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Back pain and school bag weight –a study on Indian children
and review of literature
Gauri A. Oka
a
, Ashish S. Ranade
b
and Aditi A. Kulkarni
a
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. J Pediatr Orthop B 00:000–000 Copyright © 2019
Wolters Kluwer Health, Inc. All rights reserved.
Journal of Pediatric Orthopaedics B 2019, 00:000–000
Keywords: back pain, bag weight, physical factors, psychosocial factors,
students
a
Department of Research and
b
Blooming Buds Centre for Pediatric
Orthopaedics, Deenanath Mangeshkar Hospital and Research Center, Pune,
Maharashtra, India
Correspondence to Gauri A. Oka, MBBS, M PH, Department of Research,
Deenanath Mangeshkar Hospital and Research Center, Pune 411004,
Maharashtra, India
Tel: +91 982 382 8445; fax: + 91 202 542 0104; e-mail: gaurioak@yahoo.com
Introduction
Since the past two decades or so, there has been a
growing interest among researchers all over the world
regarding back pain in school-going children. Many have
studied back pain in children through epidemiological
studies [1–3], as well as investigations of potential risk
factors such as spinal strength and mobility [4,5], early
radiological changes in the spine [6–8] and mechanical
factors such as weight of school bags [9–12]. Some studies
have reported association of both increase and decrease
in physical activities with back pain in children [4,5,11,
13]. However, there have also been studies from various
countries that have reported association between psy-
chological factors and back pain in adolescents [10,14]. It
is quite apparent that today, the scientific world is divi-
ded in opinion over factors contributing to back pain in
school children, and the question remains whether or not
to implicate the school bag.
Almost universally, a large number of school children
carry school bags on their shoulders for carrying books,
water bottles and lunch boxes. Although there have been
studies from India looking at back pain in children of
school-going age with respect to weight of school bags
[15–21], none have investigated the possible role of
psychosocial factors. Thus, Indian data about back pain
in school children and its association with physical and
psychosocial factors are lacking. Moreover, owing to
confusing media reports, there is an ever-increasing
concern among students, teachers, parents, as well as,
medical professionals over the issue of back pain in
school children and its contributing factors.
Participants and methods
We conducted a cross-sectional study in two English-
medium schools of Pune City, India. The study was
approved by Independent Review Board. It was decided
to include students from standards VII and IX as repre-
sentatives of students from standards V–X. The study
was conducted in those schools where we were granted
permission by the respective school principals. We
explained the details about our study to the students.
Detailed information sheets explaining the nature of our
study and informed consent forms were sent home with
180 students to be read and filled in by their parents. The
information sheets explained clearly to the parents that
consent for their child’s participation in the study was
completely voluntary. Parents of 163 students from
standards VII and IX from two schools provided their
written informed consent. These students were included
in our study.
Original article 1
1060-152X Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BPB.0000000000000602
Copyright r2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
The students’weights and weights of their school bags
were recorded using a digital weighing scale. Students
were then administered two questionnaires to be filled
in. One questionnaire sought information regarding a
month’s recall of back pain and physical factors such as
mode of transport to school, method of carrying the
school bag, a month’s recall of injury to the back, fre-
quency of sports/exercise activities in school and a week’s
recall of duration of computer/laptop use and hours spent
watching TV (per day). Students were provided with a
diagram of the back and were requested to mark the area
of their back pain on it. For the purpose of our study,
‘upper back pain’was defined as pain upto and above the
level of spine of scapula. ‘Middle back pain’was defined
as the area between spine of scapula and a horizontal line
passing through the lowermost border of the last rib and
‘lower back pain’was defined as the region below the
horizontal line passing through the lowermost border of
the last rib.
The second questionnaire that we used for exploring
psychosocial factors was a standardized brief behavioral
screening tool, the ‘strengths and difficulties ques-
tionnaire’(SDQ) [22]. SDQ is designed to gather and
score information regarding a child’s prosocial behavior
(such as sharing and helping), hyperactivity (including
behaviors such as restlessness, impulsiveness, or easy
distraction), emotional problems (such as worrying, being
unhappy, or nervous), peer problems (such as preference
for being solitary) and conduct problems (such as obe-
dience or display of temper tantrums). A research coor-
dinator read out the questionnaires and explained in
detail their contents. All queries and difficulties raised by
the students regarding answering the questionnaire were
satisfactorily addressed. Data were analyzed using SPSS
20 (SPSS Inc., Chicago, Illinois, USA). Associations were
determined using the χ
2
-test, and odds ratio (OR) were
calculated to determine risk.
Results
Our sample of 163 students consisted of an almost equal
proportion of boys and girls (49.7 and 50.3%, respec-
tively). The mean age of students was 13.5 ±1.05 years
(range: 12–16 years), mean weight was 47.1 ±11 kg
(range: 27–99.2 kg) and mean height was 156 ±8.7 cm
(range: 137.7–179.6 cm). The weights of students’school
bags ranged from 2.2 to 15.6 kg, with mean bag weight of
6.1 ±2.4 kg. The mean weight of school bag as a per-
centage of body weight was found to be 13.5 ±6.2%. It
was observed that 124/163 (76.1%) students carried
school bags weighing more than 10% of their body
weight. The proportion of students reporting back pain in
the last one month was 88/163 (53.9%), consisting of 45
(51.1%) boys and 43 (48.9%) girls. From among these, 38
(43.1%) had upper back pain, 22 (25%) had lower back
pain and 20 (22.7%) reported middle back pain. The
remaining students had pain in a combination of areas.
Moderate pain [visual analog scale (VAS) score of 4–6]
was reported by most students (59.1%). As far as the
duration of back pain was concerned, majority, that is
64/88 (72.7%) students, said that their back pain lasted for
less than 2 days, whereas back pain of 23/88 (26.1%)
lasted for greater than or equal to 2 days. The salient
characteristics of back pain are shown in Table 1.
Mean weights of school bags carried by students with and
without back pain were not found to be significantly
different (6.14 and 6.04 kg, respectively; P=0.795). Same
was true for the mean percent bag weights as a percen-
tage of body weights in students with and without back
pain (13.66 and 13.39%, respectively, P=0.786). Among
students who carried school bags weighing greater than
10% of their body weight, the proportion of those
reporting back pain was not statistically different from
those without back pain (55.6 vs. 44.4%, respectively;
P=0.46). Weight of school bag was thus found to have no
association with back pain.
We compared mean BMI of students with and without
back pain. However, it was found that there was no sig-
nificant difference in the means (19.1 vs. 19.3 kg/m
2
,
respectively; P=0.73). We conducted the same analysis
using ‘modified BMI’, where weight was the addition of
weight of the child and weight of his/her school bag.
Again, we found no significant difference in the mean
modified BMI of students with and without back pain
(21.6 vs. 21.8 kg/m
2
, respectively; P=0.8).
Of 163 students, 100 (61.3%) exercised or participated in
sports activities more than once a week. It was seen that
among the students engaging in more frequent sports and
exercise activities, the proportion of girls with back pain
was greater than boys with back pain (72.1 vs. 51.1%).
However, this difference was not statistically significant
(P>0.05). Table 2 summarizes all risk factors for back
pain as seen in students with and without back pain.
Mode of transport to school (walking, cycling, by car/bus/
two-wheeler) and method of carrying the school bag
(either on one or both shoulders) had no association with
back pain either. Significant findings of students report-
ing back pain compared with those without back pain are
Table 1 Some characteristics of back pain (n=88)
Location n(%)
Upper back 38 (43.1)
Middle back 20 (22.7)
Lower back 22 (25)
Combination of the three 8 (9)
Intensity (VAS scores)
1–3 (mild pain) 25 (28.4)
4-6 (moderate pain) 52 (59.1)
7–10 (severe pain) 11 (12.5)
Frequency (1 month’s recall)
1–3 times 47 (53.4)
4–6 times 32 (36.4)
>6 times 09 (10.2)
VAS, visual analog scale.
