Neck, shoulder, upper back and lower back pain and associated risk factors among

primary school children in Malaysia

Nurul Asyiqin MAa*, Shamsul BMTa, Mohd Shahrizal Db, Mohamad Azhar MNa,
Mohd Rafee BBa, Zailina Ha
a
Faculty of Medicine and Health Sciences, UPM, 43400, Malaysia
b
Faculty of Design and Architecture,UPM, 43400, Malaysia
*Corresponding authors email: qin_syiqin@yahoo.com

ABSTRACT

OBJECTIVE: To determine the prevalence of upper body parts (neck, shoulder, upper
and lower back) pain and associations with ergonomic factors in Malaysian primary
school children.

METHODOLOGY: A cross-sectional study was done in 10 randomly selected primary

schools from 4 regions of Peninsular Malaysia to represent the school environment in
Peninsular Malaysia with a total of 451 pupils representing the age group of 11 year-old.
Bahasa Malaysia translated Nordic Questionnaire (TNQ) was used to determine the
prevalence of musculoskeletal disorders (MSD) for upper body parts (life time complaint
and within 7 days of the interview). School bags were weighted to determine the average
weight of the school bags carried by the children.

RESULTS: The lifetime prevalence of neck pain was the highest (35%), followed by
shoulder pain (34%), upper back pain (15%) and low back pain (10 %). For MSD
occurring within 7 days of the interview, neck pain was the highest complaint (14%),
followed by shoulder pain (11%), upper back pain (6%) and low back pain (4%).
Although 6 factors (gender, bringing book following time table, school furniture, school
bag, carrying bag and weight of the bag) increased the risk of neck pain, none were
significantly associated. Similar results were observed for shoulder pain (gender, bringing
school book following time table, furniture, perception of the school bag weight, methods
of carrying bag and weight of the bag) (p>0.05), upper back pain (gender, furniture,
school bag and bag weight) (p>0.05) and low back pain (gender, school bag and bag
weight). However, for shoulder pain, furniture used in the class was found to be
significantly associated (OR = 3.8, 95%CI: 1.16, 12.33).

CONCLUSION: The study shows that the existing school furnitures contributed toward
the risk of developing MSD. Although the study was unable to associate other ergonomic
risks with MSD, the increased OR of ergonomic risks should be considered when future
follow-up research is to be carried out.

Keywords: Musculoskeletal Disorders, Risk Factors, Primary School Children

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1. INTRODUCTION

Every school is unique by virtue of its design, location, and students, and each has its

own history and culture. Some schools are relatively open and safe; others are highly protected

yet unsafe. Therefore any mitigating hazards in school facilities should be planned and

implemented by those who understand and knowledgeable of the school environment and its

community. One of the health related hazards that is related to school children is ergonomics and

one of the important ergonomics related health problem is musculoskeletal disorders (MSD).

Several studies have highlighted the high prevalence of back pain and other MSD involving the

neck, shoulder, arms, thigh and knees that exist among school children (Grimmer and Williams,

2000; Wedderkopp et al., 2001; Watson et al., 2002; Murphy et al., 2007; and El-Metwally et al.,

2007). Mikkelsson et al. (1997) found that a higher prevalence (32.1%) of schoolchildren

reported having MSD at least once a week and (39%) of the children having pain at least once a

month. In many previous researches undertaken, there were many contributing factors studied in

determining the risk of MSD among schoolchildren, viz. 1) age 2) gender 3) school bag weight 4)

psychological factors 5) physical activities 6) competitive sports or a high level of activity

trauma, 7) school furniture and 8) posture.

