Association of relative backpack weight with reported pain, pain sites, medical utilization, and lost school time in children and adolescents

Examining the Backpack Weight Relative to Students' Body Weight Among Urban and Rural Schoolchildren: A Cross-Sectional Study

Background Schoolbags or backpacks have been an essential part of the education system for a long time. However, a hefty backpack causes the child to arch the back excessively or bend their head and trunk forward to withstand the weight of the schoolbag. If the student carries the backpack on one shoulder, he/she bends to the opposite side to compensate for the extra weight, which may damage the shoulders and spine. Considering these factors, the main aim of this study was to investigate the percentage of backpack weight in proportion to the student's body weight regarding the new guidelines among urban and rural schoolchildren aged 12 to 15 years in Bangalore, Karnataka. Methodology In southern India, over a year, a cross-sectional study was conducted with 500 students who voluntarily participated after providing written consent. They completed a questionnaire, underwent vital and anthropometric measurements, and had their weights measured, including the weights of their backpacks. Sample bags were inspected to determine contributing weight factors and evaluate adherence to timetables. Results The average weight carried by children of all ages was 6.53 kg, averaging 13.53% of their body weight. Among males, the percentage carrying backpacks weighing over 10% of their body weight was 80.9%, while among females, it was 85.7%. Of all the males carrying bags weighing more than 10% of their body weight, 67.7% attended government schools, while 32.3% attended private schools. Among females studying in government schools, 63.6% carried backpacks weighing more than 10% of their body weight, while among those in private schools, 36.4% carried bags exceeding that weight. Conclusions The study concluded that despite regulations being implemented on backpack weight for children, a significant number still carry bags exceeding 10% of their body weight among both urban and rural school children. This could elevate pressure on neck and back muscles, leading to excessive fatigue and potential damage to the skeletal system, ultimately contributing to spinal deformities.

The Influence of the Weight of the Backpack on the Biomechanics of the Child and Adolescent: A Systematic Review and Meta-analysis With a Meta-Regression

PURPOSE

To evaluate and explore the influence of the weight of a backpack on standing posture and gait in children and adolescents.

METHODS

We conducted a search of MEDLINE (PubMed), Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science, with the last search in July 2021. Standardized mean differences (SMD) and 95% confidence intervals were calculated for relevant outcomes and were pooled in a meta-analysis using the random-effects model. The participants were healthy children or adolescents. The outcomes were postural variables, spatiotemporal gait variables, gait kinematics, and muscle activity. We analyzed the influence of a loaded backpack on posture while standing and spatiotemporal and kinematic variables while walking. We used GRADE, Risk of Bias 2, ROBINS-I, MINORS, and PEDro scales to rate the quality, certainty, and applicability of the evidence.

RESULTS

Wearing a loaded backpack induces a significant increase of the craniohorizontal angle while standing and a decrease of walking speed and stride length while walking. Only the craniovertebral angle had a significant relationship with the weight of the backpack.

CONCLUSIONS

Wearing a backpack induces postural changes while standing and affects gait in children and adolescents; however, almost all the changes are not related to the backpack weight.

Effects of School-Based Educational Program on Backpack Carrying Behavior in Teenage Students

One of the most serious issues is the growing prevalence of backaches among adolescent students as a result of carrying backpacks. The purpose of this study was to examine the impact of an education program (remedial information) on the school backpack carrying habits of adolescent students. The study sample consisted of 138 adolescent students aged 12 to 16 from 4 schools who were randomly assigned to either the experimental (N = 69) or control (N = 69) groups. The experimental group was subjected to a 6-week education program consisting of 6 sessions, whereas the control group received no educational intervention. During the pre-test and 3 months after the intervention, participants completed a questionnaire. The results (healthy items) were as follows: (1) carry as little as possible, (2) carry a school backpack on both shoulders, and (3) use lockers or something similar. After a 3-month follow-up, healthy items in the experimental group improved, but no significant changes were observed in the control group. When compared to the baseline, the experimental group’s healthy backpack usage habits improved significantly at the post-test (P = .001). The current study’s findings show that school-based education interventions on backpack behaviors improve the school-bag carrying habits of adolescent students.

School Bag-Related Factors and Their Implications for Walking and Cycling to School among New Zealand Adolescents

Excessive school bag weight may be a modifiable barrier to active transport to school. This study examined correlates of school bag weight and adolescents’ perceptions of excessive school bag weight for walking and cycling to school among New Zealand adolescents living in diverse settlement types. Adolescents (n = 1512; 15.0 ± 1.3 years) completed a questionnaire and had their bag weight (n = 1190) and body weight (n = 1038) measured. Adolescents using active transport and rural adolescents had lighter school bags compared to their counterparts. One-third of adolescents reported excessive school bag weight for walking (31.2%) and cycling (37.2%) to school. Positive correlates of relative school bag weight were female gender (regression coefficient (95% CI): 0.53 (0.13, 0.93)), and underweight (2.21 (1.39, 3.02)), whereas negative correlates were Māori ethnicity (−0.87 (−1.41, −0.32)), overweight (−1.84 (−2.35, −1.34)) and obesity (−3.57 (−4.26, −2.87)), and school location in small urban areas (−2.10 (−4.19, −0.01)), and rural settlements (−3.58 (−5.66, −1.49)). Older adolescents, females, those with greater relative school bag weight, and those experiencing school bag-related pain symptoms and/or fatigue were more likely to report excessive school bag weight for both walking and cycling to school. Future initiatives should target reducing excessive school bag weight, particularly in female and urban adolescents.

