E61 Prevalence and related factors of spinal pain in Tunisian children and adolescents
Authors: Fazaa Alia , Cherif Ines , Miladi Saoussen , Boussaa Hiba , Makhlouf Yasmine , Souabni Leila , Kassab Salma , Chekili Salma , Ben Abdelghani Kawther , Laatar Ahmed 
Published: August 2023

Abstract

Introduction
The prevalence of back and neck pain is common in children and adolescents, and in some series the numbers are alarming. Various risk factors have been identified, although some are controversial.

Objective
To determine the prevalence of neck and back pain in children and adolescents and to investigate the potential association with various risk factors identified in the literature.

Methods
We established a questionnaire targeting parents of children and adolescents aged between 6–18 years old in Tunisia. The recruitment of participants was done online using the Google Forms application. The questionnaire was divided into 2 parts: Part one collected the sociodemographics characteristics of the participants: age, gender, body mass index (BMI), exposure to passive smoking, the practice of a physical activity, puberty status and age at puberty if applicable, type and weight of the schoolbag, mean daily time spent on electronic devices, type of school the child attends (private/public), mode of transport from home to school, parental history of neck and/or back pain, posture of the sitting position of the child, and finally whether the child reports neck/back pain.
The second part was aimed at parents whose child reported neck and/or back pain. We asked about the weekly frequency of neck/back pain, school absenteeism due to neck/back pain, whether it prevented the child from practicing physical activity and, finally, whether the child had ever seen a doctor/chiropractor/physiotherapist for their neck/back pain. For all statistical tests, the significance threshold was fixed at 0,05.

Results
Eighty-two participants (sex-ratio = 1) answered the questionnaire. Mean age was 11.4 ± 3.8[6–18]. Thirty (36.6%) were pubescent. Fifty-three children practiced regularly an extracurricular physical activity (swimming n = 11, basketball n = 9, football = 9, tennis = 9, gymnastics= 6, ballet = 5, horseback riding n = 3, krav maga = 2, running n = 1, volley ball n = 1). Mean schoolbag weight according to the participants was 7.6 ± 1.6 kg [1–9]. Fifty-seven children (69.5%) attended private school. Mode of transport was walking, taking public transport and driving the family car respectively in 10 and 1 and 71 children. Parental history of neck and/or back pain was positive in 47 participants (57.3%). Forty-four participants (53.7%) reported bad sitting position of their child.
Neck pain, dorsal pain and low back pain (LBP) were reported respectively in 21 (25.6%), 15 (18.3%), 25 (30.5%) participants. Four children (4.9%) had neck, dorsal and low back pain.
Among participants who reported neck or back pain, the average weekly frequency was 1.6 [0–7] and 3.7% had a history of missing school due to neck/back pain with a mean truancy per trimester of 3.6 times [1–12]. Spinal pain prevented 9 participants from engaging in physical activity. Twelve participants (14.6%) revealed that their spinal pain made them see a doctor and three (3.7%) a chiropractor/physiotherapist. The analytical study didn’t show an association between neck/back pain and gender, physical activity, type of school and mode of transport to school.
A positive parental history of neck or back pain was significantly associated with the presence of neck, dorsal and LBP (P = 0.043, P = 0.011 and P &lt; 0.0001 respectively). The presence of neck pain and LBP were both associated with a bad sitting position (P = 0.05 and P = 0.02 respectively). Presence of LBP was associated with a positive puberty status (P = 0.016), use of a backpack (P = 0.05), and exposure to passive smoking (P = 0.001). No significant correlations were found between neck/back pain and age at puberty, time spent daily on electronic devices, weekly duration of physical activity, schoolbag weight and absenteeism rate. LBP was significantly associated with higher BMI (P = 0.001) and higher age (P = 0.003). Similarly, dorsal pain was associated with higher age (P = 0.03).

Conclusion
The prevalence of spinal pain was frequent in our series. A positive parental history of spinal pain, a bad posture while sitting, passive smoking, use of backpack, higher age and higher BMI were potential associated factors.