Journal Information
Share
Share
Download PDF
More article options
Visits
...
Original article
DOI: 10.1016/j.jped.2019.07.008
Open Access
Available online 6 October 2019
Low back pain in adolescents and association with sociodemographic factors, electronic devices, physical activity and mental health
Lombalgia em adolescentes e associação com fatores sociodemográficos, dispositivos eletrônicos, atividade física e saúde mental
Visits
...
Thiago Paulo Frascareli Bentoa,
Corresponding author
thibento10@gmail.com

Corresponding author.
, Guilherme Porfirio Corneliob, Priscila de Oliveira Perrucinic, Sandra Fiorelli Almeida Penteado Simeãod, Marta Helena Souza de Contia, Alberto de Vittac
a Universidade do Sagrado Coração (USC), Programa de Mestrado em Fisioterapia em Saúde Funcional, Bauru, SP, Brazil
b Universidade do Sagrado Coração (USC), Curso de Fisioterapia, Bauru, SP, Brazil
c Universidade Anhanguera (Uniderp), Campo Grande, MS, Brazil
d Universidade do Sagrado Coração (USC), Programa de Mestrado em Odontologia, Bauru, SP, Brazil
Received 13 May 2019. Accepted 31 July 2019
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Tables (4)
Table 1. Distribution of absolute and relative frequencies of electronic devices in high school adolescents by sex.
Table 2. Bivariate analysis of low back pain with sociodemographic characteristics, level of physical activity and mental health problems in high school adolescents.
Table 3. Bivariate analysis of low back pain with electronic devices in high school adolescents.
Table 4. Multivariate logistic regression, for associations of variables with low back pain in high school adolescents.
Show moreShow less
Abstract
Objectives

To determine the prevalence of low back pain and to analyze the association with the individual, sociodemographic variables, electronic devices, habitual practice of physical activity, and mental health problems.

Methods

Cross-sectional study with 1628 students in public schools in the city of Bauru, SP, Brazil. The following data were collected: 1. demographic and socioeconomic aspects; 2. Use of electronic devices; 3. habitual physical activity level (Baecke); 3. mental health (SDQ). 4. low back pain (Nordic Questionnaire). Descriptive analyzes and bivariate and multivariate logistic regression were used.

Results

The overall prevalence of low back pain was 46.7% (95% CI: 44.27–49.11); men showed a prevalence of 42.0% (95% CI: 36.63–43.41) and women 58.0% (95% CI: 49.73–56.51), a statistically significant difference. The variables associated with pain in the low back region were: female gender (PR=1.70), daily TV use for more than 3h (PR=1.17), use of laptop computer (PR=1.40), use of the cell phone in the supine position (PR=1.23), use of the cell phone in semi-supine position (PR=1.49), daily cell phone use for more than 3h (PR=1.36), use of tablet (PR=1.67), daily tablet use for more than above 3h (PR=1.46), and clinically important mental health problems (PR=2.62).

Conclusion

There is a high prevalence of low back pain in high school students and striking association with female sex, electronic devices, and mental health problems.

Keywords:
Adolescent
Low back pain
Epidemiology
Risk factors
Palavraschave:
Adolescente
Lombalgia
Epidemiologia
Fatores de risco
Resumo
Objetivos

Determinar a prevalência de lombalgia e analisar a associação com variáveis individuais e sociodemográficas, dispositivos eletrônicos, prática habitual de atividade física e problemas de saúde mental.

Métodos

Estudo transversal com 1628 alunos matriculados em escolas públicas na cidade de Bauru/SP. Para a coleta de dados: 1. aspectos demográficos e socioeconômicos; 2. dispositivos eletrônicos; 3. nível habitual de atividade física (Baecke); 3. saúde mental (SDQ); 4. Lombalgia (Questionário Nórdico). Foram utilizadas análises descritivas e de regressão logística bivariada e multivariada.

Resultados

A prevalência geral de lombalgia foi 46,7% (IC de 95%: 44,27 a 49,11), sendo que os homens mostraram uma prevalência de 42,0% (IC de 95%: 36,63 a 43,41) e as mulheres mostraram uma prevalência de 58,0% (IC de 95%: 49,73 a 56,51), com diferença significativa. As variáveis associadas a dor na região lombar inferior foram: sexo feminino (RP=1,70), tempo de uso de TV acima de 3 horas por dia (RP=1,17), uso de notebook (RP=1,40), uso de celular na posição supina (RP=1,23), uso de celular na posição semissupina (RP=1,49), tempo de uso de celular acima de 3 horas por dia (RP=1,36), uso de tablet (RP=1,67), tempo de uso de tablet acima de 3 horas por dia (RP=1,46) e problemas de saúde mental clinicamente importantes (RP=2,62).

