Sedentary Behavior and Low Back Pain in Children and Adolescents: A Systematic Review and Meta-Analysis

TL;DR

More screen time is linked to a higher risk of low back pain in children and teens, but study quality and methods affect the certainty of this link.

Contribution

A dose–response meta-analysis reveals a significant increase in low back pain risk with more daily screen time in children and adolescents.

Findings

Each additional hour of daily screen time increases low back pain odds by 26%.

Pairwise meta-analyses found no significant association between screen time and low back pain.

High heterogeneity and risk of bias in studies suggest the need for better research methods.

Abstract

What are the main findings?
Dose–response meta-analysis shows a 26% increase in the odds of low back pain (LBP) for each additional hour of daily screen time in children and adolescents.Pairwise meta-analyses did not show a statistically significant association between screen time and LBP.

Dose–response meta-analysis shows a 26% increase in the odds of low back pain (LBP) for each additional hour of daily screen time in children and adolescents.

Pairwise meta-analyses did not show a statistically significant association between screen time and LBP.

What are the implications of the main findings?
Reducing screen-based sedentary behavior may help lower the risk of LBP in pediatric populations.High heterogeneity and risk of bias in existing studies highlight the need for standardized, high-quality research to better understand the relationship.

Reducing screen-based sedentary behavior may help lower the risk of LBP in pediatric populations.

High heterogeneity and risk of bias in existing studies highlight the need for standardized, high-quality research to better understand the relationship.

Background/Objectives: Low back pain (LBP) is increasingly prevalent among children and adolescents and represents a growing public health concern due to its potential persistence into adulthood. Screen-based sedentary behavior has substantially increased in pediatric populations. However, evidence regarding its association with LBP remains inconsistent, and the existence of a dose–response relationship is not well established. Methods: A systematic review and meta-analysis of observational studies was conducted in accordance with PRISMA guidelines. Studies examining the association between screen-based sedentary behavior and LBP in children and adolescents aged 6–18 years were included. Random-effects meta-analyses were used to pool continuous exposure estimates, and a multivariate random-effects dose–response meta-analysis was performed to assess changes in LBP risk across increasing levels of daily screen time. Results: A total of 30 studies were included. The pairwise meta-analysis of continuous exposure showed no statistically significant association between screen time and LBP, with OR = 1.02 (95% CI 0.65 to 1.59). In contrast, the dose–response meta-analysis demonstrated a significant positive association, with a 26% (95% CI 8% to 48%) increase in the odds of LBP for each additional hour of daily screen time. High between-study heterogeneity was observed, and most studies relied on self-reported measures of screen exposure and LBP, which may have introduced recall and misclassification bias and warrants cautious interpretation of the findings. Conclusions: Higher levels of screen-based sedentary behavior were associated with an increased risk of LBP in children and adolescents when examined using a dose–response approach, whereas pairwise meta-analyses did not identify a significant association. Nevertheless, substantial between-study heterogeneity and high risk of bias limit causal inference and require cautious interpretation.

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