ArticlePDF Available

School bags and associated back pain

Authors:
  • Fakultet zdravstvenih studija Sarajevi, BiH
  • University of Sarajevo, Faculty of Health Studies, Bosnia and Herzegovina

Abstract and Figures

Introduction: The most common health problem associated with the negative effect of heavy school bags is back pain, and non-specific back pain is frequently observed in childhood. The prevalence of back pain in schoolchildren varies from 12% to 92%, depending on the age and affected region of the back. To prevent the occurrence of back pain in schoolchildren, the weight of school bag should not exceed 10% of the child’s body mass. Methods: This was a descriptive, cross-sectional study conducted in April 2017. We included 79 students of the fifth and sixth grade from the elementary school in Sarajevo. Information on the weight and type of school bag, method of carrying a school bag, and feelings of pain and tiredness due to school bag were obtained by questionnaire. Results: In the total sample, the majority of the students (64.6%) reported occasional back pain while carrying the bag, 20.3% of students reported no back pain, and 11.4% of students experienced frequent back pain. The mean school bag weight in the fifth grade was 4.01 ± 0.57 kg, and it was significantly higher (4.61 ± 0.86 kg) in the sixth grade. About 48.5% of the students in the fifth and 50% in the sixth grade carried school bags weighing more than 10% of the body mass. A higher mean weight of school bag was significantly more frequent in students who reported always feeling tired (11.03 ± 2.74%) compared to those who did not feel tired while carrying the school bag (8.41 ± 2%). Conclusions: Overall, more frequent occurrence of back pain and tiredness in schoolchildren was associated with heavier school bags (>10% of the body mass), and the occurrence of back pain due to school bag was related to gender (i.e., back pain was more common in girls compared to boys).
Content may be subject to copyright.
Journal of Health Sciences XXXX;X(X):1-10 http://www.jhsci.ba
Journal of Health Sciences
RESEARCH ARTICLE Open Access
Schoolbags and associated back pain
Amra Mačak Hadžiomerović¹*, Amila Jaganjac¹, Dijana Avdić¹, Emira Švraka¹, Arzija Pašalić¹,
Eldad Kaljić¹, Danijela Domljan2, Edita Omerović¹
¹Faculty of Health Studies, University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina,
2Faculty of Forestry, University of Zagreb, Svetosimunska 25, 10000 Zagreb, Croatia
ABSTRACT
Introduction: The most common health problem associated with the negative effect of heavy schoolbags
is back pain, and non-specific back pain is frequently observed in childhood. The prevalence of back pain
in schoolchildren varies from 12% to 92%, depending on the age and affected region of the back. To
prevent the occurrence of back pain in schoolchildren, the weight of schoolbag should not exceed 10%
of the child’s body mass.
Methods: This was a descriptive, cross-sectional study conducted in April 2017. We included 79 students
of the fifth and sixth grade from the elementary school in Sarajevo. Information on the weight and type
of schoolbag, method of carrying a schoolbag, and feelings of pain and tiredness due to schoolbag were
obtained by questionnaire.
Results: In the total sample, the majority of the students (64.6%) reported occasional back pain while
carrying the bag, 20.3% of students reported no back pain, and 11.4% of students experienced frequent
back pain. The mean schoolbag weight in the fifth grade was 4.01 ± 0.57 kg, and it was significantly
higher (4.61 ± 0.86 kg) in the sixth grade. About 48.5% of the students in the fifth and 50% in the
sixth grade carried schoolbags weighing more than 10% of the body mass. A higher mean weight of
schoolbag was significantly more frequent in students who reported always feeling tired (11.03 ± 2.74%)
compared to those who did not feel tired while carrying the schoolbag (8.41 ± 2%).
Conclusions: Overall, more frequent occurrence of back pain and tiredness in schoolchildren was associ-
ated with heavier schoolbags (>10% of the body mass), and the occurrence of back pain due to school-
bag was related to gender (i.e., back pain was more common in girls compared to boys).
Key words: Schoolbag weight; back pain; tiredness
INTRODUCTION
Non-specic back pain is a common symptom in
childhood, and it may occur more frequently in
some cases. Considering the potential eect of recur-
rent non-specic back pain, which is experienced
by children and adolescents during their everyday
activities at home and school, health professionals,
teachers as well as parents and guardians should pay
close attention to this issue (1,2).
Pain associated with musculoskeletal disorders is a
condition caused by the load of the musculoskeletal
system over a longer period. is load does not only
aect the tendons and muscles but also the cervical
*Corresponding author: Amra Mačak Hadžiomerović, Faculty
of Health Studies, University of Sarajevo, Bolnička 25, 71000
Sarajevo, Bosnia and Herzegovina.
E-mail: amramacak@yahoo.com
Submitted: 25 February 2018/Accepted: 30 March 2018
DOI: https://doi.org/10.17532/jhsci.2017.510
© 2018 Amra Mačak Hadžiomerović,
et al.
licensee University of Sarajevo - Faculty of Health
Studies. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly
cited.
81,9(56,7<2)6$5$-(92
)$&8/7<2)+($/7+678',(6
2
http://www.jhsci.ba Amra Mačak Hadžiomerović et al. Journal of Health Sciences 2018;X(X):1-10
nerves and joints, upper and lower back, thorax,
shoulders, arms, and hands. According to epidemio-
logical studies on non-specic back pain in children
and adolescents, the prevalence rate increases with the
age of respondents, ranging between 12% and 92%.
Some studies showed a higher prevalence of back
pain in girls compared to boys, while other studies
reported that boys are at greater risk to develop back
pain or they found no statistically signicant gen-
der dierence in the prevalence of back pain (3-6).
According to the National Health and Nutrition
Examination Survey Series II, non-specic back
pain occurs before the age of 20 in approximately
11% of the general population (7).
Although certain types of behavior and sociode-
mographic factors are assumed to aect the onset
of musculoskeletal changes and back pain, the most
important causative factors remain unclear (2).
Factors that are commonly associated with non-spe-
cic back pain in schoolchildren are: Age and gender,
schoolbags (heavy schoolbags, method of schoolbag
carrying, and improperly packed schoolbags), poor
lifestyle habits (watching TV for long hours, exces-
sive computer use, and playing video games), poor
posture while sitting for long periods, furniture that
does not t the body proportions of a child, lack of
physical activity, obesity, etc. (2,5,6,8).
