Abstracts
Objective:
To determine the prevalence of low back pain nonspecific and associated factors in schoolchildren.
Method:
This cross-sectional study investigated 343 adolescents, aged between 12 and 15 years, of both sexes of public schools. The questionnaire included questions regarding sociodemographic characteristics, type of school transportation, body mass index and low back pain. The outcome was defined as discomfort localized below the costal margin and above the inferior gluteal folds in the last 12 months.
Results
: The prevalence of low back pain in the last year was 57% (n=195) among participants, with no significant difference between the sexes (OR 1.13, 95% CI 0.93 to 1.37). Advancing age and body mass index were associated with the presence of low back pain in the bivariate analysis. The remaining seated at school in usual days was considered one of the main activities that trigger symptoms that lasted up to seven days for the majority (80%) of adolescents.
Conclusions:
The high prevalence of low back pain presented, indicating that it is a common condition among these adolescents. There was no difference between the sexes, but had influence of age and body mass index. Our results point to the need for the development epidemiological studies of low back pain among children and adolescents.
low back pain; prevalence; epidemiology; adolescent; rehabilitation
Objetivo:
Determinar a prevalência de dor lombar não específica e fatores associados em escolares.
Método:
Este estudo transversal investigou 343 adolescentes, com idade entre 12 e 15 anos, de ambos os sexos, de escolas públicas municipais. O questionário abordava características sociodemográficas, tipo de transporte escolar, índice de massa corporal e dor lombar. O desfecho foi definido como desconforto localizado abaixo da margem costal e acima das pregas glúteas inferiores nos últimos 12 meses.
Resultados:
A prevalência de lombalgia no último ano foi de 57% (n=195) entre os participantes, sem diferença significativa entre os sexos (RP=1,13; IC95% 0,93-1,37). O avanço da idade e o índice de massa corporal foram as variáveis associadas à presença de dor lombar na análise bivariada. O permanecer sentado na escola em dias habituais foi apontado como uma das principais atividades desencadeadoras dos sintomas que tiveram duração de até sete dias para a maioria (80%) dos adolescentes.
Conclusões:
A dor lombar apresentou alta prevalência, indicando que é uma condição comum entre esses adolescentes. Não houve diferença entre os sexos, entretanto teve influência da idade e do índice de massa corporal. Nossos resultados apontam para a necessidade de estudos epidemiológicos sobre dor lombar entre crianças e adolescentes.
dor lombar; prevalência; epidemiologia; adolescente; reabilitação
Introduction
Low back pain (LBP) or lumbago 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 thigh11. Chou R, Qaseem A, Snow V, Casey D, Cross JRT, 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.
2007;147(7):478-91. PMid:17909209.
http://dx.doi.org/10.7326/0003-4819-147-7-200710020-00006
http://dx.doi.org/10.7326/0003-4819-147-...
. LBP is a sensory and emotional
experience that may be associated with trauma. This condition is difficult to
diagnose22. International Association for the Study of Pain - IASP. Psychological
intervention for acute and chronic pain in children. Pain.
2006;14(4):1-4., since many different factors (e.g.
physiological, emotional and cultural) are responsible for triggering pain stimuli in
individuals. Due to the complaints being subjective, it is challenging to characterize
and to describe this multidimensional experience, or to quantify it in numbers or
measurable data33. Silva JA, Ribeiro-Filho NP. A dor como um problema psicofísico. Rev
Dor. 2011;12(2):138-51. Available from:
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-00132011000200011&lng=en.
http://www.scielo.br/scielo.php?script=s...
.
The diagnostic of LBP, obtained through the clinical history of the patient associated
with a physical examination, classifies LBP into three categories: 1) LBP potentially
associated with a specific cause in the spine, 2) LBP potentially associated with spinal
stenosis, or 3) LBP with a nonspecific cause11. Chou R, Qaseem A, Snow V, Casey D, Cross JRT, 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.
2007;147(7):478-91. PMid:17909209.
http://dx.doi.org/10.7326/0003-4819-147-7-200710020-00006
http://dx.doi.org/10.7326/0003-4819-147-...
.
The first two diagnoses have defined etiology, since the pain has a specific cause (i.e.
congenital, neoplastic, inflammatory, infectious, metabolic, traumatic, degenerative or
functional) and this pain affects less than 15% of the adult, adolescent and childhood
populations44. Brazil A, Ximenes AC, Radu AS, Fernandes AR, Appel C, Maçaneiro CH,
et al. Diagnóstico e tratamento das lombalgias e lombociatalgias. Rev Bras Reumatol.
2004;44(6):419-25.. On the other hand, for the
nonspecific LBP, the causal agent is unknown55. Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, et
al. Chapter 2. European guidelines for prevention in low back pain. Eur Spine J.
2006;15(2):136-68..
In Europe, the cumulative annual incidence of LBP symptoms in adolescents is 24%66. Jones GT, Watson KD, Silman AJ, Symmons DPM, Macfarlane GJ.
Predictors of low back pain in British schoolchildren: a population-based prospective
cohort study. Pediatrics. 2003;111(4 Pt 1):822-8. PMid:12671119.
http://dx.doi.org/10.1542/peds.111.4.822
http://dx.doi.org/10.1542/peds.111.4.822...
, with prevalence reaching more than half of these
individuals77. Harreby MS, Nygaard B, Jessen TT, Larsen E, Storr-Paulsen A, Lindahl
A, et al. Risk factors for low back pain among 1.389 pupils in the 8th and 9th grade:
an epidemiologic study. Ugeskr. Laeg. 2001;163(3):282-6.
PMid:11219106.
,
88. Kovacs FM, Gestoso M, Gil Del Real MT, López J, Mufraggi N, Méndez
JI. Risk factors for non-specific low back pain in schoolchildren and their parents:
a population based study. Pain. 2003;103(3):259-68.
http://dx.doi.org/10.1016/S0304-3959(02)00454-2
http://dx.doi.org/10.1016/S0304-3959(02)...
. It has become a common condition among
adolescents, similar to adults, and may reach 70-80% of the population under 20 years of
age99. Jeffries LJ, Milanese SF, Grimmer-Somers KA. Epidemiology of
adolescent spinal pain: a systematic overview of the research literature. Spine
(Phila Pa 1976). 2007;32(23):2630-7. PMid:17978666.
http://dx.doi.org/10.1097/BRS.0b013e318158d70b
http://dx.doi.org/10.1097/BRS.0b013e3181...
. Several investigations on LBP in
children and adolescents have been conducted in other countries77. Harreby MS, Nygaard B, Jessen TT, Larsen E, Storr-Paulsen A, Lindahl
A, et al. Risk factors for low back pain among 1.389 pupils in the 8th and 9th grade:
an epidemiologic study. Ugeskr. Laeg. 2001;163(3):282-6.
PMid:11219106.
8. Kovacs FM, Gestoso M, Gil Del Real MT, López J, Mufraggi N, Méndez
JI. Risk factors for non-specific low back pain in schoolchildren and their parents:
a population based study. Pain. 2003;103(3):259-68.
http://dx.doi.org/10.1016/S0304-3959(02)00454-2
http://dx.doi.org/10.1016/S0304-3959(02)...