Prevalence of Musculoskeletal Pain and Its Relation With Weight of Backpacks in School-Going Children in Eastern India

Background: Recently, heavy school backpacks have become a significant concern among parents and health professionals, as well as the media, but evidence for the same is limited in the Indian context.

Aim: To find the prevalence of musculoskeletal pain among school-going children and its relationship with backpack weight.

Design: Cross-sectional study.

Method: This study was carried out among school-going children from grade 6 to 10 with age of 10 to 16 years from an urban and rural location. Schools were selected randomly from all enlisted schools in the district of Khurdha, Odisha state of India. A structured questionnaire was administered to assess symptoms of musculoskeletal pain. Anthropometric measurements along with backpack weight were taken.

Statistical Analysis: Chi-square test was performed for categorical variables and Student's t-test for continuous variables. Multivariate regression analysis was performed to identify factors with maximum effect on musculoskeletal pain.

Results: The prevalence of musculoskeletal pain was 18.8% in the preceding year. Backpacks weights were higher among children of urban schools as compared with rural areas. Children from urban schools were more likely to have pain than those from rural schools (OR 1.88, 95% CI 1.41–2.49). Those children with a backpack weight more than 10% of body weight had almost twice the risk of musculoskeletal pain compared to backpack weight less than 10% (OR 1.91, 95% CI 1.4–2.6) in univariate analysis where as no significant association was found on multivariate analysis.

Conclusion: The prevalence of musculoskeletal pain was high in school-going children. In children, carrying higher backpack weight, and a higher percentage of the backpack to bodyweight had a significant association with musculoskeletal pain. Gender, height, body mass index, and backpack weight to body weight > 10% had no association with musculoskeletal pain.

Perspectives of spinal health within the school setting in a South African rural region: A qualitative study

BACKGROUND

Spinal pain is one of the leading causes of morbidity globally. There is an increase in the number of children and adolescents who experience spinal pain and the lifetime prevalence of adolescent spinal pain varies between countries. In Africa, one in two adolescents experiences spinal pain and the prevalence is increasing.

OBJECTIVE

This study reports on the knowledge and perspectives of school-attending children, adolescents, teachers, and parents/guardians regarding spinal health.

METHODS

We conducted a descriptive qualitative case study with an interpretative and phenomenological approach. Data coding, management and analysis was done using ATLAS.ti computer software.

RESULTS

Ninety-three participants (66 women and 27 men) were enrolled in the study. The barriers associated with students' spinal health were multifactorial, including low levels of physical activity, dangerous gameplay, sports risks, poor ergonomics, school bags, insufficient knowledge, and pregnancy risks. Participants proposed strategies to improve spinal health including the provision of students' lockers, advice on appropriate school bag types, embedding spinal education in the curriculum, general advocacy for spinal health, and integration of technology in teaching and learning.

CONCLUSION

There is a need for further engagement on school-based spinal health promotion programs that consider local socio-economic, educational, and cultural factors.

Remote Actuation Systems for Fully Wearable Assistive Devices: Requirements, Selection, and Optimization for Out-of-the-Lab Application of a Hand Exoskeleton

Wearable robots assist individuals with sensorimotor impairment in daily life, or support industrial workers in physically demanding tasks. In such scenarios, low mass and compact design are crucial factors for device acceptance. Remote actuation systems (RAS) have emerged as a popular approach in wearable robots to reduce perceived weight and increase usability. Different RAS have been presented in the literature to accommodate for a wide range of applications and related design requirements. The push toward use of wearable robotics in out-of-the-lab applications in clinics, home environments, or industry created a shift in requirements for RAS. In this context, high durability, ergonomics, and simple maintenance gain in importance. However, these are only rarely considered and evaluated in research publications, despite being drivers for device abandonment by end-users. In this paper, we summarize existing approaches of RAS for wearable assistive technology in a literature review and compare advantages and disadvantages, focusing on specific evaluation criteria for out-of-the-lab applications to provide guidelines for the selection of RAS. Based on the gained insights, we present the development, optimization, and evaluation of a cable-based RAS for out-of-the-lab applications in a wearable assistive soft hand exoskeleton. The presented RAS features full wearability, high durability, high efficiency, and appealing design while fulfilling ergonomic criteria such as low mass and high wearing comfort. This work aims to support the transfer of RAS for wearable robotics from controlled lab environments to out-of-the-lab applications.

School bag weight and the occurrence of back pain among elementary school children

Background: Children in primary schools use school bags to carry study material, although the heavy bags are often associated with musculoskeletal problems, especially back pain. This practice requires strength, which significantly changes the body posture and walking pattern, subsequently leading to the incidence of back pain as a side effect. The aim of this study, therefore, is to analyze the differences in bag loads between elementary school children in urban and suburban area, and also analyze the relationship with the occurrence of back pain.