Schoolbags are the most common means of carry-
ing books and school supplies among schoolchil-
dren (9). e problem of heavy schoolbags is a
global problem, and a number of studies addressed
this problem in dierent countries. e most com-
mon health problem related to heavy schoolbags is
back pain. Other consequences of heavy schoolbags
include bad posture, fatigue, exhaustion, and con-
sequently concentration problems and poor school
performance (10,11). Moreover, heavy schoolbags
can aect the bone growth, cause stress injuries,
and shift the center of gravity of a body in the same
direction as the load (12).
According to the World Health Organization rec-
ommendations, the weight of schoolbags should not
exceed 10% of child body mass (13). Schoolbags
with a load exceeding 10% of the body mass increase
energy consumption, increase the neck and trunk for-
ward lean, and result in decreased pulmonary volume
and increased cardiorespiratory parameters (14).
If a schoolbag is worn incorrectly, it may cause strain
or injury to the back and abdominal muscles. To pre-
vent this, the shoulder straps of schoolbag should be
adjusted, as well as the hip belt if it is present, thus
ensuring that the load to the lower back is reduced
(15). When a schoolbag is well designed and posi-
tioned properly to the back and abdominal muscles,
which are among the strongest muscles in the body,
they can support the weight of schoolbag. In this way,
the load is evenly distributed over the body, reducing
the risk of back pain and musculoskeletal disorders
(11). e proper method of carrying a schoolbag
and the recommended weight are based on the body
mass index (BMI) and age of the child (16).
Assessing non-specic back pain at school age may
provide a closer insight into the possible develop-
ment of related disorders in adulthood. To avoid
the adverse eects of back pain, early prevention is
required (17,18). Early childhood and adolescence is
the period when a child develops basic healthy hab-
its and related behavioral characteristics. erefore,
a child should be able to develop its physical abilities
from an early age, to acquire new skills and knowl-
edge, and most importantly, to learn how to take
care of the body (19).
Our aim was to investigate the prevalence of back
pain in fth- and sixth-grade students of the ele-
mentary school as well as to analyze whether school-
bag weight and method of carrying schoolbag lead
to tiredness and back pain in children. We have also
analyzed the BMI in relation to the occurrence of
back pain in the fth-and sixth-grade students.
METHODS
Study groups
e sample consisted of the fth-and sixth-grade
students of the Elementary School Izet Šabić in
Sarajevo. Atotal of 79 students were included, of
which 39 students were enrolled in the fth grade
and 40 students in the sixth grade.
is descriptive, cross-sectional study was conducted
in April 2017. We included those students who were
present in the school at the time of investigation and
for which parental consent was obtained. e students
who were not present in the school at the time of
investigation as well as students diagnosed with mus-
culoskeletal conditions were excluded from the study.
3
Amra Mačak Hadžiomerović et al. Journal of Health Sciences XXXX;X(X):1-10 http://www.jhsci.ba
e study was approved by the Ministry of
Education, Science and Youth of Sarajevo Canton
and the management of the elementary school.
Research instruments
Measurement of schoolbag weight
We measured schoolbag weight for ve consecutive
days during a work week (Monday to Friday), using
the transtheoretical model scale, model M 130. e
ratio of mean schoolbag weight to body weight was
determined for each student and used to calculate
the percentage weight of schoolbag in relation to the
body weight.
Measurement of the BMI
We measured the BMI in the fth-and sixth-grade
students of the Elementary School Izet Šabić in
Sarajevo. e BMI is an anthropometric measure of
body composition (fat) in relation to age and gender
and is calculated by dividing body mass in kilograms
by the square of the height in meters (BMI = kg/m2).
e BMI is used as an indicator of malnutrition,
obesity, and risk of developing obesity in children
and adolescents (20).
e questionnaire for assessing schoolbag type,
method of carrying schoolbag, items included in
the bag, and subjective perception of the school-
bag load, described in the study of Kellis and
Emmanouilidou(21), was adapted and used in this
study, with permission of the authors: e ques-
tionnaire included questions related to the age and
gender of students, weight, and type of schoolbag,
method of carrying schoolbag, sport activities, dis-
tance from school to home, as well as means of com-
muting to school (21).
Statistical analysis
e database including all survey data was created
using Microsoft Excel 2013. After data integrity
was conrmed, statistical analysis was performed
using IBM SPSS Statistics for Windows, Version
20.0 (IBM Corp., Armonk, NY). Data were pre-
sented using dierent measures of descriptive sta-
tistics, including arithmetic mean, standard devi-
ation, median, interquartile range [the 25th and
75thpercentile], absolute frequency (N), and relative
frequency (%).
Normal distribution of continuous variables was
assessed graphically (histogram and quantile plot)
and by the Kolmogorov–Smirnov test. Categorical
variables were analyzed using Pearson’s Chi-squared
test or Fisher’s exact test. Data with normal distri-
bution were compared using analysis of variance
(ANOVA) and Dunnett’s test, while data without
normal distribution were analyzed using ANOVA
with a Bonferroni correction. e results are pre-
sented in the forms of tables (with 3 decimal places)
or graphs. e level of signicance was set at p < 0.05.
RESULTS
e study included 79 students enrolled in the
Elementary School Izet Šabić in Sarajevo, who met
the inclusion criteria. Out of the total number, 39
students attended the fth grade and 40 attended
the sixth grade. ere were 45.6% boys and 54.4%
girls in the total sample. In the fth grade, there
were 46.2% males and 53.8% females, and similar
distribution was observed in the sixth grade (45%
males and 55% females). No signicant dierence
was observed in the gender distribution between the
grades (χ2 = 0.010; p = 0.549; Table1).
e mean age in the total sample was
11.04 ± 0.85years. In the fth grade, the mean age
TABLE 1. Gender distribution in fth‑ and sixth‑grade
elementary school students
Grade
n
(%) Total
n
(%)
Fifth Sixth
Gender
Males 18 (46.p2) 18 (45.0) 36 (45.6)
Females 21 (53.8) 22 (55.0) 43 (54.4)
Total 39 (100.0) 40 (100.0) 79 (100.0)
χ
2=0.010; p=0.549
TABLE 2. Age distribution in fth‑ and sixth‑grade elementary
school students
Grade N X SD SEM Minimum Maximum
Fifth
grade
39 10.31 0.46 0.07 10 11
Sixth
grade
40 11.75 0.43 0.06 11 12
Total 79 11.04 0.85 0.09 10 12
F=200.095; p=0.001; SD: Standard deviation; SEM: Standard
error of the mean
4
http://www.jhsci.ba Amra Mačak Hadžiomerović et al. Journal of Health Sciences 2018;X(X):1-10
was 10.31 ± 0.46years, while in the sixth grade, it
was 11.75 ± 0.43years (Table 2). We observed no
statistically signicant dierence in the BMI between
the students of the fth and sixth grade (χ2 = 0.574;
p = 0.449). e BMI <18kg/m2 (indicating malnutri-
tion) had 54.1% of the students in the fth grade and
42.1% of the students in the sixth grade. e BMI
19–25 kg/m2 (normal weight) had 43.2% of fth-
grade students and 57.9% of sixth-grade students. In
the overweight category (BMI 26-30 kg/m2), there
was only one student from the fth grade and no stu-
dent from the sixth grade (Figure1).
e mean schoolbag weight in the fth grade was
4.01 ± 0.57kg, while it was 4.61 ± 0.86kg in the
sixth grade, with a signicant dierence between
the two groups (F = 12.931; p = 0.001). Asigni-
cant dierence in schoolbag weight between the two
groups was also observed in relation to the work-
ing days of the week, except for Friday (F = 2.224;
p = 0.140).