-
99. Jeffries LJ, Milanese SF, Grimmer-Somers KA. Epidemiology of
adolescent spinal pain: a systematic overview of the research literature. Spine
(Phila Pa 1976). 2007;32(23):2630-7. PMid:17978666.
http://dx.doi.org/10.1097/BRS.0b013e318158d70b
http://dx.doi.org/10.1097/BRS.0b013e3181...
, but few studies have investigated the symptoms
within this age group in Brazil1010. De Vitta A, Martinez MG, Piza NT, Simeão SFAP, Ferreira NP.
Prevalência e fatores associados à dor lombar em escolares. Cad. Saúde Pública.
2011;27(8):1520-8. http://dx.doi.org/10.1590/S0102-311X2011000800007
http://dx.doi.org/10.1590/S0102-311X2011...
11. Onofrio AC. Dor lombar aguda em adolescentes do ensino médio de uma
cidade do sul do Brasil: prevalência e fatores associados [dissertation]. Rio Grande
do Sul: Universidade Federal de Pelotas; 2010.
-
1212. Graup S, Santos SG, Moro ARP. Estudo descritivo das alterações
posturais sagitais da coluna lombar em escolares da rede federal de ensino de
Florianópolis. Rev Bras Ortop. 2010;45(5):453-9.
http://dx.doi.org/10.1590/S0102-36162010000500013
http://dx.doi.org/10.1590/S0102-36162010...
. Furthermore, there is a great difference
between the prevalence rates in Brazilian studies, ranging from 13% to 49% in
individuals between 11 and 19 years of age1111. Onofrio AC. Dor lombar aguda em adolescentes do ensino médio de uma
cidade do sul do Brasil: prevalência e fatores associados [dissertation]. Rio Grande
do Sul: Universidade Federal de Pelotas; 2010.
,
1212. Graup S, Santos SG, Moro ARP. Estudo descritivo das alterações
posturais sagitais da coluna lombar em escolares da rede federal de ensino de
Florianópolis. Rev Bras Ortop. 2010;45(5):453-9.
http://dx.doi.org/10.1590/S0102-36162010000500013
http://dx.doi.org/10.1590/S0102-36162010...
.
The literature has shown that, when considering the etiology of the nonspecific LBP, the
possible risk factors include: age1313. Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DP, Silman
AJ, et al. Low back pain in schoolchildren: the role of mechanical and psychosocial
factors. Arch Dis Child. 2003;88(1):12-7. PMid:12495949 PMCid:PMC1719294.
http://dx.doi.org/10.1136/adc.88.1.12
http://dx.doi.org/10.1136/adc.88.1.12...
,
1414. Vidal ARC. Dor lombar específica em alunos adolescentes em função do
gênero, idade e nível de atividade física [master's thesis]. Porto: Universidade do
Porto; 2009., female gender1313. Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DP, Silman
AJ, et al. Low back pain in schoolchildren: the role of mechanical and psychosocial
factors. Arch Dis Child. 2003;88(1):12-7. PMid:12495949 PMCid:PMC1719294.
http://dx.doi.org/10.1136/adc.88.1.12
http://dx.doi.org/10.1136/adc.88.1.12...
,
1414. Vidal ARC. Dor lombar específica em alunos adolescentes em função do
gênero, idade e nível de atividade física [master's thesis]. Porto: Universidade do
Porto; 2009., race/ethnicity11. Chou R, Qaseem A, Snow V, Casey D, Cross JRT, 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.
2007;147(7):478-91. PMid:17909209.
http://dx.doi.org/10.7326/0003-4819-147-7-200710020-00006
http://dx.doi.org/10.7326/0003-4819-147-...
, type of transportation used to go to school1111. Onofrio AC. Dor lombar aguda em adolescentes do ensino médio de uma
cidade do sul do Brasil: prevalência e fatores associados [dissertation]. Rio Grande
do Sul: Universidade Federal de Pelotas; 2010., tight muscles1515. Feldman DE, Shier I, Rossignol M, Abenhaim L. Risk factors for the
development of low back pain in adolescence. Am J Epidemiol. 2001;154(1):30-6.
PMid:11427402. http://dx.doi.org/10.1093/aje/154.1.30
http://dx.doi.org/10.1093/aje/154.1.30...
, accelerated
growth in height1515. Feldman DE, Shier I, Rossignol M, Abenhaim L. Risk factors for the
development of low back pain in adolescence. Am J Epidemiol. 2001;154(1):30-6.
PMid:11427402. http://dx.doi.org/10.1093/aje/154.1.30
http://dx.doi.org/10.1093/aje/154.1.30...
,
1616. Poussa MS, Heliövaara MM, Seitsamo JT, Könönen MH, Hurmerinta KA,
Nissinen MJ. Anthropometric measurements and growth as predictors of low-back pain: a
cohort study of children followed up from the age of 11 a 22 years. Eur Spine J.
2005;14(6):595-8. PMid:15789230 PMCid:PMC3489232.
http://dx.doi.org/10.1007/s00586-004-0872-4
http://dx.doi.org/10.1007/s00586-004-087...
, remaining seated for long hours1717. Sjolie AN. Persistence and changes in nonspecific low back pain
among adolescents. Spine (Phila Pa 1976). 2004;29(21):2452-7. PMid:15507810.
http://dx.doi.org/10.1097/01.brs.0000143666.58758.8b
http://dx.doi.org/10.1097/01.brs.0000143...
, child work1717. Sjolie AN. Persistence and changes in nonspecific low back pain
among adolescents. Spine (Phila Pa 1976). 2004;29(21):2452-7. PMid:15507810.
http://dx.doi.org/10.1097/01.brs.0000143666.58758.8b
http://dx.doi.org/10.1097/01.brs.0000143...
,
1818. Fassa AG, Facchini LA, Dall'Agnol MM, Christiani DC. Child labor and
musculoskeletal disorders: the Pelotas (Brazil) epidemiological survey. Public Health
Rep. 2005;120(6):665-73. PMid:16350337 PMCid:PMC1497777., psychosocial barriers1919. Jones GT, Macfarlane GJ. Predicting persistent low back pain in
schoolchildren: a prospective cohort study. Arthritis Rheum. 2009;61(10):1359-66.
PMid:19790124. http://dx.doi.org/10.1002/art.24696
http://dx.doi.org/10.1002/art.24696 ...
and body mass index (BMI)2020. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E.
The association between obesity and low back pain: a meta-analysis. Am J Epidemiol.
2010;171(2):135-54. PMid:20007994. http://dx.doi.org/10.1093/aje/kwp356
http://dx.doi.org/10.1093/aje/kwp356...
. There are authors who also considered low parental educational status,
which is an indicator of socio economic status of the family, as a factor that has been
associated with LBP in children and adolescents2121. Hestbaek L, Korsholm L, Leboeuf-Yde C, Kyvik KO. Does socioeconomic
status in adolescence predict low back pain in adulthood? A repeated cross-sectional
of 4,771 Danish adolescents. Eur Spine J. 2008;17(12):1727-34. PMid:18830719
PMCid:PMC2587673. http://dx.doi.org/10.1007/s00586-008-0796-5
http://dx.doi.org/10.1007/s00586-008-079...
.