Design and methods: This was a cross sectional study, which used stratified random sampling to choose 2 elementary schools each representing the urban and suburban areas. Furthermore, a total sample of 164 students were selected, whose school bag weight were measured for 5 consecutive days, particularly in the morning on respondents arrival at school. Moreover, the occurrence of back pain was evaluated using a modified Nordic map, and data analysis required the use of independent sample analysis t test and χ² test.

Results: The results showed the presence of highly significant differences in the school bags weight of respondents in the urban and suburban areas, as well as between schools using the 2013 curriculum and otherwise.

Conclusions: In conclusion, there is a correlation between the weight measured and the occurrence of back pain, hence the 2013 curriculum is recommended to be adopted by all elementary schools. Also, the use of lockers to store items used at school repeatedly by children is also highly encouraged.

Relationship between School Backpacks and Musculoskeletal Pain in Children 8 to 10 Years of Age: An Observational, Cross-Sectional and Analytical Study

Back pain in children is a reality and various factors are involved in its etiology. The study’s aim was to analyze the relationship between the use and type of backpack and pain in children. An analytical observational cross-sectional study was conducted among 123 schoolchildren between 8–10 years. Data on the participants’ weight and height and their backpacks were collected, as well as the way of travel to school and their physical activity during the week. The results indicated that all backpacks were large because the backpack’s height is longer than torso length. Participants who studied in a traditional educational system (62.60%) carried backpacks that exceeded 10% of their body weight. Additionally, 31.7% of the students presented pain. There is no significant correlation between the weight or type of backpack and the pressure pain threshold collected from shoulders muscles. Participants who carried backpacks heavier than 10% of their body weight did not have more musculoskeletal pain or a lower pressure pain threshold than the others, although they did report greater fatigue. All these topics should be debated considering the student’s social environment and the backpack’s discomfort to the children, even though no relationship was found between musculoskeletal pain and backpack weight.

Effects of Backpacks on Ground Reaction Forces in Children of Different Ages When Walking, Running, and Jumping

Backpacks for transporting school loads are heavily utilized by children, and their mechanical advantages have been allowing children to transport heavy loads. These heavy loads may increase ground reaction forces (GRFs), which can have a negative effect on joints and bone health. The aim of this study was to investigate the effect of backpacks on the GRFs generated by children during walking, running, and jumping. Twenty-one children from the fifth (G-5, n = 9) and ninth (G-9, n = 12) grades walked, ran, and jumped over a force plate. When walking, the G-5 had GRF increments in the first (17.3%; p < 0.001) and second (15.4%; p < 0.001) peak magnitude, and in the total integral of the vertical force (20%; p < 0.001), compared to the control condition (i.e., no backpack), and the G-9 had increments of 10.4%, 9%, and 9% (p < 0.001), respectively. The G-9 did not prolong their total stance time (p > 0.05), unlike the G-5 (p = 0.001). When running, total stance time increased 15% (p < 0.001) and 8.5% (p < 0.001) proportionally to the relative load carried, in the G-5 and G-9, respectively. Peak GRF did not increase in any group when running or landing from a jump over an obstacle. It was found that GRF was affected by the backpack load when walking and running. However, when landing from a jump with the backpack, schoolchildren smoothed the landing by prolonging the reception time and thus avoiding GRF peak magnitudes.

Normative values for relative schoolbag weight in primary school children aged 6-14 from Czech Republic: A pilot study

Little evidence from observational studies has been provided regarding ‘optimal’ relative schoolbag load during primary education. Also, no study to date has provided reference-based standards for relative schoolbag weight. Therefore, the main purpose of the study was to establish normative values of relative schoolbag weight in a sample of children. In this cross-sectional study, we recruited 584 primary school students aged 6–14 (mean_age±SD = 9.6±2.4 yrs, mean_height±SD = 1.4±0.2 m, mean_weight±SD = 37.5±13.3 kg, mean_{body-mass index}±SD = 17.6±3.1 kg/m², 44.4% girls) chosen from five schools in the city of Brno. Schoolbag weight and child’s body weight were objectively measured by using digital scale. Relative schoolbag weight was calculated by dividing schoolbag weight with child’s body weight and the result was expressed in percentage. Lambda, Mu and Sigma (LMS) method was used to create sex- and age-percentile curves. Boys carried slightly heavier schoolbag, compared with girls (mean difference 0.2 kg, p = 0.020). No significant differences between sexes in relative schoolbag weight were observed (p = 0.240). Median values (P50) for boys and girls were similar and the largest observed between ages 6–9 in boys (15–17%) and 6–8 in girls (16–18%). The percentage of children carrying relative schoolbag weight beyond 10% of their body weight was very high, especially between ages 6–10 in boys (85.1–100%) and 6–11 in girls (86.8–95.4%). This study provides first sex- and age- relative schoolbag weight normative values in primary school children. Future studies should use similar methods for generating comparable data.