2Journal of Pediatric Orthopaedics B 2019, Vol 00 No 00
Copyright r2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
depicted in Fig. 1. We found that a significantly greater
proportion of students with back pain had a history of
back injury in the last 1 month [19.3 vs. 4%, P=0.003;
OR: 4.8 with 95% confidence interval (CI): 1.47–15.8]
and divulged having a family member complaining of
back pain (47.7 vs. 24%, P=0.002, OR: 1.98, 95% CI
1.25–3.14). Of 163 students, 143 (87.7%) watched tele-
vision. A significantly greater proportion of students
watching television for more than 1 h a day over the past
1 week (76.8 vs. 23.8%) were found to report back pain
(OR: 3.3, 95% CI 1.5–7.5; P=0.003). Of the 163 students,
112 (68.7%) reported using the computer or laptop. No
significant association was found between number of
hours spent using computer/laptop and presence of back
pain (P=0.506).
Based on the calculated psychosocial scores, it was found
that a significantly greater proportion of students who
reported back pain had abnormal scores on SDQ in the
domain of hyperactivity problems (23.9 vs. 9.3%; P=0.045)
and conduct problems (19.3 vs. 12%; P=0.042) as com-
pared with those without back pain. No associations were
found between back pain and the other calculated psy-
chosocial scores, namely, emotional problems score, peer
problems score, and prosocial behavior score.
We also asked students to report what they thought
caused their back pain (Fig. 2). It was found that most
attributed their back pain to heavy school bags (51.1%),
followed by a combination of heavy school bags and too
much physical activity (15.9%) and bad posture (6.9%).
There were 18 (20.4%) students who could not say for
sure what caused their back pain with two girls attribut-
ing their back pain to painful menses.
Discussion
Our study, conducted in Indian children, found no
association between back pain and weight of school bag,
weight of school bag as a percentage of body weight and
physical activities. Significant association was found
between back pain and conduct and hyperactivity pro-
blems. Table 3 depicts studies that focused on associa-
tion between back pain and school bag weight, as well as,
psychosocial and other physical factors. It was found that
school bag weight was associated with back pain in eight
studies, of which five were from the Americas (USA and
Brazil) [11,35,40,42,45], two from Europe (Malta and
Spain) [23,31], and one from Asia (Saudi Arabia) [41].
There were four studies that reported no association
between school bag weight and back pain [9,29,43,47].
We found six studies from Europe [10,12,26,30,33,48]
and one from New Zealand [32], which have studied
both, weight of school bag, as well as, psychosocial factors
and their association with back pain. All seven studies
have found association between psychosocial factors and
back pain. There were 10 studies, six from Europe [24,
25,27,34,39,44], one from Asia (Iran) [37], two from Africa
(Uganda and South Africa) [28,46] and one from Australia
[36], which reported association between back pain and
physical factors such as method of carrying school bag,
watching TV and posture. The study conducted by
Murphy et al. [38] found that upper back pain was asso-
ciated with the weight of school bag, and lower back pain
was associated with school furniture, emotional problems,
and previous injury. Results of these studies show a
considerable variation in the contribution of different
factors associated with back pain across the continents.
There is no study from India that explores the con-
tribution of school bag weight, as well as, psychosocial
and other physical factors towards back pain in school
children.
The debate about the ideal limit of weight of school bag
as a percentage of the student’s body weight has also
been a long drawn one. It was arbitrarily decided in 1996
by the Ministry for Education in Austria that school bags
should not be allowed to weigh more than 10% of the
student’s body weight [12]. A government resolution to
the same effect was passed in the state of Maharashtra
(India) in 2015 [49]. Our study found that 76.1% students
carried bags heavier than 10% of their body weight.
Comparable figures are reported by Aundhakar et al. [20]
(82.4%) and more recently by Dockrell et al. [26] (69.3%).