Similar to what occurs among adults2222. Ferreira GD, Silva MC, Rombaldi AJ, Wrege ED, Siqueira FV, Hallal
PC. Prevalence and associated factors of back pain in adults from southern Brazil: a
population-based study. Rev Bras Fisioter. 2011;15(1):31-6. PMid:21390471.
http://dx.doi.org/10.1590/S1413-35552011005000001
http://dx.doi.org/10.1590/S1413-35552011...
, LBP might
affect the social lives of adolescents at school and during leisure2323. Skoffer B, Foldspang A. Physical activity and low-back pain in
schoolchildren. Eur Spine J. 2008;17(3):373-9. PMid:18180961 PMCid:PMC2270392.
http://dx.doi.org/10.1007/s00586-007-0583-8
http://dx.doi.org/10.1007/s00586-007-058...
,
2424. Prista A, Balangué F, Nordin M, Skovrom ML. Low back pain in
mozambican adolescents. Eur Spine J. 2004;13(4):341-5. PMid:15034774
PMCid:PMC3468049. http://dx.doi.org/10.1007/s00586-004-0683-7
http://dx.doi.org/10.1007/s00586-004-068...
, as well as their economic life, since the
condition triggers costs for doctors and treatments. Therefore, an investigation of the
prevalence of LBP and its risk factors are important for the development of preventive
measures55. Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, et
al. Chapter 2. European guidelines for prevention in low back pain. Eur Spine J.
2006;15(2):136-68. and effective interventions to
improve the quality of life of these young people.
The present study had the objective of determining the prevalence of LBP among adolescents in schools in southern Brazil, and its association with socio demographic factors, types of school transportation and BMI.
Method
This cross-sectional study evaluated students from the 6th to the 9th year of elementary education in public schools, 12-15 years of age, that were living in the city of Santa Maria, RS, Brazil. The Municipal Secretary of Education authorized the project and provided a list of 45 elementary public schools in the urban area and the number of students per grade, by school and by administrative region. A total of 5,471 students were enrolled in 2012.
The sample size a power calculation was made using EpiInfo(tm) software version 6.04. The aim was to have 80% power to observe a significant diference (alpha level) of 5%, with prevalence ratio of 1.3 and estimated dropout rate of 20%, we needed to include 328 adolescents in group.
The sampling was performed in multiple stages, with stratified cluster selection proportional to the number of students enrolled in each of the six urban administrative regions of the municipality. One school per region was selected by simple random sampling, and all students of the target population were invited to participate. When there was refusal of the school to participate in the study, another school was drawn until the sample reached the number of students required. One school refused to participate in the study on the grounds that the data collection would delay the school schedule and a second school because of the existence of other health projects that were already in development. Therefore two other schools were selected to make up the final sample.
Exclusion criteria were students with alterations in the central nervous system (CNS) (e.g. cerebral palsy, paraplegia) and/or cognitive deficits, based on the school records; students with musculoskeletal problems (e.g. fractures in the upper limbs, lower limbs, trunk or a prosthesis) and pregnancy, as these conditions could interfere with the quality of the anthropometric data.
The project was approved by the Ethical Committee in Research from Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil, under protocol number 7061/2012. The researcher instructed the students about the informed consent (IC), so that parents/or guardians could authorize their participation in the study. Likewise, the adolescents also signed a consent form.
Data collection was carried out between May and July 2012 during two visits: one for the application of the questionnaire and another for the measurement of the body weight and height, both performed by one of the researchers. The adolescents completed the questionnaire after the interviewer had read each question and its alternatives, had clarified any confusion and had emphasized that the answers were independently given. The interview took place in a room reserved by the school, with a group of 20 to 25 students, and lasted approximately 30 minutes for each student. The questions were pre-coded and addressed socio demographic characteristics, and types of transportation used to go to school, the presence of LBP and body positions that would trigger the pain. In addition, the measurements of body weight and height were obtained to calculate the BMI.
The socio demographic variables included age, gender, paid child work (yes or no), self-chosen ethnic group (i.e., Caucasian, Black, Brown, Asian and Indigenous) and the highest level of education of the parent/guardian responsible for the adolescent (i.e., no education, incomplete or complete primary education, incomplete or complete secondary education, incomplete or complete post-secondary education).
The type of transportation used to go to school was classified as: on foot, by bicycle, by bus, by car or other. The responses were grouped into "passive transportation" when the adolescent travelled by car, motorcycle or bus; and "active transportation" when they travelled on foot or by bicycle. The type of transportation, the colour of their skin and the parents' level of education were grouped for the bivariate analysis, forming one of the many categories presented in the tables to facilitate the tests.
The dependent variable, nonspecific LBP, was anatomically defined as any pain that
occurred between the twelfth rib and the inferior gluteal fold without radiation to the
lower limbs11. Chou R, Qaseem A, Snow V, Casey D, Cross JRT, 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.
2007;147(7):478-91. PMid:17909209.
http://dx.doi.org/10.7326/0003-4819-147-7-200710020-00006
http://dx.doi.org/10.7326/0003-4819-147-...
,
55. Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, et
al. Chapter 2. European guidelines for prevention in low back pain. Eur Spine J.
2006;15(2):136-68.. To increase the accuracy of data collection,
we added the following information, a minimum duration of 24 hours of symptoms since
onset, to avoid reports of LBP due to fatigue, which can be resolved within a few
hours1919. Jones GT, Macfarlane GJ. Predicting persistent low back pain in
schoolchildren: a prospective cohort study. Arthritis Rheum. 2009;61(10):1359-66.
PMid:19790124. http://dx.doi.org/10.1002/art.24696
http://dx.doi.org/10.1002/art.24696 ...
. To measure this outcome we used the
adapted version of the Nordic Questionnaire (Standardized Nordic Questionnaire,
originally created by Kuorinka2525. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F,
Andersson G, et al. Standardised Nordic questionnaires for the analysis of
musculoskeletal symptoms. Appl Ergon. 1987;18(3):233-7.
http://dx.doi.org/10.1016/0003-6870(87)90010-X
http://dx.doi.org/10.1016/0003-6870(87)9...
) proposed by
Sjolie2626. Sjolie AN. Active or passive journeys and low back pain in
adolescents. Eur Spine J. 2003;12(6):581-8. PMid:12928857 PMCid:PMC3467993.
http://dx.doi.org/10.1007/s00586-003-0557-4
http://dx.doi.org/10.1007/s00586-003-055...
, for children and adolescents. The
Brazilian Portuguese version was validated and showed an excellent intraclass
correlation coefficient (0.70 to 0.99) and Cronbach's alpha (0.795). The questionnaire
showed the lower back region in a drawing of the human body and investigated pain
through nine dichotomous answers (yes or no). The instrument evaluated LBP reports
within the last year and its duration in days (i.e., one to seven days, eight to 30
days, more than 30 days - but not every day, and every day) as well as the presence of
trauma in the lumbar spine (for exclusion criteria). In addition, it evaluated the
respondent's ability to recognize whether or not the pain was triggered or enhanced by
certain body positions (i.e., seated in school, seated at home, seated in a car, seated
in situations other than those already listed, watching television, or physical
work)1414. Vidal ARC. Dor lombar específica em alunos adolescentes em função do
gênero, idade e nível de atividade física [master's thesis]. Porto: Universidade do
Porto; 2009..
