weight. The prevalence of back pain (over last 1 month) was 53.9%. No associations were found between back pain and weight of school bag, weight of school bag as a percentage of body weight and physical activities. Significant associations were found between back pain and number of hours spent watching television [odds ratio (OR): 3.3, 95% confidence interval (CI): 1.5-7.5; P=0.003], history of injury to the back (OR: 4.8, 95% CI: 1.47-15.8, P=0.003), presence of a family member complaining of back pain (OR: 1.98, 95% CI: 1.25-3.14, P=0.002), conduct (P=0.042) and hyperactivity problems (P=0.045). Thus, there appears a need to consider psychosocial factors along with physical factors when evaluating a young student with back pain.

The association between psychological and social factors and spinal pain in adolescents

Spinal pain, back pain, and/or neck pain begins early in life and is strongly associated with spinal pain in adulthood. Understanding the relationship between psychological and social factors and adolescent spinal pain may be important in both the prevention and treatment of spinal pain in this age group. We aimed to determine if psychological and social factors were associated with spinal pain in a cross-sectional study of a school-based cohort of 1279 Danish adolescents aged 11-13, who were categorized into "any" and "substantial" spinal pain. "Substantial spinal pain" was defined as a lifetime frequency of "sometimes" or "often" and a pain intensity of at least two on the revised Faces Pain Scale. Logistic regression analyses, stratified by sex, were conducted for single and all variables together. Eighty-six percent of participants reported "any spinal pain" and 28% reported "substantial spinal pain". Frequency of psychological and social factors was significantly higher in those with spinal pain compared to those without. As the frequency of psychological and social factors increased, the odds of both "any spinal pain" and "substantial spinal pain" also increased.Conclusion: Psychological and social factors may be important determinants in adolescent spinal pain. What is Known: • Spinal pain begins early in life to reach adult levels by age 18. Spinal pain in adolescence is strongly associated with spinal pain in adulthood. • In adults, psychological and social factors and spinal pain are strongly related; however, this relationship in adolescence is poorly understood. What is New: • Adolescents with spinal pain reported a significantly higher frequency of psychological factors and loneliness and lower levels of pupil acceptance. • Adolescents reporting higher levels of loneliness, lower levels of pupil acceptance, and increased frequency of psychological factors had increased odds of reporting "substantial spinal pain".

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.

Effect of 12-Week Whole-Body Vibration Exercise on Lumbopelvic Proprioception and Pain Control in Young Adults with Nonspecific Low Back Pain

BACKGROUND Nonspecific low back pain (NSLBP) accounts for a large proportion of low back pain cases. The present study aimed to investigate the effect of the whole-body vibration (WBV) exercise on lumbar proprioception in NSLBP patients. It was hypothesized that WBV exercise enhances lumbar proprioception. MATERIAL AND METHODS Forty-two patients with NSLBP performed an exercise program 3 times a week for a total of 12 weeks of WBV. The lumbar proprioception was measured by joint position sense. Outcomes were lumbar angle deviation and visual analogue scale (VAS) score. RESULTS After the 12-week WBV exercise, lumbar flexion angle deviation was reduced from 3.65±2.26° to 1.90±1.07° (P=0.0001), and extension angle deviation was reduced from 3.06±1.85° to 1.61±0.75° (P=0.0001), significantly lower than baseline. After participating in the 12-week WBV exercise, a significant pain reduction was observed (P=0.0001). Men in the whole group (n=32) indicated significantly lower angle deviations in flexion and extension, whereas women (n=10) indicated significantly lower flexion angle deviation (P=0.037), and no significant difference was found in extension angle deviation (P=0.052). However, by subdividing the entire group (n=42) into poor and good proprioceptive groups, WBV exercise presented significant enhancement of lumbar proprioceptive ability in the poor flexion proprioception subgroup, poor extension proprioception subgroup, and good extension proprioception subgroup (each P=0.0001), but not in the subgroup with good flexion proprioceptive ability (P=0.165). CONCLUSIONS Lumbar flexion and extension proprioception as measured by joint position sense was significantly enhanced and pain was significantly reduced after 12-week WBV exercise in NSLBP patients. However, the patients with good flexion proprioceptive ability had limited proprioceptive enhancement.

