Medical Research>> Research projects on back disorders>> Projects on risk factors>> Frequency of back disorders among adolescents and factors associated with greater risk.

FREQUENCY OF BACK DISORDERS AMONG ADOLESCENTS AND FACTORS ASSOCIATED WITH GREATER RISK.

Title.

Mechanical pathologies of the spine among the youth of Mallorca: a study of prevalence and factors associated with a greater risk of suffering them.

Background.

Available data suggest that back disorders technically known as "mechanical pathologies of the spine" are increasing in frequency among adolescents. Some studies show that the subjects who suffer back problems in adolescence have a greater risk of having chronic back problems as adults and greater limitations in their adult lives. In some of the studies published, the average salary of those adults who had suffered back problems as adolescents is also lower than those who did not.

According to these data, the frequency of back problems among children under 12 years old was very low, while for those over 16 years old, it was similar to that of adults, which suggested that the pivotal age when frequency increased was between 13 and 15 years old.

Published studies suggest that, contrary to what was previously thought, many structural disorders (such as scoliosis of less than 60º) do not increase the risk of suffering back pain and several studies have been made to try to identify the factors that are truly associated with a greater risk. However, the factors under suspicion were numerous and the studies were usually made with samples that were too small to be able to prove their effect. Also, the use of research methods which had not been previously validated exposed the results to an unknown degree of random error. As a consequence of this, the eventual influence of numerous factors in modern life affecting adolescents is still not known (such as leisure and study habits, sports, different kinds of resting surfaces, etc.) and the conclusions of these studies on the eventual influence of certain factors were contradictory.

In order to carry out a study that could confirm or rule out the influence of several factors possibly associated with a greater risk, it was first necessary to define research methods that would make it viable to include broad samples and to evaluate their viability, reliability and validity.

Once previously validated, by means of an earlier study made by the Foundation, the reliability of the data collected through specific questionnaires and the viability of using that research method in practice opened the possibility of studying sufficiently large samples in order to explain the possible association of different factors with the risk of back disorders.

Objectives.

Methodology.

A questionnaire was distributed to the 14,400 schoolchildren of Mallorca between the ages of 13 and 15 years old at the time of the study, as well as to their parents. In all, 16,394 subjects participated in the study.

The questionnaire investigated various factors that are potentially associated with a greater risk of back pain, such as intense dedication to certain sports, leisure habits, load carried to school and means of transport, etc. The validity and reliability of these questionnaires had been established previously.

The adolescents filled out the questionnaire in school, took the questionnaires for their parents home and returned them, once filled out, over the following three days.

The information collected was analyzed to determine the prevalence of back disorders among the adolescents and their parents as well as the factors associated with a greater risk of suffering them

Participants, along with the Science Department of the Kovacs Foundation.

Councils of Health and Consumer Services and of Education and Culture of the Regional Government of the Balearic Islands, Illustrious College of Physicians of the Balearic Islands, Provincial Headquarters of INSALUD in the Balearic Islands, Provincial Headquarters of the Ministry of Education and Science in the Balearic Islands, and the Federations of Parents' Associations (FAPA and CONCAPA).

The study was co-funded by the Kovacs Foundation and GESA (Gas y Electricidad, SA).

Status.

The study was published in the magazine Pain (Kovacs FM, Gestoso M, Gil del Real MT et al. Pain 2003; 103:259-268).

In short, the results show that in 50.9% of the boys and 69.3% of the girls between 13 and 15 years old, the back has already ached at some moment of their lives. Weight, height, the way in which school materials are carried, the hours spent sitting, alcohol consumption and smoking are not associated with a greater risk of having suffered back pain. On the contrary, being a girl (rather than a boy) is associated with an increase of 11% risk of back pain at those ages, practicing any sport on a competitive level (and only competitively), a 23% increase in risk, and having been diagnosed with a difference in leg length or scoliosis, a 26% and a 187% increase respectively. (Because of the study design, that does not mean that the fact of suffering it increases the risk but rather that the risk is associated with the fact of having been diagnosed, since it is also possible that, on the contrary, the corresponding tests are made more commonly among school children with back pain). It is especially noteworthy that the factor most associated with a greater risk of back pain among adolescents is the fact of feeling discomfort in bed, which is associated with a 1807% greater risk of back pain. This result prompted the Foundation to study in greater depth the association between the bed and back pain.