Article Text

Do schoolbags cause back pain in children and adolescents? A systematic review
  1. Tiê Parma Yamato1,2,3,
  2. Chris G Maher1,4,
  3. Adrian C Traeger1,
  4. Christopher M Wiliams2,3,5,
  5. Steve J Kamper1,3
  1. 1Institute for Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
  3. 3Centre for Pain, Health and Lifestyle, Australia
  4. 4Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
  5. 5School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
  1. Correspondence to Dr Tiê Parma Yamato, Musculoskeletal Health Sydney, School of Public Health, Sydney Medical School, The University of Sydney, Sydney NSW 2050, Australia; tie.yamato{at}


Objective To investigate whether characteristics of schoolbag use are risk factors for back pain in children and adolescents.

Data sources Electronic searches of MEDLINE, EMBASE and CINAHL databases up to April 2016.

Eligibility criteria for selecting studies Prospective cohort studies, cross-sectional and randomised controlled trials conducted with children or adolescents. The primary outcome was an episode of back pain and the secondary outcomes were an episode of care seeking and school absence due to back pain. We weighted evidence from longitudinal studies above that from cross-sectional. The risk of bias of the longitudinal studies was assessed by a modified version of the Quality in Prognosis Studies tool.

Results We included 69 studies (n=72 627), of which five were prospective longitudinal and 64 cross-sectional or retrospective. We found evidence from five prospective studies that schoolbag characteristics such as weight, design and carriage method do not increase the risk of developing back pain in children and adolescents. The included studies were at moderate to high risk of bias. Evidence from cross-sectional studies aligned with that from longitudinal studies (ie, there was no consistent pattern of association between schoolbag use or type and back pain). We were unable to pool results due to different variables and inconsistent results.

Summary/conclusion There is no convincing evidence that aspects of schoolbag use increase the risk of back pain in children and adolescents.

  • children
  • adolescent
  • school
  • spine
  • paediatrics

Statistics from


  • Contributors TPY performed this study as part of her PhD degree, she led the main writing, screening, data extraction and analysis. CGM was her supervisor and contributed with the concept idea and guiding during the study. ACT, CMW and SJK contributed with revision, screening, data extraction and interpretation of the study.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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