A review of the methodology and applications of anthropometry in ergonomics and product design

Anthropometry is a key element of ergonomic studies for addressing the problem of fitting the tasks/products to user characteristics, but there is a gap between anthropometric data and their application for designing ergonomic products and environments. This research was conducted to review the literature on the methodology and applications of anthropometry for the ergonomic design of products and environments, and to identify where further research is needed to improve its application and evaluation protocols. One hundred and sixteen papers meeting the inclusion criteria were reviewed. Although a number of anthropometric investigations have been conducted to improve the design of products/environments for different users, further research seems to be necessary, particularly for special groups, such as children, the elderly and people with disabilities. Different anthropometric measurement methods/techniques and fitting criteria are discussed regarding their applicability for various design applications. This review also highlights methodological issues (sampling considerations and prototype evaluation and testing) that should be considered in future research to ensure a user-centred approach of the design process. Practitioner Summary: A literature review was conducted on the methodology and applications of anthropometry for the ergonomic design of products/environments. This review emphasises the need for anthropometric research to design for special groups, such as children, the elderly and people with disabilities, and methodological issues that should be considered in future research. Abbreviations: 1D: one-dimensional; 2D: two-dimensional; 3D: three-dimensional; HF/E: Human Factors/Ergonomics; PCA: Principal Components Analysis; CA: Cluster Analysis; DHM: Digital Human Modelling.

Multigroup latent class model of musculoskeletal pain combinations in children/adolescents: identifying high-risk groups by gender and age

Background

To investigate the combinations of Musculoskeletal pain (MSP) (neck, shoulder, upper and low back pain) among a sample of Iranian school children.

Methods

The MSP combinations was modeled by latent class analysis (LCA) to find the clusters of high–risk individuals and multigroup LCA taking into account the gender and age (≤ 13 years and ≥ 14 years of age categories).

Results

The lowest and highest prevalence of MSP was 14.2% (shoulder pain in boys aged ≥14 years) and 40.4% (low back pain in boys aged ≤13 years), respectively. The likelihood of synchronized neck and low back pain (9.4–17.7%) was highest, while synchronized shoulder and upper back pain (4.5–9.4%) had the lowest probability. The probability of pain at three and four locations was significantly lower in boys aged ≥14 years than in other gender–age categories. The LCA divided the children into minor, moderate, and major pain classes. The likelihood of shoulder and upper back pain in the major pain class was higher in boys than in girls, while the likelihood of neck pain in the moderate pain class and low back pain in the major pain class were higher in children aged ≥14 years than those aged ≤13 years. Gender–age specific clustering indicated a higher likelihood of experiencing major pain in children aged ≤13 years.

Conclusions

The findings highlight the importance of gender– and age–specific data for a more detailed understanding of the MSP combinations in children and adolescents, and identifying high-risk clusters in this regard.

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.

Risk factors for neck and shoulder pain among schoolchildren and adolescents

AIM

To evaluate the potential risk factors for neck and shoulder pain among schoolchildren.

METHODS

Demographic, physical/leisure activity, school-related and psychosocial factors for neck/shoulder pain were evaluated in a cross-sectional study of 1611 schoolchildren aged 11-14 years.

RESULTS

Neck and shoulder complaints were reported in 27.9 and 19.0% of the sample, respectively. According to multivariate logistic regression models, high desk height (odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.22-4.07), forward-inclined seat pan (OR = 2.38, 95% CI: 1.40-4.05), time spent (30-60 min/day) carrying school bag (OR = 1.61, 95% CI: 1.16-2.23) and psychosocial factors (OR = 1.95, 95% CI: 1.03-3.72) independently increased the risk of neck pain, while low body mass index (OR = 0.63, 95% CI: 0.42-0.95) decreased it. Time spent on watching TV (OR = 1.45, 95% CI: 1.02-2.06), backward-inclined seat backrest (OR = 1.62, 95% CI: 1.02-2.58), curved seat backrest (OR = 1.80, 95% CI: 1.05-3.08), too much homework (OR = 1.45, 95% CI: 1.03-2.03) and psychosocial factors (conduct problems) (OR = 1.63, 95% CI: 1.07-2.46) independently increased the risk of shoulder pain, while prosocial behaviour (OR = 0.56, 95% CI: 0.35-0.90) decreased it.

CONCLUSION

Both physical and psychosocial factors influenced the risk for neck/shoulder pain in school-aged children, suggesting that they should be considered in assessment and treatment of such symptoms in this population.

Vertigo and dizziness in adolescents: Risk factors and their population attributable risk

OBJECTIVES

To assess potential risk factors for vertigo and dizziness in adolescents and to evaluate their variability by different vertigo types. The role of possible risk factors for vertigo and dizziness in adolescents and their population relevance needs to be addressed in order to design preventive strategies.