Age was the most commonly considered factor in exploring the risk factors for MSD with

Grimmer and Williams (2000), Wedderkop et al. (2001) and Watson et al. (2002) showing a

relationship between increasing age and the susceptibility to develop MSD. Pain or discomfort

was more often reported by female compared to male schoolchildren (Hareby et al., 1999; Kujala

et al., 1999; Viry et al., 1999 Grimmer and Williams., 2000; Watson et al., 2002). Several authors

have reported a positive relationship between the occurrence of low back pain (LBP) and the

weight of the school bag carried (Viry et al., 1999; Grimmer and Williams, 2000; Mackie et al.,

2003). Brattberg (1994) found that psychological factors such as loneliness and bullying

increased the risk of LBP. Physical and sport activities were also found to increase the reported

pain among children (Hereby et al., 1999, Kujala et al., 1999 and Grimmer and Williams, 2000).

Another important risk factor is un-ergonomic use of school furniture. New ergonomically
2
designed furniture is more acceptable and preferred by the schoolchildren. Therefore, the

furniture might be able to reduce MSD complaint and discomfort among them. There are studies

demonstrating a mismatch between school furniture dimensions and the children’s anthropometry

(Claudia et al., 1999; Gouvali et al., 2006). Furniture mismatch may lead to awkward posture

during school session as reported by Troussier et al. (1999) and that pain was most likely to occur

while sitting. Kratenove et al. (2007) found a significant occurrence of poor posture with

mismatch furniture in children aged between 7 and 11 years.

This paper is a preliminary report concerning the prevalence of MSD and the ergonomic

risk severity in Malaysian schoolchildren. The major research objective is to determine the

prevalence and risk factors of MSD and to develop an intervention program to prevent MSD in

Malaysian schoolchildren aged between 8 and 11 years. This study is funded by the Malaysian

Ministry of Higher Education (MOHE) beginning from 2007 to 2009 under the Research

University Grant Scheme (RUGS).

The main objectives of this study are (1) to report the prevalence of neck, shoulder, upper

back and lower back pain among schoolchildren aged 11 years old and (2) to identify the risk

factors associated with the complaint of acute neck (NP), shoulder (SP), upper back (UBP) and

lower back pain (LBP).

2. MATERIALS AND METHOD

A cross-sectional study was done involving 451 primary schoolchildren from September

2007 to March 2008 in 4 regions in Peninsular Malaysia. Although, the term “primary school

children” is defined as children within the age of 7 to 12 years in Malaysia, only 11 year old

schoolchildren were randomly selected in this study. Random sampling was used to select the

states, districts and schools. Four states were randomly selected from the list of thirteen states viz

Selangor (central region), Pahang (eastern region), Perak (northern region) and Johor (southern

region). Each state has a different number of districts randomly chosen for the study. For the
3
central region, two districts were involved, namely Serdang and Petaling Jaya, Kuala Rompin in

Pahang (eastern region), Pengkalan Hulu in Perak (northern region) and Pasir Gudang in Johor

(southern region). Figure 1 shows the states involved and the location of the schools. Ten primary

schools participated in this study. The sampling frame of the schools was obtained from the

Malaysian Ministry of Education (MOE). Due to difficulty to separate the students from the class,

therefore the study randomly selects among the list of fifth grade students in every school. The

class and respondent name list was obtained from the latest database of each school.

A set of interview questionnaire was distributed to the respondents during school hours.

The questionnaire session was conducted in a group and prior to the session, each group was

briefed on the correct procedure of completing the questionnaire. The respondents answered all

the questions under the supervision and guidance of research assistants. At the end of the session,

each questionnaire was checked for completeness to reduce missing cases. Each of the session

lasted approximately in 30 minutes.

The questionnaire included socio-demographic and background information such as

ethnicity, gender, age, type of transportation, leisure activities, sports activities and hobby such as

playing video games and using personal computer. The information regarding parents’ monthly

income was obtained from the school database. The schoolchildren were asked regarding their

school bags including frequent method of carrying (over two shoulders, one shoulder, using one

hand and pulling the trolley bag). In addition, the perception of own schools bag weight (heavy

weight or lightweight) and whether the load of their school bags was according to their daily class

timetable or otherwise.