On Monday, the mean schoolbag weight in the
fth grade was 4.39 ± 0.94kg, and it was 4.93 ±
0.70kg in the sixth grade (F = 8.237; p = 0.005).
On Tuesday, the mean schoolbag weight was 4.21 ±
0.81kg in the fth grade vs. 4.95 ± 1.12kg in the
sixth grade (F = 11.168; p = 0.001); on Wednesday,
75 ± 0.93kg in the fth grade versus 4.41 ± 1.39kg
in the sixth grade (F = 6.005; p = 0.017); and on
ursday, 3.97 ± 0.93 kg in the fth grade ver-
sus 4.64 ± 1.25kg in the sixth grade (F = 7.196;
p = 0.009) (Table3).
We also observed a signicant dierence in the
method of carrying schoolbag between the fth-and
sixth-grade students (χ2 = 6.344; p = 0.002). Among
the students in the fth grade, 94.9% carried the
bag on the shoulders, 2.6% on one shoulder and
2.6% across the body. In the sixth grade group,
62.5% students carried the bag on the shoulders,
30% on one shoulder, and 7.5% on the side of the
body. No student in the sixth grade carried the bag
across the body (Figure2).
Overall, most students (50.6%) reported sometimes
feeling tiredness while carrying the schoolbag. is
feeling was reported by 64.1% of fth-grade students
and 37.5% of sixth-grade students, with no signi-
cant dierence between the two groups (χ2 = 3.001;
p = 0.083). Frequent, schoolbag-related tiredness
was reported by 25.6% of students in the fth and
32.5% of students in the sixth grade. Among the
fth-grade students, 5.1% reported that they never
felt tired while carrying the schoolbag, and the same
percentage of students was always tired. In the sixth-
grade group, 10% of students never felt tired and
20% always felt tired while carrying the schoolbag
(Table4).
In the total sample, the majority of the participants
(64.6%) reported occasional back pain while carrying
the bag in the last 4weeks, and no signicant dier-
ence was observed between the two groups (χ2 = 0.671;
p = 0.413). In the fth grade, 23.1% of students and in
the sixth grade17.5% of students reported no school-
bag-related back pain. Frequent schoolbag-related
FIGURE 1. Groups of fth‑ and sixth‑grade elementary school students according to the body mass index.
5
Amra Mačak Hadžiomerović et al. Journal of Health Sciences XXXX;X(X):1-10 http://www.jhsci.ba
FIGURE 2. Methods of carrying schoolbag among fth‑ and sixth‑grade students of elementary school.
TABLE 3. Mean schoolbag weight (kg) in relation to workdays of the week
Day of week NX (kg) SD SEM Minimum Maximum
Monday
Fifth 39 4.39 0.94 0.15 2.50 6.25
Sixth 40 4.93 0.70 0.11 3.50 6.50
F=8.237; p=0.005
Tuesday
Fifth 39 4.21 0.81 w0.13 2.50 6.75
Sixth 40 4.95 1,12 0.17 3.00 7.00
F=11.168; p=0.001
Wednesday
Fifth 39 3.75 0.93 0.14 1.75 6.50
Sixth 40 4.41 1,39 0.22 2.25 7.50
F=6.005; p=0.017
Thursday
Fifth 39 3.97 0.93 0.14 2.25 6.25
Sixth 40 4.64 1,25 0.19 2.50 7.00
F=7.196; p=0.009
Friday
Fifth 39 3.73 0.98 0.15 2.00 5.75
Sixth 40 4.09 1,13 0.18 2.00 6.00
F=2.224; p=0.140
Total
Fifth 39 4.01 0.57 0.09 2.79 5.70
Sixth 40 4.61 0.86 0.13 2.90 6.04
F=12.931; p=0.001
SD: Standard deviation; SEM: Standard error of the mean
6
http://www.jhsci.ba Amra Mačak Hadžiomerović et al. Journal of Health Sciences 2018;X(X):1-10
back pain was experienced by 10.3% of fth grade
and 12.5% of sixth-grade students (Table5).
e mean schoolbag weight/body mass ratio was
9.94 ± 2.70% (4.8–16.3%) in the overall sample,
with no signicant dierence in the ratio between
the two groups (9.67 ± 2.72% in the fth and 10.21
± 2.68% in the sixth grade; F = 0.765; p = 0.384).
While there was no signicant dierence in the body
mass of students between the fth-and sixth-grade
groups (p = 0.304), there was a signicant dierence
in schoolbag weight (p = 0.001), i.e.,the weight of
schoolbag was higher in sixth grade (Table6).
