Background
Methods
Eligibility criteria
Study selection, data charting and synthesis of results
Results
Study selection
Study characteristics and synthesis of results
Temporal precursor variables
Sex
Variable | Number of studies | Number of studies: Increased risk | Number of studies: Decreased risk | Number of studies not significant | Strength of association (95% CI) | |
---|---|---|---|---|---|---|
Female sex | 53 | 32 | 3 | 18 |
Positive association:
OR 1.9 (1.4, 2.0) (c) [10] OR 1.9 (1.4, 2.4) (c) [16] OR 2.4 (1.9, 3.1) (LBP), OR 2.2 (1.6, 2.9)(MBP) (c) [17] OR 1.6 (1.2, 2.0) [26] OR 1.7 (1.4, 2.1) (c) [28] OR 1.6 (1.4, 2.0) (c) [29] OR 7.7 (4.7, 12.6)) [34] OR 1.7 (1.5, 2.0) [39] OR 1.3 (1.4, 3.3) [42] OR 1.5 (1.2, 1.8) [43] OR 2.2 (1.4, 3.3) [44] OR 1.5 (1.1, 1.9) [45] OR 1.5 (1.1, 1.9) [47] OR 2.4 (1.7, 3.3) [51] OR 1.5 (1.0, 2.1) [53] OR 2.1 (1.6, 2.9) [54] OR 1.4 (1.0, 2.1) (c) [58] | OR 1.1 (1.1, 1.2) [59] OR 1.9 (1.7, 2.2) [64] OR 2.1 (1.6, 2.7) [66] PR 1.1 (1.1, 1.2) [69] PR 1.2 (1.1, 1.3) [70] OR 1.6 (1.3, 2.1) [74] OR 1.8 (1.2, 2.7) (c) [76] OR 4.6 (1.8, 11.7) [78] OR 2.2 (1.6, 2.9) [77] OR 2.4 (1.9, 3.2) [79] OR 1.6 (1.3, 2.0) (c) [81] OR 1.8 (1.3, 2.4) (c) [83] OR 2.7 (1.2, 6.1) [84] Females: 28%, Males 19% [85] OR 1.9 (1.3, 3.0) [89]
Negative association:
Males: HR 3.2 (2.7, 3.7) [27] OR 0.6 (0.4, 0.8) [50] OR 0.3 (0.2, 0.5) (c) [68] |
Older Age | 34 | 19 | 2 | 13 |
Positive association:
OR 2.9 (2.6, 3.3) (c) [32] OR 1.5 (1.1, 2.3) [35] OR (17 index), 21 yr 2.2 (1.2, 4.2), 23 yr 3.2 (1.7, 6.2), 24 yr 2.8 (1.5, 5.3) [42] OR (10–11 index), 12–14 yr: 1.1 (1.1, 1.3) [47] OR 1.1 (1.1, 1.2) [51] (15 index) 16/17 yr OR 1.7 (1.2, 2.3), 18/19 yr: OR 1.8 (1.2, 2.8) [53] 14 to 15 yr: 6.4% increase [54] OR 1.2 [58] r 0.2 [61] (17/18 index), 21+ yr: OR 1.6 (1.2, 2.1) [65] (10–12 index), 13–16 yr: OR 1.5 (1.2, 2.0) [66] (per year): OR 1.2 (1.1, 1.4) [72] OR 1.2 (1.1, 1.3) [74] Older 25.1%, younger adolescents 12.4% [75] (12 index), 14 yrs.: OR 1.3 (1.1, 1.7) [80] Younger age: OR 1.5 (males), OR 1.4 (females) [81] 11 yr 18%, 14 yr 34% (girls) 11 yr 14%, 14 yr 25% (boys) [85] OR 1.3 (1.1, 1.7) [88] OR 1.3 (1.2–1.4) [89]
Negative association:
Younger age: OR 0.2 (0.1, 0.6) [46] OR 0.5 (0.4, 0.6) [67] | |
Positive family history | 19 | 15 | 0 | 4 | OR 3.6 (1.3, 10.2) [11] OR 2.1 (1.4, 3.1) [35] OR 2.0 (1.1, 4.0) [36] OR 2.6 (1.4, 5.9) [38] OR 2.1 [40] OR 3.8 (2.9, 5.9) [41] OR 1.8 (1.4, 2.4) [43] OR: 1.5 (1.1, 1.9) (c) [48] | OR 1.7 [58] OR 1.8 (1.5, 2.0) [64] PR 1.2 (1.2, 1.3) [69] PR 1.2 (1.1, 1.3) [70] OR 2.0 (1.2, 3.3) [72] OR 2.3 (1.2, 4.7) [89] OR 2.6 (1.9, 3.6) [90] |
