Backpack weight and back pain reduction: effect of an intervention in adolescents

Prevalence of Musculoskeletal Disorders among General and Technical Secondary School Students in Egypt

(1) Background: Children spend a lot of time within schools. The school setting generally has many ergonomic hazards and reinforced behavior patterns which put children at greater risk of environmental hazards than adults during their critical developmental stages. (2) Objective: The aim of the current study was to investigate the prevalence of musculoskeletal disorders (MSDs) and detect spinal deformities amongst general and technical secondary school students. (3) Methods: A total of 418 students from the second grade of secondary school in Shaquira governorate, Egypt participated in this cross-sectional study. Each student in the study was screened via Nordic Musculoskeletal Questionnaire (NMQ) and had their upper limb posture measured via RULA (Rapid Upper Limb assessment), and the deviation in their thoracic curve was measured using a scoliometer. (4) Results: There was a prevalence of MSDs amongst students as there were 69.7% of general school students and 83.8% of the technical school students suffering from MSDs with a statistically significant difference between both technical and general school students in RULA score and musculoskeletal complaints, whereas there were non-statistical differences in the scoliometer scale in both general and technical education students. (5) Conclusions: Musculoskeletal problems are prevalent among Egyptian secondary school students, with higher prevalence between technical school students. Therefore, preventive measures and strategies are recommended to overcome the future complications of these musculoskeletal disorders.

Anthropometric perspective to classroom furniture ergonomics and the need for standards in Nigerian schools

BACKGROUND: Classroom furniture designs have been implicated in musculoskeletal disorders among school age persons due to high level mismatches between the furniture dimensions and users’ anthropometrics. OBJECTIVE: The objective of the study was to analyze classroom furniture ergonomics at selected primary, secondary and tertiary educational institutions in Nigeria and to understand if there are noticeable patterns in the match/mismatch. METHOD: Anthropometric measures relevant to furniture design were obtained from primary and secondary school children as well as from university undergraduates. The dimensions of classroom furniture available to the participants were also taken and an assessment of the suitability of the furniture was completed. RESULT: The ergonomic evaluation of the classroom furniture available to the study participants revealed enormous discrepancies between the furniture dimensions and the anthropometric measures of the users. In addition, a pattern was observed in the way the matches/mismatches occurred. The furniture dimensions that matched majority of the users tend to match across the three categories and those that did not match majority of the students, also followed the same pattern. CONCLUSION: The study presents remarkably high levels of mismatches between classroom furniture and users’ anthropometrics and therefore calls for a review of the policies for classroom furniture design in Nigeria, if at all any policy exists.

Effectiveness of physiotherapy interventions for back care and the prevention of non-specific low back pain in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Non-specific low back pain in children and adolescents has increased in recent years. The purpose of this study was to upgrade the evidence of the most effective preventive physiotherapy interventions to improve back care in children and adolescents.

METHODS

The study settings were children or adolescents aged 18 years or younger. Data were obtained from the Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, and PsycINFO databases and the specialized journals BMJ and Spine. The included studies were published between May 2012 and May 2020. Controlled trials on children and adolescents who received preventive physiotherapy for back care were considered. Data on all the variables gathered in each individual study were extracted by two authors separately. Two authors assessed risk of bias of included studies using the RoB2 and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines. To calculate the effect size, a standardized mean difference "d" was used and a random-effects model was applied for the following outcome variables: behaviour, knowledge, trunk flexion muscle endurance, trunk extension muscle endurance, hamstring flexibility and posture.

RESULTS

Twenty studies were finally included. The most common physiotherapy interventions were exercise, postural hygiene and physical activity. The mean age of the total sample was 11.79 years. When comparing the change from baseline to end of intervention in treatment and control groups, the following overall effect estimates were obtained: behaviour d+ = 1.19 (95% CI: 0.62 and 1.76), knowledge d+ = 1.84 (0.58 and 3.09), trunk flexion endurance d+ = 0.65 (-0.02 and 1.33), trunk extension endurance d+ = 0.71 (0.38 and 1.03), posture d+ = 0.65 (0.24 and 1.07) and hamstrings flexibility d+ = 0.46 (0.36 and 0.56). At follow-up, the measurement of the behaviour variable was between 1 and 12 months, with an effect size of d+ = 1.00 (0.37 and 1.63), whereas the knowledge variable obtained an effect size of d+ = 2.08 (-0.85 and 5.02) at 3 months of follow-up.