STUDY DESIGN

The study population consisted of 1482 school-children between the age of 12 and 19 years, who were instructed to fill out a questionnaire on different vertigo types and related potential risk factors. The questionnaire specifically asked for any vertigo, spinning vertigo, swaying vertigo, orthostatic dizziness, and unspecified dizziness. Further a wide range of potential risk factors were addressed including gender, stress, muscular pain in the neck and shoulder region, sleep duration, migraine, coffee and alcohol consumption, physical activity and smoking.

RESULTS

Gender, stress, muscular pain in the neck and shoulder region, sleep duration and migraine were identified as independent risk factors following mutual adjustment: The relative risk was 1.17 [1.10-1.25] for female sex, 1.07 [1.02-1.13] for stress, 1.24 [1.17-1.32] for muscular pain, and 1.09 [1.03-1.14] for migraine. The population attributable risk explained by these risk factors was 26%, with muscular pain, stress, and migraine accounting for 11%, 4%, and 3% respectively.

CONCLUSION

Several established risk factors in adults were also identified in adolescents. Risk factors amenable to prevention accounted for 17% of the total population risk. Therefore, interventions targeting these risk factors may be warranted.

Musculoskeletal complaints while growing up from age 11 to age 14: the PIAMA birth cohort study

For musculoskeletal complaints (MSCs) among adults, several risk factors are known, but the most important determinant is an earlier episode of MSCs. Research has shifted to younger ages, showing a high prevalence of MSCs among children and adolescents. Our purpose was to evaluate the prevalence of MSCs among those growing up from age 11 to 14 and to explore the role of several sociodemographic, growth and development, psychosocial, and lifestyle factors. Data collected at age 11 (n = 2651) and age 14 (n = 2522) in the ongoing Dutch Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study were used. Analyses included multiple logistic regression analyses using stepwise backward selection. The 1-year prevalence of any MSCs for at least 1 month increased from 15.8% at age 11 to 24.4% at age 14, and this was also found for upper extremity complaints (from 4.7% to 7.6%), back complaints (from 2.7% to 9.3%), and lower extremity complaints (from 11.9% to 14.7%). More MSCs were found among girls, those with sports injuries, those with sleeping problems, and those with daytime tiredness, although complaints at age 11 were by far the most important factor associated with MSCs at age 14 for all pain sites. This study showed that MSC is already common at an early age and that already at age 14 the factor with the strongest association is an earlier episode of MSCs. Sleeping problems and tiredness may also play a role in the early development of MSCs, either as determinant or as a consequence.

Psychogenic Low-Back Pain and Hysterical Paralysis in Adolescence

STUDY DESIGN

A retrospective review.

OBJECTIVE

The purpose of this study was to investigate the clinical outcomes in adolescents diagnosed with psychogenic low-back pain and hysterical paralysis and to evaluate the efficacy of differential diagnosis methods.

SUMMARY OF BACKGROUND DATA

The incidence of low-back pain in adolescence is similar to that in adults, but the causes of low-back pain are difficult to determine in most cases. For these patients, a definitive diagnosis of psychogenic low-back pain and hysterical paralysis as well as adequate treatment are clinically important to avoid unnecessary surgical treatment.

METHODS

Eleven patients (3 males and 8 females; mean age, 16.5 years; range, 13-19 y) diagnosed with psychogenic low-back pain and hysterical paralysis were followed up for 2-10.25 years (mean, 4.67 y). Nonorganic signs were observed in almost all patients. For the purpose of excluding organic disorders, the thiopentone pain study was used in patients who complained mainly of pain, and motor evoked potentials using transcranial magnetic stimulation were measured in patients experiencing primarily muscle weakness.

RESULTS

The psychiatric diagnosis was neurosis in 9 patients, whereas it was psychosomatic disorder in 2 patients. Conservative treatment, such as physiotherapy, was performed, and at the final follow-up evaluation, outcomes were regarded as excellent in 7 patients and good in 4 patients.

CONCLUSIONS

The prognosis of psychogenic low-back pain and hysterical paralysis in adolescence is relatively good. However, it is important to understand the characteristics of psychogenic low-back pain and hysterical paralysis in childhood and young adulthood and to perform accurate diagnosis by screening for nonorganic signs and excluding organic disorders by using the thiopentone pain study and motor evoked potentials obtained using transcranial magnetic stimulation.

Prevalence and risk factors of low back pain among school age children in Iran

Background: Most available data on the prevalence and characteristics of back pain in schoolchildren is related to industrialised and developed countries. The aim of this study was to investigate the prevalence of low back pain (LBP) and potential risk factors among schoolchildren and adolescents in a developing country, Iran.

Methods: A cross-sectional study was conducted among 1611 Iranian schoolchildren aged 11–14 years. A self-complete questionnaire was used to assess LBP prevalence, physical leisure activities, school-related and psychosocial factors.