Conclusão

Há alta prevalência de lombalgia em alunos do ensino médio e forte associação ao sexo feminino, dispositivos eletrônicos e problemas de saúde mental.

Full Text
Introduction

Low back pain (LBP) is the leading cause of disability among adolescents and adults of all ages. According to the World Health Organization (WHO), the musculoskeletal comorbidities are the most incapacitating conditions; of the 209 health conditions, LBP has contributed more to the overall incapacity, occupying the sixth position in the global burden of diseases defined by disability-adjusted life years.1,2

In both developed and developing countries, the prevalence of LBP in high school adolescents has been reported. In Shanghai (China),3 the prevalence was 33.1%; in Brazil, this rate was reported as 13.7% in Pelotas,4 13.4% in Porto Alegre,5 42.1% in Petrolina,6 and 46.9% in Recife.7

The Brazilian and international literature relate the nonspecific LBP in adolescents to sociodemographic factors, practice of physical exercise, smoking, nutritional status, conditions associated to school (support type and mode of transport of the material, weight of the school bag, school furniture), use of devices electronics (TV, computer, tablet, and cell phone),8–11 and mental health problems.5,9 Regarding the use of tablet and cell phone, there are no Brazilian data on this association.

Studies on the prevalence of LBP in the population are important due to generating social and economic consequences, both for the state as for individuals. For the individual it means the loss of quality of life, and for the state, the expenses with treatment and rehabilitation. Due to factors related to the growth process, adolescents have higher chances of developing postural changes and pain in the lumbar spine, interfering directly in their academic performance. Furthermore, adolescents with LBP will probably develop pain in the economically active age, contributing to the increase of indirect costs (absenteeism, falling productivity, early retirement, and sickness),7 which represent approximately 85% of the total costs.11

The present study contributes to other epidemiological investigations and collaborate for the knowledge of the national estimates of the prevalence and its risk factors, for systematic reviews and meta-analysis, since the availability of the sources of data from surveys on the association of LBP with the use of electronic devices (tablet and cell phone) in Brazilian adolescents are scarce. This study may also assist in the understanding of its global cause and contribute to public policies aimed to control this problem, based on preventive and/or therapeutic interventions.12

Considering these points, this study aimed to determine the prevalence of LBP and to analyze the association with the individual and sociodemographic variables, use of electronic devices, practice of physical activity, and mental health problems.

MethodsStudy design

This was a cross-sectional study, approved by the Ethics in Research Committee of Universidade Sagrado Coração, (number 1.972.579), with 1628 students of the first and second grades of secondary education in public schools of Bauru, SP, Brazil.

Participants

The study included adolescent enrolled in the first and second grades of secondary education in public schools in the city of Bauru, SP, Brazil. According to data provided by the State Department of Education—Teaching Board of Bauru, in 2017 there were approximately 9000 students.

Age groups and sex were defined through sampling areas, for which minimum numbers in the sample were calculated to allow subsequent analyzes. The sampling areas were the 1st and 2nd year of secondary education of both sexes.

To determine the size of the sample, the formula for the calculation of samples for finite populations was used, with the following parameters: confidence level of 95%, prevalence of 50%, unknown percentage complement (100-p), size of the population (9000 high school students from state schools), and maximum permissible error of 3%. Thus, the sample size for the group was calculated at least 990 individuals, plus 20% of expected losses and 15% for association studies, for a total of 1366 adolescents.

The sample size calculation considered a plan with cluster sampling in two stages, where the primary sampling units (PSU) were the schools and secondary sampling units (SSU) were the classes of the three years of high school of the selected schools. The sample of schoolchildren was formed, therefore, by all the students of SSU classes selected in the sample of schools PSU.

The PSU schools were stratified, initially, considering their geographical location in accordance with the division of the city into eight sectors. In each of these, schools with classes of 1st and 2nd years of high school were counted, reaching the quantities in each sector. It was observed that in three consecutive sectors, between the west and the east of the city (counterclockwise), state high schools were not located; therefore these three sectors were rejected and considered only the remaining five, which concentrate the 30 schools, between the east and west of the city (counterclockwise).

