Does sedentary behaviour cause spinal pain in children and adolescents? A systematic review with meta-analysis.

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A systematic review with meta-analysis.", "doi": "10.1136/bjsports-2024-108648", "pmid": "39438037", "authors": null, "journal": "British journal of sports medicine", "year": 2025, "abstract": null, "claims": [{"id": "claim-1", "statement": "the adjusted odds ratio of the association between sedentary behaviour and spinal pain in children and adolescents from cross-sectional data", "kind": "quantitative", "state": "complete", "target": {"value": 1.25, "unit": "adjusted odds ratio", "tolerance": null, "source": "chars 721-929 of source sha256 b89a3ea4818c2e3b676590ff0ae5d346728edbc4ab2658c7133fd5633802be84"}, "evidence": [{"asset": "source:pmid:39438037", "locator": "chars 721-929 of source sha256 b89a3ea4818c2e3b676590ff0ae5d346728edbc4ab2658c7133fd5633802be84", "quote": "(1) From cross-sectional data, we found low certainty evidence of a small positive association between sedentary behaviour and spinal pain (adjusted odds ratio 1.25 (95% CI 1.17 to 1.33), k = 44, n > 92 617)."}]}], 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"section_title": "Results of syntheses", "row_count": 25, "column_count": 6}, "table": {"label": "Table 1", "caption": "Primary, subgroup and sensitivity analyses by review objective", "rows": [["Meta-analysis"], ["(1) Association analysis:cross-sectional studies", "Adjusted OR(95% CI), n, k, I2 (χ2)", "Adjusted PR(95% CI), n, k, I2 (χ2)", "Unadjusted OR(95% CI), n, k, I2 (χ2)", "Unadjusted PR(95% CI), n, k, I2 (χ2)"], ["Primary", "", "1.25 (1.17 to 1.33), n>92 617, k=44, I2 88.6% (p=0.000)", "1.04 (0.97 to 1.11), n=5754, k=6, I2 15.3% (p=0.316)", "1.27 (1.19 to 1.34), n>118 561, k=75, I2 86.9% (p=0.000)", "1.10 (1.01 to 1.19), n=7930, k=7, I2 60.6% (p=0.018)"], ["Subgroups:sex", "Female", "1.48 (1.25 to 1.76), n=12 092, k=10, I2 93.6% (p=0.000)", "–", "1.62 (1.35 to 1.96), n=11 638, k=13, I20.0% (p=0.621)", "1.20 (1.05 to 1.36), n=2070, k=2, I2 35.2% (p=0.214)"], ["Male", "1.08 (1.02 to 1.15), n=10 846, k=10, I2 34.1% (p=0.135)", "–", "1.14 (0.95 to 1.36), n=10 275, k=13, I28.2% (p=0.364)", "–"], ["Age", "≤13 years", "1.13 (0.93 to 1.38), n=9912, k=5, I2 58.9% (p=0.045)", "–", "1.26 (1.00 to 1.57), n=22 981, k=26, I2 86.8% (p=0.000)", "–"], [">13 years", "1.28 (1.18 to 1.40), n=51 694, k=26, I2 79.8% (p=0.000)", "–", "1.39 (1.22 to 1.58), n=37 165, k=24, I2 71.8% (p=0.000)", "–"], ["SP region", "NP", "1.62 (1.40 to 1.87), n=22 401, k=12, I2 48.6% (p=0.029)", "–", "1.28 (1.15 to 1.44), n=23 137, k=13, I2 70.8% (p=0.000)", "1.37 (1.14 to 1.66), n=2826, k=2, I2 0.0% (p=0.470)"], ["MBP", "1.11 (0.98 to 1.25), n=3814, k=3, I2 18.3% (p=0.294)", "–", "1.03 (0.78 to 1.36), n=5010, k=13 I2 54.8% (p=0.009)", "–"], ["LBP", "1.20 (1.08 to 1.34), n=27 732, k=17, I2 77.6% (p=0.000)", "–", "1.20 (1.07 to 1.36), n=41 393, k=36, I2 83.0% (p=0.000)", "0.92 (0.60 to 1.40), n=2908, k=2, I2 73.1% (p=0.054)"], ["SB