The BMI, obtained by dividing the body mass in kilograms by the square of the height in
meters, was classified as follows: excessively lean if less than 17 Kg/m2,
normal if between 17 and 24.9 Kg/m2, overweight if between 25 and 29.9
Kg/m2 and obese if ≥30 Kg/m2. This classification is considered
the most appropriate for children and adolescents2727. Cole TJ, Belizzi MC, Flegal KM, Dietz WH. Establishing a standard
definition for child overweight and obesity worldwide: international survey. BMJ.
2000;320:1240. PMid:10797032 PMCid:PMC27365.
http://dx.doi.org/10.1136/bmj.320.7244.1240
http://dx.doi.org/10.1136/bmj.320.7244.1...
. The overweight and obese categories were grouped into the category
"overweight" for analysis. Body mass and height were recorded using an electronic
digital scale (Soehnle brand) with a stadiometer consisting of a metal rod scaled from
zero to 2.30 meters and with intervals of one centimeter. These measurements were
recorded using the techniques recommended by the World Organization of Health2828. World Health Organization - WHO. Physical status: the use and
interpretation of anthropometry. Geneva: WHO; 1995. WHO Technical Report Series,
854..
The information was stored in a database in EpiInfo 6.04, with double entry and data validation. This was followed by descriptive and bivariate analyses. The descriptive analysis showed the distributions of absolute and relative frequencies for categorical variables. For the continuous variables, mean and standard deviation were applied. For analysis, the bivariate analysis with calculations of Odds Ratio (OD) with the 95% confidence interval (CI), and the chi-square for nominal variables, were conducted. Associations with p≤0.05 were considered significant.
Results
This cross-sectional study assessed 355 adolescents attending public schools in 2012. Sample loss from those who agreed to participate in the survey accounted for 3% of the total sample (n=12), and occurred due to the interruption of the interview process by a professor who had scheduled other activities for the students. The final sample included 343 individuals, with a greater number of girls, caucasian or brown, normal BMI and with a mean age of 13 years (SD=0.96) (Table 1). Almost half of the parents interviewed had an educational level lower than elementary school education; most students walked to school, and the paid child labour was observed in 13%. These characteristics are shown in Table 2.
For the adolescents who reported back pain in the last year, the most reported activity and/or body position that triggered or increased pain was seated in school followed by seated in another situation, seated at home, doing physical work, physical education classes, watching TV and seated in the car, as shown in Table 3.
The prevalence of LBP in the last year was 57% (n=195) among participants, 60% in girls (n=125) and 53% in boys (n=70), with no significant difference between the sexes (RP=1.13, 95% CI 0.93 to 1.37). The vicariate analysis also showed a trend of increased prevalence of LBP in older adolescents, with a statistically significant difference between 14 year old students compared to 12 year olds.
The BMI was associated with LBP and the prevalence was significantly lower among excessively lean students compared to normal individuals. There was no difference in LBP between obese compared with students having a normal weight. Their ethnic group (Table 4), doing paid child labour, level of parental schooling and type of transportation to school were not associated with LBP (Table 5).
The symptoms of LBP lasted up to seven days for most students who reported pain (80%), but 7% reported that pain was present every day and 5% of those students had pain that lasted longer than 30 days. There was no association between the duration of LBP and other variables assessed.
Discussion
This study found that LBP was highly prevalent in students 12 to 15 years of age from public schools. In addition, the prevalence was similar among boys and girls. The cross-sectional design of this study prevented inference of causality, however, the sample size was sufficient to detect relationships between the outcome and the variables studied. Being older was associated with increased occurrence of low back pain, however, this occurrence was less frequent among excessively lean adolescents (i.e., those with BMI <17Kg/m2).
Studies on the prevalence of LBP among Brazilian adolescents are scarce1010. De Vitta A, Martinez MG, Piza NT, Simeão SFAP, Ferreira NP.
Prevalência e fatores associados à dor lombar em escolares. Cad. Saúde Pública.
2011;27(8):1520-8. http://dx.doi.org/10.1590/S0102-311X2011000800007
http://dx.doi.org/10.1590/S0102-311X2011...
11. Onofrio AC. Dor lombar aguda em adolescentes do ensino médio de uma
cidade do sul do Brasil: prevalência e fatores associados [dissertation]. Rio Grande
do Sul: Universidade Federal de Pelotas; 2010.
-
1212. Graup S, Santos SG, Moro ARP. Estudo descritivo das alterações
posturais sagitais da coluna lombar em escolares da rede federal de ensino de
Florianópolis. Rev Bras Ortop. 2010;45(5):453-9.
http://dx.doi.org/10.1590/S0102-36162010000500013
http://dx.doi.org/10.1590/S0102-36162010...
. Furthermore, the data presented regarding the
definition of LBP and the types of instruments used to collect data are conflicting. To
minimize these issues, our study followed the standard definition of LBP established by
the European Guidelines for Prevention of Low Back Pain (European Guidelines for
Prevention in Low Back Pain) by the group Cost Action B13
55. Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, et
al. Chapter 2. European guidelines for prevention in low back pain. Eur Spine J.
2006;15(2):136-68.. This research group was created by the
European Commission to establish guidelines for the management of LBP. It consisted of
invited researchers, experts in the field of LBP, from nine countries. The instrument
chosen to determine the outcome was adapted to the population of interest and has been
shown to have good reproducibility1414. Vidal ARC. Dor lombar específica em alunos adolescentes em função do
gênero, idade e nível de atividade física [master's thesis]. Porto: Universidade do
Porto; 2009..
Based on the criteria measured, this study observed a higher prevalence of LBP than the
study of Vitta (19%) conducted in the southeast of Brazil1010. De Vitta A, Martinez MG, Piza NT, Simeão SFAP, Ferreira NP.
Prevalência e fatores associados à dor lombar em escolares. Cad. Saúde Pública.
2011;27(8):1520-8. http://dx.doi.org/10.1590/S0102-311X2011000800007
http://dx.doi.org/10.1590/S0102-311X2011...
. The findings were similar to international reports, demonstrating that
LBP is a common condition among adolescents77. Harreby MS, Nygaard B, Jessen TT, Larsen E, Storr-Paulsen A, Lindahl
A, et al. Risk factors for low back pain among 1.389 pupils in the 8th and 9th grade:
an epidemiologic study. Ugeskr. Laeg. 2001;163(3):282-6.
PMid:11219106.
,
88. Kovacs FM, Gestoso M, Gil Del Real MT, López J, Mufraggi N, Méndez
JI. Risk factors for non-specific low back pain in schoolchildren and their parents:
a population based study. Pain. 2003;103(3):259-68.
http://dx.doi.org/10.1016/S0304-3959(02)00454-2
http://dx.doi.org/10.1016/S0304-3959(02)...
,
2525. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F,
Andersson G, et al. Standardised Nordic questionnaires for the analysis of
musculoskeletal symptoms. Appl Ergon. 1987;18(3):233-7.
http://dx.doi.org/10.1016/0003-6870(87)90010-X
http://dx.doi.org/10.1016/0003-6870(87)9...
, as well as among adults2222. Ferreira GD, Silva MC, Rombaldi AJ, Wrege ED, Siqueira FV, Hallal
PC. Prevalence and associated factors of back pain in adults from southern Brazil: a
population-based study. Rev Bras Fisioter. 2011;15(1):31-6. PMid:21390471.
http://dx.doi.org/10.1590/S1413-35552011005000001
http://dx.doi.org/10.1590/S1413-35552011...