e students from the fth and sixth grade were
compared in relation to schoolbag weight according
TABLE 4. Feeling of tiredness related to schoolbag
Grade n (%) Total n (%)
Fifth Sixth
Feeling of schoolbag‑related tiredness
Never 2 (5.1) 4 (10.0) 6 (7.6)
Sometimes 25 (64.1) 15 (37.5) 40 (50.6)
Often 10 (25.6) 13 (32.5) 23 (29.1)
Always 2 (5.1) 8 (20.0) 10 (12.7)
Total 39 (100.0) 40 (100.0) 79 (100.0)
χ
2=3.001; p=0.083
TABLE 5. Occurrence of schoolbag ‑related back pain in the last 4 weeks
Grade n (%) Total n (%)
Fifth Sixth
Occurrence of back pain due to schoolbag
Never 9 (23.1) 7 (17.5) 16 (20.3)
Sometimes 25 (64.1) 26 (65.0) 51 (64.6)
Often 4 (10.3) 5 (12.5) 9 (11.4)
Always 1 (2.6) 2 (5.0) 3 (3.8)
Total 39 (100.0) 40 (100.0) 79 (100.0)
χ
2 =0.671; p=0.413
TABLE 6. Schoolbag weight (absolute and relative) in relation to the body mass of students
Parameters N X SD SEM Minimum Maximum
Schoolbag weight (kg)
Fifth grade 39 4.01 0.57 0.09 2.79 5.70
Sixth grade 40 4.61 0.86 0.13 2.90 6.04
Total 79 4.32 0.73 0.11 2.90 6.04
F=12.931; p=0.001
Child body mass (kg)
Fifth grade 39 44.36 11.62 1.86 29 80
Sixth grade 40 46.73 8.49 1.34 31 66
Total 79 45.56 10.16 1.14 29 80
F=1.071; p=0.304
Schoolbag weight (%)
Fifth grade 39 9.67 2.72 0.43 4.80 16.30
Sixth grade 40 10.21 2.68 0.42 5.80 15.80
Total 79 9.94 2.70 0.30 4.80 16.30
F=0.765; p=0.384. SD: Standard deviation; SEM: Standard error of the mean
7
Amra Mačak Hadžiomerović et al. Journal of Health Sciences XXXX;X(X):1-10 http://www.jhsci.ba
to the body mass, i.e.,≤10% or >10% of the body
mass of the student. ere was no signicant dif-
ference between the fth-and sixth-grade students
(p = 0.546) with regard to the schoolbag weight
(%), and in both groups, about half of the students
(48.5% in the fth grade and 50% in the sixth
grade) carried heavier schoolbags (>10% of body
mass) (Figure3).
A higher mean weight of schoolbag (%) was signi-
cantly more frequent in students who reported always
feeling tired (11.03 ± 2.74%) compared to those
who did not feel tired while carrying the schoolbag
(8.41 ± 2%) (p = 0.034), thus conrming the associ-
ation between the weight of schoolbag and the occur-
rence of tiredness in children of school age (Table7).
Similarly, back pain was more common in students
with a higher mean weight of schoolbag (%)
compared to those with lower schoolbag weight
(p = 0.042). e mean schoolbag weight was
10.90 ± 3.81% in students who reported persistent
back pain while carrying the bag (Table8).
ere was also a signicant dierence in the occur-
rence of back pain in relation to gender, where back
pain was more frequent in female compared to male
students (p = 0.005). In our study group, the BMI
was not associated with the occurrence of back pain
while carrying schoolbag (p = 0.457) (Table9). e
type of schoolbag and method of carrying schoolbag
were also not associated with the occurrence of back
pain in our group (p > 0.05) (Table10).
DISCUSSION
Our study group comprised 45.6% boys (46.2%
males in the fth grade and 45% in the sixth) and
54.4% girls (53.8% females in the fth grade and
55% in the sixth). e average age in the total sam-
ple was 11.04 ± 0.85years.
e BMI <18kg/m2 had 54.1% of the students in
the fth grade and 42.1% in the sixth grade. e
BMI 19–25kg/m2 had 43.2% of the fth-grade stu-
dents and 57.9% of the sixth-grade students. Only
one student from the fth grade had BMI 26–30kg/
m2, and no student from the sixth grade was in that
FIGURE 3. The percentage of students in each grade in relation
to the weight of schoolbag (%), i.e., ≤10% or >10% of the body
mass.
TABLE 7. Schoolbag weight (%) in relation to feeling of tiredness
Schoolbag‑related feeling of tiredness N X (%) SD SEM Minimum Maximum
Never 6 8.41 2.00 0.82 4.80 10.50
Sometimes 40 10.06 2.78 0.44 5.80 16.30
Often 23 9.67 2.62 0.54 6.40 15.80
Always 10 11.03 2.74 0.86 7.90 15.70
Total 79 9.94 2.70 0.30 4.80 16.30
F=8.142; p=0.034. SD: Standard deviation; SEM: Standard error of the mean
TABLE 8. Schoolbag weight (%) in relation to back pain
Schoolbag‑related back pain N X (%) SD SEM Minimum Maximum
Never 16 9.66 2.66 0.66 4.80 14.30
Sometimes 51 9.95 2.75 0.38 5.80 16.30
Often 9 10.07 2.53 0.84 7.70 15.80
Always 3 10.90 3.81 2.20 6.50 13.20
Total 79 9.94 2.70 0.30 4.80 16.30
F=7.041; p=0.042. SD: Standard deviation; SEM: Standard error of the mean
8
http://www.jhsci.ba Amra Mačak Hadžiomerović et al. Journal of Health Sciences 2018;X(X):1-10
category. ere was no statistically signicant dier-
ence in the BMI between the students of the fth
and sixth grade.
Zaidi et al. (22) investigated association of musculo-
skeletal pain with heavy bag packs in schoolchildren.
In their group consisting of 56% girls and 44%
boys of average age of 12years, 48% of students had
BMI lower than normal (BMI <18kg/m²) indicat-
ing malnutrition in those children, 52% had nor-
mal BMI, between 19kg/m² and 25kg/m², and no
student was overweight (BMI 26–30kg/m²) (22).
ese results are in agreement with ours.
In our group, the mean schoolbag weight in the
fth grade was 4.01 ± 0.57kg, and it was signi-
cantly higher (4.61 ± 0.86 kg) in the sixth grade
(F = 12.931; p = 0.001). Asignicant dierence in
schoolbag weight between the fth-and sixth-grade
students was also observed in relation to the work-
ing days of the week, except for Friday (F = 2.224;
p = 0.140).
Paušić et al. investigated the eects of schoolbag
weight on back pain in students from the rst to
fourth grade of elementary school. ey showed that
a higher weight of schoolbag was signicantly asso-
ciated with higher grades, i.e.,in the rst grade, the
mean schoolbag weight was 4.92kg, in the second
5kg, in the third 4.54kg, and in the fourth, it was
5.28 kg (23). Considering that Paušić et al. (23)
used a similar methodology as in our study, we can
conclude that the results of the two studies are in
agreement.
Moreover, in the study of Kellis and Emmanouilidou
(21), which provided the questionnaire used in
our study, the mean schoolbag weight was 5.30 ±
1.25kg, in 703 boys and girls from Greece, aged
6 to 14years. ey also showed that the weight of
schoolbag was signicantly higher in groups with
older students compared to groups with younger
students (21).
Most of our students carried the bag on both shoul-
ders, i.e., 94.9% students in the fth grade and
62.5% in the sixth grade. In the study of Paušić
et al. (23), 93.1% of the students wore the bag on
both shoulders. Similar results were reported by two
other studies that investigated back pain in school-
children (24,25). On the other hand, El-Nagar and
Mady reported that the majority of students who
felt back pain in their study carried the schoolbag
on one shoulder or in one hand (6), which is not in
agreement with our results.
