# 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.

## Key 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.