The Influence of the Schoolbag on Standing Posture of First-Year Elementary School Students

The purpose of this study was to determine the influence of the mass of a schoolbag on standing posture in first-year elementary school children. First-year elementary school students (n = 76) participated in this study. The data was digitized and analyzed using SkillSpector and Kinovea. Results have shown a change of Center of Gravity (COG) position in all three anatomical planes (p < 0.01), as well as a change in two out of three measured postural angles-craniovertebral (p < 0.01) and craniocervical (p < 0.01) angle. The most important aspect of changed posture, anterior shift of COG, was measured to be 2.4 cm and was in moderate negative correlation with student body mass (-0.4, p < 0.01) and height (-0.4, p < 0.01) when students were encumbered with a schoolbag weighing 16.11% of their body mass, on the average. Also, this study confirms that when encumbered, students' head posture shifts to a more protracted position.

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.

Schoolbag weight carriage in Portuguese children and adolescents: a cross-sectional study comparing possible influencing factors

BACKGROUND

Schoolbags and the consequences of carrying them, particularly those associated with overload, are often studied as a health concern. Modifications in gait and posture were reported when children carried loads that corresponded to more than 10% of their body weight (BW). The aims of this study were to verify the load that is carried by Portuguese students and how it is influenced by factors such as school grade, school schedule, lunch site, physical education, sex and body mass index (BMI). Acquiring a more specific knowledge of the Portuguese context and understanding the influence of these factors may allow us to generate proposals to control them in ways that benefit students.

METHODS

The load carried by students in the 5th grade (10.6 ± 0.4 years) and 9th grade (14.7 ± 0.6 years) were weighed with a luggage scale on all days of the week, resulting in 680 evaluations. Data related to the school day were also collected, such as the student's lunch site, how he or she got to school and his or her school schedule for that day. Individual height and weight were also assessed.

RESULTS

The 5th grade students carried greater loads than the 9th grade students, resulting in a substantial difference relative to their BW. The school loads of the 5th grade students were mostly greater than 10% of their BWs. Girls tended to carry heavier loads than boys, and overweight students also tended to carry heavier loads. Students who could eat lunch at home carried less weight, and on physical education days, the total load carried increased, but the backpacks of the 5th grade students were lighter.

CONCLUSIONS

The results of the current study describe excessive schoolbag weight among Portuguese students and expound on some of the factors that influence it, which can help researchers and professionals design a solution to decrease children's schoolbag loads.

School Bag Weight as a Barrier to Active Transport to School among New Zealand Adolescents

Background: Excessive school bag weight is a barrier to active transport to school (ATS). This study examined parents’ and adolescents’ perceptions of school bag weights and actual school bag weights for adolescents in New Zealand. Methods: Parents (n = 331; 76.7% women) completed a survey. Adolescents (n = 682; age 15.1 ± 1.4 years; 57.3% boys) completed a survey, underwent anthropometry, and had their school bags weighed. Results: Overall, 68.3% of parents perceived that adolescents’ school bags were too heavy to carry to school. This parental perception differed by adolescents’ mode of transport to school (active/motorized/combined: 35.1%/78.4%/68.8%, p < 0.001). Adolescents perceived that their school bags were too heavy to carry to walk (57.8%) or cycle (65.8%) to school. Adolescent perceptions differed by mode of transport to school (for walking (active/motorized/combined): 30.9%/69.2%/55.9% agree, p < 0.001; for cycling: 47.9%/72.8%/67.7%; p < 0.001). Actual school bag weight was, on average, 5.6 ± 2.1 kg. Relative school bag weight (% of body weight) was higher for boys and underweight adolescents compared to their counterparts. Neither absolute nor relative school bag weight differed by mode of transport to school. Conclusions: School bag weight was perceived a barrier to ATS and was a greater perceived barrier among users of motorized versus active transport. Perceptions of school bag weights should be considered in future ATS interventions.

Parental awareness of schoolbag carriage: A comparative study of Irish and United States parents

BACKGROUND

Given the global nature of schoolbag carriage, there has been extensive research on schoolbag weight and use with resultant guidance on many aspects of carrying a schoolbag. However, there is limited evidence of knowledge translation or parents' awareness of schoolbag carriage.

OBJECTIVE

This study investigated parental awareness of factors related to schoolbag carriage.

METHOD

A cross-sectional survey using an anonymous 30-item questionnaire and purposive sampling was used. Questionnaires were distributed to parents of primary school children through the schools. Descriptive statistics of frequencies and percentages were used and associations were tested using Chi-square analysis in SPSS v23.

RESULTS

A total of 700 parents in Ireland (Ire) and the United States (US) participated in the study (n = 444 [Ire] and n = 256 [US]). Generally, parents had satisfactory awareness of appropriate schoolbag type and carriage. The majority of children owned a backpack (89.9% [Ire] vs. 93.7% [US]), although fewer parents considered this to be the most suitable bag for their child (69.6% [Ire] vs. 88.2% [US]). More Irish parents (29.2%) favoured a wheeled schoolbag compared to US parents (6.2%) (p < 0.001). The majority (70.8% [Ire] vs. 55.7% [US]) wanted more information. The preferred platforms for receiving information were a handout (78.1% [Ire] vs. 71.6% [US]) and on-line (44.6% [Ire] vs. 53.9% [US]).