The prevalence of MSD was determined using a body map questions where respondents

were asked to indicate if they had any painful experience in each region of the body identified in

the Nordic manikin (Kuorinka et al., 1987). A picture of human body parts, divided into neck,

shoulder, upper back and lower back was provided to assist the children in identifying the correct

body parts to answer the questionnaire. The questions utilized a simple phrase such as “Do you

have any problem within the past 12 months (aching, pain and discomfort) at the following

4
areas?: 1) neck 2) shoulder 3) upper back 4) lower back. For detection of recent acute MSD cases,

the same question was rephrased “Do you have any problem within the past 7 days (aching, pain

and discomfort) at the following areas?: 1) neck 2) shoulder 3) upper back 4) lower back.

The respondent’s body weights and their school bag weights were measured using the

same digital electronic weighing scale. Body Mass Index (BMI) was calculated as body weight in

kilograms divided by the height in meters squared. Measurement was taken thrice for each

respondent and his or her school bag in order to determine the average weight. Martin type

anthropometry and customised anthropometric chair was used to measure the respondent’s

anthropometry. A measurement tape was used to measure current seat measurement. The

anthropometric measurements were based on the method suggested by Pheasant S. and

Haslegrave C. M. (2006).

Severity of the risk of MSD among the respondents was determined using the odds ratio

(OR) and risk assessment (RA) method. The OR was determined by using binary logistic

regression adjusting for BMI, sport activities and history of previous accident. The severity of the

risk was determined using the Hazard Identification Risk Assessment and Risk Control

(HIRARC) method with four main processes in sequence. The sequence includes the following 1)

classify work activities among students, 2) identify hazards through school’s daily activities that

could pose significant risks to the health and safety of students, and 3) conduct RA by analyzing

and estimating risks from each hazard involved. The RA involved calculating or estimating the

likelihood of occurrence and severity of each hazard identified and 4) determining each of the

risk identified whether the outcome is acceptable or necessary control measures need to be

applied. The process of HIRARC was based on the guidelines by the Malaysian Department of

Safety and Health (DOSH) (DOSH, 2008).

Each of the standard operating procedures (SOP) was followed to maintain quality

control. The questions used in this study showed good reliability (Cronbach alpha of 0.918). This

study uses univariate analysis in determining the prevalence of MSD and in determining the

5
measurement of anthropometry, while the risk factors were determined using HIRARC and

binary logistic regression adjusting for BMI, sports activities and history of previous accidents.

The Faculty of Medicine and Health Sciences, Universiti Putra Malaysia Ethics

Committee approved the study ethics [Ref: UPM/FPSK/PADS/T7-MJKEtikaPer/F01

(LECT_Oct11)].

3. RESULTS

3.1 Socio- demographic characteristics

Four hundred and fifty one primary schoolchildren aged 11 years in Peninsular Malaysia

participated in this study. From the total respondents, 52% was male, the mean body weight was

35.88 ± 10.23 kg, and the mean height was 136.61 ± 8.06 cm. The average BMI was 18.4 kg/m2.

Table 1 summarizes the overall demographic information.

3.2 Sports and physical activities

More than 94% of the schoolchildren played sports either during school or after school

hours. The most popular sport was football (30%), followed by badminton (17%), cycling (15%),

netball (14%) and other sport activities such as swimming and martial art (9%). In addition, most

of the children reported having indoor activities (94 %) such as playing computer games and

watching television before or after school time.

3.3 Load carrying by schoolchildren

The study shows that the mean bag weight expressed as percentage of bodyweight was

almost 13% of body weight. Sixty two percent of the respondents carried their school bags over

10% of their body weights. The most common type of school bag was the backpack; 80% of

children used this type of bag and most of them carried the school bags using both shoulders.

Majority (59%) claimed that they travelled to school by using motor vehicles such as car,

6
motorcycle and bus; only 15% of them cycled to and from school and a small fraction walked the

whole way (to and from school)

3.4 Prevalence of neck (NP), shoulder (SP), upper back (UBP) and low back pain (LBP)

The study reveals that for life time prevalence of MSD, a total of 35% of the school

children reported that they had NP followed by SP (34%), UBP (15%) and LBP (10%) at least

once in their lifetime. The study also shows that NP (38%) was the highest complaint among

male respondents; however, female students reported that SP was the highest (35%) compared to

other body parts.