However, we failed to find any association between back
pain and neither weight of school bag nor its weight as a
percentage of students’body weight. Studies conducted
by Negrini and Carabalona [9], Jones et al. [10], van Gent
et al. [12], Watson [48] and Mwaka et al. [28] also have not
found any such association. Our study has found a
Table 2 Distribution of risk factors for back pain
Back pain
Risk factor Yes No Pvalue
Female sex (%) 52.4 47.6 0.69
Mean weight of student (kg) 46.7 ±11.1 47.5 ±11 0.65
Mean bag wei ght 6.1 ±2.3 6.0 ±2.5 0.79
Weight of school bag as % of body
weight
13.66 ±5.7 13.39 ±6.8 0.786
Carrying school bag on back (%) 57.7 42.3 0.06
Carrying school bag on one
shoulder (%)
40 60 0.52
Walking to school (%) 61.5 38.5 0.17
History of back injury (%) 85 15 0.003
Presence of family member
complaining of back pain (%)
70 30 0.002
Number of hours of computer use/
day
0.86 ±0.7 0.65 ±0.64 0.07
Number of hours spent watching TV/
day
1.3 ±0.6 1.0 ±0.6 0.009
Frequent sports activity in school
(>once a week) (%)
57 43 0.33
SDQ –emotional problem score 3.42 ±1.7 2.92 ±1.5 0.06
SDQ –conduct problem score 3.9 ±1.7 3.21 ±1.5 0.009
SDQ –hyperactivity score 2.41 ±1.4 1.93 ±1.3 0.029
SDQ –peer problem score 2.59 ±1.8 2.15 ±1.2 0.079
SDQ –prosocial score 8.25 ±1.8 8.63 ±1.5 0.164
Bold values indicate statistically significant (P<0.05).
SDQ, strengths and difficulties questionnaire.
Back pain: school bag and beyond Oka et al.3
Copyright r2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
significant association between back pain and duration of
watching television. This association was also reported by
Mohseni-Bandpei et al. [37] in their study on Iranian
students, along with reporting no association between
back pain and school bag weight. Prevalence of back pain
found in our study (53.9%) is higher, on one hand, than
the prevalence reported by some studies from various
parts of the world including some Indian studies (18.6%
according to Jones et al. [10], 23.9% according to Watson
[48] and 22.7% according to Kumar et al. [21]) and com-
parable, on the other hand, to 51% from a study by Patil
et al. [19], 57.1% as reported by Aundhakar et al. [20] and
60% by Aprile et al. [25]. Greater proportion of boys in our
study reported back pain (though the difference was not
Fig. 1
19.3%
47.7%
85.9%
23.9%
19.3%
4.0%
24.0%
64.6%
9.3% 12.0%
0
10
20
30
40
50
60
70
80
90
100
Injury to back Family member
complaining of
back pain
Watching TV
>1hr/day
Abnormal
hyperactivity
scores
Abnormal
conduct problem
scores
Back pain No back pain
Comparison of significant findings among students with and without back pain.
Fig. 2
45(51.1%)
14(15.9%)
6(6.9) 5(5.7%)
18(20.4%)
0
10
20
30
40
50
60
and too much
physical activity
Heavy school bag Heavy school bag Bad posture Injury Others
Students’perceived reasons for back pain (n=88).