CONCLUSIONS

Despite gaps identified, parents had good awareness of factors relating to schoolbag carriage, but this study shows that they would like more information. The preferred platform for knowledge translation was a handout. Parents are the best advocates for safety promotion and represent the group most likely to improve schoolbag carriage among children.

Schoolbags and back pain in children between 8 and 13 years: a national study

Schoolbag weight in schoolchildren is a recurrent and contentious issue within the educational and health sphere. Excessive schoolbag weight can lead to back pain in children, which increases the risk of chronic back pain in adulthood. There is limited research regarding this among the Maltese paediatric population. A cross-sectional study was undertaken across all schools in Malta among students aged 8-13 years (inclusive). Data were collected using a questionnaire detailing schoolbag characteristics, self-reported pain and demographic variables, such as age and gender. Structured interviews with participants were also carried out by physiotherapists. A total of 4005 participants were included in the study, with 20% of the total Malta schoolchildren population. Over 70% of the subjects had a schoolbag that exceeded the recommended 10% bag weight to body ratio. A total of 32% of the sample complained of back pain, with 74% of these defining it as low in intensity on the face pain scale-revised. The presence of back pain was statistically related to gender, body mass index (BMI), school and bag weight to body weight ratio. After adjusting for other factors, self-reported back pain in schoolchildren is independently linked to carrying heavy schoolbags. This link should be addressed to decrease the occurrence of back pain in this age group.

The effects of a simple intervention on exposures to low back pain risk factors during traditional posterior load carriage

Traditional posterior load carriage (PLC), typically performed without the use of an assistive device, is associated with a high prevalence of low back pain (LBP). However, there are few studies that have evaluated potential interventions to reduce exposures to LBP risk factors. This work examined the effects of a simple, potentially low-cost intervention using an assistive device (i.e., carrying aid) on exposures to factors related to LBP risk during PLC. Torso kinematics and kinetics, slip risk, and ratings of perceived discomfort (RPD) were obtained during simulated PLC on a walkway. Consistent with earlier results, increasing load mass substantially increased torso flexion and lumbosacral flexion moment, as well as RPDs in all anatomical regions evaluated. Using the carrying aid with a higher load placement resulted in substantially lower mean lumbosacral moments when carrying the heaviest load. In contrast, using the carrying aid with a lower load placement resulted in substantially higher torso flexion angles, higher mean lumbosacral moments when carrying heavier loads, and higher peak lumbosacral moments across all load masses. With use of the carrying aid, both higher and lower load placement resulted in significantly lower RPDs in the elbows and hands compared to the control condition. In summary, use of a carrying aid with higher load placement may be beneficial in reducing the risk of LBP during PLC. Future studies are needed, though, to improve the device design and to enhance external validity.

Guidelines for schoolbag carriage: An appraisal of safe load limits for schoolbag weight and duration of carriage

BACKGROUND

There is no global agreement on a schoolbag weight limit and little assessment of its utility. The duration of carriage is another factor yet there is no previous systematic assessment of the utility of cut-off values for it in identifying schoolbag-related discomfort.

OBJECTIVES

The objectives were to establish if there was a threshold for musculoskeletal discomfort based on (i) percentage bodyweight (% BW) of the schoolbag; (ii) duration of carriage; or (iii) combined % BW and duration.

METHODS

Using data from 462 primary school children, a novel experimental approach was used to explore the utility of conventional schoolbag weight limit guidelines and duration of carriage. A receiver operating characteristic (ROC) curve was constructed to examine the predictive performance of schoolbag weight and duration of carriage.

RESULTS

The mean schoolbag weight (4.8±1.43  kg) represented a mean 12.4±4.18% BW. Only 30.7% of the sample carried schoolbags that were ≤10% BW. The majority (76%) carried schoolbags to school for ≤10 minutes. No % BW, duration of carriage or mechanical burden criterion provided a threshold cut-off point for accurately predicting schoolbag-related discomfort.

CONCLUSIONS

Guidelines for safe schoolbag carriage that are based on mechanical factors alone could not be upheld. The association between duration of carriage and back discomfort warrants further investigation.

[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.

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

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

Influence of the Weight of a School Backpack on Spinal Curvature in the Sagittal Plane of Seven-Year-Old Children

The aim of the paper was to determine a correlation between the weight of a child's backpack, their body weight, and certain features of their body posture. Material and Methods. The study group consisted of 109 children, all aged seven years. The parameters of body posture were determined using the Zebris Ultrasonic System. Results. The number of children carrying a school backpack in accordance with recommendations was 44 subjects (40.37%). Statistically significant changes were found in the total length of the spine (Z = 2.223, p = 0.026) and between backpack weight and changes in the following parameters: the total length of the spine (r_s = −0.3999, p = 0.017), the length and the angle of the lumbar lordosis (r_s = −0.3352, p = 0.049), the angle of the lumbar lordosis (r_s = −0.5065, p = 0.002), and the sacral angle (r_s = −0.4279, p = 0.010). Conclusions. Wearing a backpack heavier than 10% of one's body weight can cause shallowing of the lumbar lordosis and a tendency towards a vertical position of the sacrum. Monitoring the weight of children's school backpacks and enabling them to leave books and notebooks at school would probably be beneficial in reducing the daily burden put on children's spines.