In each geographic stratum, the sample was obtained in two stages. First, schools were selected through a method of selection with probabilities proportional to size. The measure of size considered in the selection of the schools was the total number of students in the 2 years of high school in each school, and that the percentage of each year in relation to the total number of students (9000): 36.9% and 33.6%, respectively. These percentages were applied to the sample (1366 students), obtaining the total number of students to be interviewed per sector and per year of high school (second approach). To reach the total determined for each sector, the schools were randomly selected, as well as the classes of the respective schools.

The criteria adopted for the exclusion of some schools randomly selected for the study were: individuals younger than 14 years or older than 18 years; non submission of informed consent form (ICF) signed by parents/guardians; and refusal to participate.

Instruments

The socio-demographic aspects were: sex (male and female), age, marital status (married or common law union, single, separated, and widowed), ethnicity (white, black, brown/mixed-race), and socioeconomic classification (class E=up to one Brazilian minimum wage, class D=one to five Brazilian minimum wages, class C=five to ten Brazilian minimum wages, class B=10–20 Brazilian minimum wages, class A=more than 20 Brazilian minimum wages).

Regarding electronic devices (use of TV, computer, tablet, or cell phone) the following questions were asked: "In a normal week class, do you watch TV?" (yes/no); "How many times a week do you watch TV?" (once or twice, three or four times, five times, more than five times); "How many hours a day do you watch TV?" (less than one hour, two hours, three hours, four hours, five hours, more than five hours a day); "Do you use a computer?" (yes/no); "What type of computer do you use?" (Desktop, laptop); "What is the height of your computer screen?" (eyes above the midpoint of the screen, eyes approximately in the middle point of the screen, eyes below the mid-point of the screen); "How many times a week do you use a computer?" (once or twice, three or four times, five times, more than five times); "How many hours a day do you use a computer?" (less than one hour, two hours, three hours, four hours, five hours, more than five hours a day); What is the eye-to-screen distance while using your computer? (<20cm, 20cm–25cm, 25cm–30cm, and >30cm); "Do you use a cell phone?" (yes/no); "What posture are you when you use a mobile phone?" (standing, sitting, lying, or semi-lying); "Average daily time using cell phone?" (<1h, 2h–3h, 3h–4h, and 4h); "What is the eye-to-screen distance during the use of the cell phone?" (<10cm, 10cm–15cm, 15cm–20cm, and >20cm); "Do you use a tablet?" (yes/no); "What posture are you when you use a tablet?" (standing, sitting, lying, or semi-lying); "Average daily time using tablet?" (<1h, 2h–3h, 3h–4h and >4h); and "What is the eye-to-screen distance while using the tablet? (<10cm, 10cm–15cm, 15cm–20cm, and >20cm).

The habitual physical activity level was verified using the Baecke Questionnaire of Habitual Physical Activity (BQHPA), validated in Brazil.13

Mental health was evaluated through the Strengths and Difficulties Questionnaire (SDQ), validated in Brazil by Fleitlich-Bilyk. The possibilities of results indicated by the instrument for all five subscales and the total number of difficulties are three: "Normal" (healthy): indicates that there are no difficulties regarding what is being assessed; "Borderline": indicates that the child or adolescent already presents some difficulty that, if not properly cared for, can deteriorate and jeopardize their development; "abnormal" (clinical): indicates that there are major difficulties relating to what is being assessed, requiring specialized intervention.14,15

The variable “LBP” was observed using the Nordic questionnaire, which was validated and adapted to the Brazilian culture.16,17 LBP (LBP) is characterized by pain or discomfort in the lumbar region, below the costal margin and above the gluteal fold, that may or may not irradiate to the thigh. In the interview, individuals were asked the following question: “Did you have any pain or discomfort in your lower back in the past year?” In addition to the verbal questionnaire, an image of the spinal regions in different colors was also presented, so the interviewees could better specify the lower back region where the pain was located.16–18

Data collection procedure

The State Department of Education authorized the research and, after consent of the parents/guardians, data collection took place between the months of March to June 2017. Data was collected by undergraduates and post-graduates, trained based on a protocol of standardization procedures data collection (theoretical and practical), previously established with the intention of minimizing possible intra- and inter-rater errors.

At the time of collection, the study participants received the questionnaire with instructions and recommendations for its fulfillment; no time limit was established for its completion and any doubts expressed by the adolescents were promptly answered by the professional who would monitor the data collection process. When completing the questionnaire, the adolescents did not communicate among themselves, in order to minimize possible undesirable interference in their answers.

