The backpack load in schoolchildren: clinical and social importance, and efficacy of a community-based educational intervention. A prospective controlled cohort study.

AIM: The aims of this paper were: to establish the efficacy of an educational intervention in reducing school backpack weight and, possibly, back pain; to verify the content of backpacks and the social importance of the problem; to confirm existing data in the literature. DESIGN: controlled prospective educational intervention. SETTING: community. PARTICIPANTS: the entire Year 6 population (402 pupils) of 2 randomly chosen rural school districts of the province of Mantua (Italy); of these, we took 108 (selected according to position in the class register): 82.4% completed the study; 402 parents and 124 teachers entered the study, 77.1% and 37.1% respectively completed it. INTERVENTION: instructive meeting and written material for teachers, and a leaflet for parents on backpack management. MAIN OUTCOME MEASURES: backpack weight and content; back pain; subjective perceptions of backpack load; packing and carrying methods; backpack load: importance, management and education; backpack characteristics. RESULTS: We obtained a statistically significant reduction in the backpack weight in each of the groups (study 11.2%; control 7.9% - not a statistically significant difference); 90.1% of the material carried is necessary. Backpacks are considered a problem by 95.1% of parents, 73% of teachers, and 60.3% of pupils. Backpack weight: 8.75+/-1.26 kg (19.9+/-5.3% of body weight); fatigue during backpack carrying: 72.7%; back pain life prevalence: 58.4%; fatigue during backpack carrying and considering backpacks a problem were associated with back pain (odds ratios 4.4 and 5). CONCLUSIONS: Educational intervention is not the answer to the problem and solutions, like the clear legal limits established for adults, need to be found.

Reliability of the Scoliosis Research Society-22 Patient Questionnaire (Italian version) in mild adolescent vertebral deformities.

AIM: The reliability evaluation of the Italian version of the Scoliosis Research Society-22 Patient Questionnaire (SRS-22-I), administered to adolescents with mild vertebral deformities, is evaluated. STUDY DESIGN: forward-backward translation, pretest, final version according to a focus-group evaluation, and 1 week test/retest. POPULATION: pretest: 35 subjects (22 females), age range 8.5-19 years, 28 idiopathic scoliosis (17 degrees +/-7 degrees ), 7 hyperkyphosis (54 degrees +/-4 degrees ); test/retest: 20 subjects (11 females), age range 12-17.5 years, 15 idiopathic scoliosis (16 degrees +/-8 degrees ), 5 hyperkyphosis (55 degrees +/-5 degrees ). STATISTICAL ANALYSIS: Spearman rank test, percent of agreement. Statistical significance: 0.05. Software: Statgraphics 3.0. We calculated the results of the questionnaire and performed the statistical analysis using non parametric test because of the charcteristics of the data: this differ from previously published RESULTS: Response rate was 100%. Total score: median 4 (range 3-5); results for different domains (median, range): function/activity 4 (3-5), pain 5 (3-5), self image/ appearance 3 (2-5), mental health 4 (3-5), satisfaction with management 4 (2-5). Time required to answer the questionnaire ranged from 5 to 20'; for 12 to 17.5 years old subjects from 5 to 10'. pretest showed difficulties with questions on pain; the questionnaire was changed accordingly. Spearman's rho ranged from 0.42 to 1, not significantly different from null value for questions 12 and 21. Percent of agreement (evaluated only for question 11a) was 100%. The ceiling and floor effects have been found high. CONCLUSIONS: The SRS-22-I was found to be reliable for young patients with mild vertebral deformities of different type. Lack of reliability for questions 12 and 21 should be better understood. Until now the psychometric properties of SRS-22 questionnaire have been evaluated only in USA populations, and in idiopathic scoliosis. Moreover, only one study has been proposed including patients with mild idiopathic scoliosis. This, together with the non-parametric statistical analysis used, could explain the high ceiling and floor effects we found in our data.

The upper body segmental movements during walking by young females.

OBJECTIVES: To characterise the physiological pattern of trunk and shoulders movements during walking and provide a reference for further studies on spine deformities. DESIGN: Implementation of a model for measuring spine and shoulder girdle movements during gait. Data collection on a population of eighteen, young, healthy, female subjects. BACKGROUND: The analysis of gait modifications in subjects with idiopathic scoliosis could offer an insight to better understand the functional relationship with the pathology. METHODS: Retroreflective markers were positioned on the main spine processes and acromions to be detected by a TV-based motion analysis system. A model of kinematic computation was implemented and integrated in a previously developed protocol for multifactorial gait analysis. Movements in the main reference planes and in relation to pelvis were analysed. RESULTS: The trunk was on average bent forward by 3.4 degrees with respect to standing; of the two physiological curves in the sagittal plane only lordosis changed during walking; in the frontal plane, a dynamic spine deformation appeared, that was maximum at heel strike-early stance; the trunk was bent controlaterally of the foot on the ground, while the shoulders remained stable; in the horizontal plane, the shoulders rotated contralaterally to the pelvis. CONCLUSIONS: In our population all the segmental movements analysed were smaller than 5 degrees during gait, except the angle of proximal curvature in the frontal plane, shoulder rotation, and angle between shoulders and pelvis; all the measured angles were far below their possible ranges of motion. RELEVANCE: Quantitative data on upper body kinematics as a complement to gait analysis can help understanding movement disorders and compensation strategies in several pathologies.

General practitioners' management of low back pain: impact of clinical guidelines in a non-English-speaking country.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To evaluate the assessment of patients with low back pain by general practitioners (GPs) in a non-English-speaking country and to compare their behavior with AHCPR and CSAG clinical guidelines. SUMMARY OF BACKGROUND DATA: The diffusion of clinical guidelines (and their everyday application by health care professionals) is a significant problem. Because most guidelines are developed in English, concerns over their diffusion are obviously greater in non-English-speaking countries. METHODS: A questionnaire was sent to all the GPs in the province of Mantua, Italy (n = 318). The authors evaluated what examinations are routinely performed and what danger symptoms and signs prompt referral of patients. GPs indicated the frequency of their prescription of radiographs, computed tomography scans, magnetic resonance imaging, laboratory tests, and consultations. The findings were compared with a "gold standard": the AHCPR and CSAG clinical guidelines. RESULTS: The response rate was 68.2%. Only 28.0% of GPs perform all the tests considered important by the clinical guidelines, and 33.0% were aware of all the red flags. Correspondence with the clinical guideline recommendations ranged from 14.6% to 89.4%. There is a clear tendency to overprescribe examinations in acute cases, whereas in chronic cases underprescription is sometimes seen. CONCLUSIONS: In a non-English-speaking country the evaluation of low back pain by GPs does not reflect current recommendations, and the situation is seen to be worse than in English-speaking countries. Concerns over the diffusion of guidelines must therefore be considered greater in non-English-speaking countries, where thorough presentation to GPs of the existing "evidence-based" guidelines is to be recommended.

Backpack as a daily load for schoolchildren.

34.8% of Italian schoolchildren carry more than 30% of their bodyweight at least once a week, exceeding limits proposed for adults. Given increasing evidence of back pain in children, the time has come to propose some limitations to backpack load.