Investigation of the relationship between carrying school bags (handbags and backpacks) and the prevalence of musculoskeletal pains among 12-15 year old students in Shiraz

Inappropriate school bags put students at risk of musculoskeletal problems and early fatigue. Heavy bags can change the body posture and the musculoskeletal system must react appropriately in order to compensate for this stress. It is recommended that the weight of a school bag must not be more than 10% of the student's body weight and the weight must be placed on both shoulders. The present study aimed to identify the risk factors associated with musculoskeletal disorders by comparing the prevalence of musculoskeletal pains among the students. The present descriptive, cross-sectional study was conducted in different educational districts of Shiraz. The study samples were selected using cluster sampling method. In this study, 800 students marked their painful areas on body maps and the SPSS statistical software (v. 11.5) was used to analyze the data. The results showed that among the students who used backpacks, 48.9% carried the weight on both shoulders, 40.4% carried the weight on their right shoulders, and 10.6% used their left shoulders. Besides, 68.02% of the students carrying handbags often used their right shoulders, while 31.98% used their left shoulders. The study results showed that similar to other countries, Iranian students also mostly made use of backpacks. Moreover, the musculoskeletal pains were most prevalent in the shoulders, which is in line with many other studies conducted on the issue.

Backpack-related musculoskeletal symptoms among Nigerian secondary school students

Musculoskeletal discomfort in schoolchildren is significantly related to the weight and mode of carrying backpack to school. Prevalence and patterns of musculoskeletal discomfort among Nigerian secondary school students carrying backpack was investigated. Systematic sampling technique was used in the selection of the participating junior secondary schools for this study. Participants comprised 1,785 students aged 10-15 years. Standardised Nordic musculoskeletal questionnaire was used to collect information on musculoskeletal pain. Backpack weight and participants' body weight were measured using a weighing scale. The visual analogue scale was used to assess pain intensity. Gender differences in backpack weight, backpack percentage and musculoskeletal discomfort were studied using Mann-Whitney U test; Kruskal-Wallis test was used to study the influence of backpack carrying style on musculoskeletal discomfort; and Spearman rho correlation to determine the relationships between backpack weight, backpack to body weight ratio, age and pain intensity. There were 882 boys and 903 girls recruited into the study. Shoulder pain was the most prevalent discomfort (63.5 %), and pain was significantly higher in girls (p = 0.013). There were weak relationships between pain intensity, body weight and backpack to body weight ratio (r range 0.433-0.442; p < 0.001), and a weak negative relationship between pain intensity and age [r = -0.135; p < 0.001; 95 % confidence interval (CI) -0.168, -0.075]. There was a strong relationship between backpack weight and age (r = 0.892; p < 0.001; 95 % CI -0.129, -0.013); however, there was a weak relationship between backpack weight and body weight (r = 0.136; p < 0.001). Prevalence of shoulder pain was high, particularly among the girls, in this sample. We suggest that factors other than the weight of backpack may predispose to musculoskeletal pain. Parents, teachers and clinicians can influence the mode of carrying backpack by secondary school students.

Effects of Different Backpack Loads in Acceleration Transmission during Recreational Distance Walking

It is well established nowadays the benefits that physical activity can have on the health of individuals. Walking is considered a fundamental method of movement and using a backpack is a common and economical manner of carrying load weight. Nevertheless, the shock wave produced by the impact forces when carrying a backpack can have detrimental effects on health status. Therefore, the aim of this study was to investigate differences in the accelerations placed on males and females whilst carrying different loads when walking. Twenty nine sports science students (16 males and 13 females) participated in the study under 3 different conditions: no weight, 10% and 20% body weight (BW) added in a backpack. Accelerometers were attached to the right shank and the centre of the forehead. Results showed that males have lower accelerations than females both in the head (2.62 ± 0.43G compared to 2.83 + 0.47G) and shank (1.37 ± 0.14G compared to 1.52 ± 0.15G; p<0.01). Accelerations for males and females were consistent throughout each backpack condition (p>0.05). The body acts as a natural shock absorber, reducing the amount of force that transmits through the body between the foot (impact point) and head. Anthropometric and body mass distribution differences between males and females may result in women receiving greater impact acceleration compared to men when the same load is carried.

Relative weights of the backpacks of elementary-aged children

The purpose of the study was to describe the range of relative backpack weights of one group of elementary-aged children and the extent to which they exceeded recommended levels. A second purpose was to explore whether gender and age help predict the relative weight of children's backpacks. Ninety-five 8- to 12-year-old elementary school students (56% girls; 88% car or bus riders) participated. Their school backpacks were weighed, and their age, gender, and mode of transportation to school were recorded. Only 40% of the sample carried backpacks that were less than 10% of their body weights. Five percent of the students' backpacks exceeded 20% of their body weights. Neither age group nor gender significantly predicted relative backpack weight or relative weight levels. Recommendations are made for ways to reduce the weight these young children carry.

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.

Postural compensations and subjective complaints due to backpack loads and wear time in schoolchildren

PURPOSE

This study investigated the effects of carrying weighted backpacks of up to 20% of body weight on the posture and pain complaints of elementary-school children.