type", "Screen", "–", "–", "–", "–"], ["Non-screen", "–", "–", "–", "–"], ["SB duration", ">2 hours/day", "1.47 (1.27 to 1.70), n=44 561, k=14, I2 78.8% (p=0.000)", "1.09 (0.99 to 1.21), n=3 256, k=2, I2 26.7% (p=0.243)", "1.22 (1.00 to 1.47), n=43 105, k=30, I2 83.7% (p=0.000)", "1.07 (0.98 to 1.17), n=1732, k=2, I2 0.0% (p=0.491)"], [">4 hours/day", "1.43 (1.17 to 1.74), n=7744, k=10, I2 41.7% (p=0.079)", "1.05 (0.88 to 1.26), n=406, k=2, I2 0.0% (p=0.967)", "1.47 (1.17 to 1.85), n=18 140, k=12, I2 72.9% (p=0.000)", "–"], [">6 hours/day", "1.70 (1.23 to 2.34), n=13 672, k=7, I2 34.5% (p=0.165)", "–", "1.65 (1.18 to 2.30), n=7271, k=5, I2 40.9% (p=0.149)", "–"], [">8 hours/day", "–", "–", "1.32 (1.15 to 1.51), n=16 419, k=6, I2 21.4% (p=0.272)", "1.22 (0.96 to 1.57), n=4423, k=3, I2 77.1% (p=0.013)"], [">10 hours/day", "–", "–", "1.49 (1.34 to 1.65)n=7437, k=4I2 0.0% (p=0.897)", "–"], ["Sensitivity:RoB", "Low", "1.62 (1.13 to 2.32), n=4399, k=4, I2 84.9% (p=0.000)", "–", "–", "–"], ["(2)Risk assessment:longitudinal studies", "Adjusted OR(95% CI), n, k, I2 (χ2)", "Adjusted RR(95% CI), n, k, I2 (χ2)", "Unadjusted OR(95% CI), n, k, I2 (χ2)", "Unadjusted RR(95% CI), n, k, I2 (χ2)"], ["Primary", "", "–", "1.07 (0.84 to 1.35), n=1292, k=4, I2 48.7% (p=0.119)", "1.13 (0.82 to 1.55), n=850, k=2, I2 0% (p=0.335)", "1.14 (0.76 to 1.70), n=323, k=3, I2 56.4% (p=0.101)"], ["Subgroups:", "", "–", "–", "–", "–"], ["Sensitivity:RoB", "Low", "–", "1.18 (0.57 to 2.45), n=284, k=2, I2 80.1% (p=0.025)", "–", "–"], ["Follow-up duration", "", "–", "–", "–", "–"], ["(3)Prognosis assessment:longitudinal studies"], ["Primary", "", "–", "–", "–", "–"]], "row_count": 25, "column_count": 6, "numeric_cells": 56, "header_rows": 1, "locator": "section[26]/table-wrap[1]#T1"}}, {"id": "asset:table:pmid:39438037:2", "role": "table", "format": "jats-table", "media_type": "application/vnd.jats.table+json", "uri": null, "sha256": "sha256:36d9e41642433897d4aca8b71df58c33ca57c56a39750d011df15543661d43c7", "bytes": 1457, "access": "open", "state": "verified", "reader": "read_table", "reader_status": "available", "identifier": "section[27]/table-wrap[1]#T2", "version": null, "note": "GRADE level of confidence in the certainty of the evidence by review objective", "structure": {"pmcid": "PMC11874411", "section_index": 27, "section_title": "Certainty of evidence and reporting bias", "row_count": 14, "column_count": 12}, "table": {"label": "Table 2", "caption": "GRADE level of confidence in the certainty of the evidence by review objective", "rows": [["Primary meta-analyses", "GRADE factors", "Level of confidence"], ["n", "k", "Pooled estimate (95%CI)", "I2", "▼Study limitations*", "▼ Inconsistency†", "▼Imprecision‡", "▼Indirectness§", "▼Reporting bias¶", "▲Moderate to large, pooled estimate", "▲Dose response"], ["Association analysis: cross-sectional studies"], [">92 617", "44", "aOR 1.25 (1.17 to 1.33)", "88.6%", "▼", "▼", "✓", "✓", "▼", "✗", "✗", "Very low"], ["5754", "6", "aPR 1.04 (0.97 to 1.11)", "15.3%", "▼", "✓", "✓", "✓", "▼", "✗", "✗", "Low"], [">118 