. Although measures were taken to ensure subject participation,
some students refused to participate in this investigation. This result is similar to
other studies conducted with adolescents using questionnaires1515. Feldman DE, Shier I, Rossignol M, Abenhaim L. Risk factors for the
development of low back pain in adolescence. Am J Epidemiol. 2001;154(1):30-6.
PMid:11427402. http://dx.doi.org/10.1093/aje/154.1.30
http://dx.doi.org/10.1093/aje/154.1.30...
,
2929. Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C. The course of low
back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine
(Phila Pa 1976). 2006;31(4):468-72. PMid:16481960.
http://dx.doi.org/10.1097/01.brs.0000199958.04073.d9
http://dx.doi.org/10.1097/01.brs.0000199...
,
3030. Mikkelsson LO, Nupponen H, Kaprio J, Kautiainen H, Mikkelsson M,
Kujala UM. Adolescent flexibility, endurance strength, and physical activity as
predictors of adult tension neck, low back pain, and knee injury: a 25 year follow up
study. Br J Sport Med. 2006;40(2):107-13. PMid:16431995 PMCid:PMC2492014.
http://dx.doi.org/10.1136/bjsm.2004.017350
http://dx.doi.org/10.1136/bjsm.2004.0173...
. However, the observed high prevalence
suggests that the non-participants did not affect the study's outcome. It also suggests
that the outcome was not underestimated and the expected random distribution of the
non-respondents did occur. In addition, the two variables observed, age and BMI, were
associated with non-specific LBP.
Age showed a direct relationship with LBP, a fact that has been supported by most
studies1616. Poussa MS, Heliövaara MM, Seitsamo JT, Könönen MH, Hurmerinta KA,
Nissinen MJ. Anthropometric measurements and growth as predictors of low-back pain: a
cohort study of children followed up from the age of 11 a 22 years. Eur Spine J.
2005;14(6):595-8. PMid:15789230 PMCid:PMC3489232.
http://dx.doi.org/10.1007/s00586-004-0872-4
http://dx.doi.org/10.1007/s00586-004-087...
,
1818. Fassa AG, Facchini LA, Dall'Agnol MM, Christiani DC. Child labor and
musculoskeletal disorders: the Pelotas (Brazil) epidemiological survey. Public Health
Rep. 2005;120(6):665-73. PMid:16350337 PMCid:PMC1497777.
,
1919. Jones GT, Macfarlane GJ. Predicting persistent low back pain in
schoolchildren: a prospective cohort study. Arthritis Rheum. 2009;61(10):1359-66.
PMid:19790124. http://dx.doi.org/10.1002/art.24696
http://dx.doi.org/10.1002/art.24696 ...
,
2424. Prista A, Balangué F, Nordin M, Skovrom ML. Low back pain in
mozambican adolescents. Eur Spine J. 2004;13(4):341-5. PMid:15034774
PMCid:PMC3468049. http://dx.doi.org/10.1007/s00586-004-0683-7
http://dx.doi.org/10.1007/s00586-004-068...
,
2929. Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C. The course of low
back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine
(Phila Pa 1976). 2006;31(4):468-72. PMid:16481960.
http://dx.doi.org/10.1097/01.brs.0000199958.04073.d9
http://dx.doi.org/10.1097/01.brs.0000199...
, and according to some researchers, strongly
associated with the growth spurt observed in adolescence1515. Feldman DE, Shier I, Rossignol M, Abenhaim L. Risk factors for the
development of low back pain in adolescence. Am J Epidemiol. 2001;154(1):30-6.
PMid:11427402. http://dx.doi.org/10.1093/aje/154.1.30
http://dx.doi.org/10.1093/aje/154.1.30...
,
1616. Poussa MS, Heliövaara MM, Seitsamo JT, Könönen MH, Hurmerinta KA,
Nissinen MJ. Anthropometric measurements and growth as predictors of low-back pain: a
cohort study of children followed up from the age of 11 a 22 years. Eur Spine J.
2005;14(6):595-8. PMid:15789230 PMCid:PMC3489232.
http://dx.doi.org/10.1007/s00586-004-0872-4
http://dx.doi.org/10.1007/s00586-004-087...
. The peak of the growth spurt, which occurs
earlier for girls (on average between the ages of 11 and 12 years) than for boys
(commonly between the ages of 13 and 14)3131. Instituto Brasileiro de Geografia e Estatística - IBGE. Pesquisa
Nacional de Saúde do Escolar: PeNSE. Rio de Janeiro: Ministério da Saúde;
2009., may
be responsible for the decreased flexibility, especially of the quadriceps and
hamstrings muscles1515. Feldman DE, Shier I, Rossignol M, Abenhaim L. Risk factors for the
development of low back pain in adolescence. Am J Epidemiol. 2001;154(1):30-6.
PMid:11427402. http://dx.doi.org/10.1093/aje/154.1.30
http://dx.doi.org/10.1093/aje/154.1.30...
, that causes functional
impairment of the lumbar muscles, and consequently pain.
In this study, LBP was commonly seen in the 14 year old group. It is possible that the small number of 15 year old participants in the sample (10%), compared with the 14 year old (20%), may have influenced the results, despite the fact that LBP has been shown to be prevalent among 15 year old adolescents.
Even with the high occurrence of overweight and obese adolescents (16%), the findings of
the relationship of LBP and BMI were inconsistent with the findings of a previous
study2020. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E.
The association between obesity and low back pain: a meta-analysis. Am J Epidemiol.
2010;171(2):135-54. PMid:20007994. http://dx.doi.org/10.1093/aje/kwp356
http://dx.doi.org/10.1093/aje/kwp356...
,
3232. Auvinen JP, Tammelin TH, Taimela SP, Zitting PJ, Järvelin M, Taanila
AM, et al. Is insufficient quantity and quality of sleep a risk factor for neck,
shoulder and low back pain? A longitudinal study among adolescents. Eur Spine J.
2009;19(4):641-9. PMid:19936804 PMCid:PMC2899838.
http://dx.doi.org/10.1007/s00586-009-1215-2
http://dx.doi.org/10.1007/s00586-009-121...
,
3333. Balangué F, Bibbo E, Mélot C, Szpalski M, Gunzburg R, Keller TS. The
association between isoinertial trunk muscle performance and low back pain in male
adolescents. Eur Spine J. 2010;19(4):624-32. PMid:19771455 PMCid:PMC2899830.
http://dx.doi.org/10.1007/s00586-009-1168-5
http://dx.doi.org/10.1007/s00586-009-116...
, since excess body weight was not correlated
with LBP in the present study, even with the slight increase as compared to normal.
Because most of the studies2020. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E.
The association between obesity and low back pain: a meta-analysis. Am J Epidemiol.
2010;171(2):135-54. PMid:20007994. http://dx.doi.org/10.1093/aje/kwp356
http://dx.doi.org/10.1093/aje/kwp356...
,
3232. Auvinen JP, Tammelin TH, Taimela SP, Zitting PJ, Järvelin M, Taanila
AM, et al. Is insufficient quantity and quality of sleep a risk factor for neck,
shoulder and low back pain? A longitudinal study among adolescents. Eur Spine J.