Results: The prevalence of LBP was 34.3%. Female gender (odds ratio [OR] = 1.57, 95% CI:1.28–1.94), family member with back pain (OR = 1.82, 95% CI: 1.40–2.36), difficulty in viewing the (black)board (OR = 1.50, 95% CI: 1.13–1.99), too much homework (OR = 1.47, 95% CI:1.09–1.99), time spend carrying a schoolbag (min/d) (OR = 1.37, 95% CI: 1.01–1.85), and psychosocial factors (emotional symptoms) (OR = 2.28, 95% CI: 1.54–3.39) were independently associated with LBP. Physical activity, having a job, watching television, using a computer, playing games and schoolbag weight had no effect.

Conclusion: It can be concluded that both physical and psychosocial factors influenced the risk for LBP, but emotional symptoms had a stronger association with LBP than physical factors. Knowledge about LBP in school children and adolescents could be important in assessment and treatment of such symptoms in this population.

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.

Long-term adolescent multi-site musculoskeletal pain is associated with psychological distress and anxiety

OBJECTIVE

Although several studies have shown that adolescent musculoskeletal pain is associated with psychological problems in a cross-sectional setting, the associations of long-term musculoskeletal pain with psychological distress and anxiety are not known.

METHODS

The study included 1773 adolescents belonging to the Northern Finland Birth Cohort 1986. They received a postal questionnaire at the age of 16years and a follow-up questionnaire two years later. The first inquiry contained questions about the sites of musculoskeletal pain; the second had the same pain questions, along with measures of distress and anxiety. Risk ratios (RR) were assessed by log-linear regression analysis.

RESULTS

Multi-site musculoskeletal pain (in ≥2 body locations) at both 16 and 18years was common, reported by 53% of girls and 30% of boys. Multi-site pain at both ages, compared to those with multi-site pain neither at 16 nor 18years, was associated with psychological distress at the age of 18 among both girls (RR 1.8 95% CI 1.2-2.7) and boys (RR 3.5 95% CI 2.1-5.9). For anxiety, the corresponding relative risks were 1.5 (95% CI 1.0-2.2) and 1.8 (95% CI 1.4-2.3), respectively. For short-term multi-site pain (prevalent only at the age of 16 or 18), these relative risks were between 0.8 and 2.3.

CONCLUSIONS

Adolescents with long-term multi-site pain have higher levels of distress and anxiety than those without or with only short-term multi-site pain. Associations were found in both genders, but the relationship between pain and distress was more pronounced among boys. The associations had modest effect strength.

The influence of school furniture on students' performance and physical responses: results of a systematic review

The purpose of this study was to determine, using a systematic review, whether the design and/or dimensions of school furniture affect the students' physical responses and/or their performance. Of the review studies, 64% presented positive results, i.e. proven effects; 24% presented negative effects or no change/effect; and the remaining 12% showed an unclear effect. The compatibility between school furniture dimensions and students' anthropometric characteristics was identified as a key factor for improving some students' physical responses. Design characteristics such as high furniture, sit-stand furniture, and tilt tables and seats also present positive effects. Finally, we concluded that further research should be conducted exploring various aspects of those variables, particularly focusing on more objective measures complemented by controlled and prospective design. Practitioner Summary: A systematic review of the literature presents a clearly positive effect of school furniture dimensions on students' performance and physical responses. Similar results appeared when school furniture design was tested. However, studying the effects of design and dimensions together produced an unclear positive effect.

[Factors associated with back pain in adolescents from public schools in one city from South Brazil]

OBJECTIVE

To investigate the prevalence of back pain and associated factors in children attending public schools from South Brazil.

METHODS

A cross-sectional study, conducted between May-July 2014, where a random sample of 619 adolescents, aged 10-17 years of age, was evaluated. The prevalence of back pain was assessed using the Nordic Musculoskeletal Questionnaire, and the independent variables (demographic and biological information, the way of transporting school supplies, and pain during and after the walk) were obtained through a standardized questionnaire. The Poisson regression model was used to estimate unadjusted and adjusted prevalence of back pain in association with the factors investigated.

RESULTS

The prevalence of back pain was 45.2 %, out of which 64.6 % reported pain in one region, 27.1 % in two and 8.3 % in the three regions investigated. After an individual assessment of regions, it was found that the highest prevalence of pain relates to the dorsal region (26.2 %). The most relevant associated factors include female gender (OR=1.43, 95 %CI 1.19-1.74; p<0.01), age between 14 and 17 (OR=1.22; 95 %CI = 1.03-1.45; p=0.02), and dark skin (OR=1.20, 95 %CI 1.01-1.43; p=0.04).