561", "75", "cOR 1.27 (1.19 to 1.34)", "86.9%", "▼", "▼", "✓", "✓", "▼", "✗", "✗", "Very low"], ["7930", "7", "cPR 1.10 (1.01 to 1.19)", "60.6%", "▼", "▼", "✓", "✓", "▼", "✗", "✗", "Very low"], ["Risk assessment: longitudinal studies"], ["NA", "4", "aOR NA", "NA", "✓", "▼", "✓", "✓", "▼", "✗", "✗", "Low"], ["1292", "4", "aRR 1.07 (0.84 to 1.35)", "48.7%", "▼", "✓", "✓", "✓", "▼", "✗", "✗", "Low"], ["850", "2", "cOR 1.13 (0.82 to 1.55)", "0%", "▼", "✓", "✓", "✓", "▼", "✗", "✗", "Low"], ["323", "3", "cRR 1.14 (0.76 to 1.70)", "56.4%", "✓", "▼", "✓", "✓", "▼", "✗", "✗", "Low"], ["Prognosis assessment: longitudinal studies"], ["0", "0", "NA", "NA", "NA", "NA", "NA", "NA", "NA", "NA", "NA", "NA"]], "row_count": 14, "column_count": 12, "numeric_cells": 32, "header_rows": 2, "locator": "section[27]/table-wrap[1]#T2"}}, {"id": "asset:table:pmid:39438037:3", "role": "table", "format": "jats-table", "media_type": "application/vnd.jats.table+json", "uri": null, "sha256": "sha256:1b23f97016d792cd249b5fad195cdc92aa837448bf7cd10d7e5a2d500478de2d", "bytes": 8155, "access": "open", "state": "verified", "reader": "read_table", "reader_status": "available", "identifier": "section[29]/table-wrap[1]#T3", "version": null, "note": "Summary of longitudinal reports estimating if sedentary behaviour increased the risk for onset of spinal pain", "structure": {"pmcid": "PMC11874411", "section_index": 29, "section_title": "Study selection, characteristics and results of individual studies", "row_count": 59, "column_count": 9}, "table": {"label": "Table 3", "caption": "Summary of longitudinal reports estimating if sedentary behaviour increased the risk for onset of spinal pain", "rows": [["Report", "Samplecountry, setting", "Baselinesample size (n=), age range (mean±SD)", "Follow-upPeriod, n= (F%), response rate", "Sedentary behaviourExposure vs reference", "Spinal painoutcome vs reference", "Unadjusted estimate (95%CI)", "Adjusted estimate (95%CI)", "Potential confounders included in the analysis"], ["Aartun 2016167xiv", "Denmark, School students", "n=181, 11– 15 y (NR±NR)", "2 y, n=144 (F46.8%), 87.3%", "TSB: >50th centile vs <50th centile", "SP vs No SP", "RR 0.81 (0.65 to 1.02)", "RR 0.83 (0.66 to 1.04)", "Individual (sex, hand grip strength test)"], ["TSB: >75th centile vs <75th centile", "RR 1.04 (0.70 to 1.55)", "RR 1.02 (0.78 to 1.32)", "Individual (sex, weight squared, height, BMI, waist-to-height ratio, contact/collision sport, 10×5 m shuttle run, hand grip strength test, Andersen test)"], ["TSB: >90th centile vs <90th centile", "RR 0.83 (0.54 to 1.29)", "RR 0.82 (0.52 to 1.28)", "Individual (sex, height, BMI, hand-grip strength test, Andersen test)"], ["Aartun 2016168xiv", "Denmark, School students", "n=906, 11– 15y (NR±NR)", "2y, n=625 (F50.2%), 95.8%", "TSB: >75th centile vs <25th centile", "SP, 1–3 sites vs No SP", "RR 0.99 (0.94 to 1.05)", "–", "–"], ["SP, 2–3 sites vs SP, 0–1 sites", "RR 1.04 (0.92 to 1.18)", "–", "–"], ["SP, often or sometimes vs SP, never or once or twice", "RR 1.01 (0.89 