4Journal of Pediatric Orthopaedics B 2019, Vol 00 No 00
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Table 3 Studies exploring association between back pain, school bag weight, psychosocial factors, and other physical factors
References Country of origin Sample size Risk factors studied Key findings
Spiteri et al. [23] Malta 4005 School bag weight, BMI, and sex Sex, BMI and weight of school bag to body weight ratio were found to be
statistically related to back pain
Minghelli et al. [24] Portugal 966 Weight of backpack and postural habit No association between weight of backpack and LBP
≠
. Incorrect sitting
posture had 1.77 times the risk of developing LBP
Aprile et al. [25] Italy 5318 Sex and weight of school bag Girls showed more prevalence, and school bag weight had a weak effect;
however, school bag carrying time was a strong predictor of back pain
Dockrell et al. [26] Ireland 529 Physical and psychosocial risk factors School bag weight or none of the physical factors were associated with
school bag related discomfort. Psychosocial factors are associated
with back discomfort
Macedo et al. [27] Portugal 149 Sex and backpack weight No association between back pain and weight of backpack. Back pain
and disability more among females and with lower physical functioning
Mwaka et al. [28] Uganda 532 School bag weight Association was significant between LBP and method of bag carriage,
long duration walking and time spent sitting after school. No direct
association between weight of school bag and LBP
Dianat et al. [29] Iran 586 Sex and school bag weight No association between school bag weight and LBP, and girls were more
likely to have LBP
Wirth et al. [30] Switzerland 836 Psychosocial parameters and physical
parameters
Psychosocial factors were associated with back pain
Rodriguez-Oviedo et al. [31] Spain 1403 Backpack weight, BMI, sex and age Carrying backpacks increases the risk of back pain
Trevelyan and Legg [32] New Zealand 245 Psychosocial parameters, school and leisure
activities and family characteristics
Psychosocial and emotional factors may have stronger relationship with
back pain than physical factors
Erne C [33] Switzerland 192 Age, BMI, sex, participation in sports, hours of
daily TV, video and computer use,
psychosocial strain and grade in mathematics
Stress caused by unsatisfactory grade in maths and school-type
recommendation were predictors of back pain
Akdag et al. [34] Turkey 222 BMI, sex, posture, transportation, bag handling
and type of bed
Pain was found to be associated with duration of studying, type of bed,
transportation to/from school and BMI
Giusti et al. [35] Brazil 463 Weight of school bag and other materials taken
to school, private versus public school and
type of school bag
Positive association between weight excess of school material and school
bag type (trolley pack) and notebook type (hard back)
Haselgrove et al. [36] Australia 1202 School bag weight, method of carrying bag, sex,
duration of carriage and method of transport to
school
Carrying school bag for >30 min daily and t aking an inactive form of
transport to school (car or bus) increased the odds of both back and
neck pain
Mohseni-Bandpei et al. [37] Iran 5000 School bag weight, age, B MI, position and time
spent watching TV and duration of homework
Significant association between position and duration of watching TV. No
association between school bag weight and LBP
Murphy et al. [38] England 679 School furniture, family history of back pain,
emotional and conduct problems and previous
treatment for musculoskeletal disorders
Upper back pain was associated with weight of school bag. LBP was
associated with school furniture features, emotional problems, family
history and previous injury
Skoffer [39] Denmark 546 School bag weight, school furniture dimensions
and sitting positions
LBP was associated with carrying school bag on 1 shoulder (in
asymmetric manner) and not associated with different types of school
furniture
Moore et al. [40] USA 531 Weight of backpack, age and sex Younger students and females were more at risk of having back pain, and
greater backpack weight was associated with upper and mid-back pain
but not neck or lower back pain
Al-Hazzaa [41] Saudi Arabia 702 BMI, fat percentage, mode of travel and bag
surface area
Positive correlation between weight of school bag and back pain
Skaggs [42] USA 1540 Locker availability, sex, weight of backpack and
use of one or two straps for backpack
Heavier backpack, younger age, female sex and a positive screening
examination for scoliosis associated with back pain
Whittfield et al. [43] New Zealand 140 School bag weight School bag weight not associated with back pain
Korovessis et al. [44] Greece 1263 Backpack and trunk alignment Asymmetrical backpack carrying was found to be associated with back
pain
Siambanes et al. [45] USA 3498 Student’s weight, weight of backpack,
socioeconomic status and method of
backpack wear
Backpack weight was effective in predicting back pain, and girls and
those who walk to and fro from school were more likely to report back
pain. No effect of method of wear, socioeconomic status and age on
back pain
Back pain: school bag and beyond Oka et al.5
Copyright r2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
significant) in contrast to the study by Skaggs et al. [42]
(43% girls vs. 32% boys) and Aprile et al. [25], where they
found a significantly higher female preponderance (RR:
1.72, P<0.001). The intensity of back pain found in our
study was predominantly moderate, that is, VAS score of
4–6 (59.1%). This is similar to pain intensities reported
by Skaggs et al. [42] (mean pain score: 5.2, SD: 2.7) and
Kumar et al. [21] (VAS score of 4–6 in 51.2% students).