2009;19(4):641-9. PMid:19936804 PMCid:PMC2899838.
http://dx.doi.org/10.1007/s00586-009-1215-2
http://dx.doi.org/10.1007/s00586-009-121...
,
3333. Balangué F, Bibbo E, Mélot C, Szpalski M, Gunzburg R, Keller TS. The
association between isoinertial trunk muscle performance and low back pain in male
adolescents. Eur Spine J. 2010;19(4):624-32. PMid:19771455 PMCid:PMC2899830.
http://dx.doi.org/10.1007/s00586-009-1168-5
http://dx.doi.org/10.1007/s00586-009-116...
are generally focused on excess body weight,
it is necessary to evaluate the influence of the non-respondents, but it was not
possible to carry out this procedure, in the present study.
On the other hand, the low occurrence of LBP among excessively lean adolescents is of
note. In this sample, a BMI<17 Kg/m2 appears to be a factor that decreases
the occurrence LBP. However, this finding has not been emphasized by the literature
reviewed, because the focus of most of the studies2020. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E.
The association between obesity and low back pain: a meta-analysis. Am J Epidemiol.
2010;171(2):135-54. PMid:20007994. http://dx.doi.org/10.1093/aje/kwp356
http://dx.doi.org/10.1093/aje/kwp356...
,
3232. Auvinen JP, Tammelin TH, Taimela SP, Zitting PJ, Järvelin M, Taanila
AM, et al. Is insufficient quantity and quality of sleep a risk factor for neck,
shoulder and low back pain? A longitudinal study among adolescents. Eur Spine J.
2009;19(4):641-9. PMid:19936804 PMCid:PMC2899838.
http://dx.doi.org/10.1007/s00586-009-1215-2
http://dx.doi.org/10.1007/s00586-009-121...
,
3333. Balangué F, Bibbo E, Mélot C, Szpalski M, Gunzburg R, Keller TS. The
association between isoinertial trunk muscle performance and low back pain in male
adolescents. Eur Spine J. 2010;19(4):624-32. PMid:19771455 PMCid:PMC2899830.
http://dx.doi.org/10.1007/s00586-009-1168-5
http://dx.doi.org/10.1007/s00586-009-116...
have generally involved the overweight group.
According to our results, it is important to consider that the assessments based on BMI
could be a complicating factor due to the changes in body composition that occur during
sexual maturation of the adolescent3434. Conde WL, Monteiro CA. Body mass index cut off points for evaluation
of nutritional status in Brazilian children and adolescents. J Pediatr.
2006;82(4):266-72. http://dx.doi.org/10.2223/JPED.1502
http://dx.doi.org/10.2223/JPED.1502...
.
In this study, the seated position during the usual school day was one of the activities
considered harmful to the lumbar region, both for those who had LBP and those who did
not. It is possible that seated postures1212. Graup S, Santos SG, Moro ARP. Estudo descritivo das alterações
posturais sagitais da coluna lombar em escolares da rede federal de ensino de
Florianópolis. Rev Bras Ortop. 2010;45(5):453-9.
http://dx.doi.org/10.1590/S0102-36162010000500013
http://dx.doi.org/10.1590/S0102-36162010...
,
1717. Sjolie AN. Persistence and changes in nonspecific low back pain
among adolescents. Spine (Phila Pa 1976). 2004;29(21):2452-7. PMid:15507810.
http://dx.doi.org/10.1097/01.brs.0000143666.58758.8b
http://dx.doi.org/10.1097/01.brs.0000143...
and school furniture77. Harreby MS, Nygaard B, Jessen TT, Larsen E, Storr-Paulsen A, Lindahl
A, et al. Risk factors for low back pain among 1.389 pupils in the 8th and 9th grade:
an epidemiologic study. Ugeskr. Laeg. 2001;163(3):282-6.
PMid:11219106. might lead to lumbar muscle dysfunction and predispose the
individual to painful symptoms1212. Graup S, Santos SG, Moro ARP. Estudo descritivo das alterações
posturais sagitais da coluna lombar em escolares da rede federal de ensino de
Florianópolis. Rev Bras Ortop. 2010;45(5):453-9.
http://dx.doi.org/10.1590/S0102-36162010000500013
http://dx.doi.org/10.1590/S0102-36162010...
,
1616. Poussa MS, Heliövaara MM, Seitsamo JT, Könönen MH, Hurmerinta KA,
Nissinen MJ. Anthropometric measurements and growth as predictors of low-back pain: a
cohort study of children followed up from the age of 11 a 22 years. Eur Spine J.
2005;14(6):595-8. PMid:15789230 PMCid:PMC3489232.
http://dx.doi.org/10.1007/s00586-004-0872-4
http://dx.doi.org/10.1007/s00586-004-087...
,
1717. Sjolie AN. Persistence and changes in nonspecific low back pain
among adolescents. Spine (Phila Pa 1976). 2004;29(21):2452-7. PMid:15507810.
http://dx.doi.org/10.1097/01.brs.0000143666.58758.8b
http://dx.doi.org/10.1097/01.brs.0000143...
. However, this conjecture was not assessed in
the present study.
No association was found between LBP and gender in this study, which it is consistent
with some of the other studies66. Jones GT, Watson KD, Silman AJ, Symmons DPM, Macfarlane GJ.
Predictors of low back pain in British schoolchildren: a population-based prospective
cohort study. Pediatrics. 2003;111(4 Pt 1):822-8. PMid:12671119.
http://dx.doi.org/10.1542/peds.111.4.822
http://dx.doi.org/10.1542/peds.111.4.822...
,
29 29. Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C. The course of low
back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine
(Phila Pa 1976). 2006;31(4):468-72. PMid:16481960.
http://dx.doi.org/10.1097/01.brs.0000199958.04073.d9
http://dx.doi.org/10.1097/01.brs.0000199...
in the literature. Nevertheless, there is no
consensus regarding this gender outcome, since there are authors who have found an
association between LBP and females77. Harreby MS, Nygaard B, Jessen TT, Larsen E, Storr-Paulsen A, Lindahl
A, et al. Risk factors for low back pain among 1.389 pupils in the 8th and 9th grade:
an epidemiologic study. Ugeskr. Laeg. 2001;163(3):282-6.
PMid:11219106.
,
88. Kovacs FM, Gestoso M, Gil Del Real MT, López J, Mufraggi N, Méndez
JI. Risk factors for non-specific low back pain in schoolchildren and their parents:
a population based study. Pain. 2003;103(3):259-68.
http://dx.doi.org/10.1016/S0304-3959(02)00454-2
http://dx.doi.org/10.1016/S0304-3959(02)...
,
1010. De Vitta A, Martinez MG, Piza NT, Simeão SFAP, Ferreira NP.
Prevalência e fatores associados à dor lombar em escolares. Cad. Saúde Pública.
2011;27(8):1520-8. http://dx.doi.org/10.1590/S0102-311X2011000800007
http://dx.doi.org/10.1590/S0102-311X2011...
,
1717. Sjolie AN. Persistence and changes in nonspecific low back pain
among adolescents. Spine (Phila Pa 1976). 2004;29(21):2452-7. PMid:15507810.
http://dx.doi.org/10.1097/01.brs.0000143666.58758.8b
http://dx.doi.org/10.1097/01.brs.0000143...