TABLE 9. Gender and BMI in relation to back pain
Parameters Occurrence of schoolbag‑related back pain in the last 4 weeks p
Never Sometimes Often Always
Gender (%)
Male 11 (68.8) 24 (47.1) 0 (0.0) 1 (33.3) 0.005
Female 5 (31.3) 27 (52.9) 9 (100.0) 2 (66.7)
BMI (kg/m2) 19.79±4.32 18.43±3.07 19.77±3.40 18.84±3.41 0.457
BMI: Body mass index
TABLE 10. Type of schoolbag and method of schoolbag carrying in relation to back pain
Parameters Occurrence of schoolbag‑related back pain in the last 4 weeks (%) p
Never Sometimes Often Always
Type of schoolbag
Backpack 16 (21.3) 48 (64.9) 7 (9.5) 3 (4.1) 0.166
Single‑trap bag 0 (0.0) 3 (60.0) 2 (40.0) 0 (0.0)
Method of carrying schoolbag
On both shoulders 12 (19.4) 39 (62.9) 8 (12.9) 3 (4.8) 0.384
On one shoulder 3 (23.1) 9 (69.2) 1 (7.7) 0 (0.0)
Across the body 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0)
On one side of the body 0 (0.0) 3 (100.0) 0 (0.0) 0 (0.0)
9
Amra Mačak Hadžiomerović et al. Journal of Health Sciences XXXX;X(X):1-10 http://www.jhsci.ba
Most of the students from both of our groups
(50.6%) reported that they sometimes felt tiredness
while carrying the schoolbag (64.1% of fth-grade
students and 37.5% of sixth-grade students), with
no signicant dierence between the two groups.
Frequent tiredness was reported by 29.1% of stu-
dents in the total sample (25.6% in the fth and
32.5% in the sixth grade). Similar results were
reported by Kellis and Emmanouilidou (21),
i.e.,most of their participants (28.2%) felt tiredness
often or sometimes, while carrying the schoolbag.
e majority of the students in our group (64.6%)
reported occasional back pain while carrying the
bag in the last 4weeks (64.1% in the fth grade
and 65.0% in the sixth grade). In the total sample,
20.3% of students reported no back pain (23.1%
of fth-grade students and 17.5% of sixth-grade
students). Frequent back pain was experienced by
11.4% of students (10.3% of fth grade and 12.5%
of sixth-grade students). In a cross-sectional study
on 586 Iranian schoolchildren aged 12–14 years,
Dianat et al. (26) showed that the students of higher
grades reported feeling of pain while carrying the
schoolbag signicantly more frequently than the
lower grades students (26). eir results correlated
with ours to some extent.
In our study, the mean schoolbag weight/body mass
ratio was 9.94 ± 2.70% (4.8-16.3%) in the over-
all sample, with no signicant dierence in the
ratio between the fth- and sixth-grade groups.
Furthermore, there was no signicant dierence in
the body mass of students between the fth-and
sixth-grade groups, but schoolbag weight was sig-
nicantly higher in the sixth-grade group. is
may be explained by the fact that schoolbag weight
depends on class schedule, where students of higher
grades usually have more school subjects and con-
sequently more books and other school items to
carry. In general, the weight of schoolbag should not
exceed 10% of the child body mass (13).
We observed no signicant dierence between the
fth- and sixth-grade students in relation to the
schoolbag weight (≤10% or >10% of child body
mass), and in both groups, about half of the stu-
dents (48.5% in the fth and 50% in the sixth
grade) carried schoolbags weighing more than
10% of the body mass. Two other studies on the
association between schoolbag weight and back
pain in children showed that majority of students
carried heavier schoolbags (>10% of the body
mass) (27,28). Overall, these results indicate that
schoolchildren are often required to carry school-
bags that are heavier than recommended.
A higher mean weight of schoolbag (%) was signi-
cantly more frequent in students who reported feel-
ing tired constantly compared to those who did not
feel tired while carrying the schoolbag, conrming
the relationship between the weight of schoolbag
and the occurrence of tiredness in schoolchildren.
is is probably because the body tries to compen-
sate for the load on the spine caused by a heavy
schoolbag, leading to higher levels of tiredness.
Consistently, back pain was more common
in our students with a higher mean weight of
schoolbag (%) compared to those with lower bag
weight. e mean schoolbag weight was 10.90 ±
3.81% in the students who reported persistent back
pain. In agreement with our ndings are the results
of Adeyemi et al. (28) who also demonstrated the
signicant eect of heavy schoolbag on the degree
of feeling back pain in 615 schoolchildren aged
between 7 and 12years.
In our group, the occurrence of back pain was related
to the gender, and back pain was more frequent in
female compared to male students. Comparably
to our results, Aprile et al. (29) demonstrated, in
a group of 5318 healthy students aged 6-19years,
that schoolbag-related pain was signicantly
more frequent and more severe in girls compared
to boys (29).
CONCLUSION
Almost two-thirds (64.6%) of fth-and sixth-grade
schoolchildren experience occasional back pain due
to the weight of the schoolbag, while 11.4% experi-
ence frequent back pain. Half of the schoolchildren
carry the schoolbags weighing more than 10% of the
student’s own weight and heavy schoolbags are more
frequently associated with tiredness and back pain.
Back pain associated with weight of the schoolbag
occurs more frequently in female students. No asso-
ciation was observed between the method of carry-
ing the schoolbag and back pain.
10
http://www.jhsci.ba Amra Mačak Hadžiomerović et al. Journal of Health Sciences 2018;X(X):1-10
REFERENCES
1. Chiwaridzo M, Naidoo N. Are parents and adolescents in agreement
on reporting of recurrent non‑specic low back pain in adolescents? A
cross‑sectional descriptive study. BMC Pediatr 2015;15:203.
https://doi.org/10.1186/s12887‑015‑0518‑1.
2. Yao W, Luo C, Ai F, Chen Q. Risk factors for nonspecic low‑back pain in
Chinese adolescents: A case‑control study. Pain Med 2012;13(5):658‑64.
https://doi.org/10.1111/j.1526‑4637.2012.01369.x.
3. Calvo‑Muñoz I, Gómez‑Conesa A, Sánchez‑Meca J. Prevalence of low
back pain in children and adolescents: A meta‑analysis. BMC Pediatr
2013;13:14.
https://doi.org/10.1186/1471‑2431‑13‑14.
4. Onofrio A, Silvia M, Domingues M, Rombladi A. Acute low back pain in high
school adolescents in Soutern brazil; prealence and associated factors.
Eur Spine J 2012;21(7):1234‑40.
https://doi.org/10.1007/s00586‑011‑2056‑3.