Our study highlights the contribution of psychosocial
factors apart from physical ones that play an important
role in back pain in children and probably reflect psy-
chological distress in this group. Jones et al. [10] have
reported that children with greater psychosocial difficul-
ties are more likely to develop back pain. Emotional and
conduct problems were found strongly associated with
complaints of low back pain in a study of 11–14 year olds
by Watson [48]. They too did not find any association
with mechanical factors like school bag weight and phy-
sical activity. Results of a Swedish study [14] highlight a
significant association between back pain and headache
and social, emotional and psychological factors among
school students, but no association with physical factors.
In a study of two secondary schools, Balagué et al. [13]
have found significant association between psychological
factors and low back pain in school children. They also
found a significant association between low back pain
and sibling history of low back pain [13]. Similarly, our
study has shown a significant association between back
pain among school students and presence of a family
member complaining of back pain.
Most students in our sample perceived heavy school bags
as the reason for their back pain. The same perception
was found among adolescents in studies by Negrini and
Carabalona [9], Mwaka et al. [28] and Haselgrove et al.
[36]. We agree with Skaggs et al. [42] when they talk
about the influence that an unblinded study could have
had on students’responses. We too cannot deny the
possibility that, as students were aware of the nature of
our study, their responses could have been influenced at
the outset. However, among others, our survey also
included questions about history of seeking medical care
and remaining absent from school because of back pain,
history of injury to the back and about television and
computer use. We are quite sure that such questions
succeeded in evoking unbiased responses to a consider-
able extent.
Conclusion
There was no association between bag weight and back
pain in our study sample. Factors such as history of injury
to the back, having a family member complaining of back
pain, spending more than an hour watching television per
day and conduct and hyperactivity problems were found
to be significantly associated with back pain. Our study
attempts to shift the focus from ‘heavy school bags’to
other physical and psychological factors that could be
Table 3 (continued)
References Country of origin Sample size Risk factors studied Key findings
Puckree et al. [46] South Africa 176 Backpack weight, method of carrying backpack
and sex
Female sex and type of bag more related to pain
Wall et al. [47] USA 346 Age and backpack weight No association between backpack use and back pain
van Gent et al. [12] Netherlands 745 Weight and type of school bag and physical and
psychological factors
Psychosomatic factors appear to be more strongly related to occurrence
of back pain than type and weight of school bag
Sheir-Neiss et al. [11] USA 1126 Body weight, height, and backpack weight Female sex and larger BM I were significantly associated with back pain.
Use of backpack and its weight were independently associated with
back pain
Jones et al. [10] England 1046 Mechanical and psychosocial factors No association between weight of school bag and back pain; children
reporting high levels of psychosocial difficulties were found to be more
likely to develop LBP
Watson [48] England 1446 Mechanical factors and psychosocial factors Mechanical factors (physical activity and school bag weight) were not
associated with LBP. A Strong association was observed for emotional
problems and conduct problems
Negrini and Carabalona [9] Italy 237 Features of backpack carrying and subjective
perceptions of the load
No direct relationship between backpack load and back pain
6Journal of Pediatric Orthopaedics B 2019, Vol 00 No 00
Copyright r2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
associated with back pain among students. We are aware
that our study covered 12–16-year-old students from two
urban schools only. However, we feel that these results
definitely warrant a bigger survey of many more schools
across the country to better understand this issue.
Limitations
We understand that our study has the following limitations:
we did not collect details of back injuries and socio-
economic details reflecting students’lifestyle such as
family income, and no clinical examination was carried out.
Acknowledgements
The authors wish to acknowledge the valuable inputs
from Dr Sujala Watve PhD and Dr Sucharita Gadre PhD
from Jnana Prabodhini Institute of Psychology, Pune, and
Dr Asawari Kanade, PhD.
Conflicts of interest
There are no conflicts of interest.
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