,
1919. Jones GT, Macfarlane GJ. Predicting persistent low back pain in
schoolchildren: a prospective cohort study. Arthritis Rheum. 2009;61(10):1359-66.
PMid:19790124. http://dx.doi.org/10.1002/art.24696
http://dx.doi.org/10.1002/art.24696 ...
, and others with males1616. Poussa MS, Heliövaara MM, Seitsamo JT, Könönen MH, Hurmerinta KA,
Nissinen MJ. Anthropometric measurements and growth as predictors of low-back pain: a
cohort study of children followed up from the age of 11 a 22 years. Eur Spine J.
2005;14(6):595-8. PMid:15789230 PMCid:PMC3489232.
http://dx.doi.org/10.1007/s00586-004-0872-4
http://dx.doi.org/10.1007/s00586-004-087...
,
2929. Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C. The course of low
back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine
(Phila Pa 1976). 2006;31(4):468-72. PMid:16481960.
http://dx.doi.org/10.1097/01.brs.0000199958.04073.d9
http://dx.doi.org/10.1097/01.brs.0000199...
. Furthermore, other variables (ethnicity, type
of school transport, education level of responsibility and child work) were not
significantly associated with LBP. However, the literature indicates some of these
variables as risk factors for the presence of painful symptoms in the lumbar region in
schoolchildren1111. Onofrio AC. Dor lombar aguda em adolescentes do ensino médio de uma
cidade do sul do Brasil: prevalência e fatores associados [dissertation]. Rio Grande
do Sul: Universidade Federal de Pelotas; 2010.
,
1313. Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DP, Silman
AJ, et al. Low back pain in schoolchildren: the role of mechanical and psychosocial
factors. Arch Dis Child. 2003;88(1):12-7. PMid:12495949 PMCid:PMC1719294.
http://dx.doi.org/10.1136/adc.88.1.12
http://dx.doi.org/10.1136/adc.88.1.12...
,
1818. Fassa AG, Facchini LA, Dall'Agnol MM, Christiani DC. Child labor and
musculoskeletal disorders: the Pelotas (Brazil) epidemiological survey. Public Health
Rep. 2005;120(6):665-73. PMid:16350337 PMCid:PMC1497777.
19. Jones GT, Macfarlane GJ. Predicting persistent low back pain in
schoolchildren: a prospective cohort study. Arthritis Rheum. 2009;61(10):1359-66.
PMid:19790124. http://dx.doi.org/10.1002/art.24696
http://dx.doi.org/10.1002/art.24696 ...
-
2020. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E.
The association between obesity and low back pain: a meta-analysis. Am J Epidemiol.
2010;171(2):135-54. PMid:20007994. http://dx.doi.org/10.1093/aje/kwp356
http://dx.doi.org/10.1093/aje/kwp356...
.
This study showed that there is evidence that problems in the lumbar spine in children and adolescents are common, but more epidemiological studies should be performed to assess the prevalence and incidence in other geographical regions of Brazil, which may have cultural, social and climate differences from the one studied. In addition, other factors need to be investigated. For example: do the symptoms persist over a number of years? do the majority of children with these problems receive appropriate treatment? do untreated disorders lead to the occurrence of severe LBP in adulthood? do the symptoms limit activities? what is the impact of this severity on health services? Finally, how does this condition affect the quality of life of young people?
Conclusion
The knowledge of the prevalence and incidence of LBP in a specific population, as well as the identification of the risk factors, forms the basis for the development of treatments and prevention programs and assists in the planning of health care services directed to help children and adolescents. In the present study, LBP showed a high prevalence in the 12 to 15 year old age group, indicating that it is a common condition among adolescents. The majority of the participants reported that the symptoms lasted for a week, were similar among boys and girls, were significantly higher in older adolescents, and were lower among the excessively lean students. In addition, the seated position during school days was considered the main activity that triggered LBP symptoms.
References
-
1Chou R, Qaseem A, Snow V, Casey D, Cross JRT, 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. 2007;147(7):478-91. PMid:17909209. http://dx.doi.org/10.7326/0003-4819-147-7-200710020-00006
» http://dx.doi.org/10.7326/0003-4819-147-7-200710020-00006 -
2International Association for the Study of Pain - IASP. Psychological intervention for acute and chronic pain in children. Pain. 2006;14(4):1-4.
-
3Silva JA, Ribeiro-Filho NP. A dor como um problema psicofísico. Rev Dor. 2011;12(2):138-51. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-00132011000200011&lng=en.
» http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-00132011000200011&lng=en -
4Brazil A, Ximenes AC, Radu AS, Fernandes AR, Appel C, Maçaneiro CH, et al. Diagnóstico e tratamento das lombalgias e lombociatalgias. Rev Bras Reumatol. 2004;44(6):419-25.
-
5Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, et al. Chapter 2. European guidelines for prevention in low back pain. Eur Spine J. 2006;15(2):136-68.
-
6Jones GT, Watson KD, Silman AJ, Symmons DPM, Macfarlane GJ. Predictors of low back pain in British schoolchildren: a population-based prospective cohort study. Pediatrics. 2003;111(4 Pt 1):822-8. PMid:12671119. http://dx.doi.org/10.1542/peds.111.4.822
» http://dx.doi.org/10.1542/peds.111.4.822 -
7Harreby MS, Nygaard B, Jessen TT, Larsen E, Storr-Paulsen A, Lindahl A, et al. Risk factors for low back pain among 1.389 pupils in the 8th and 9th grade: an epidemiologic study. Ugeskr. Laeg. 2001;163(3):282-6. PMid:11219106.
-
8Kovacs FM, Gestoso M, Gil Del Real MT, López J, Mufraggi N, Méndez JI. Risk factors for non-specific low back pain in schoolchildren and their parents: a population based study. Pain. 2003;103(3):259-68. http://dx.doi.org/10.1016/S0304-3959(02)00454-2
» http://dx.doi.org/10.1016/S0304-3959(02)00454-2 -
9Jeffries LJ, Milanese SF, Grimmer-Somers KA. Epidemiology of adolescent spinal pain: a systematic overview of the research literature. Spine (Phila Pa 1976). 2007;32(23):2630-7. PMid:17978666. http://dx.doi.org/10.1097/BRS.0b013e318158d70b
» http://dx.doi.org/10.1097/BRS.0b013e318158d70b -
10De Vitta A, Martinez MG, Piza NT, Simeão SFAP, Ferreira NP. Prevalência e fatores associados à dor lombar em escolares. Cad. Saúde Pública. 2011;27(8):1520-8. http://dx.doi.org/10.1590/S0102-311X2011000800007
» http://dx.doi.org/10.1590/S0102-311X2011000800007 -
11Onofrio AC. Dor lombar aguda em adolescentes do ensino médio de uma cidade do sul do Brasil: prevalência e fatores associados [dissertation]. Rio Grande do Sul: Universidade Federal de Pelotas; 2010.