5. Minghelli B, Oliveira R, Nunes C. Non‑specic low back pain in adolescents
from the south of Portugal: Prevalence and associated factors. J Orthop
Sci 2014;19:883‑92.
https://doi.org/10.1007/s00776‑014‑0626‑z.
6. El‑Nagar SA, Mady MM. School bag usage, postural and behavioral habits
and its effect on back pain occurrence among school children. Am J Nurs
Sci 2017;6:218‑31.
https://doi.org/10.11648/j.ajns.20170603.20.
7. Akdag B, Cavlak U, Cimbiz A, Camdeviren H. Determination of pain inten‑
sity risk factors among school children with nonspecic low back pain. Med
Sci Monit 2011;17(2):PH12‑5.
https://doi.org/10.12659/MSM.881378.
8. Noll M, Candotti CT, Rosa BN, Loss JF. Back pain prevalence and asso‑
ciated factors in children and adolescents: An epidemiological population
study. Rev Saúde Públ 2016;50:31.
https://doi.org/10.1590/S1518‑8787.2016050006175.
9. Azuan M, Zailina H, Shamsul BM, Asyiqin N, Azhar MN, Aizat IS. Neck,
upper back and lower back pain and associated risk factors among primary
school children. J Appl Sci 2010;10(5):431‑5.
https://doi.org/10.3923/jas.2010.431.435.
10. Pavić IS. School bags and health of students. Croatian Journal for Public
Health 2012;8(31):114‑9.
11. Rai A, Agarawal S. Back problems due to heawy backpacks in school chil‑
dren. IOSR J Hum Soc Sci 2013;10:22‑6.
12. Khan R, Jabeen H, Arshad HS. Neck, shoulder, and back pain with carrying
heavy back packs among the spirit school children in Lahore. Int J Sci Res
2016;5(6):397‑400.
13. Brzek A, Dyrda B, Nowotny‑Czupryna O, Jachacz‑Lopata M. Postural
defects prevention programme as the exemplication of actions in the
scope of health promotion in early school education‑an action research
perspective. New Educ Rev 2011;24(2):194‑204.
14. Panicker RK, Sandesh TS. Prevalence of musculoskeletal pain in school
going adolescents using school bags: A co‑relational research. Int J Ther
Rehabil Res 2014;3(4):1.
https://doi.org/10.5455/ijtrr.00000039.
15. Čelik S. Zastupljenost Fizičke Aktivnosti i Ponašanje Školske Djece Prema
Fizičkoj Aktivnosti u Školskoj Sredini na Području KS. In: Travnik: 5.
Međunarodni Seminar „Uloga Sporta u očuvanju zdravlja“, Zbornik Radova;
2012. p. 164‑71.
16. Balamurugan J. School bags and musculoskeletal pain among elementary
school children in Chennai City. Int J Med Sci Clin Inven 2014;1(6):302‑9.
17. Sirsat J, Rehman Z, Rajan R, Kumar S, Mirghani AZ, Al‑Qatrani RA, et al.
Prevalence of back pain among high school students: A cross‑sectional
study in Dubai, United Arab Emirates. Gulf Med J 2014;3(2):16‑23.
18. Shamsoddini AR, Hollisaz MT, Hafezi R. Backpack weight and muscu‑
loskeletal symptoms in secondary school students, Tehran, Iran. Iran J
Public Health 2010;39(4):120‑5.
19. Protić‑Gava B. Dobro Držanje tela u Detinjstvu‑Sigurnost za Budućnost
Kvalitetnijeg života. U: 5. Međunarodna Konferencija Sportske Nauke i
Zdravlje. Zbornik Radova. Banja Luka; 2015.
20. Bralić I, Jovančević M, Predavec S, Grgurić J. Pretilost djece‑novo područje
multidisciplinarnog preventivnog programa. Pediatr Croat 2010;54:33‑42.
21. Kellis E, Emmanouilidou M. The effects of age and gender on the weight
and use of schoolbags. Pediatr Phys Ther 2010;22:17‑25.
https://doi.org/10.1097/PEP.0b013e3181cbf852.
22. Zaidi SM, Ansari FA, Waseem HF, Fahim S, Irfan M. Association of
Musculoskeletal Pain with Heavy Bag Packs Among School Children.
Vol. 29. 14. International Conference on Statistical Sciences; 2016.
p. 229‑38.
23. Paušić J, Kujundžić H, Penjak A. Possible effects of the school bag weight
on back pain in schoolchildren. Croat J Educ 2013;15:283‑7.
24. Dockrell S, Simms C, Blake C. Schoolbag carriage and schoolbag‑related
musculoskeletal discomfort among primary school children. Appl Ergon
2015;51:281‑90.
https://doi.org/10.1016/j.apergo.2015.05.009.
25. Baidoo NA, Quartey J, Esseiman KP, Armah JE, Assamoah DP.
Association between bag weight carrying style and low back paion and spi‑
nal curvatures among school children in Ablekuma South. Physiotherapy
2015;101(1):1243‑2.
https://doi.org/10.1016/j.physio.2015.03.1143.
26. Dianat I, Sorkhi N, Pourhossein A, Alipour A, Asghari‑Jafarabadi M.
Neck, shoulder and low back pain in secondary schoolchildren in relation
to schoolbag carriage: Should the recommended weight limits be gen‑
der‑specic? Appl Ergon 2014;45:437‑42.
https://doi.org/10.1016/j.apergo.2013.06.003.
27. Spiteri K, Busutti ML, Aquilina S, Gauci D, Camilleri E, Grech V. Schoolbags
and back pain in children between 8 and 13 years: A national study. Br J
Pain 2017;11(2):81‑6.
https://doi.org/10.1177/2049463717695144.
28. Adeyemi AJ, Rohani JM, Rani MA. Back pain arising from schoolbag usage
among primary schoolchilren. Int J Ind Ergon 2014;44:590‑600.
https://doi.org/10.1016/j.ergon.2014.06.001.
29. Aprile I, Di Stasio E, Vincenzi MT, Arezzo MF, De Santis F, Mosca R, et al.
The relationship between back pain and schoolbag use: A cross‑sectional
study of 5,318 Italian students. Spine J 2016;16(6):748‑55.
https://doi.org/10.1016/j.spinee.2016.01.214.
... Despite the fact that the multifactorial nature of schoolbag-related discomfort in schoolchildren should be considered, school bags weighing more than 10% of BW are associated with a higher occurrence of back pain also 16,28 . Moreover, Sahli et al. 15 in their study revealed that postural stability and bodily orientation parameters increase with increasing backpack load 15 . ...