Data analysis

Data analysis was performed in the program SPSS (IBM SPSS Statistics 18.0—SPSS. Inc., Chicago, IL, United States). In the descriptive analysis, the prevalence of all the variables included in the study was calculated, with the respective confidence intervals. The demographic and socioeconomic variables, use of electronic devices, habitual physical activity level, and mental health were considered independent variables. Independent variables with a significance level of p<0.20 in the bivariate analysis were included in a Poisson regression model with robust variance, and the assumptions required for Poisson regression to yield a valid result were respected. The effect measure was presented as prevalence ratio (PR) with 95% confidence interval (CI). The threshold α=0.05 was used to indicate statistical significance.19

Results

A total of 1628 students were assessed, already deducted from the final percentage of 2.05% of refusals. Regarding the sociodemographic characteristics of the sample, 51.5% of the males and 53.7% of the females were in the first year of high school; 87.0% of the males and 82.5% of the females were in the age group of 15 to 18 years; 47.4% of males and 51.9% of females were white; and 85.9% of males and 97.2% of females were single. Regarding the level of physical activity, the majority of males (46.5%) and females (50.7%) were classified as sufficiently active and 16.4% of the males and 35.7% of the females, as insufficiently active. For the mental health variable, 68.7% of males and 42.3% of females were considered healthy, while 11.3% of men and 30.0% of women were classified as unhealthy.

The variables related to the use of electronic devices in high school adolescents are presented in Table 1.

Table 1.

Distribution of absolute and relative frequencies of electronic devices in high school adolescents by sex.

FactorsSex
Male (n=798)Female (n=830)
Watch TV     
No  123  15.4  67  8.1 
Yes  675  84.6  763  91.9 
How many times TV/week 
Up to 2 times  168  24.7  205  21.1 
3 times or more  507  67.2  558  63.5 
Number of hours of TV/day 
Up to 2383  48.0  376  45.3 
Above 3292  36.6  387  46.6 
Use of computer 
No  105  13.2  215  25.9 
Yes  693  86.8  615  74.1 
Type of computer 
Desktop  344  43.1  224  27.0 
Laptop  263  33.0  339  40.8 
Desktop and laptop  86  10.8  52  6.3 
Height of the computer screen 
Above the midpoint  153  19.2  114  13.7 
At the midpoint  473  59.3  435  52.4 
Below the midpoint  67  8.4  66  8.0 
How many times/week 
Up to 2 times  184  23.1  295  35.5 
3 times or more  509  63.8  320  38.6 
How many hours/day 
Up to 2250  31.3  341  41.1 
3h or more  443  55.5  274  33.0 
Use of cell phone         
No  33  4.1  1.1 
Yes  765  95.9  821  98.9 
What posture is the cell phone used         
Standing  276  34.6  282  34.0 
Sitting  403  50.5  441  53.1 
Lying down  436  54.6  491  59.2 
Semi-lying  215  26.9  344  41.4 
Daily use time         
Up to 2220  27.6  125  15.1 
3h or more  545  68.3  696  83.9 
Use of tablet         
No  656  82.2  649  78.2 
Yes  142  17.8  181  21.8 
What posture is the tablet used         
Standing  25  3.0  47  5.6 
Sitting  83  10.4  102  12.3 
Lying down  68  8.5  82  9.9 
Semi-lying  26  3.3  56  6.7 
Daily use time         
Up to 294  11.8  149  18.0 
3h or more  48  6.0  32  3.9 

Of the subjects interviewed, 46.7% (95% CI: 44.27–49.11) reported LBP at least some time in the 12 months preceding the interview; 42.0% (95% CI: 36.63–43.41) of men and 58.0% (95% CI: 49.73–56.51) of women, a statistically significant difference.

Table 2 presents a statistically significant association between LBP with the female sex, black ethnicity, and mental health problems

Table 2.

Bivariate analysis of low back pain with sociodemographic characteristics, level of physical activity and mental health problems in high school adolescents.

FactorsLow back pain
PR (95% CI) 
Gender       
Male  319  42.0  1.00 
Female  441  58.0  1.33 (1.20–1.48)a 
Age range       
14 years  108  14.2  1.00 
15 to 18 years  652  85.8  1.09 (0.94–1.27) 
Marital status       
Married  30  3.9  1.00 
Single  730  88.6  1.10 (0.82–1.48) 
Ethnicity       
White  395  52.0  1.00 
Black  54  7.1  0.77 (0.62–0.97)a 
Brown/Mixed-race  262  34.5  0.93 (0.83–1.04) 
Yellow  30  3.9  1.04 (0.80–1.35) 
Native Brazilian  19  2.5  1.02 (0.74–1.42) 
Level of physical activity       
Very active  196  25.8  1.00 
Sufficiently active  370  48.7  0.97 (0.86–1.11) 
Insufficiently active  194  25.5  0.95 (0.82–1.10) 
Mental health problems       
Normal  357  47.0  1.00 
Borderline  188  24.7  1.33 (0.97–1.51) 
Clinical  215  28.3  1.61 (1.43–1.81)a 

CI, confidence interval; PR, prevalence ratio.

a

Factor associated.