-
12Graup S, Santos SG, Moro ARP. Estudo descritivo das alterações posturais sagitais da coluna lombar em escolares da rede federal de ensino de Florianópolis. Rev Bras Ortop. 2010;45(5):453-9. http://dx.doi.org/10.1590/S0102-36162010000500013
» http://dx.doi.org/10.1590/S0102-36162010000500013 -
13Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DP, Silman AJ, et al. Low back pain in schoolchildren: the role of mechanical and psychosocial factors. Arch Dis Child. 2003;88(1):12-7. PMid:12495949 PMCid:PMC1719294. http://dx.doi.org/10.1136/adc.88.1.12
» http://dx.doi.org/10.1136/adc.88.1.12 -
14Vidal ARC. Dor lombar específica em alunos adolescentes em função do gênero, idade e nível de atividade física [master's thesis]. Porto: Universidade do Porto; 2009.
-
15Feldman DE, Shier I, Rossignol M, Abenhaim L. Risk factors for the development of low back pain in adolescence. Am J Epidemiol. 2001;154(1):30-6. PMid:11427402. http://dx.doi.org/10.1093/aje/154.1.30
» http://dx.doi.org/10.1093/aje/154.1.30 -
16Poussa MS, Heliövaara MM, Seitsamo JT, Könönen MH, Hurmerinta KA, Nissinen MJ. Anthropometric measurements and growth as predictors of low-back pain: a cohort study of children followed up from the age of 11 a 22 years. Eur Spine J. 2005;14(6):595-8. PMid:15789230 PMCid:PMC3489232. http://dx.doi.org/10.1007/s00586-004-0872-4
» http://dx.doi.org/10.1007/s00586-004-0872-4 -
17Sjolie AN. Persistence and changes in nonspecific low back pain among adolescents. Spine (Phila Pa 1976). 2004;29(21):2452-7. PMid:15507810. http://dx.doi.org/10.1097/01.brs.0000143666.58758.8b
» http://dx.doi.org/10.1097/01.brs.0000143666.58758.8b -
18Fassa AG, Facchini LA, Dall'Agnol MM, Christiani DC. Child labor and musculoskeletal disorders: the Pelotas (Brazil) epidemiological survey. Public Health Rep. 2005;120(6):665-73. PMid:16350337 PMCid:PMC1497777.
-
19Jones GT, Macfarlane GJ. Predicting persistent low back pain in schoolchildren: a prospective cohort study. Arthritis Rheum. 2009;61(10):1359-66. PMid:19790124. http://dx.doi.org/10.1002/art.24696
» http://dx.doi.org/10.1002/art.24696 -
20Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171(2):135-54. PMid:20007994. http://dx.doi.org/10.1093/aje/kwp356
» http://dx.doi.org/10.1093/aje/kwp356 -
21Hestbaek L, Korsholm L, Leboeuf-Yde C, Kyvik KO. Does socioeconomic status in adolescence predict low back pain in adulthood? A repeated cross-sectional of 4,771 Danish adolescents. Eur Spine J. 2008;17(12):1727-34. PMid:18830719 PMCid:PMC2587673. http://dx.doi.org/10.1007/s00586-008-0796-5
» http://dx.doi.org/10.1007/s00586-008-0796-5 -
22Ferreira GD, Silva MC, Rombaldi AJ, Wrege ED, Siqueira FV, Hallal PC. Prevalence and associated factors of back pain in adults from southern Brazil: a population-based study. Rev Bras Fisioter. 2011;15(1):31-6. PMid:21390471. http://dx.doi.org/10.1590/S1413-35552011005000001
» http://dx.doi.org/10.1590/S1413-35552011005000001 -
23Skoffer B, Foldspang A. Physical activity and low-back pain in schoolchildren. Eur Spine J. 2008;17(3):373-9. PMid:18180961 PMCid:PMC2270392. http://dx.doi.org/10.1007/s00586-007-0583-8
» http://dx.doi.org/10.1007/s00586-007-0583-8 -
24Prista A, Balangué F, Nordin M, Skovrom ML. Low back pain in mozambican adolescents. Eur Spine J. 2004;13(4):341-5. PMid:15034774 PMCid:PMC3468049. http://dx.doi.org/10.1007/s00586-004-0683-7
» http://dx.doi.org/10.1007/s00586-004-0683-7 -
25Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233-7. http://dx.doi.org/10.1016/0003-6870(87)90010-X
» http://dx.doi.org/10.1016/0003-6870(87)90010-X -
26Sjolie AN. Active or passive journeys and low back pain in adolescents. Eur Spine J. 2003;12(6):581-8. PMid:12928857 PMCid:PMC3467993. http://dx.doi.org/10.1007/s00586-003-0557-4
» http://dx.doi.org/10.1007/s00586-003-0557-4 -
27Cole TJ, Belizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240. PMid:10797032 PMCid:PMC27365. http://dx.doi.org/10.1136/bmj.320.7244.1240
» http://dx.doi.org/10.1136/bmj.320.7244.1240 -
28World Health Organization - WHO. Physical status: the use and interpretation of anthropometry. Geneva: WHO; 1995. WHO Technical Report Series, 854.
-
29Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C. The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine (Phila Pa 1976). 2006;31(4):468-72. PMid:16481960. http://dx.doi.org/10.1097/01.brs.0000199958.04073.d9
» http://dx.doi.org/10.1097/01.brs.0000199958.04073.d9 -
30Mikkelsson LO, Nupponen H, Kaprio J, Kautiainen H, Mikkelsson M, Kujala UM. Adolescent flexibility, endurance strength, and physical activity as predictors of adult tension neck, low back pain, and knee injury: a 25 year follow up study. Br J Sport Med. 2006;40(2):107-13. PMid:16431995 PMCid:PMC2492014. http://dx.doi.org/10.1136/bjsm.2004.017350
» http://dx.doi.org/10.1136/bjsm.2004.017350 -
31Instituto Brasileiro de Geografia e Estatística - IBGE. Pesquisa Nacional de Saúde do Escolar: PeNSE. Rio de Janeiro: Ministério da Saúde; 2009.
-
32Auvinen JP, Tammelin TH, Taimela SP, Zitting PJ, Järvelin M, Taanila AM, et al. Is insufficient quantity and quality of sleep a risk factor for neck, shoulder and low back pain? A longitudinal study among adolescents. Eur Spine J. 2009;19(4):641-9. PMid:19936804 PMCid:PMC2899838. http://dx.doi.org/10.1007/s00586-009-1215-2
» http://dx.doi.org/10.1007/s00586-009-1215-2 -
33Balangué F, Bibbo E, Mélot C, Szpalski M, Gunzburg R, Keller TS. The association between isoinertial trunk muscle performance and low back pain in male adolescents. Eur Spine J. 2010;19(4):624-32. PMid:19771455 PMCid:PMC2899830. http://dx.doi.org/10.1007/s00586-009-1168-5
» http://dx.doi.org/10.1007/s00586-009-1168-5 -
34Conde WL, Monteiro CA. Body mass index cut off points for evaluation of nutritional status in Brazilian children and adolescents. J Pediatr. 2006;82(4):266-72. http://dx.doi.org/10.2223/JPED.1502
» http://dx.doi.org/10.2223/JPED.1502
Publication Dates
-
Publication in this collection
10 Oct 2014 -
Date of issue
Sept-Oct 2014
History
-
Received
10 July 2013 -
Reviewed
25 Nov 2013 -
Accepted
10 Feb 2014