Socioeconomic factors | 15 | 7 | 0 | 8 | Higher Socioeconomic index: OR 0.8 (0.7, 1.0) [34] Higher social class: OR: 0.9 (0.8, 0.9) [55] Parental low level of education: OR 1.8 (1.1, 2.0) [62] Ethnicity: (Index white) Asian PR: 1.2 (1.1, 1.4), indigenous PR: 1.4 (1.3, 1.5) [70] Non-white: PR 1.4 (1.0, 1.9) [71] Location (index peripheral center) Urban centre: OR 3.1 [73] Residence: 52% (city), 43% (village) [83] | |
Increased height or increased growth spurt | 12 | 4 | 1 | 7 | High growth spurt: OR 3.1 (1.5, 6.0) [4] linear growth: IRR 1.2 (1.2, 1.2) [18] Shorter than median height (158 cm): RR 2.1 (1.2, 3.8) [23] Height: OR 1.2 (1.0–1.5) [31] Taller: t test − 3.3 [58] | |
Later pubertal status | 6 | 4 | 1 | 1 |
Positive association
IRR 1.5 (1.2, 2.0) (Tanner stage 2), IRR 2.1 (1.5, 3.0) (Tanner stage 3) IRR 3.3 (2.1, 5.0) (Tanner stage 4/5) [18] OR 1.6 (1.3, 2.0) (USA), OR 1.3 (1.1, 1.6) (Dutch) [22] OR 2.0 (girls), OR 1.9 (boys) [63] Stage 4: OR 2.0 (1.3, 3.5), stage 5: OR 2.1 (1.1, 1.4) [86]
Negative association:
HR 0.6 (0.5, 0.8) (males) [27] | |
History of back pain | 3 | 3 | 0 | 0 | BP in adolescence for BP in adulthood: OR 4.3 (3.5, 5.4) [21] History of BP: OR 2.7 (1.1, 7.1) (ever), OR 9.1 (3.0, 27.2) (> 7 days) [33] History of BP: OR 7.7 (4.7–12.6) (girls) [34] |
Age
Family history
Socioeconomic status
Increased height or increased growth spurt
Pubertal status
History of back pain
Bidirectional variables
Physical activity and work
Variable | Number of studies | Number of studies: Increased risk | Number of studies: Decreased risk | Number of studies not significant | Strength of association (95% CI) |
---|---|---|---|---|---|
Physical activity/work | 10 | 6 | 0 | 4 | Playing sport OR 9.5 (1.9, 48.2) [11] White collar work OR 4.9 (1.7, 14.2) [13] Vigorous intensity physical activity: OR 1.2 (1.0–1.4) (diagnostic spinal pain) OR 1.3 (1.0–1.5) (traumatic) [15] Provoked by manual work: OR 9.2 (2.9, 28.8) [33] Increased physical activity OR 1.9 (1.2, 2.8) [34] |
Psychological factors | 7 | 4 | 0 | 3 | High level of peer problems: RR 2.3 (1.3, 4.2) [23] High level of psychological factors: RR 1.6 (1.1, 2.3) [24] Externalising behaviour: RR 1.5 (1.3, 1.7) (boys), RR 1.4 (1.3, 1.5) (girls), RR 3.6 (1.5, 8.5) (girls 18) [28] High levels of aggressive behaviour OR 1.4 (1.2, 1.6) [34] High level of somatic complaints OR 1.3 (1.1, 1.5) [34] |
