# Nonspecific back pain in adolescents, its associated physical and psychological factors and urban–rural differences: a cross-sectional analytical study

## TL;DR

This study finds that nonspecific back pain is common in Indian adolescents and is linked to physical and psychological factors, with differences between urban and rural areas.

## Contribution

The study identifies multiple risk factors for nonspecific back pain in Indian adolescents, including psychological and urban–rural differences, beyond school bag weight.

## Key findings

- The prevalence of nonspecific back pain was 38.5% among 1,225 adolescents.
- Urban students reported higher back pain prevalence than rural students.
- Psychological factors like hyperactivity and family history of back pain were significant risk factors.

## Abstract

The school bag weight is a frequently implicated cause of back pain (BP) in children. Researchers from high-income countries have highlighted the contributions of physical and psychosocial factors, along with ergonomics and screen time exposure. However, almost all Indian studies on BP in children have focused on the school bag weight only, without clinical examination. Our objective was to estimate the prevalence of nonspecific BP and identify the associated physical and psychological factors in urban and rural adolescents.

We conducted a cross-sectional study on students from 5th, 7th, and 9th grades from urban and rural schools across five districts of an Indian state. We documented students’ anthropometry, the school bag weights, physical factors, psychological factors (using the Strengths and Difficulties Questionnaire), and screen time exposure. A pediatric orthopaedic surgeon clinically examined students reporting BP to rule out specific causes.

We included 1,225 children [653 (53.3%) boys]. The prevalence of BP was 472/1225 (38.5%). Clinical examination of those with BP confirmed 441/472 (93.5%) students had nonspecific BP. More urban students reported BP (43.4% Vs. 33.2%, p < 0.001). A greater proportion of students with BP had some/high need in the emotional (OR 1.8, 95% CI 1.3 to 2.4), conduct (OR 1.7, 95% CI 1.3 to 2.2), hyperactivity (OR 1.8, 95% CI 1.3 to 2.6), and peer problem (OR 1.2, 95% CI 1.0 to 1.6) domains. Multivariate regression showed that some/high need in the SDQ hyperactivity domain [OR 2.05, 95% CI 1.1 to 3.6], mobile use of ≥ 60 min [OR 1.67, 95% CI 1.1 to 2.4], using computers [OR 1.4, 95% CI 1.0 to 1.9], presence of a family member with BP [OR 2.91, 95% CI 2.1 to 3.9] and history of back injury [OR 7.46, 95 CI 4.2 to 13.0] were significant risk factors of BP. Rural adolescents attributed BP to domestic and farm work, while urban adolescents attributed it to heavy school bags.

Prevalence of nonspecific BP in adolescents is substantial. Apart from school bag weight, several physical and psychological factors and urban–rural differences exist. There is a clear need for tailor-made interventions to address these factors.