The effects of backpack load and placement on postural deviation in healthy students: A systematic review

Background: Knowledge about the appropriate load and placement of a backpack for children is thought to be important in reducing both immediate and future musculoskeletal problems in students. The purpose of this systematic review is to investigate the evidence related to effects of backpack load and placement on postural deviation in healthy students. Methods: Six electronic databases were systematically searched to identify studies that reported the effects of backpack load and placement on postural deviation in healthy students in June 2012. All study designs and years of publication were included. Search results were selected based on relevance to the topic; participants should be healthy, aged between 6 and 12 years, and the full text available in English. Level of evidence for each article was determined based on NHMRC Evidence Hierarchy (2009), while the quality ofeach article was assessed using a modified PEDro and modified Downs & Black scales (1998). Results: Seventy relevant articles were identified, of which eleven articles metinclusion and exclusion criteria and six were deemed appropriate for review. Only one article was categorized as Level II hierarchy of evidence. One randomised control article was classified as highquality using the modified PEDro scale and five non-randomised control articles were classified as intermediate quality using modified Downs & Black checklist. Results on appropriate load limit seemed to meet the consensus but the appropriate load placement was inconsistent between articles. Further investigation is urgently required to identify appropriate load and placement of backpacks for school students. Conclusions: Most articles have shown that the appropriate load limit for students is between 10%-15% BW. However, lack of articles, the low hierarchy of evidence, inconsistent results, and small sample size are the limitations for recommending the appropriate load placement of backpacks in students