Sedentary behavior and neck pain in children and adolescents; a systematic review and meta-analysis

Background: Sedentary behavior (SB) is considered a risk factor for musculoskeletal pain. We aimed to explore the association of sedentary behavior indicators with neck pain among children and adolescents.Methods: A comprehensive review was performed in different databases until the end of January 2022. Odds ratios (ORs) with 95% confidence intervals were used as desired effect sizes to evaluate the association between prolonged screen time or mobile phone (MP) usage and neck pain risk.Results: Among 1651 records, 15 cross-sectional studies were included in the systematic review, and 7 reports were included in the meta-analysis. Our results suggested a significant relationship between prolonged MP use and neck pain (OR = 1.36, 95% CI = 1.001-1.85, I2= 40.8%, P value for heterogeneity test = 0.119). Furthermore, a marginally insignificant association was found between prolonged screen time and neck pain (OR = 1.13, 95% CI = 0.98-1.30, I2= 60.3%, P value = 0.01); however, after sensitivity analysis and removing one study, this association became significant (OR = 1.30, 95% CI = 1.03-1.64). Moreover, a significant association between prolonged sitting time and neck pain was reported in two studies.Conclusion: Available good-quality evidence reveals a significant mild association between sedentary behavior and the risk of neck pain among children and adolescents. However, longitudinal studies with objective measurement tools are warranted. In particular, potential preventive educational programs are suggested for pediatrics to reduce sedentary behavior and neck pain.