Table 3 presents the association of LBP with the use of laptop computer; use of a cell phone in the postures standing up, lying and semi-lying; daily cell phone use for more than 3h; and use of a tablet.

Table 3.

Bivariate analysis of low back pain with electronic devices in high school adolescents.

FactorsLow back pain
PR (95% CI) 
Watch TV       
No  79  10.4  1.00 
Yes  681  89.6  1.14 (0.95–1.36) 
How many times TV/week       
Up to 2 times  174  22.9  1.00 
3 times or more  507  66.7  1.02 (0.90–1.16) 
Number of hours of TV/day       
Up to 2345  45.4  1.00 
Above 3336  44.2  1.09 (0.98–1.21) 
Use of PC/videogame       
No  612  80.5  1.00 
Yes  148  19.5  0.99 (0.87–1.3) 
Type of computer       
Desktop  243  32.0  1.00 
Laptop  304  40.0  1.18 (1.04–1.34)a 
Desktop and laptop  65  8.6  0.91 (0.74–1.11) 
Height of the computer screen       
Below the midpoint  138  18.2  1.00 
At the midpoint  416  54.7  0.89 (0.77–1.02) 
Below the midpoint  58  7.6  0.84 (0.67–1.06) 
How many times/week       
Up to 2 times  233  30.7  1.00 
3 times or more  379  49.9  0.94 (0.84–1.06) 
How many hours/day       
Up to 2274  36.1  1.00 
3h or more  338  44.5  1.02 (0.91–1.14) 
Use of a cell phone       
No  22  2.9  1.00 
Yes  738  97.1  0.89 (0.66–1.19) 
What posture is the cell phone used       
Standing  285  37.5  1.16 (1.04–1.29)a 
Sitting  411  54.1  1.10 (0.99–1.23) 
Lying down  458  60.3  1.16 (1.04–1.30)a 
Semi-lying  301  39.6  1.27 (1.14–1.40)a 
Daily use time       
Up to 2136  17.9  1.00 
3h or more  602  79.2  1.23 (1.06–1.42)a 
Use of tablet       
No  576  75.8  1.00 
Yes  184  24.2  1.29 (1.15–1.44)a 
What posture is the tablet used       
Standing  44  5.8  1.12 (0.90–1.38) 
Sitting  107  14.1  1.04 (0.86–1.27) 
Lying down  85  11.2  0.99 (0.82–1.20) 
Semi-lying  52  6.8  1.16 (0.95–1.41) 
Daily use time       
Up to 2136  17.9  1.00 
3h or more  48  6.3  1.07 (0.87–1.32) 

CI, confidence interval; PR, prevalence ratio.

a

Factor associated.

The variables that remained significantly associated with LBP were: female sex, daily TV use for more than 3h, use of a laptop computer, use of a cell phone in lying position, use of a cell phone in semi-lying position, daily cell phone use for more than 3h, use of tablet; daily tablet use for more than 3h, and mental health problems (Table 4).

Table 4.

Multivariate logistic regression, for associations of variables with low back pain in high school adolescents.

FactorsLow back pain.
Value of p  PR adjusted (95% CI) 
Sex     
Male  < 0.0011.00 
Female  1.70 (1.39–2.07) 
Number of hours of TV/day     
Up to 20.0321.00 
Above 31.17 (1.01–1.36) 
Type of computer     
Desktop    1.00 
Laptop  0.005  1.40 (1.10–1.77) 
Desktop and laptop  0.499  1.18 (0.72–1.94) 
What posture is the cell phone used     
Lying down     
No  0.0421.00 
Yes  1.23 (1.001.52) 
Semi-lying down     
No  < 0.0011.00 
Yes  1.49 (1.20–1.83) 
Daily use time (cell phone)     
Up to 20.003 
3h or more  1.36 (1.11–1.68) 
Use of tablet     
No  < 0.0011.00 
Yes  1.67 (1.31–2.14) 
Daily use time (tablet)     
Up to 2< 0.0011.00 
3h or more  1.46 (1.21–1.76) 
Mental health problems     
Normal  < 0.0011.00 
Borderline  1.67 (0.98–2.13) 
Clinical  2.62 (2.03–3.38) 

CI, confidence interval; PR, prevalence ratio.

Discussion

In the present study, the prevalence of LBP was 46.7%. The prevalence in other countries has been reported as follows: 33.1% in Shanghai, China.3 In some Brazilian localities, a prevalence of 13.7% was observed in Pelotas,4 13.4% in Porto Alegre,5 42.1% in Petrolina,6 46.9% in Recife,7 32.9% in Piauí,20 and 27.7% in São Leopoldo, RS.21 These variations in prevalence may be a result of sociocultural, demographic, economic, and occupational differences of the locations investigated.

The outcome remained associated with females, with daily TV use for more than 3h, use of laptop computer, use of mobile in lying position, using the cell phone in semi-lying position, daily cell phone use for more than 3h, use of tablet, daily table use for more than 3h, and mental health problems.

Females were approximately 1.70 times more likely to develop pain when compared with men, similar to other studies in adolescents.3,7,20,22 The female sex presents structural and psychosocial differences in relation to males, such as musculoskeletal differences, which make women predisposed to overload in the vertebral column in the long periods that adolescents are sitting in school, hormonal changes resulting from puberty, lower levels of physical activity, and greater frequency of pain reporting.20,23 The present study assessed whether the LBP was related to the menstrual period, which excludes the risk of an overestimated prevalence in women and confirms it as an associated factor.

The use of television, cell phone, and tablet over 3h a day was associated with the outcome, corroborating the findings of other investigations.23–26 The use of information and communication technologies is a potential risk factor for the development of spinal pain. It is believed that the explanation is based on inadequate static posture adopted using these devices associated with a prolonged time, which generates musculoskeletal overload, reduction of blood flow, and muscle spasm, activating the pain receptors. In addition, the excess time daily in static posture generates insufficient recovery time after local muscle fatigue, essential in the genesis of muscle pain in static work.10

The use of laptops and tablets were associated with the outcome, corroborating the findings of a study conducted in China.3 Stationary computers can be positioned on a more comfortable way, for example, the height of the screen, keyboard, chair, and table, adapting the most appropriate posture, while these adjustments are not possible with laptops and tablets. Another important point is the longer time of exposure to inappropriate postures, since the laptops and tablets can be used at any location.3,26

The lying down and semi-lying postures when using cell phone were factors associated with LBP; the first posture described corroborates with the study conducted in China,3 while, in relation to the second, no studies assessing its association with LBP were retrieved. The maintenance of fixed postures for prolonged time reduces the pumping action of the intervertebral disc, reducing the nutrition of this structure. Due to poor mechanical conditions generated by these postures, the fluid from the disc decreases and degenerates gradually, causing abnormal movements among the vertebral bodies, predisposing degeneration and pain. Moreover, these inappropriate postures generate mechanical tension in the muscles, ligaments, and joints.27,28

The clinical category related to mental health problems was associated with LBP in adolescents, corroborating the results of previous studies carried out in Southern Brazil, in Iran, and New Zealand.29,30 The emergence of emotional symptoms is common among students, which may be triggered by the moment lived, pressure in the school environment, economic hardship, and relationship problems. There appears to be an association between emotional symptoms and physical manifestations, such as increased secretion of cortisol and changes in hormonal regulation of adrenal glands, which generates inhibitory effects on the immune response, digestion, and symptoms of excessive wear of the body, tiredness, fatigue, muscle pain, joint disorders, and reduced physical capacity.30

This study had a series of methodological limitations: first, some confounding factors were not controlled, such as the types of tablet used, previous injuries, and exposure to other technologies. Second, no data were collected about how the outcome affected and/or limited their usual activities or caused changes in their daily routine and their relationship with psychosocial factors. Third, the data were based on self-reported responses, which increases the risk of recall bias. The strength of this study is the consistency of results with the literature, the use of validated questionnaires for the studied outcome, and the number of individuals interviewed.

LBP is a common condition that causes substantial disability. Considering that the available data from national surveys on the outcome are scarce in Brazil, this study will serve as a reference to other epidemiological investigations and contribute to the national evaluation of prevalence and risk factors, systematic reviews, and meta-analyzes.

It can be concluded that LBP had high prevalence and important association with the female sex, daily TV use for more than 3h, use of laptop computer, use of the cell phone in the lying down posture, use of the cell phone in semi-lying down posture, daily cell phone use for more than 3h, use of tablet, daily tablet use for more than 3h, and mental health problems.