to 1.15)", "–", "–"], ["SP, often vs SP, never or once or twice or sometimes", "RR 0.98 (0.72 to 1.34)", "–", "–"], ["Brink 2009169xv", "South Africa, School students", "n=104, 15–17y (16.0±0.7)", "6m, n=93 (F43.3%), 89.4%", "Computer: ≥105 m/d vs <105 m/d", "UQMP, last m vs No UQMP", "OR 1.70 (0.7 to 4.2)", "–", "–"], ["F", "OR 0.50 (0.1 to 4.3)", "–", "–"], ["M", "OR 1.00 (0.3 to 3.4)", "–", "–"], ["Computer: ≥6 h/w vs <6 h/w", "UQMP, in last m vs No UQMP", "OR 1.60 (0.7 to 3.8)", "–", "–"], ["F", "OR 1.80 (0.4 to 8.7)", "–", "–"], ["M", "OR 0.90 (0.3 to 2.8)", "–", "–"], ["Brink 2015170xv", "South Africa, School students", "n=235, 15–17y (16.3±0.5)", "6m, 12m, n=153 (F73.0%), 89.8%", "Computer: NR vs NA", "No UQMP vs NA", "Mean8.9±5.0 (8.0 to 9.8)", "–", "–"], ["UQMP, <4.5/10 NRS vs NA", "Mean9.1±5.7 (7.4 to 10.9)", "–", "–"], ["UQMP, >4.5/10 NRS vs NA", "Mean8.6±4.1 (6.9 to 10.3)", "–", "–"], ["Brink 2020180xv", "South Africa, School students", "n=211, 15–18y (NR±NR)", "12m, n=153 (NR%), 72.5%", "Computer: >30 m vs <30 m", "UQMP last m, seated related vs No UQMP last m", "–", "OR 0.90 (0.5 to 1.9)", "Individual (change in postural angles from T1 to T2)"], ["de Vitta 2021179xvi", "Brazil, School students", "n=1628, 14–18 y (NR±NR)", "12m, n=757 (F43.8%), 85.6%", "Computer: ≥3 h/d vs <3 h/d", "New LBP, 12m vs No LBP", "OR1.06 (0.75 to 1.49)", "–", "–"], ["TV: ≥3 h/d vs <3 h/d", "OR 0.90 (0.65 to 1.25)", "–", "–"], ["Mobile: ≥3 h/d vs <3 h/d", "OR 1.44 (0.97 to 2.14)", "OR 1.49 (1.11 to2.00)", "Individual (sex, age, skin colour, marital status, clinical mental health, mobile and tablet use, physical activity) and environmental (SES)"], ["Tablet: ≥3 h/d vs <3 h/d", "OR 0.66 (0.21 to 2.11)", "OR 3.21 (1.41to 7.30)"], ["de Vitta 2023178xvi", "Brazil, School students", "n=1628, 14–18y (NR±NR)", "12m, n=140 (F50.3%), 85.6%", "Mobile: ≥3 h/d vs <3 h/d", "New TSP at T2 vs No TSP at T1 or T2", "–", "RR 1.72 (1.08 to2.74)", "Individual (sex, clinical mental health, mobile and tablet use) and environmental (SES, race)"], ["Jones 2003177", "England, School students", "n=1046, 11–14y (NR±NR)", "12m, n=933 (NR%), 89.0%", "TV+computer games: >275 m/d vs <120 m/d", "LBP, new onset, lasting ≥1 d last m vs No LBP last m, or lasting less than 1d", "–", "RR 1.00 (0.6 to 1.8)", "Individual (age, gender)"], ["183–270 m/d vs <120 m/d", "–", "RR 1.20 (0.7 to 1.9)"], ["125–183 m/d vs <120 m/d", "–", "RR 1.00 (0.6 to 1.6)"], ["70–180 m/d vs <120 m/d", "–", "RR 0.90 (0.6 to 1.5)"], ["Noll 2021176xvii", "Brazil, School students", "n=726, 11–16y (NR±NR)", "3y, n=525 (F54.3%), 72.3%", "Computer: ≥6 h/d vs <1 h/d", "BP vs No BP", "RR 1.06 (0.97 to 1.13)", "RR 1.06 (0.99 to 1.14)", "Individual (sex, age, way to carry backpack, sitting computer posture, sitting writing posture, sleeping posture, read/study in bed, sleep h/n, TV h/d, computer h/d) and environmental (parents with back pain)"], ["Computer: 2–5 h/d vs <1 h/d", "RR 0.98 (0.94 to 1.03)", "RR 1.00 (0.96 to 1.05)"], ["TV: ≥6 h/d vs <1 h/d", "RR 1.08 (1.01 to1.14)", "RR 