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How Schooling and Lifestyle Factors Effect Neck and Shoulder Pain? A Cross-sectional Survey of Adolescents in China

Shan, Zhi MD*,†; Deng, Guoying MD*; Li, Jipeng MD*; Li, Yangyang MD*; Zhang, Yongxing MD*; Zhao, Qinghua MD*

doi: 10.1097/BRS.0000000000000124

Study Design. A cross-sectional survey by anonymous self-assessment questionnaire was given to 3600 high school students from 30 high schools.

Objective. The purpose of this study was to analyze the prevalence of neck and shoulder pain (NSP) and its effects among high school students in Shanghai, China.

Summary of Background Data. NSP has become a problem in many countries in recent years among adolescents. No recent studies have estimated the prevalence of NSP in Chinese school populations.

Methods. A total of 3600 high school students from all 3 grades chosen from 30 random schools participated in this study. Participants were asked to fill out a questionnaire on NSP and to provide information on demographic items, family factors, schooling, and lifestyles. χ2 tests were used to compare the incidence of NSP, univariate and multivariate logistic regression analyses were used to obtain influencing factors of NSP.

Results. In total, 3600 questionnaires were distributed, and 2842 were valid. The cross-sectional prevalence of NSP was 41.1%, with more girls (653 of 1478, i.e., 44.2%) reporting having NSP than boys (514 of 1364, i.e., 37.7%) (odds ratio = 0.764; 95% confidence interval = 0.657–0.888; P < 0.05). The frequency, duration, and degree of NSP in girls were also higher than in boys. For high school years 1, 2, and 3, the incidence of NSP was 40.1%, 40.7%, and 45.4%, respectively. The multivariate logistic regression indicated that sex, family history of NSP, school furniture, long sitting time, computer use, insufficient rest time, sleep time, commuting method, perceived schoolbag weight, and smoking had a significant effect on NSP.

Conclusion. The incidence of NSP in high school students in Shanghai is quite high. The occurrence of NSP is related to several factors including sex and school year, as well as some factors related to family, schooling, and lifestyles.

Level of Evidence: 3

A cross-sectional survey concerning the prevalence of neck and shoulder pain (NSP) and its effects among Chinese high school students. The prevalence of NSP was high, especially among girls. Several factors including schooling, lifestyle, and family have effect on the prevalence of NSP.

*Department of Orthopaedic Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; and

Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China.

Address correspondence and reprint requests to Qinghua Zhao, MD, Department of Orthopaedic Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Shanghai 200080, China; E-mail:

Acknowledgment date: May 28, 2013. First revision date: September 1, 2013. Second revision date: October 7, 2013. Acceptance date: November 4, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Class Tutor Program of Shanghai Jiao Tong University, School of Medicine, in contract of 2012006 funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins