Prevalence and risk factors associated with spinal pain in adolescent computer users: a systematic review.

BACKGROUND Increased computer use has been suggested as a contributing factor for a rapid increase in the prevalence of neck and back pain in adolescents in the late 1990s and the beginning of 2000. OBJECTIVE The overall objective of this review was to synthesise the best available evidence on the estimates of prevalence of, and risk factors associated with, spinal discomfort in adolescent computer users. INCLUSION CRITERIA This review considered cross-sectional, case-control, or cohort studies. Studies were considered for inclusion if they reported either prevalence or risk factors associated with spinal pain in adolescents aged between 13 and 18 years using computer in school or at home. SEARCH STRATEGY The search included The Cochrane Library, JBI Library of Systematic Reviews, PEDro, MEDLINE, CINAHL, Web of Science, ERIC, PsycINFO, EMBASE, and CEPS. The grey literature was also searched. The search was limited to English and Chinese language papers, and spanned from the inception of each database to May 2011. METHODOLOGICAL QUALITY Two review authors independently evaluated the methodological quality of the included studies using the standardised Joanna Briggs Institute instruments. DATA EXTRACTION Data was extracted using the standardised Joanna Briggs Institute data extraction form. DATA SYNTHESIS Meta-analysis was not appropriate because there was considerable heterogeneity between studies. The findings were summarised in tables and in narrative form. RESULTS Seven studies were included in this review: three studies were carried out in Finland, two in the USA, one in Sweden, and one in South Africa. There was marked variability in the period prevalence data across different studies: 15-60% for cervical pain and 12-53% for lumbar pain. None of the reviewed studies reported the confidence intervals for prevalence estimate. Four studies investigated the association between the duration of computer use and cervical pain, two studies for lumbar pain and none for thoracic pain. Positive associations between the duration of computer use and cervical pain were found in three out of four studies, with the odds ratio ranged from 1.3 (95% CI 1.1 to 1.6) to 2.3 (95% CI 1.5 to 3.6). One study found that weekly internet use greater than 42 hours predicted the occurrence of lumbar pain, and the odds ratio was 1.9 with 95% CI of 1.1 to 3.4. The other study reported non-significant association without providing statistical evidence. CONCLUSION This systematic review suggests a relatively high prevalence of spinal pain in adolescents. The cervical spine region appears to be more prone to musculoskeletal pain than the lumbar or thoracic regions. Cervical spine pain was statistically significantly associated with duration of computer use, however the odds ratio may be too small to be considered clinical significant. There is conflicting evidence on the association with duration of computer use and lumbar pain and no evidence for thoracic spine. IMPLICATIONS FOR PRACTICE The relatively high prevalence of spinal pain in adolescents highlights the need for preventative and treatment strategies. IMPLICATIONS FOR RESEARCH Further research, preferably prospective cohort studies utilising physical examination, is required to more rigorously investigate the issue of computer use and spinal pain among adolescents. There is a need to conduct more research in Asian or developing countries to reflect any cultural or socioeconomic differences that may influence the amount of computer exposure and its potential impact on musculoskeletal health in adolescent computer users.