Article
Full-text available
Prospective study, Level of evidence II. The aim of the study was to assess the prevalence of scoliosis among children aged 8–15 years old and to identify the impact of schoolbag weight in developing adolescent idiopathic scoliosis (AIS). AIS is a common disease whose prevalence varies between countries and gender, with an increased rate among females compared to males. Screening children in primary school settings for idiopathic scoliosis (IS) is an important public health issue and is crucial for early detection, prevention of further deformity, and healthy child growth. Our sample was composed of 1619 pupils from the municipality of Prishtina, surveyed from March to April 2019. Measurements were made with a scoliometer on the basis of the Adams test process. Three measurements were taken for each of the participants. Additionally, all the pupils were subjected to bare-foot height and weight measurements with and without school bags. The mean ± standard deviation age of pupils was 11.67 ± 2.00 years old and 49% were females. The prevalence of the angle of trunk rotation (ATR) ≥ 5 ° was 26.1%, females had 1.49 higher odds (95%CI 1.19–1.86) to develop an ATR of ≥ 5° compared to males. The highest rate of ATR of ≥ 5° was seen among the ninth-grade students (31.3%). 56.5% of 4th grade students carry a schoolbag weighing over 12.5% of body weight. Relatively high prevalence of idiopathic scoliosis was found in primary schools in Prishtina. The highest prevalence was found in students attending the ninth grade, while females gender dominated.
... Yorgunluğun, çocukların ağır okul çantalarını uzun süre taşımalarından dolayı sırt bölgesi ve omuz kuşağı üzerinde meydana gelen aşırı yüklenmeyi azaltan kompansasyon mekanizmalarından kaynaklandığını düşünmekteyiz. Bosna'da 5. ve 6. sınıflardan 79 öğrenciyi kapsayan bir çalışmada, çocukların yarısı okul çantalarını taşırken yorgunluk hissettiklerini bildirmiş, okul çantası ağırlığı ile yorgunluk ortaya çıkışı arasında ilişki olduğu belirtilmiştir (35). Çocuklarda ağır okul çantalarını taşımaktan kaynaklanan yorgunluğun ortaya çıkışı başka çalışmalarda da gösterilmiştir (12,36,37). ...
... The backpack weight of school students has been reported to range from 10% to as high as 25% of their body weight (BW) and may have a harmful impact on their body [33]. However, half of the schoolchildren carry schoolbags weighing more than 10% of BW, which is more frequently associated with tiredness and back pain [20]. Furthermore, the recent review study of Janakiraman et al. [21] stated that the backpack load limit for schoolchildren should be 10-15% of BW. ...
Article
Full-text available
Study aim : This study aimed to examine the effect of carrying backpacks on neck posture and ground reaction forces (GRFs) and to investigate the relationship between neck angles and GRFs during backpack carriage in schoolchildren. Material and methods : The craniohorizontal angle (CHA), craniovertebral angle (CVA), sagittal shoulder posture (SSP) and GRFs were measured in right-handed schoolchildren (14 male and 12 female) with mean age 10.17 ± 1.15 years during loaded and unloading conditions. The Qualisys motion analysis system with a force plate was used to assess the neck angles and GRFs. Results : During backpack carriage there was a significant increase in the CHA (p = 0.001), significant decrease in the CVA and SSP (p = 0.001, 0.016 respectively), no significant difference in the normalized (scaled to body weight) vertical GRFs (p > 0.05), and a significant increase in the anterior braking and posterior propulsive GRFs (p = 0.035, 0.002 respectively) compared to the unloading condition. While carrying a backpack there was a moderate negative correlation between the SSP and first vertical GRF (r = –0.464) and a strong negative correlation with the second vertical GRF (r = –0.571) and the posterior propulsive GRF (r = –0.587). Conclusion : Carrying a backpack weighing 15% of the child’s body weight changes the head posture and increases the normalized value of the anterior-posterior shear force. During backpack carriage, decreasing the SSP is associated with increasing the load acceptance, thrusting and posterior propulsive forces. Increasing the shearing force may lead to development of postural abnormities. Consequently, the ideal backpack weight should be considered by parents and teachers.
Article
Full-text available
Physical and psychological disorders in school-age children, as a consequence of prolonged sitting in class, denote one of the alarming issues of the today’s civilization. Scientific and professional literature pays great attention to the causes and phenomena of postural disorders caused by prolonged sitting, such as musculoskeletal disorders and back pain (MSD/BP). This phenomenon in children is increasingly correlated with school furniture design. School furniture, especially the chair and desk, are one of the most important factors to achieve the right body posture of pupils during school education. Despite this, not much attention is paid to the ergonomic requirements in furniture design, which are a prerequisite for good health, motivation improvement and learning of students. The objective of this paper is to show the impact of unmatched school furniture on the development of health problems and poor pupils’ posture through a review of scientific literature and previous studies concerning the issue. The results include a comparison of ten papers published in the period from 2004 to 2017 in Finland, Greece, Croatia, Slovenia, Nigeria, Brazil, Iran, Belgium, United Kingdom and India. Various databases have been used, including Pub Med, Google Scholar, Medline, Hrčak, Dabar, Science Direct and Science Citation Index. By reviewing the previous research of the selected authors dealing with sitting posture in school, an insight was gained into the effect of inadequate body postures on pupils’ health that could be used as guidance for new school furniture design.
Article
Full-text available
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.
Article
Full-text available
Regular use of heavy school bags and inappropriate carrying methods can put children at the risk ofmusculoskeletal problems and changes the body posture. This study set out to determine the prevalence ofmusculoskeletal pain and their relationship with school bags weight. This cross sectional exploratory study wasconducted in different elementary schools in Chennai, South India. A total of 510 elementary school childrencomprising of 297 boys and 213 girls aged between 6 to 12 years participated in the study. Each pupils body weightand school bag weight were measure using standard technique. The ratio of pupil's school weight to body weightwas calculated and used to estimate the percentage weight of school bag in relation to body weight and theparticipants also completed a designed questionnaire to identify prevalence of pain. A high prevalence ofmusculoskeletal pain 60.6% and 65.7% among male and female elementary school children respectively wasreported and the most common area being back and neck. A significantly positive association was found betweenpercentage of school bag weight and presence of musculoskeletal pain among the children (P< 0.05). The studyresults were in line with the prevalence of primary school children of many developing countries and below parwith some African studies owing to different educational demands.
