Musculoskeletal Complaints Among 11-Year-Old Children and Associated Factors

The PIAMA Birth Cohort Study

Gerben Hulsegge; Sandra H. van Oostrom; H. Susan J. Picavet; Jos W. R. Twisk; Dirkje S. Postma; Marjan Kerkhof; Henriëtte A. Smit; Alet H. Wijga


Am J Epidemiol. 2011;174(8):877-884. 

In This Article


The study population consisted of 1,313 girls and 1,325 boys, with an average age of 11 years and 4 months (standard deviation, 2.9 months). Back complaints were reported by 2.8% of the children (2.1% of boys and 3.2% of girls; P > 0.05), upper extremity complaints by 4.8% (3.1% of boys and 6.3% of girls; P < 0.01), lower extremity complaints by 10.9% (10.4% of boys and 11.2% of girls; P > 0.05), and any MSC by 15.8% (14.1% of boys and 17.1% of girls; P < 0.05). One percent of the children visited a physician because of their back complaints, 2.2% because of upper extremity complaints, 5.7% because of lower extremity complaints, and 7.9% because of any MSC. Baseline characteristics in the original data set and the multiply imputed data set were very similar (Table 1).

Mental health status was the only variable that was significantly (P < 0.05) associated with all types of MSC in the multivariable analyses; poorer mental health was associated with more MSC (Table 2). Taking all MSC together, a poorer mental health score (odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.75, 0.92), advanced pubertal status (OR = 1.36, 95% CI: 1.09, 1.70), the presence of daytime tiredness (OR = 1.60, 95% CI: 1.18, 2.15), being physically active at age 11 years (OR = 1.28, 95% CI: 1.02, 1.60), and higher weight (weight-for-height z score) (OR = 1.12, 95% CI: 1.01, 1.25) were significantly associated with more MSC.

For lower extremity complaints, associations were also found with weight gain, the presence of daytime tiredness, and being physically active at age 11 years. In addition, greater numbers of upper extremity complaints were reported by children of non-Western origin. Back complaints were associated only with poorer mental health. In the univariable analyses, the presence of daytime tiredness and advanced pubertal status were also associated with more MSC in 2 of the 3 musculoskeletal locations. Pubertal stage was significantly associated with back complaints in boys (OR = 2.86, 95% CI: 1.14, 7.15) but not in girls (OR = 1.09, 95% CI: 0.65, 1.84), and this sex difference was borderline significant (P = 0.08 for interaction). Parental educational status, height, height gain, television/computer use, and physical activity from ages 5 to 11 years were not significantly associated with any of the outcomes in multivariable analyses.

The directions of the associations—statistically significant or not—did not differ for the different MSC, except for physical activity. Being physically active at age 11 years and always being active from age 5 years to age 11 years were associated with a decreased (though nonsignificant) risk of back complaints and an increased (P < 0.01) risk of lower extremity complaints.

The sensitivity analysis showed similar directions of results and only small differences in odds ratios between the complete-case analyses and the imputed-data analyses.


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