CONCLUSION

The results highlight the need for greater attention to adolescents complaining of back pain, in order to prevent the presence of this chronical disorder in adolescence and later in adulthood. Therefore, it is necessary to educate adolescents and their guardians for the stimulation and consequent adoption of healthy practices for musculoskeletal integrity.

Static Anthropometric Characteristics of Bangladeshi Vehicle Driver: A Case Study

Background. Inappropriate design of sitting furniture and working equipment causes the serious musculoskeletal injuries and various pains as well as reducing working efficiency. Uncomfortable sitting posture in prolonged driving in Bangladesh is an issue to be solved immediately. Therefore, anthropometric databank of user population is significantly essential for the suitable dimensional design for avoiding these remarkable problems. Methods. This study analyses the anthropometric data of the Bangladeshi male vehicle driver aged between 30 and 60 years. A total of 210 Bangladeshi healthy drivers are considered for 15 anthropometric measurements and compared with the similar anthropometrics of other nationalities. Results. The mean stature and sitting height erect of Bangladeshi driver are 1645 mm and 843 mm, respectively. The mean of body mass index (BMI) of the drivers is 26.09 kg/m(2), which indicates that the drivers are overweight. The mean stature of Bangladeshi driver is 17 mm shorter than the driver of Korea and 115 mm shorter than the driver of Iran. Conclusion. There are substantial differences between the body dimensions of Bangladeshi driver and similar dimensions of other countries. In comparison, Bangladeshi driver is found to be the shortest compared with the sample of other nationalities.

Prevalence and its risk factors for low back pain among operation and maintenance personnel in wind farms

Background

With the increasingly severe energy shortage and climate change problems, developing wind power has become a key energy development strategy and an inevitable choice to protect the ecological environment worldwide. The purpose of this study was to investigate the prevalence of low back pain (LBP) and analyze its risk factors among operation and maintenance personnel in wind farms (OMPWF).

Methods

A cross-sectional survey of 151 OMPWF was performed, and a comprehensive questionnaire, which was modified and combined from Nordic Musculoskeletal Questionnaires (NMQ), Washington State Ergonomics Tool (WSET) and Syndrome Checklist-90(SCL-90) was used to assess the prevalence and risk factors of LBP among OMPWF.

Results

The prevalence of LBP was 88.74 % (134/151) among OMPWF. The multivariable model highlighted four related factors: backrest, somatization, squatting and lifting objects weighing more than 10 lb more than twice per minute.

Conclusions

The prevalence of LBP among OMPWF appears to be high and highlights a major occupational health concern.

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.

Impact of information and communication technology on child health

This article provides a general framework for understanding the use of information and communication technology in education and discusses the impact of computer usage on students' health and development. Potential beneficial and harmful effects of computer use by children are discussed. Early epidemiological and laboratory studies have indicated that children are at least of similar risk of developing musculoskeletal and vision problems as adults, and musculoskeletal and visual health problems developed in childhood are likely to persist into adulthood. This article, therefore, aims to provide a reflection on the deficits of existing policy and recommendations for child-specific guidelines in computer use.

Postural education program for elementary school: a one-year follow-up study

AbstractThe objective of this study was to verify the short- and long-term effectiveness of the Elementary School Postural Program in the performance, generalization, and perception of daily school activities. The final sample consisted of 61 subjects divided into experimental (14 years ±0.93; ♀=22; ♂=10) and control group (15.38 years ±0.97; ♀=16; ♂=13), all participants attended a Brazilian public school in Porto Alegre, State of Rio Grande do Sul. The postural program included 20 sessions over a 10-week period. In each session, participants discussed and practiced routine actions that typically occurred at schools. Eight other meetings were required for the completion of the pre- and post-tests. The experimental group performed significantly better than the control group in the short-term evaluations, although there were no significant statistical differences in the long-term follow-up evaluations. The children demonstrated a good behavioral response to the postural program; nevertheless, the knowledge had not been completely mastered after a year.

[Low back pain and associated factors in children and adolescents in a private school in Southern Brazil]

Studies have shown that children and adolescents with low back pain are also similarly affected when they reach adulthood, thus highlighting the importance of investigating causes of low back pain in school-age children. The study examined low back pain and associated factors in 770 schoolchildren 7 to 17 years of age in a private school in Porto Alegre, Rio Grande do Sul State, Brazil. Low back pain was defined as pain or discomfort in the lumbar region in the previous month, assessed by a questionnaire. Low back pain was found in 31.6% of the subjects and was more prevalent in girls (41.9%) than boys (21.4%). Factors associated with lumbar pain were female gender, age 9 to 17 years, hyperactivity (borderline and abnormal categories), and emotional symptoms (abnormal category). Mapping the occurrence of low back pain and associated factors is important for identifying children and adolescents at risk and for developing effective programs for primary prevention.