Funding

This study was supported by funding from the FAPESP (São Paulo Research Foundation).

Conflicts of interest

The authors declare no conflicts of interest.

References
[1]
D. Hoy, L. March, P. Brooks, F. Blyth, A. Woolf, C. Bain, et al.
The global burden of low back pain: estimates from the Global Burden of Disease 2010 study.
Ann Rheum Dis, 73 (2014), pp. 968-974
[2]
I. Calvo-Muñoz, A. Gómez-Conesa, J. Sánchez-Meca.
Prevalence of low back pain in children and adolescents: a meta-analysis.
BMC Pediatr, 13 (2013), pp. 14
[3]
Z. Shan, G. Deng, J. Li, Y. Li, Y. Zhang, Q. Zhao.
Correlational analysis of neck/shoulder pain and low back pain with the use of digital products, physical activity and psychological status among adolescents in Shanghai.
PLoS ONE, 8 (2013), pp. 1-9
[4]
A.C. Onofrio, M.C. Silva, M.R. Domingues, A.J. Rombaldi.
Acute low back pain in high school adolescents in Southern Brazil: prevalence and associated factors.
Eur Spine J, 21 (2012), pp. 1234-1240
[5]
A.T. Lemos, F.R. Santos, R.B. Moreira, D.T. Machado, F.C. Braga, A.C. Gaya.
Ocorrência de dor lombar e fatores associados em crianças e adolescentes de uma escola privada do sul do Brasil.
Cad Saúde Pública, 29 (2013), pp. 2177-2185
[6]
I.B. Saueressig, V.M. Oliveira, M.K. Xavier, L.R. Santos, K.M. Silva, R.C. Araújo.
Prevalence of musculoskeletal pain in adolescents and its association with the use of electronic devices.
Rev Dor, 16 (2015), pp. 129-135
[7]
G.R. Silva, A.C. Pitangui, M.K. Xavier, M.A. Correia-Júnior, R.C. De Araújo.
Prevalence of musculoskeletal pain in adolescents and association with computer and videogame use.
J Pediatr (Rio J), 92 (2016), pp. 188-196
[8]
D.E. Feldman, I. Shrier, M. Rossignol, L. Abenhaim.
Risk factors for the development of low back pain in adolescence.
Am J Epidemiol, 154 (2001), pp. 30-36
[9]
R. Moncer, S. Jemni, S. Frioui, E. Toulgui, I. BelHadjYoussef, F. Khachnaoui.
Cross-sectional study of low-back pain (LBP) in children and adolescents: prevalence and risk factor.
Ann Phys Rehabil Med, 59S (2016), pp. e96
[10]
A. Aarås, G. Horgen, O. Ro.
Work with the visual display unit: health consequences.
Int J Hum Comput Int, 12 (2000), pp. 107-134
[11]
H.R. Casser, H.G. Schaible.
Muskuloskeletaler Schmerz.
Der Schmerz, 29 (2015), pp. 490-495
[12]
I.C. Muños, A.G. Conesa, J.S. Meca.
Prevalencia del dolor lumbar durante la infancia y la adolescencia. Una revisión sistemática.
Rev Esp Salud Pública, 86 (2012), pp. 331-356
[13]
D.P. Guedes, C.C. Lopes, J.E. Guedes, L.C. Stanganelli.
Reprodutibilidade e validade do questionário Baecke para avaliação da atividade física habitual em adolescentes.
Rev Port Cien Desp, 6 (2006), pp. 265-274
[14]
R. Goodman.
The Strengths and Difficulties Questionnaire:a research note.
J Child Psychol Psychiatry, 38 (1997), pp. 581-586
[15]
B. Fleitlich, P.G. Cortazar, R. Goodman.
Questionário de Capacidades e Dificuldades (SDQ).
Infanto, 8 (2000), pp. 44-50
[16]
F.A. Pinheiro, B.T. Tróccoli, C.V. Carvalho.
Questionário Nórdico de Sintomas Osteomusculares: validade do instrumento como medida de morbidade.
Rev Saúde Pública, 36 (2002), pp. 307-312
[17]
I.J. Kuorinka, L.C. De Jong, A. Kilbon, H. Vinterberg, F. Bieringsorensen, G. Anderson.
Standardised nordic questionnaires for analysis of musculoskeletal symptoms.
Appl Ergon, 18 (1987), pp. 233-237
[18]
Chou R, Qaseem A, Snow V, Casey D, Cross JR, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice Guideline from the American College of Physicians and the American Pain Society Ann Intern Med. 20071477478–491. [cited 12 Feb 2019]. Available from: https://doi.org/10.7326/0003-4819-147-7-200710020-00006.
[19]
A.J. Barros, V.N. Hirakata.
Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio.
BMC Med Res Methodol, 3 (2003), pp. 21
[20]
R.D. Meucci, A.O. Linhares, D.W. Olmedo, S.E. Cousin, V.M. Duarte, C.J. Almeida.
Low back pain among adolescents in the semiarid region: results of a population census in the city of Caracol, State of Piauí, Brazil.
Cien Saude Colet, 23 (2018), pp. 733-740
[21]
C.D. Fonseca, C.T. Candotti, M. Noll, A.M. Luz, A.C. dos Santos, C.O. Corso.
Prevalence of back pain among high school students in a municipality in southern Brazil.
Fisioter Mov, 29 (2016), pp. 137-146
[22]
L.B. Queiroz, B. Lourenço, L.E. Silva, D.M. Lourenço, C.A. Silva.
Musculoskeletal pain and musculoskeletal syndromes in adolescents are related to electronic devices.
J Pediatr (Rio J), 94 (2018), pp. 673-679
[23]
A. Bener, E.E. Dafeeah, K. Alnaqbi, O. Falah, T. Aljuhaisi, A. Sadeeq, et al.
An epidemiologic analysis of low back pain in primary care: a hot humid country and global comparison.
J Prim Care Community Health, 4 (2013), pp. 220-227
[24]
J.S. Oliveira, L.A. Barufaldi, A. Abreu Gde, V.S. Leal, G.S. Brunken, et al.
ERICA: use of screens and consumption of meals and snacks by Brazilian adolescents.
Rev Saude Publica, 50 (2016), pp. S7
[25]
C.W. Schaan, F.V. Cureau, M. Sbaraini, K. Sparrenberger, I.I.I.H.W. Kohl, B.D. Schaan.
Prevalence of excessive screen time and TV viewing among Brazilian adolescents: a systematic review and meta-analysis.
J Pediatr (Rio J), 95 (2019), pp. 155-165
[26]
B. Sakboonyarat, K. Chokcharoensap, M. Meesaeng, N. Jaisue, D. Janthayanont, P. Srisawat.
Prevalence and associated factors of low back pain (LBP) among adolescents in central Thailand.
Glob J Health Sci, 10 (2018), pp. 49-59
[27]
A.R. Zapater, D.M. Silveira, A. De Vitta, C.R. Padovani, J.P. Silva.
[Seat posture: the efficiency of an educational program for scholars].
Cien Saude Colet, 9 (2004), pp. 191-199
[28]
S.S. Barros, R.C. Angelo, E.R. Uchoa.
[Occupational low back pain and the sitting position].
Rev Dor, 12 (2011), pp. 226-230
[29]
I. Dianat, A. Alipour, J.M. Asghari.
Prevalence and risk factors of low back pain among school age children in Iran.
Health Promot Perspect, 7 (2017), pp. 223-229
[30]
F.C. Trevelyan, S.J. Legg.
Risk factors associated with back pain in New Zealand school children.
Ergonomics, 54 (2011), pp. 257-262

