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School Bags and Back Pain in Children Between 8 and 13 Years: A National Study

by MASS4D® Prescription Orthotics June 05, 2017


A national cross-sectional study was undertaken in order to assess the prevalence of back pain in school children, as well as its association with school bags.

This study took a national representative sample of school children in the Maltese Islands (Malta and the sister Island Gozo) from all education providers, namely, state schools, church-run schools and independent private schools.

The target population identified for this study were students in the last two grades of primary school and first three grades of secondary school, aged 8–13 years.

The interview included questions regarding bag type, how the bag is carried, the use of lockers, participation in sport, presence of back pain, pain location through the use of a body chart, pain intensity using a face pain scale–revised (FPS-R), frequency, and consequence of back pain.

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The FPS-R was used as it provides a simplified tool to measure pain intensity in children; the scale has six facial expressions representing increasing pain.

The findings regarding bag weight to bodyweight ratios revealed that 71% of the participants carried a bag weight in excess of the recommended 10% of bodyweight.

The prevalence of back pain was higher among females, those carrying two or more bags and those carrying their bag on one shoulder.

Students in non-public school and those in secondary school had a higher prevalence of self-reported back pain.

The mean age, body mass index and percentage bag weight to bodyweight were also higher in students reporting back pain.

After adjusting for other factors, self-reported back pain in school children is independently linked to carrying heavy school bags.

The authors concluded that this link should be addressed to decrease the occurrence of back pain in this age group.

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  1. Spiteri, K., Busuttil, M., Aquilina, S., Gauci, D., Camilleri, E., Grech, V. (2017) Schoolbags and Back Pain in Children Between 8 and 13 Years: A National Study. British Journal of Pain: February 2017, Vol. 11, No. 2, pp. 81-86. https://doi.org/10.1177/2049463717695144

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