Musculoskeletal complaint within 7 days of interviewing showed the same trend with

lifetime but slightly lower prevalence of MSD. The result shows that the highest prevalence was

NP (14%), followed by SP (11%) while both UBP and LBP reported less than 10% of the total

samples for 1 day or more in the week preceding the completion of the questionnaire. Detailed

prevalence of MSD complaints is shown in Table 2.

3.5 Anthropometry and current school’s furniture measurement

Table 3 summarizes the anthropometric parameters of the 5th and 95th percentile of the

year 5 schoolchildren. Table 4 shows the measurements of existing furniture used by the year 5

schoolchildren.

3.6 Risk factors of Upper MSD among the year five students

3.6.1 HIRARC

HIRARC assessment study reveals that four ergonomics parameters were found to be of

high risk namely: 1) un-ergonomically designed chair/table/furniture 2) awkward posture 3)

prolonged sitting and 4) excessive loading. All the 4 items were found to be related to MSD and

was assessed based on 1) anthropometrics 2) awkward posture during teaching and learning

7
process 3) contact stress for the hip and back of the thigh, static posture to the neck and shoulder,

4) weight of school bags, types of school bags and location of classes as shown in Table 5.

Among school activities, classroom learning indicated the highest risk level (relative risk

=15) (high risk) compared to laboratory and class room practicum. The high risk indicated an

immediate response that requires action to be taken to control the hazard as in the hierarchy of

control. The detailed is shows in Table 5.

3.6.2 Neck pain (NP) for 1 day or more within the 7 days of interviewing

The study shows that no significant variables were associated with the reported pain.

However, there was an increased trend of risk among female schoolchildren who did not bring

their school books based on the timetable given by the school (OR=1.9, CI: 0.77,2.92), perception

of heavy school bag weight (OR=1.33, CI: 0.69,2.58) and carrying school bag using one shoulder

(OR=6.61, CI: 0.77,2.92). The use of existing furniture in the class (OR=2.46, CI: 0.83,7.33) and

perception pain due to the effect of bag carrying also increases the trend of risk (OR=6.61, CI:

0.81,53.61). Table 6 shows the NP complaints and associated risk factors.

3.6.3 Shoulder pain (SP) for 1 day or more within the 7 days of interviewing

There was a significant association between complaints of SP with the use of current

furniture (OR=3.79, CI: 1.16,12.33). However, no other risk factor was found to be significantly

associated with SP. Other risk factors show an increased trend of risk among standard five

children who did not bring books following the timetable given by the school (OR=1.22, CI:

0.23,6.55), perception of heavy bag weight (OR=1.18, CI: 0.58,2.42) and the school children

perception of pain caused by carrying of school bag (OR=1.94, CI: 0.87,4.3). The study also

reveals that male standard schoolchildren are more at risk of getting pain compared to female

schoolchildren. Table 7 shows the SP complaint and the associated risk factors.

8
3.6.4 Upper back pain (UBP) for 1 day or more within the 7 days of interviewing

No significant variables were associated with the reported pain of the UBP and

discomfort among the schoolchildren. However, there was an increased trend of risks of

developing UBP among the female schoolchildren (OR = 1.67, CI: 0.6,4.65). The use of existing

furniture also increases the risk of developing UBP (OR = 2.07, CI: 0.69,6.22). In addition, the

perception of pain caused by carrying their school bag also increase (OR = 2.12, CI: 0.73,6.20).

Table 8 shows the UBP complaint and associated risk factors.