Neck, shoulder and low back pain in secondary schoolchildren in relation to schoolbag carriage: should the recommended weight limits be gender-specific?

The occurrence of neck, shoulder and low back complaints in relation to schoolbag carriage and other potential risk factors were investigated in a cross-sectional study of 586 Iranian schoolchildren aged 12-14 years. The average load carried by schoolchildren was 2.8 kg. Neck, shoulder and low back complaints during the preceding month were reported by 35.3%, 26.1% and 33% of the students, respectively. Gender was an independent factor predicting musculoskeletal symptoms in schoolchildren. Girls were more likely than boys to suffer from neck, shoulder and low back complaints, although there was no significant difference between genders in terms of schoolbag carriage variables. The findings suggest that the recommended weight limit for schoolbag carriage may need to differ between boys and girls. The associations between schoolbag variables and reported symptoms are also discussed. The results provide evidence that the current weight limit should consider a broader combination of factors that influence the use of schoolbags.

Risks of musculoskeletal disorders among betel quid preparers in Taiwan

BACKGROUND

Betel quid chewing is common in Taiwan. The work of betel quid preparers is characterized by long hours of static work, awkward working posture and highly repetitive hand/wrist motion. However, the musculoskeletal health of betel quid preparers receives very little attention.

METHODS

The Chinese version of the Standardized Nordic Musculoskeletal Questionnaire (NMQ) was administered, and electrogoniometers and electromyography were used in this cross-sectional study to characterize the hand/wrist motion of the subjects. Physical examinations on the thumbs and wrists of the subjects were conducted by means of Phalen's test and Finkelstein's test, respectively.

RESULTS

Among the 225 participants, more than 95% attributed their musculoskeletal complaints to their work, and shoulder, neck, hand/wrist, and lower back discomfort were most frequently reported. More than 70% of the preparers did not seek medical treatment for their musculoskeletal problems. Based on the physical examination, 24% of the participants had suspected symptom of either carpal tunnel syndrome (CTS) or DeQuervain's tenosynovitis. The instrumental measurements indicated that betel quid preparation is characterized by extreme angle ranges and moderate repetition of wrist motion as well as low forceful exertion.

CONCLUSIONS

This study concludes that betel quid preparers are a high risk group of developing musculoskeletal disorders (MSDs). Future studies by electrogoniometers and detailed physical examination on betel quid preparers are needed to determine the predisposing factors for CTS. Some intervention measures to prevent MSDs and to lessen psychological stress for this group of workers are strongly suggested.

How schooling and lifestyle factors effect neck and shoulder pain? A cross-sectional survey of adolescents in China

STUDY DESIGN

A cross-sectional survey by anonymous self-assessment questionnaire was given to 3600 high school students from 30 high schools.

OBJECTIVE

The purpose of this study was to analyze the prevalence of neck and shoulder pain (NSP) and its effects among high school students in Shanghai, China.

SUMMARY OF BACKGROUND DATA

NSP has become a problem in many countries in recent years among adolescents. No recent studies have estimated the prevalence of NSP in Chinese school populations.

METHODS

A total of 3600 high school students from all 3 grades chosen from 30 random schools participated in this study. Participants were asked to fill out a questionnaire on NSP and to provide information on demographic items, family factors, schooling, and lifestyles. χ tests were used to compare the incidence of NSP, univariate and multivariate logistic regression analyses were used to obtain influencing factors of NSP.

RESULTS

In total, 3600 questionnaires were distributed, and 2842 were valid. The cross-sectional prevalence of NSP was 41.1%, with more girls (653 of 1478, i.e., 44.2%) reporting having NSP than boys (514 of 1364, i.e., 37.7%) (odds ratio = 0.764; 95% confidence interval = 0.657-0.888; P < 0.05). The frequency, duration, and degree of NSP in girls were also higher than in boys. For high school years 1, 2, and 3, the incidence of NSP was 40.1%, 40.7%, and 45.4%, respectively. The multivariate logistic regression indicated that sex, family history of NSP, school furniture, long sitting time, computer use, insufficient rest time, sleep time, commuting method, perceived schoolbag weight, and smoking had a significant effect on NSP.

CONCLUSION

The incidence of NSP in high school students in Shanghai is quite high. The occurrence of NSP is related to several factors including sex and school year, as well as some factors related to family, schooling, and lifestyles.

LEVEL OF EVIDENCE

3.