1.07 (1.01 to1.13)"], ["TV: 2–5 h/d vs <1 h/d", "RR 0.95 (0.91 to 0.99)", "RR 0.96 (0.92 to 1.01)"], ["Rosa 2022175xvii", "Brazil, School students", "n=165, NRy (B11.6 G11.4±0.5)", "6y, n=75 (F53.3%), 45.5%", "Computer: ≥6 h/d vs 0–1 h/d", "BP vs No BP", "RR 1.38 (1.17 to1.63)", "RR 1.01 (0.99 to 1.02)", "Individual (sex, age, competitive PA, TV h/d, computer h/d, read/study on bed, sleep posture, lifting posture, backpack carry posture, backpack type) and environmental (parents with back pain)"], ["Computer: 2–5 h/d vs 0–1 h/d", "RR 1.31 (1.17 to1.46)", "RR 1.02 (0.99 to 1.01)"], ["TV: ≥6 h/d vs 0–1 h/d", "RR 1.54 (1.38 to1.72)", "RR 1.56 (1.15 to2.13)"], ["TV: 2–5 h/d vs 0–1 h/d", "RR 1.39 (1.24 to1.56)", "RR 1.40 (0.9 to 1.99)"], ["Siivola 2004171", "Finland, School students", "n=714, 15–18y (NR±NR)", "7y, n=104 (F59.8%), 87.0%", "Computer, playing musical instrument, crafts etc: NR vs NR", "NSP, occasional or weekly in last 6 m vs no NSP, in last 6 m", "RR 1.20 (0.3 to 4.7)", "–", "–"], ["F", "RR 1.50 (0.2 to 11.3)", "–", "–"], ["M", "RR 1.00 (0.1 to 7.4)", "–", "–"], ["Homework: Q2 vs Q1", "NSP, occasional or weekly in last 6 m vs no NSP, in last 6 m", "RR 1.40 (0.7 to 2.9)", "–", "–"], ["F", "RR 1.20 (0.5 to 2.8)", "–", "–"], ["M", "RR 1.60 (0.5 to 5.2)", "–", "–"], ["Homework: Q3 vs Q1", "NSP, occasional or weekly in last 6 m vs no NSP, in last 6 m", "RR 1.00 (0.5 to 2.0)", "–", "–"], ["F", "RR 1.10 (0.5 to 3.2)", "–", "–"], ["M", "RR 0.90 (0.2 to 3.3)", "–", "–"], ["Homework: Q4 vs Q1", "NSP, occasional or weekly in last 6 m vs no NSP, in last 6 m", "RR 1.10 (0.6 to 2.3)", "–", "–"], ["F", "RR 1.60 (0.6 to 4.7)", "–", "–"], ["M", "RR 1.40 (0.4 to 5.2)", "–", "–"], ["Reading, listening to music, etc: NR vs NR", "NSP, occasional or weekly in last 6 m vs no NSP, in last 6 m", "RR 1.00 (0.4 to 2.4)", "–", "–"], ["F", "RR 0.60 (0.1 to 2.5)", "–", "–"], ["M", "RR 1.60 (0.5 to 5.3)", "–", "–"], ["Smith 2017172", "Australia, Western Australian Pregnancy Cohort (Raine)", "n=1608, 14 −17y (NR±NR)", "3y, n=1088 (F35.3%), 67.7%", "Computer: 0,<7, 7–14, 14–21,>21 h/w", "No LBP, LBP with minimal impact and LBP with impact", "–", "P value, p=0.40", "Individual (Sex, back pain at 14 years)"], ["TV: 0,<7, 7–14, 14–21,>21 h/w", "–", "P value, p=0.57"], ["Szita 2018173", "Hungary, School students", "n=NR, 7–16 y (11.8±1.8)", "5y, n=NR (F52.0%), NR%", "Computer &/or gaming, weekdays: >2 v. <2 h/d", "SP, nonspecific for days vs NR", "OR 1.36 (0.67 to 2.76)", "ORNR (NR)", "Individual (age >12 years, no sports activity, asymmetrical school bag, carrying school bag tiring, uncomfortable school desk, frequent sleeping problems, general discomfort, frequent missing from school,) and environmental (afternoon learning>2 hrs/day, TV>2 hours weekdays, TV>2 hours weekend days, uncomfortable school desk, spinal disorder among relatives)"], ["Computer &/or gaming, weekends: >2 v. <2 h/d", "OR 0.91 (0.59 to 1.39)", "ORNR (NR)"], ["Homework (Afternoon learning): >2 v. 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