CONCLUSIONS

Recent studies provide strong support for the use of physiotherapy in the improvement of back care and prevention of non-specific low back pain in children and adolescents. Based on GRADE methodology, we found that the evidence was from very low to moderate quality and interventions involving physical exercise, postural hygiene and physical activity should be preferred.

Sagittal standing spinal alignment and back pain in 8 to 12-year-old children from the Region of Murcia, Spain: The ISQUIOS Program

BACKGROUND

The child's spine shows changes in posture and balance of its curvatures during growth and musculoskeletal spinal conditions are likely to develop, such as back pain (BP).

OBJECTIVE

The purposes of this study were (a) to describe the sagittal spinal alignment in a relaxed standing position and (b) to analyze its association with BP among 8 to 12-year-old children.

METHODS

This was a cross-sectional study. A total of 731 elementary schoolchildren (379 girls and 352 boys), from 16 Spanish schools, participated. An unilevel inclinometer was used to quantify the sagittal spinal curvatures (thoracic and lumbar) in a relaxed standing position. Sagittal spinal morphotype was analyzed by sex, age, weight, height, and BMI. Children's parents or legal guardians filled in a questionnaire according to the children's responses about the BP suffered in the previous week and the preceding year.

RESULTS

The mean angular value of thoracic kyphosis was 36.08 ± 8.99∘ and significantly higher in males than in females (p= 0.036). In contrast, the mean value of lumbar lordosis was 32.11 ± 7.46∘, being higher in females than in men (p< 0.01). The thoracic curve tends to increase by age (p= 0.003). Children who had low back pain (LBP) in the previous week had a significantly greater lumbar curve (35.88 ± 8.20∘) than those who did not have LBP in the preceding week (32.24 ± 7.30∘). The angle for lumbar curvature was a small predictor of LBP occurrence in the assessed children (OR = 1.082 [small]; 95% CI = 1.009-1.160, p= 0.028).

CONCLUSIONS

To conclude, almost 3/4 of the students were classified with normal thoracic kyphosis; however, 27.36% of the students had thoracic hyperkyphosis. Lumbar hyperlordosis was identified in 9.05% of the students, and was 2.5 times more frequent in girls. The lumbar curvature was a small predictor of LBP occurrence in the assessed children and the angle of lumbar curvature that most accurately identified individuals at risk of developing LBP was determined to be 33∘. The results of this study indicate the need to assess sagittal spinal curvatures at school during development ages.

Back Pain Related with Age, Anthropometric Variables, Sagittal Spinal Curvatures, Hamstring Extensibility, Physical Activity and Health Related Quality of Life in Male and Female High School Students

Spinal pain (SP) is widely extended among adolescents. The origin of SP can be multifactorial; thus, the present study aimed to estimate the prevalence and risk of SP in high school students and to determine the differences in sagittal spinal curvatures and pelvic tilt, hamstring extensibility, age, anthropometric variables and healthy lifestyle habits dependent on SP between sexes. Two hundred seventy-three teenagers took part in this cross-sectional study. Age, sagittal spinal curvatures, hamstring extensibility, physical activity, sedentary lifestyle, anthropometric variables and health related quality of life (HRQL) were recorded. SP was reported by 16.12% of adolescents. Differences were observed in the HRQL according to SP (p < 0.05). Participants without SP were less sedentary (22.12%) and younger (13.10 years old) than participants with SP (40.91% and 13.66, respectively) (p < 0.05). A logistic regression model showed that both variables were significantly collinear (VIF = 1.01; Durbin-Watson = 2.10). Subjects with low back pain (LBP) had a higher weight, body max index, and hip girth than subjects without pain (p < 0.05). A misalignment in the lumbar spine was associated with LBP for males (Cramer’s V = 0.204, p = 0.022). In conclusion, adolescents with SP were older and had a lower HRQL in all dimensions. SP could be predicted according to age and sedentary habits.

