The complex and limited understanding of the interactions among multiple factors associated with back pain occurrence among schoolchildren might explain the current inconclusive and contradictory findings on the issue. The global increase in the prevalence of childhood overweight and obesity, which reportedly affects children's physical abilities, calls for concern among school/children ergonomists and other stakeholders.
The study analysed backpack-related back pain in school children by investigating the possibility of multiple interactions among causative factors, which may be responsible for the non-conclusive findings on the issue. Using data from 444 prepubescent schoolchildren, a mixed method design combining survey, observation and direct measurement strategies was implemented. Using a multivariate structural equation modelling approach, the study investigated interactions among anthropometry, posture, backpack volume, rating and back pain constructs, with each construct made of 2-4 indicators. Additionally, regression analysis was used to determine the feasibility of considering the two additional factors of age and body mass index along with the globally accepted recommendation of a load of 10-15% of body weight. Our model demonstrated an acceptable model fit and revealed direct and indirect effects of the factors. Obese children were recommended to carry a one-third lighter load than other children. The application of systematic/multiple strategies provided an explanation for some of the issues associated with school children's backpack-related back pain.