Article
Full-text available
School children experience neck, shoulder and back pain due to carrying heavy bags. Heavy back packs negatively affect spine as well as cause other musculoskeletal symptoms. Objective: The aim of this study was to determine the frequency of neck, shoulder and back pain in spirit school children carrying heavy back packs. Method: This cross sectional survey was conducted among 135 students of private school in Pakistan, Lahore in 2016. Modified Nordic musculoskeletal questionnaire (Extended version) was used, asking about neck, shoulder and back pain and its details. Weights of the children were measured. Weights of bags were measured and its percentage with respect to body weight was also calculated. Results: Results showed that most prevalent musculoskeletal symptom was shoulder pain (44.4%) followed by neck (29.6%), low back (23%) and upper back (3%). Conclusion: Weight of school bags was strongly related to neck, shoulder and back pain in school children. Students who used double straps and carrying bags on both shoulder showed less symptoms.
Conference Paper
Full-text available
School bag carried by school children as daily load becomes a health problem such as musculoskeletal pain. Most common example of musculoskeletal pain is low back pain. Back pain is seen to occur more in healthy children. Back pain in children is much more likely to have a serious underlying disorder. Now a day's student is often seen with heavy school bags and it is observed that it is influencing their health in this transitional period of life to adulthood over many years. Many students carry school backpacks that exceed 10 percent to 15 percent of their body weight, which puts them at risk for back pain and related disorders. Carrying backpacks increases the risk of back pain and possibly the risk of back pathology. The aim of the study is to investigate the association of musculoskeletal pain with heavy bag packs among school children. A cross-sectional study will be conducted among school children having age of 9-16 years. Data will be collected using a questionnaire regarding gender, side of back pain, time to arrive to school, type of bag, mode of transport, posture of carrying bag, pain intensity level and measure weight of student with and without bag and their height. Data will be analyzed using statistical package for social sciences (SPSS). Mean and standard deviation will be computed for quantitative variable and frequency and percentage will be calculated for qualitative variables. Chi-square and logistic regression will be applied to see the association of musculoskeletal pain with independent variables. Preventive measures and appropriate guidelines with regard to safe load carriage in school children are therefore needed to protect this age group.
Article
Full-text available
Objective: To identify the prevalence of back pain among Brazilian school children and the factors associated with this pain. Methods: All 1,720 schoolchildren from the fifth to the eight grade attending schools from the city of Teutonia, RS, Southern Brazil, were invited to participate in the study. From these, 1,597 children participated. We applied the Back Pain and Body Posture Evaluation Instrument. The dependent variable was back pain, while the independent one were demographic, socioeconomic, behavior and heredity data. The prevalence ratio was estimated by multivariate analysis using the Poisson regression model (α = 0.05). Results: The prevalence of back pain in the last three months was 55.7% (n = 802). The multivariate analysis showed that back pain is associated with the variables: sex, parents with back pain, weekly frequency of physical activity, daily time spent watching television, studying in bed, sitting posture to write and use the computer, and way of carrying the backpack. Conclusions: The prevalence of back pain in schoolchildren is high and it is associated with demographic, behavior and heredity aspects.
Article
Full-text available
Background Non-specific low back pain is a prevalent symptom in adolescents and is recurrent in some instances. Recent studies have highlighted the marked impact the condition has on daily life of adolescents. However, it is unclear if parents of adolescents reporting recurrent non-specific low back pain know about their child’s status. The purpose of the study was to determine the level of agreement between adolescents and their parents in reporting recurrent non-specific low back pain in Harare, Zimbabwe. Methods This cross-sectional study formed part of a large study carried out to ascertain the prevalence of non-specific low back pain in Zimbabwean adolescents. Six hundred and twenty (n = 620) Medical Health Questionnaires were sent to parents. School-children with returned questionnaires and informed consents signed were subsequently eligible to participate. A reliable and validated low back pain study questionnaire was administered to 544 adolescents between the ages of 13 and 19 years randomly selected from government-administered schools. The questionnaire sought to determine adolescents with recurrent NSLBP. The Kappa statistic (k) was used to analyse agreement between adolescents and parental reports on recurrent NSLBP status. Results Parental and school-children response rates were acceptable (90.3 and 97.8 %, respectively). The prevalence of recurrent NSLBP was 28.8 % [95 % Confidence Interval, CI = 26.0–31.6]. Both sexes were equally affected [χ2(1) =0.19, p = 0.67]. The prevalence increased with age in both sexes [χ2trend =90.9, p < 0.001]. Parental reports agreed in 16.3 and 98.7 % for the adolescents with and without recurrent NSLBP respectively. The value of kappa (k) was 0.20 [SE = 0.04; 95 % CI, 0.13–0.27] with a prevalence index and bias index of −0.65 and 0.23, respectively. These results suggest poor strength of the agreement. Conclusions Recurrent non-specific low back pain is relatively common among Zimbabwean adolescents. Most of the parents of school-children with recurrent non-specific low back pain are unaware of the low back pain status of their children. Although this does not dismiss the relevance of non-specific low back pain reported during adolescence, these findings create a need to involve parents in awareness or preventive initiatives against low back pain in schools. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0518-1) contains supplementary material, which is available to authorized users.
Article
Background context: Back pain at a young age is considered to be predictive of chronicity. Several studies have investigated the relationship between the use of a schoolbag and back pain, although some aspects are still unclear. Purpose: The aim of this study was to evaluate back pain due to schoolbag use in terms of (1) prevalence and intensity, (2) differences between male and female pupils, and (3) predisposing factors. Study design: This is a cross-sectional study. Patient sample: The sample was composed of 5,318 healthy pupils aged 6 to 19 years (classified according to three age groups: children, younger adolescents, and older adolescents). Outcome measures: Schoolbag-related pain was assessed by means of an ad hoc questionnaire. The intensity of pain was assessed using the Wong scale. Methods: Subjects underwent a face-to-face interview using an ad hoc questionnaire. The intensity of pain was assessed using the Wong scale. On the basis of the prevalence and intensity of back pain, we divided our population into two groups: (1) no or mild pain group and (2) moderate or severe pain group. The "schoolbag load" (ratio between schoolbag and pupil weight multiplied by 100) was calculated for each subject. Results: More than 60% of the subjects reported pain. Although the schoolbag load decreased from children to young and older adolescents, schoolbag-related pain significantly increased (p<.001). Girls reported significantly more frequent and more severe pain than boys. The logistic model confirmed that adolescent girls are the group at greatest risk of suffering from intense pain. The schoolbag load had a weak impact on back pain, whereas the schoolbag carrying time was a strong predictor. Conclusions: Adolescent girls have the highest risk of experiencing severe back pain, regardless of schoolbag load. This suggests that other factors (anatomical, physiological, or environmental) might play an important role in pain perception. These aspects should be investigated to plan appropriate preventive and rehabilitative strategies.