3.6.5 Low back pain (LBP) for 1 day or more within the 7 days of interviewing

The result for LBP risk factors also showed that there were no significant variables

associated with the reported acute LBP. However, the same increasing trend was observed as the

risk was higher among female schoolchildren (OR = 1.56, CI: 0.43,5.54), perception of heavy

school bag weight (OR = 1.56, CI: 0.43,5.6) and perception of reported pain caused by their

school bag (OR = 2.78, CI: 0.53,14.67). Table 9 shows the LBP complaint and associated risk

factors among the respondents.

4. DISCUSSION

Malays constitute the majority of schoolchildren involved in this study and most of them

enjoyed sports and physical activities as common as other children worldwide. Majority of

Malaysian schoolchildren had a variety of mode of transportation with only 6% walking to

school. Majority either used the daily school bus to school or was sent by their parents. This

indicates that the majority of Malaysian schoolchildren do not carry their school bags for long

period of time; however the 6% that walked probably stayed near to the vicinity of the respective

schools.

The present study indicates that NP had the highest prevalence followed by SP, UBP and

LBP lasting one day or more in the lifetime or within 7 days of the interview. This finding is

similar to several studies that indicated NP as the most commonly reported body pain among

9
schoolchildren (Murphy et al., 2007; El-Metwally et al., 2007; Whittfield et al., 2005; Vikat et

al., 2000). Micheal et al. (2007) reported that UBP or SP was the highest complaint among

schoolchildren whereas Murphy et al. (2004) showed that the highest complaint was LBP. Thus,

the main MSD complaint among schoolchildren appears to originate from the upper part of the

body. Therefore, it is postulated that the schoolchildren share common risk factors of MSD.

Based on the binary logistic regression analysis, this study indicates that male students

had a lower risk of developing MSD compared to female except for SP complaint. Watson et al.

(2002) found similar results and the trend among adult and adolescent female population shows

that adult females was at a higher risk of developing MSD compared to adult males. Therefore,

the onset of developing MSD does not begin in adult age but has the possibility of developing

MSD at a younger age (Viry et al., 1999).

Whittfield et al. (2005) and Siambanes et al. (2004) have reported a direct relationship

between LBP and schoolbags weight. Murphy et al. (2007) found a significant relationship

between schoolbags weight and the complaint of UBP. The present study found that the mean

schoolbags weight carried by Malaysian school children was approximately 13% of their body

weights.

However, there are different recommendations proposed as to the permissible

schoolbag’s weight limit. Moore et al. (2007) recommended that the schoolbag’s weight should

not exceed 10 % of the children’s body weight. However, the American Academy of Pediatrics

recommended that children should not carry more than 20% of their body weights (NASN, 2002).

Siambanes et al. (2004) found that the school bag load was directly associated with LBP and

there was an increasing risk of MSD among children carrying heavy bags.

In the present study, there was no significant relationship between the schoolbag’s weight

and any complaint of NP, SP, UBP or LBP, indicating that the 13% body weight factors still

within the acceptable weight to be carried by schoolchildren. In addition, other confounding

factors that could influence the relationship between schoolbag’s burden and MSD complaints is

the mode of transportation and also the duration of carrying the school bags. This is because the

10
majority of children studied went to school by various modes of transportation while only 6%

walked to schools that were mostly within the vicinity of their homed. Furthermore, Malaysian

schools also rarely change their classroom activities daily or based on subjects. Therefore, the

children tended to stay in one classroom during the school hours for the whole year, except for

selected subjects that needed practical classes such as the sciences and physical education. Even,

the children rarely need to carry the whole bag but only books needed for the practical class.

The study also reveals that there was a significant relationship between the existing

school furniture and SP complaint based on logistic regression analysis (OR 3.79, 95%CI 1.16,

12.33; p<0.05). School furniture plays a major factor in increasing the risk of pain complaint and

HIRARC indicates that existing furniture in Malaysia schools show severe risk rating and

contributes to SP complaint as shown by Table 3 and 4, which indicate differences between

anthropometric measurements with the existing furniture dimension. Malaysian schoolchildren

are exposed to a prolong awkward seating posture and remain up to 5 hours of using improper

school furniture (Year 1 to 3) and 5.30 hours for Year 4 to 6 daily. During writing, copying text

from the blackboard or drawing tasks, children tend to flex their head, neck and trunk more

forward. This awkward posture and prolonged sitting may increase the load and pressure on their

sternocleidomastoid, trapezius, pectoral, deltoid muscles and erector spinae.