Please cite this article as: Bento TP, Cornelio GP, Perrucini P de O, Simeão SF, Conti MH, Vitta A de. Low back pain in adolescents and association with sociodemographic factors, electronic devices, physical activity and mental health. J Pediatr (Rio J). 2020. https://doi.org/10.1016/j.jped.2019.07.008

Copyright © 2019. Sociedade Brasileira de Pediatria
Idiomas
Jornal de Pediatria (English Edition)

Subscribe to our newsletter

Article options
Tools
en pt
Taxa de publicaçao Publication fee
Os artigos submetidos a partir de 1º de setembro de 2018, que forem aceitos para publicação no Jornal de Pediatria, estarão sujeitos a uma taxa para que tenham sua publicação garantida. O artigo aceito somente será publicado após a comprovação do pagamento da taxa de publicação. Ao submeterem o manuscrito a este jornal, os autores concordam com esses termos. A submissão dos manuscritos continua gratuita. Para mais informações, contate assessoria@jped.com.br. Articles submitted as of September 1, 2018, which are accepted for publication in the Jornal de Pediatria, will be subject to a fee to have their publication guaranteed. The accepted article will only be published after proof of the publication fee payment. By submitting the manuscript to this journal, the authors agree to these terms. Manuscript submission remains free of charge. For more information, contact assessoria@jped.com.br.
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.