Effect of backpack load on the head, cervical spine and shoulder postures in children during gait termination

Twelve boys with an average age of 9.9 years were instructed to carry backpacks that weighed 0%, 10% and 15% of their body weights (BWs) to complete planned and unplanned gait termination experiments. The craniohorizontal, craniovertebral and sagittal shoulder posture angles at the sagittal plane as well as the anterior head alignment and coronal shoulder posture angles at the coronal plane were analysed. Results revealed significantly smaller craniohorizontal and sagittal shoulder posture angles during planned gait termination and a significantly smaller sagittal shoulder posture angle during unplanned gait termination under loaded conditions compared with those at 0% BW backpacks. Furthermore, the coronal shoulder posture angles at 10% and 15% BW during planned and unplanned gait terminations were significantly larger than those at 0% BW. Therefore, subjects were more likely to have a forward head posture, rounded shoulder posture and increased lateral tilting of the shoulders during gait termination as backpack loads were increased. However, gait termination, whether planned or unplanned, did not elicit a remarkable effect on posture.

Association of Parental Awareness of Using Schoolbags With Musculoskeletal Symptoms and Carrying Habits of Schoolchildren

The association between parental awareness of using schoolbags and the occurrence of musculoskeletal symptoms and carrying habits of children was investigated in a cross-sectional study in Tabriz, Iran. Data on 454 students aged 11−14 years and their parents ( n = 358) were analyzed. The awareness of the recommended weight limit, appropriate method of carrying schoolbags, and schoolbag strap adjustments was generally low among the respondents. A higher parental awareness of the schoolbag weight was associated with a lower prevalence of upper back and shoulder complaints among children and carrying loads less than 10% of their body weight. The findings suggest that parental awareness should have a more prominent role in changing the schoolbag carrying habits of children and particularly in reducing the weight of loads carried by them. This highlights the need to incorporate guidelines and recommendations into practice to ensure that the health and safety of schoolchildren are not compromised when using schoolbags.

Classification system of the normal variation in sagittal standing plane alignment: a study among young adolescent boys

STUDY DESIGN

Cohort study.

OBJECTIVE

To construct a sagittal standing alignment classification system in which the clinical significance of identified subgroups was considered with spinal pain measures.

SUMMARY OF BACKGROUND DATA

Numerous grading systems for the categorization of sagittal standing alignment have been devised. However, no common consensus exists about which typology should be adopted. Furthermore, the clinical significance of proposed classification schemes has rarely been assessed in terms of their relationship with spinal pain. Given the importance of the adolescent period for musculoskeletal development, research within a young adolescent population is required.

METHODS

The study population consisted of 639 prepeak height velocity boys (mean age, 12.6 yr [standard deviation, 0.54 yr]). Sagittal posture was quantified during habitual standing; data were used to develop a classification system according to 3 gross postural and 5 lumbopelvic characteristics. Prevalence rates of spinal pain measures (pain and seeking care) were compared between postural subgroups.

RESULTS

Cluster analysis indicated 3 types of characteristic overall sagittal profiles: neutral global alignment (n = 266 [41.6%]), sway-back (n = 199 [31.1%]), and leaning-forward (n = 174 [27.2%]). Within each of these categories, postural subgroups could be established according to specific lumbopelvic features. Logistic regression revealed that prevalence (lifetime and month) of low back pain and neck pain was significantly higher in boys classified as having sway-back posture than in those classified as having neutral global alignment. Spinal pain measures did not differ between groups of the lumbopelvic subclassification.

CONCLUSION

Meaningful classifications exist for sagittal plane posture in young adolescent boys, both on gross body segment and lumbopelvic level. In terms of clinical importance, that is, low back pain and neck pain prevalence, postural subgrouping strategies based on the orientation of gross body segments are suggested to be superior when compared with lumbopelvic grading.

Development of the young spine questionnaire

Background

Back pain in children is common and early onset of back pain has been shown to increase the risk of back pain significantly in adulthood. Consequently, preventive efforts must be targeted the young population but research relating to spinal problems in this age group is scarce. Focus has primarily been on the working age population, and therefore specific questionnaires to measure spinal pain and its consequences, specifically aimed at children and adolescents are absent. The purpose of this study was to develop a questionnaire for schoolchildren filling this gap.

Methods

The Young Spine Questionnaire (YSQ) was developed in three phases – a conceptualisation, development and testing phase. The conceptualisation phase followed the Wilson and Cleary model and included questions regarding spinal prevalence estimates, pain frequency and intensity, activity restrictions, care seeking behaviour and influence of parental back trouble. Items from existing questionnaires and the “Revised Faces Pain Scale” (rFPS) were included during the development phase. The testing phase consisted of a mixed quantitative and qualitative iterative method carried out in two pilot tests using 4^th grade children and focusing on assessment of spinal area location and item validity.