METHODS

Craniovertebral, forward trunk lean and pelvic tilt angles were measured from sagittal photographs of 62 children (8-11 years old) before and after walking while carrying backpacks containing 10%, 15%, or 20% of body weight. Pain severity after a 6-minute walk with the loaded backpack was recorded. Subjective complaints of pain were assessed using a visual analog scale after walking.

RESULTS

Repeated-measures ANOVA revealed statistically significant differences in postural angles and increased complaints of pain after walking with increased backpack loads.

CONCLUSION

These results indicate that typical backpack loads create worsening postural changes due to backpack loads and time spent carrying those loads, putting children at increased risk for injury and pain, the latter of which is a strong predictor for back pain in adulthood.

Effects of a postural education program on school backpack habits related to low back pain in children

PURPOSE

Population based studies have demonstrated that children and adolescents often complain of low back pain. A group-randomized controlled trial was carried out to investigate the effects of a postural education program on school backpack habits related to low back pain in children aged 10-12 year.

METHODS

The study sample included 137 children aged 10.7 years (SD = 0.672). Six classes from two primary schools were randomly allocated into experimental group (EG) (N = 63) or control group (CG) (N = 74). The EG received a postural education program over 6 weeks consisting of six sessions, while the CG followed the usual school curriculum. A questionnaire was fulfilled by the participants at pre-test, post-test, and 3 months after the intervention finished. The outcomes collected were: (1) try to load the minimum weight possible, (2) carry school backpack on two shoulders, (3) belief that school backpack weight does not affect to the back, and (4) the use of locker or something similar at school. A sum score was computed from the four items.

RESULTS

Single healthy items mostly improved after the intervention and remained improved after 3-month follow-up in EG, while no substantial changes were observed in the CG. Healthy backpack use habits score was significantly increased at post-test compared to baseline in the EG (P < 0.000), and remained significantly increased after 3-month, compared to baseline (P = 0.001). No significant changes were observed in the CG (P > 0.2).

CONCLUSIONS

The present study findings confirm that children are able to learn healthy backpack habits which might prevent future low back pain.

Biomechanical evaluation of different abduction splints for the treatment of congenital hip dysplasia

BACKGROUND

Abduction splints for the treatment of hip dysplasia normally operate on curbing the legs at the hip flexion and abduction. The forces are absorbed in different designs of shoulder straps and thus diverted to the shoulder and the spine. The present study is the first comparing these undesired forces of two spread orthoses and subsequently the transmitted forces to the infant's spine.

METHODS

Between March 2009 and October 2009 the hips of 290 infants were investigated by ultrasound within the first 3 days after birth. Thereof 20 infants with a hip dysplasia Graf type IIc, D or IIIa met our inclusion criteria and were investigated with a Tübinger and a Superior abduction splint. Biomechanical evaluation was performed by using a high-sensitive strain gauge sensor applied to the infant's orthoses between pelvic harness and shoulder straps.

FINDINGS

The transmitted forces to the infant's shoulders correlated significantly with their body mass (P<0.05). Maximal forces on the shoulder of the infants and subsequently transmitted forces on the spine were significantly higher (P<0.05) with the Tübinger splint (range 7.6N to 32.3N; arithmetic mean M: 13.7N) in comparison to the Superior orthosis (range 0.0N to 3.5N; M: 0.7N).

INTERPRETATION

The Superior orthosis works with primary load transmission to the pelvic bone. Using the Tübinger splint the shoulders of the newborn infants are loaded with a maximum of 93.9% of their body mass. This may influence the development of the growing infant's spine.

Review for the generalist: evaluation of low back pain in children and adolescents

Back pain is common in children and adolescents. Most cases of back pain are non-specific and self-limiting. In children and adolescents, pain is usually related to the posterior elements of the spine and disc-related problems are rare. Serious pathology, including malignancy and infection needs to be excluded. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the immature skeleton. Diagnostic imaging is useful in the evaluation of a child or adolescent with low back pain and can help guide management. This article will review common causes of back pain in the pediatric population.

Domestic water carrying and its implications for health: a review and mixed methods pilot study in Limpopo Province, South Africa

BACKGROUND

Lack of access to safe water remains a significant risk factor for poor health in developing countries. There has been little research into the health effects of frequently carrying containers of water. The aims of this study were to better understand how domestic water carrying is performed, identify potential health risk factors and gain insight into the possible health effects of the task.

METHODS

Mixed methods of data collection from six were used to explore water carrying performed by people in six rural villages of Limpopo Province, South Africa. Data was collected through semi-structured interviews and through observation and measurement. Linear regression modelling were used to identify significant correlations between potential risk factors and rating of perceived exertion (RPE) or self reported pain. Independent t-tests were used to compare the mean values of potential risk factors and RPE between sub-groups reporting pain and those not reporting pain.

