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Worse health status, sleeping problems, and anxiety in 16-year-old students are associated with chronic musculoskeletal pain at three-year follow-up
Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.ORCID iD: 0000-0001-9918-461X
University of Southern Denmark, Odense, Denmark & University Hospital of Southern Denmark, Sønderborg, Denmark & Lund University, Lund, Sweden.ORCID iD: 0000-0002-8081-579X
Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS).ORCID iD: 0000-0002-9337-5113
Spenshult Research and Development Center, Halmstad, Sweden.
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2019 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, no 1, article id 1565Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Chronic musculoskeletal pain is common in adolescents, and it has been shown that adolescents with pain may become young adults with pain. Pain often coincides with psychosomatic symptoms in adults, but little is known about longitudinal associations and predictors of pain in adolescents. The aim was to investigate chronic musculoskeletal pain and its associations with health status, sleeping problems, stress, anxiety, depression, and physical activity in 16-year-old students at baseline, and to identify risk factors using a three-year follow-up.

METHODS: This was a longitudinal study of 256 students attending a Swedish upper secondary school. Questionnaires regarding chronic musculoskeletal pain and distribution of pain (mannequin), health status (EQ-5D-3 L), sleeping problems (Uppsala Sleep Inventory), stress symptoms (single-item question), anxiety and depression (Hospital Anxiety and Depression Scale), and physical activity (International Physical Activity Questionnaire) were issued at baseline and follow-up. Student's t-test and chi2 test were used for descriptive statistics and logistic regression analyses were used to study associations between chronic pain and independent variables.

RESULTS: Fifty-two out of 221 students at baseline (23.5%) and 39 out of 154 students at follow-up (25.3%) were categorized as having chronic musculoskeletal pain. Chronic musculoskeletal pain at follow-up was separately associated with reporting of an EQ-5D value below median (OR 4.06, 95% CI 1.83-9.01), severe sleeping problems (OR 3.63, 95% CI 1.69-7.82), and possible anxiety (OR 4.19, 95% CI 1.74-10.11) or probable anxiety (OR 3.82, 95% CI 1.17-12.48) at baseline. Similar results were found for associations between chronic musculoskeletal pain and independent variables at baseline. In multiple logistic regression analysis, chronic musculoskeletal pain at baseline was a predictor of chronic musculoskeletal pain at follow-up (OR 2.99, 95% CI 1.09-8.24, R2 = 0.240).

CONCLUSION: Chronic musculoskeletal pain at baseline was the most important predictor for reporting chronic musculoskeletal pain at the three-year follow-up, but a worse health status, severe sleeping problems, and anxiety also predicted persistence or development of chronic musculoskeletal pain over time. Interventions should be introduced early on by the school health services to promote student health.

Place, publisher, year, edition, pages
London: BioMed Central, 2019. Vol. 19, no 1, article id 1565
Keywords [en]
Adolescent, Anxiety, Chronic musculoskeletal pain, Epidemiology, Health status, Sleep, Student
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-41079DOI: 10.1186/s12889-019-7955-yISI: 000505960700004PubMedID: 31771551Scopus ID: 2-s2.0-85075688564OAI: oai:DiVA.org:hh-41079DiVA, id: diva2:1374835
Note

The study was supported financially by Halmstad University; The Swedish Rheumatism Association; and Region Halland (grant number HALLAND-469111), Sweden.

Available from: 2019-12-03 Created: 2019-12-03 Last updated: 2023-08-28Bibliographically approved
In thesis
1. Pain and health in adolescents and young adults – pieces of a puzzle
Open this publication in new window or tab >>Pain and health in adolescents and young adults – pieces of a puzzle
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Musculoskeletal pain is a burden for the individual and for society, and it has a negative impact on overall health. The biological, psychological, and social factors that govern pain and health form a complex puzzle to put together. Musculoskeletal pain conditions may be alleviated by physical activity, but a too high level of physical activity may also increase the risk of pain. Youth athletes may be especially vulnerable to developing pain due to factors related to training load and physical maturity. Being physically active and maintaining a healthy diet is associated with better health, but if carried out to excess these health behaviours may become unhealthy. Our understanding of musculoskeletal pain and health in adolescents and young adults needs to be developed, both in individuals involved in sports and exercise and in the general population.

Aim: The overall aim was to study musculoskeletal pain and its relationship to various health-related factors in adolescents and young adults enrolled in sport or general education programmes.

Methods: Study I was a cross-sectional study on university students (aged 19–29) from an exercise science programme (n = 118) and a business programme (n = 89), assessing health status, physical activity, and orthorexia nervosa (an exaggerated fixation on healthy food). Study II was a cross-sectional study (n = 178), and Study III a 2-year longitudinal (n = 131) study on sport school students (aged 14 at baseline), assessing musculoskeletal pain, health status, physical maturity, and sports performance. Study IV was a 3-year longitudinal study on students from a general upper secondary school (n = 256, aged 16 at baseline), assessing chronic musculoskeletal pain, health status, physical activity, sleep, stress, anxiety, and depression.

Results: In Study I, compared to business students, exercise science students reported more pain, but better general health. A high level of physical activity in combination with orthorexia nervosa was most prevalent in men from the exercise science programme. In Studies II and III, pain was common in sport school students. At baseline, boys with constant pain were not as physically mature as boys with infrequent pain. Students with constant pain reported a worse health status than students with infrequent pain. At follow-up, frequent pain, frequent pain in two or more body regions, and a worse health status at baseline were identified as risk factors for having frequent pain at follow-up in girls. For boys, late physical maturation at baseline was a risk factor. Involvement in non-contact sports was also an identified risk factor over time in both sexes. Pain was associated with a worse sports performance in boys at both baseline and follow-up. In Study IV, chronic musculoskeletal pain was common in students from a general upper secondary school. A worse health status, severe sleeping problems, anxiety, and chronic musculoskeletal pain at baseline were associated with reporting chronic musculoskeletal pain at follow-up.

Conclusions: Pain was prevalent, and also persistent, in adolescents and young adults, irrespective of attending sport or general education programmes. Pain is a biopsychosocial phenomenon and must be treated as such. Pain should be frequently monitored, and treatment should be introduced early on to prevent pain from becoming persistent.

Place, publisher, year, edition, pages
Halmstad: Halmstad University Press, 2020. p. 113
Series
Halmstad University Dissertations ; 73
Keywords
musculoskeletal pain, health status, physical activity, orthorexia nervosa, sports, sleep, stress, anxiety, depression, physical maturity, students, school, biopsychosocial
National Category
Health Sciences
Identifiers
urn:nbn:se:hh:diva-43044 (URN)978-91-88749-54-3 (ISBN)978-91-88749-55-0 (ISBN)
Public defence
2020-10-09, Baertlingsalen, Visionen (hus J), Kristian IV:s väg 3, Halmstad, 13:00 (Swedish)
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Available from: 2020-09-08 Created: 2020-09-04 Last updated: 2021-03-26Bibliographically approved

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Malmborg, Julia SBremander, AnnOlsson, M. CharlotteBergman, Stefan

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