The current existing furniture utilized by Malaysian school children had many flaws

especially in terms of their mismatch with the 95th percentile of the children’s anthropometry.

Many of them had to adapt various postures to increase their comfort level during sitting. One of

the common postures was using their school bags as “lumbar support” and as padding for their

back rest. This however will reduce their space for comfort sitting as the seat pan depth was

significantly reduced. In order to reduce muscle fatigue, the children had jeopardized their sitting

comfort. They also could not flex 90o of their elbows as the table heights were much higher than

their sitting elbow heights. This will lead to severe discomfort among the children since the

furniture had to be used for a period of 5 to 5.3 hours with only 20 minutes of break. This will

11
also lead to promoting awkward postures that eventually lead to bad sitting technique, muscle

fatigue and ache. Figure 2 shows the adaptation used for the back rest.

5. CONCLUSION

In conclusion, this study shows that the prevalence of NP is highest among the

schoolchildren with MSD complaints and the use of existing school’s furniture is the most likely

associated risk. The study is unable to significantly associate most of the other ergonomics risk

factors with MSD. One of the reasons was the sample size could be low to detect any significant

risk, but the type of furniture used was found to contribute to the risk of developing SP. Despite

this limitation, the increased ORs of ergonomic risks can be considered as parameters to be

highlighted in future studies or government policies.

ACKNOWLEDGEMENT

This study was supported by Universiti Putra Malaysia under the Research University Grant

Scheme (RUGS) (04/01/07/0128RU).The grant was rewarded by the Ministry of Higher

Education of Malaysia (MOHE). The authors would like to extend their gratitude to the

Malaysian Ministry of Education (MOE) for their support and the schools that participated in this

study.

12
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14
 Northern
region Eastern
region

Southern
region

Central
region

Figure 1 : Study location

Figure 2: Children placing school bags above their seats

15
 Table 1: Respondents demographic information

Variables N (%)

Gender Male 216 (52)

Female 203 (48)
Ethnic group Malay 375 (90)
Indian 21 (5)
a
Others 23 (5)
Sports activities Yes 395 (94)
No 24 (6)
b
Physical activities Yes 391 (93)
No 28 (7)
Transportation Vehicle 245(59)
Bicycle 62 (15)
Walking 27 (6)

Mean ± S.D
Parents income (RM) 1533 ± 1293
School bag weight (kg) 4.46 ± 1.37
Weight (kg) 34.88 ± 10.23
Height (cm) 136.61 ± 8.06
BMI 18.43 ± 4.05
N=419 respondent
a
Indigenous natives
b
playing computer, playing video game, watching television

Table 2: Prevalence of MSD

Life time Within 7 days

Body parts n (%) n(%)
Male Female All Male Female All

Neck 81 (38) 66 (33) 147 (35) 36 (17) 23 (11) 59 (14)

Shoulder 70 (32) 71 (35) 141 (34) 23 (11) 23 (11) 46 (11)

Upper back 32 (15) 30 (15) 62 (15) 11 (5) 14 (7) 25 (6)

Lower back 22 (10) 19 (10) 41 (10) 7 (3) 8 (4) 15 (4)

N=419 respondent

16
 Table 3 : Anthropometric measurements

Male Female
Body Parts
5% 95 % 5% 95 %

Sitting height (mm) 599.9 771.9 612.9 794.9

Sitting elbow height (mm) 106.9 216.1 119.5 230.1
Knee height (mm) 352.5 444.7 354 445.0
Popliteal height (mm) 301.9 377.6 303 383.1
Buttock-knee length (mm) 310.0 502.8 314.5 515.6
Buttock-popliteal length
349.0 523.1 353.9 527.8
(mm)

