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

Abstract

Background The objective of this study was to determine whether carrying a heavy schoolbag is associated to a higher prevalence of low back pain (LBP). Methods A systematic review and meta‐analysis was conducted (PROSPERO, CRD42018077839). Observational studies analysing the relationship between schoolbag weight and LBP, were searched for in 20 electronic databases and 12 specialized journals until February 28th, 2019, without date or language restrictions. All studies which included ≥ 50 subjects aged 9 to 16, were reviewed. Methodological quality was assessed by two reviewers separately, using validated tools. A meta‐analysis and an individual patient data (IPD) meta‐analysis were conducted to examine the relationship between schoolbag weight and LBP. Certainty of evidence was assessed using an adapted GRADE methodology. Results 5,524 citations were screened, 21 studies (18,296 subjects) were reviewed and 11 studies (9,188 subjects) were included in the meta‐analysis. The IPD meta‐analysis included 9,188 subjects from seven studies. Among the 21 studies reviewed, the mean score for methodological quality was 78.3 of 100. Only one study suggested an association between heavier schoolbags and LBP. Neither the meta‐analysis nor the IPD meta‐analysis found an association between carrying schoolbags weighing > 10% of bodyweight, and LBP. No differences based on age, gender or sport activity were found. Discussion Available evidence does not support that schoolbags weighing > 10% of bodyweight are associated with a higher prevalence of LBP among schoolchildren aged 9–16. The certainty of evidence is low. Further research is required on the relationship between schoolbag weight and LBP. Significance This systematic review, with a meta‐analysis and an IPD meta‐analysis, failed to find a link between schoolbags weighing ≥ 10% of body weight and LBP among schoolchildren aged 9 to 16. Further longitudinal studies, with large samples, long follow‐up periods, and rigorous methods taking into account duration of carry and the physical capacity of each subject, are required in this field.

Non-specific low back pain: cross-sectional study of 11,423 children and youth and the association with the perception of heaviness in carrying of schoolbags

“…Some studies suggested that heavy schoolbags could be a risk factor contributing towards musculoskeletal diseases ( Negrini & Carabalona, 1999 ; Dianat et al, 2014 ). On the other hand, a recent systematic review reported that the available evidence does not reveal a relationship between schoolbag weight and LBP among children and teenagers ( Calvo-Muñoz et al, 2020 ). A systematic review by Yamato et al (2018) found that schoolbag characteristics such as weight, design and carriage method do not increase the risk of developing back pain in children and youth, but there is some evidence that the perception of heaviness is associated with back pain ( Yamato et al, 2018 ).…”

“…Some biomechanical studies suggest that the backpack carriage was associated with changes in body posture and with some biomechanical alterations in walking among children and adults ( Devroey et al, 2007 ; Mackie & Legg, 2007 ; Liew, Morris & Netto, 2016 ). Previous studies have investigated the association between BP and schoolbag characteristics such as weight, type (design), method of carrying ( Yamato et al, 2018 ; Calvo-Muñoz et al, 2020 ). However, the evidence has been inconsistent ( Yamato et al, 2018 ).…”

Vitamin D levels in relation to low back pain during adolescence

“…It is worth noting that the perceived weight of school bag was not correlated with the weight of school bag as a percentage of body weight but was correlated with the absolute weight of school bag. A recent literature review showed the association between backpack weight and LBP to be inconsistent across studies (19) and that the available evidence does not support that school bags weighing >10 % of the body weight are associated with higher prevalence of LBP among schoolchildren (32) .…”

“…Particular covariates have to be taken into account at this age group, and therefore, results from studies on adults cannot be directly extrapolated to adolescents. As an example, the association between LBP and the weight of school bag has been under a continuous debate (32) but hardly considered in the previous studies. Heavy weight carried in school bags can distort the natural spinal curvature in the middle and lower back causing muscle strain and irritation to the spine joints and the rib cage (33) .…”

Prevalence and factors associated with low back pain in schoolchildren in Cameroon, sub‐Saharan Africa

“…Also, the factors associated with LBP in children and adolescents are age, female gender, trunk asymmetry, increased height, time spent watching television or using a computer, smoking, competitive sports, depression and emotional factors, history of spinal trauma, and family history of LBP 3,7 . Opinions differ on the role of schoolbags in the occurrence of LBP in schoolchildren 8‐21 . Two systematic reviews agree there is no convincing evidence that certain aspects of schoolbag use increase the risk of LBP, subject to the methodological quality of the studies included in these reviews 12,13 …”