Higher BMI | 8 | 3 | 0 | 5 | OR 1.3 (1.0, 1.5) [11] RR 1.1 (1.0, 1.2) (girls), RR 1.1 (1.0, 1.3) (boys) [29] OR 2.9 (1.7, 5.1) (9 yr), 2.2 (1.4, 3.5) (10 yr), 1.6 (1.2, 2.1) (13 yr) [32] |
Smoking | 6 | 6 | 0 | 0 | OR 2.2 (1.4, 3.5) [4] OR 2.4 (1.3, 6.0) [14] OR 3.1 (1.1, 9.2) (MB), 1.8 (1.2, 2.8) (BP) [17] OR 1.7 (1.4, 2.1) [19] HR 1.6 (1.4, 1.9) [27] OR 2.5 (1.4, 4.5) (females) [30] |
Illness | 4 | 3 | 0 | 1 | Asthma OR 1.4 (1.1, 1.7) (female) [20] Headache OR 1.6 (1.1, 2.1) (female), OR 2.4 (1.2, 4.7) (male) [20] Abdominal pain RR 1.8 (1.1, 3.0) [24] Headache OR 2.4 (1.8, 3.1) [26] |
Posture/sitting position | 4 | 4 | 0 | 0 | No LB support: OR 1.7 (1.2, 2.6), OR 2.9 (1.1, 3.5) (persistent LBP) [25] Provoked by sitting OR 3.8 (1.3, 11.3) [33] Non-neutral standing posture OR 2.2 (1.3, 3.6) [34] Uncomfortable school desk OR 6.0 (3.7, 9.7) [35] |
Insufficient sleep | 3 | 3 | 0 | 0 | OR 2.9 (1.7, 5.2) (girls), OR 2.4 (1.3, 4.5)(boys) [10] OR 2.2 (1.7, 3.8) [35] OR 1.2 (1.1, 1.4) [36] |
Flexibility | 3 | 2 | 0 | 1 | Decreased flexibility: hamstrings OR 1.1 (1.0, 1.1) [4] Decreased flexibility: quad muscles: OR 1.7 (1.1, 2.8) [25] |
Screen time | 3 | 1 | 0 | 2 | Increased TV time OR 2.0 (1.4, 2.9) [35] |
Backpack factors | 3 | 1 | 0 | 2 | Heavy school satchel OR 2.2 (1.0, 4.8) [36] |
Muscle endurance | 1 | 1 | 0 | 0 | Poor back muscle endurance OR 1.9 (1.2, 3.0) [34] |
Psychosocial factors
Body mass index
Smoking
Systemic factors /illnesses
Spinal posture and sitting posture
Sleep
Flexibility
Screen time
Backpack factors
Muscle endurance
Discussion
Overall summary of potential risk factors from all studies
Potential risk factor | Likely | Weak/no significance | Mixed results/ inconsistent | Limited research |
---|---|---|---|---|
Female sex | X | |||
Older age/ advanced pubertal status | X | |||
Positive family history of back pain | X | |||
Increased growth spurt | X | |||
History of back pain | X | |||
Smoking | X | |||
Insufficient sleep | X | |||
Increased screen time | X | |||
Work | X | |||
Psychosocial factors | X | |||
Muscle flexibility | X | |||
Socioeconomic status | X | |||
Backpack related factors | X | |||
Height and weight | X | |||
Physical activity | X | |||
Spinal posture | X | |||
Sitting position | X | |||
Systemic/illness factors | X | |||
Muscle endurance | X |