RESULTS

Water carrying was mainly performed by women or children carrying containers on their head (mean container weight 19.5 kg) over a mean distance of 337 m. The prevalence of spinal (neck or back) pain was 69% and back pain was 38%. Of participants who carried water by head loading, the distance walked by those who reported spinal pain was significantly less than those who did not (173 m 95%CI 2-343; p = 0.048). For head loaders reporting head or neck pain compared to those who did not, the differences in weight of water carried (4.6 kg 95%CI -9.7-0.5; p = 0.069) and RPE (2.5 95%CI -5.1-0.1; p = 0.051) were borderline statistically significant. For head loaders, RPE was significantly correlated with container weight (r = 0.52; p = 0.011) and incline (r = 0.459; p = 0.018)

CONCLUSIONS

Typical water carrying methods impose physical loading with potential to produce musculoskeletal disorders and related disability. This exploratory study is limited by a small sample size and future research should aim to better understand the type and strength of association between water carrying and health, particularly musculoskeletal disorders. However, these preliminary findings suggest that efforts should be directed toward eliminating the need for water carrying, or where it must continue, identifying and reducing risk factors for musculoskeletal disorders and physical injury.

The effects of age and gender on the weight and use of schoolbags

PURPOSE

To examine age and gender differences in schoolbag use and to compare findings in Greece with those of other countries.

METHOD

Schoolbag weight and carrying characteristics were assessed in 703 boys and girls aged 6 to 14 years.

RESULTS

Multinomial logistic regression models showed that younger students (6-8 years) were almost 5 more times more likely to carry heavier schoolbags than older students (p < 0.05). Similarly, more girls than boys carried heavier bags, and girls were twice more likely to experience fatigue symptoms when carrying schoolbags compared with boys (p < 0.05). The mean schoolbag weight was 12.4% of the student's body weight and moderately heavier than that reported for other countries.

CONCLUSIONS

Younger children are in greater need for education about schoolbag weight compared with older ones. There is also evidence that girls might experience more problems when carrying their schoolbag compared with boys.

Short-term effects of backpack load placement on spine deformation and repositioning error in schoolchildren

Backpack weight of 10-15% has been recommended as an acceptable limit for schoolchildren. However, there is still no clear guideline regarding where the backpack centre of gravity (CG) should be positioned. The changes of spinal curvature and repositioning error when carrying a backpack loaded at 15% of body weight at different CG locations (anterior or posterior at T7, T12 or L3) in schoolchildren were analysed. Both spinal curvature and repositioning error were found to be affected by backpack anterior-posterior position and CG level. A relatively smaller change was observed during anterior carriage with the least change when the backpack CG was positioned at T12. The results also suggested that alternative carriage by changing the backpack position occasionally between anterior and posterior positions might help to relieve the effects of backpack on spine. However, future study is recommended to further substantiate the beneficial effects of alternative carriage on children. STATEMENT OF RELEVANCE: Anteriorly carried backpack with centre of gravity positioned at T12 was shown to induce relatively less effect on spinal deformation and repositioning error in schoolchildren. Changing backpack carriage position occasionally may help to relieve its effects on spinal deformation. The findings are important for ergonomic schoolbag design and determining a proper load carriage method.

Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review

BACKGROUND

Thoracic spine pain (TSP) is experienced across the lifespan by healthy individuals and is a common presentation in primary healthcare clinical practice. However, the epidemiological characteristics of TSP are not well documented compared to neck and low back pain. A rigorous evaluation of the prevalence, incidence, correlates and risk factors needs to be undertaken in order for epidemiologic data to be meaningfully used to develop evidence-based prevention and treatment recommendations for TSP.

METHODS

A systematic review method was followed to report the evidence describing prevalence, incidence, associated factors and risk factors for TSP among the general population. Nine electronic databases were systematically searched to identify studies that reported either prevalence, incidence, associated factors (cross-sectional study) or risk factors (prospective study) for TSP in healthy children, adolescents or adults. Studies were evaluated for level of evidence and method quality.

RESULTS

Of the 1389 studies identified in the literature, 33 met the inclusion criteria for this systematic review. The mean (SD) quality score (out of 15) for the included studies was 10.5 (2.0). TSP prevalence data ranged from 4.0-72.0% (point), 0.5-51.4% (7-day), 1.4-34.8% (1-month), 4.8-7.0% (3-month), 3.5-34.8% (1-year) and 15.6-19.5% (lifetime). TSP prevalence varied according to the operational definition of TSP. Prevalence for any TSP ranged from 0.5-23.0%, 15.8-34.8%, 15.0-27.5% and 12.0-31.2% for 7-day, 1-month, 1-year and lifetime periods, respectively. TSP associated with backpack use varied from 6.0-72.0% and 22.9-51.4% for point and 7-day periods, respectively. TSP interfering with school or leisure ranged from 3.5-9.7% for 1-year prevalence. Generally, studies reported a higher prevalence for TSP in child and adolescent populations, and particularly for females. The 1 month, 6 month, 1 year and 25 year incidences were 0-0.9%, 10.3%, 3.8-35.3% and 9.8% respectively. TSP was significantly associated with: concurrent musculoskeletal pain; growth and physical; lifestyle and social; backpack; postural; psychological; and environmental factors. Risk factors identified for TSP in adolescents included age (being older) and poorer mental health.

CONCLUSION

TSP is a common condition in the general population. While there is some evidence for biopsychosocial associations it is limited and further prospectively designed research is required to inform prevention and management strategies.