Results

The testing phase resulted in omission of the pain drawings and the questions and answer categories were simplified in several questions. Agreement between the questionnaire prevalence estimates and the interviews ranged between 83.7% (cervical pain today) and 97.9% (thoracic pain today). To improve the understanding of the spinal boundaries we added bony landmarks to the spinal drawings after pilot test I. This resulted in an improved sense of spinal boundary location in pilot test II. Correlations between the rFPS and the interview pain score ranged between 0.67 (cervical spine) and 0.79 (lumbar spine).

Conclusions

The Young Spine Questionnaire contains questions that assess spinal pain and its consequences. The items have been tested for content understanding and agreement between questionnaire scores and interview findings among target respondents. These preliminary results suggest that the YSQ is feasible, has content validity and is a well understood questionnaire to be used in studies of children aged 9 to 11 years.

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.

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.

Classroom furniture and anthropometric characteristics of Iranian high school students: proposed dimensions based on anthropometric data

The study evaluated the potential mismatch between classroom furniture dimensions and anthropometric characteristics of 978 Iranian high school students (498 girls, 480 boys), aged 15-18 years. Nine anthropometric measurements (stature, sitting height, sitting shoulder height, popliteal height, hip breadth, elbow-seat height, buttock-popliteal length, buttock-knee length and thigh clearance) and five dimensions from the existing classroom furniture were measured and then compared together (using match criterion equations) to identify any potential mismatch between them. The results indicated a considerable mismatch between body dimensions of the students and the existing classroom furniture, with seat height (60.9%), seat width (54.7%) and desktop height (51.7%) being the furniture dimensions with a higher level of mismatch. The levels of mismatch varied between the high-school grade levels and between genders, indicating their special requirements and possible problems. The proposed dimensions of the classroom furniture more appropriate for the students were given. This additional information on students' anthropometry can be used by local furniture industries as a starting point for designing more appropriate furniture for school children, or used by schools to aid in furniture selection.

The use of schoolbags and musculoskeletal symptoms among primary school children: are the recommended weight limits adequate?

This cross-sectional study investigated the use of schoolbags and the prevalence of musculoskeletal symptoms among a sample of 307 Iranian primary school children aged 7-12 years. The average load carried by the children was 2.9 kg (representing on average 10.1% of the child's body weight). Most children chose to carry the schoolbag across two shoulders, although significant numbers also carried it on one shoulder or in the hand. Although the amount of load carried by school children was within the currently suggested load limit of 10% to 15% of the child's body weight, the prevalence of musculoskeletal problems was very high among the study population. Multiple logistic regression models indicated that the method of carrying the schoolbag was significantly associated with hand/wrist and shoulder symptoms, and that the time spent carrying a schoolbag was associated with hand/wrist and upper back symptoms. Schoolbag weight (expressed as a percentage of body weight) was only associated with hand/wrist symptoms. The results suggest that the current recommended weight limit may not be appropriate for school children in primary school, and that guidelines ought to consider factors other than relative schoolbag weight that influence the use of schoolbags among this age group.

PRACTITIONER SUMMARY

The carrying of schoolbags by primary school children and their musculoskeletal symptoms were investigated. The results provide evidence that the current weight limit may not be appropriate for younger school children, and that such guidelines should consider a broader combination of the factors that influence the use of schoolbags.

A validation study of the Keyboard Personal Computer Style instrument (K-PeCS) for use with children

This study examines a potential instrument for measurement of typing postures of children. This paper describes inter-rater, test-retest reliability and concurrent validity of the Keyboard Personal Computer Style instrument (K-PeCS), an observational measurement of postures and movements during keyboarding, for use with children. Two trained raters independently rated videos of 24 children (aged 7-10 years). Six children returned one week later for identifying test-retest reliability. Concurrent validity was assessed by comparing ratings obtained using the K-PECS to scores from a 3D motion analysis system. Inter-rater reliability was moderate to high for 12 out of 16 items (Kappa: 0.46 to 1.00; correlation coefficients: 0.77-0.95) and test-retest reliability varied across items (Kappa: 0.25 to 0.67; correlation coefficients: r = 0.20 to r = 0.95). Concurrent validity compared favourably across arm pathlength, wrist extension and ulnar deviation. In light of the limitations of other tools the K-PeCS offers a fairly affordable, reliable and valid instrument to address the gap for measurement of typing styles of children, despite the shortcomings of some items. However further research is required to refine the instrument for use in evaluating typing among children.