Effectiveness of a theory-based back care intervention on spine-related behavior among pupils: a school-based randomised controlled trial (T-Bak study)

Background

Children’s health and welfare have a special place in research and policy in many countries. One of the most important concerns is the increasing rate of backache in children due to many of behavioral risk factors. The aim of this study was to evaluate the effectiveness of an educational program on promoting back-related behavior as well as knowledge, skills, beliefs, and self-efficacy among fifth grade girls.

Methods

The theory-based back care (T-Bak) study was a school-based randomised controlled trial (RCT) that assessed the effectiveness of developing a back care training program based on the social cognitive theory (SCT). A total of 104 schoolchildren aged 11 ± 1.0 years were assigned to intervention (n = 52) and control (n = 52) groups. The intervention group received six sessions training on proper lifting and carrying techniques, having proper posture during daily activities, and correct backpack wearing techniques with a 1-week interval while the control group received nothing. Then, the two groups were assessed for knowledge, skills, self-efficacy, beliefs, and behavior at four points in time: baseline, immediate, three and six-months post-intervention. The changes of the outcomes investigated using univariate repeated measures analysis of variance. Partial eta squared measure (η_p²) was used to calculate effect sizes.

Results

A positive change was found for the intervention group back-related behavior from baseline to immediate post-intervention and follow-ups (F = 78.865, p < 0.001, η_p² = 0.22). Overall there were 36.4% improvement for knowledge (η_p² = 0.21), 53.2% for the skills (η_p² = 0.25), 19.5% for the self-efficacy (η_p² = 0.11), and 25.6% for the beliefs (η_p² = 0.14) scores from baseline to 6 months’ follow-up assessments among the intervention group (p < 0.001). The results also showed a significant interaction effect between group and time.

Conclusion

The T-Bak intervention was effective in improving back-related behavior in pupils. It is now available and could be evaluated further in back-care related studies.

Trial registration

Current Controlled Trials IRCT20180528039885N1, 30th Oct 2018, ‘Prospectively registered’. https://www.irct.ir/trial/31534

The effect of furniture intervention on the occurrence of musculoskeletal disorders and academic performance of students in North-West Nigeria

BACKGROUND

Mismatch between classroom furniture and the students' anthropometry have been identified as a major cause of musculoskeletal disorders (MSDs) among students. Such discomforts can affect students' performance.

OBJECTIVE

This paper is aimed at investigating the prevalence of MSDs and the effect of furniture intervention among students of tertiary institutions in Northwest Nigeria.

METHODS

The Cornell's MSD questionnaire was used to investigate the prevalence of MSDs in twelve body regions of students aged between 16 and 25 years. Eleven students' anthropometric dimensions were also measured and used to compute the ergonomically compliant furniture dimensions for the participants. A new set of furniture was introduced, and the questionnaire was used to investigate if the intervention made was significant or not. The academic performance of some of the students before and after the intervention was analyzed using the t-test statistical technique.

RESULT

None of the furniture in use was suitable for the majority of the students. MSDs prevalence ranges from 14% to 67.3% among the body regions with the students reporting that low back pain is the most prevalent (67.3%), severe (19.4%) and interfering with their studies (15.8%). The intervention also reduced MSDs in all body regions except at the upper arm and the right side of the forearm. Only sitting, knee, and popliteal heights were significantly associated with MSD occurrence. There was also a significant improvement in the students' academic performance after the intervention (t = -3.239, p = 0.002).

CONCLUSION

The limited success of the intervention is an indication of the need to carry out a more holistic intervention that incorporates other inputs such as continuous enlightenment and classroom facility design.