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

Abstract

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 the weight of schoolbags and low back pain among schoolchildren: A systematic review, meta‐analysis and individual patient data meta‐analysis

“…Among these 84 studies, 21 representing a total sample of 18,296 complied with the criteria to be included in the systematic review (Akbar et al, ; Alghadir et al, ; Alghamdi, Nafee, El‐Sayed, & Alsaadi, ; Angarita‐Fonseca et al, ; Chiang, Jacobs, & Orsmond, ; de Oliveira, Chinaglia, & Lima, ; Dianat et al, ; Dianat, Sorkhi, Pourhossein, Alipour, & Asghari‐Jafarabadi, ; Grimmer & Williams, ; Johnson, Adeniji, Mbada, Obembe, & Akosile, ; Korovessis, Koureas, & Papazisis, ; Martínez‐Crespo et al, ; Minghelli, Oliveira, & Nunes, ; Mohseni‐Bandpei, Bagheri‐Nesami, & Shayesteh‐Azar, ; Mwaka, Munabi, Buwembo, Kukkiriza, & Ochieng, ; Noormohammadpour et al, ; Oka, Ranade, & Kulkarni, ; Trevelyan & Legg, ; Vidal, Borràs, Ponseti, Gili, & Palou, ; Watson et al, ; Young, Haig, & Yamakawa, ), 11 with 9,188 subjects were included in the meta‐analysis (Akbar et al, ; Alghadir et al, ; Angarita‐Fonseca et al, ; de Oliveira et al, ; Dianat et al, , ; Martínez‐Crespo et al, ; Minghelli et al, ; Mohseni‐Bandpei et al, ; Trevelyan & Legg, ; Vidal et al, ), and data from 8,218 subjects from 7 studies were included in the IPD meta‐analysis (Akbar et al, ; de Oliveira et al, ; Martínez‐Crespo et al, ; Minghelli et al, ; Mohseni‐Bandpei et al, ; Trevelyan & Legg, ; Vidal et al, ). Figure shows the PRISMA flow diagram.…”

“…All of the 21 studies included in the review were cross‐sectional, and in all of them the outcome was the prevalence of LBP. Six studies focused on the point prevalence (Alghamdi et al, ; de Oliveira et al, ; Johnson et al, ; Korovessis et al, ; Noormohammadpour et al, ; Young et al, ), 4 on the 1‐ or 2‐week prevalence (Chiang et al, ; Grimmer & Williams, ; Mwaka et al, ; Vidal et al, ), 10 on the 1‐month prevalence (Akbar et al, ; Angarita‐Fonseca et al, ; Dianat et al, , ; Martínez‐Crespo et al, ; Mohseni‐Bandpei et al, ; Noormohammadpour et al, ; Oka et al, ; Trevelyan & Legg, ; Watson et al, ), 2 on the 1‐year prevalence (Alghadir et al, ; Minghelli et al, ) and 3 on the lifetime prevalence (Akbar et al, ; Noormohammadpour et al, ; Vidal et al, ). Table shows the main characteristics of the studies included in the review.…”

“…Among these 21 studies, 19 used standardized self‐report questionnaires to determine the prevalence of LBP (Akbar et al, ; Alghadir et al, ; Alghamdi et al, ; Angarita‐Fonseca et al, ; Chiang et al, ; de Oliveira et al, ; Dianat et al, , ; Grimmer & Williams, ; Johnson et al, ; Martínez‐Crespo et al, ; Minghelli et al, ; Mohseni‐Bandpei et al, ; Mwaka et al, ; Noormohammadpour et al, ; Oka et al, ; Trevelyan & Legg, ; Vidal et al, ; Watson et al, ). One study used a non‐standardized, ad hoc self‐questionnaire (Young et al, ), and the last one verbally asked the subjects a non‐standardized question (Korovessis et al, ).Twelve of these 21 studies (including the two studies which did not use standardized self‐report questionnaires), also used some form of physical examination (Akbar et al, ; Alghadir et al, ; Chiang et al, ; de Oliveira et al, ; Johnson et al, ; Minghelli et al, ; Mohseni‐Bandpei et al, ; Mwaka et al, ; Noormohammadpour et al, ; Trevelyan & Legg, ).…”

“…Among the studies included in the systematic review, the relationship between the weight of the schoolbag and body weight was assessed quantitatively in six studies (Chiang et al, ; Korovessis et al, ; Noormohammadpour et al, ; Oka et al, ; Vidal et al, ; Young et al, ).The other 15 studies classified this relationship into categories. The cut‐off values for establishing these categories varied across studies, as follows:">6.6% of bodyweight" in one study (Alghadir et al, ),">10% of bodyweight" in 10 studies (Akbar et al, ; de Oliveira et al, ; Dianat et al, , ; Grimmer & Williams, ; Martínez‐Crespo et al, ; Minghelli et al, ; Mohseni‐Bandpei et al, ; Mwaka et al, ; Trevelyan & Legg, ),“≥12% of bodyweight" in one study (Angarita‐Fonseca et al, ), two categories ("10% to 15%", ">15%") in one study (Alghamdi et al, ), five categories ("2.2% to 6.6%"; "6.7% to 8.8%"; "8.9% to 10.5%"; "10.6% to 13.5%" and "13.6% to 32.1%") in one study (Watson et al, ), and "normal and abnormal" (without defining the classification criteria in these categories) in one study (Johnson et al, ).…”

“…Among these 21 studies, 19 used standardized self-report questionnaires to determine the prevalence of LBP Alghamdi et al, 2018;Chiang et al, 2006;Dianat et al, , 2014Grimmer & Williams, 2000;Johnson et al, 2011;Martínez-Crespo et al, 2009;Minghelli et al, 2016;Noormohammadpour et al, 2019;Oka et al, 2019;Trevelyan & Legg, 2011;Vidal et al, 2010;Watson et al, 2003). One study used a non-standardized, ad hoc self-questionnaire (Young et al, 2006), and the last one verbally asked the subjects a non-standardized question .Twelve of these 21 studies (including the two studies which did not use standardized self-report questionnaires), also used some form of physical examination Chiang et al, 2006;Johnson et al, 2011;Noormohammadpour et al, 2019;Trevelyan & Legg, 2011).…”