Table 4: Current chair and table measurements

Dimension (mm)
No Parameter
5th year
1 Seat height 430
2 Seat depth 365
3 Seat width 381
4 Backrest height 400
5 Backrest width 435
6 Table height 730

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 Table 5: Risk Level Assessed Among Primary School Children

Hazard (s) Activities / location L* S** Risk Level Remarks

Classroom 5 3 15 H
Sciences Lab 3 3 9 M
Living skills workshop 3 3 9 M
Un-ergonomic Assessments are based on
Music lab 1 2 2 L
chairs & tables anthropometric data
Audio Visual lab 1 2 2 L
Canteen 3 2 6 M
Sanitary Facilities 1 1 1 L
Classroom 5 3 15 H
Sciences Lab 2 2 4 L
Living Skills Awkward posture during
Awkward 2 2 4 L
Workshop teaching learning process
posture
and practical classes.
Music lab 1 1 1 L

Audio Visual lab 1 1 1 L

Classroom 5 3 15 H
Involves:
Sciences Lab 3 3 9 M Contact stress for the
Prolonged hip and back of the
sitting Living Skills thigh
2 2 4 L
Workshop Static posture to the
Audio Visual lab 1 1 1 L neck and shoulder

Classroom 3 2 6 M Contact stress for:

Hip and back of the
Sciences Lab 1 2 2 L thigh
Living Skills Lower back
1 2 2 L
Workshop Upper back
Neck and shoulder
Music lab 1 1 1 L
Assessments include:
Excessive load
Weight of school
bags
Types of school bags
Location of classes
Audio Visual lab 1 1 1 L
Commuting mode
anthropometric data
of the children
School’s settings

* likelihood, ** severity
H=High risk, M=Medium risk, L=Low risk
Note: Only Ergonomic hazards is shown in Table 5

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Table 6: NP for 1 day or more within 7 days and selected associated risk factors:
logistic regression analysis

Risk Variable OR (95% CI)

Gender Male 1 -
Female 1.5 0.77 – 2.92
Bring book to school following Yes 1 -
time table
No 1.9 0.5 – 7.6

Furniture No 1 -
Yes 2.46 0.83 – 7.33

School bag No 1 -
Yes 1.09 0.54 – 2.20

Carrying bag Good 1 -

Awkward 6.61 0.81 – 53.61

Bag weight Light 1 -

Heavy 1.33 0.69-2.58

Logistic regression analysis is adjusting for body mass index, sport activities and history of
previous accident

Table 7: SP for 1 day or more within the 7 days and selected associated risk factors

Risk Variable OR (95% CI)

Gender Male 1 -
Female 0.98 0.48 – 1.98

Bring book follow schedule Yes 1 -

No 1.22 0.23 – 6.55

Furniture No 1 -
Yes 3.79* 1.16 – 12.33

School bag No 1 -
Yes 1.94 0.87 – 4.3

Bag weight Light 1 -

Heavy 1.18 0.58 – 2.42

Logistic regression analysis adjusted for body mass index, sport activities and history of previous
accident
* p < 0.05

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 Table 8: UBP for 1 day or more within the 7 days and selected associated risk
factors

Risk Variable OR (95% CI)

Gender Male 1 -
Female 1.67 0.6 – 4.65

Furniture No 1
Yes 2.07 0.69 – 6.22

School bag No 1
Yes 2.12 0.73 – 6.20

Bag weight Light 1

Heavy 1.14 0.41 – 3.21

As per Table 6

Table 9: LBP for 1 day or more within the 7 days and selected associated risk
factors

Risk Variable OR (95% CI)

Gender Boys 1 -

Girls 1.56 0.43 – 5.54

School bag No 1 -

Yes 2.78 0.53 – 14.67

Bag weight Light 1 -

Heavy 1.56 0.43 – 5.6

As per Table 6

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