Effect of School-Based Posture Correction Programs on Musculoskeletal Pain: Cluster Randomized

Abstract

Background: Musculoskeletal pain is increasingly reported among school-aged children, largely attributed to poor posture, prolonged sitting, and inadequate ergonomic conditions within classrooms. Early postural deviations during growth years may contribute to persistent discomfort and long-term musculoskeletal problems. School-based preventive strategies offer a practical opportunity to address these issues within a structured and accessible environment.

Objective: This study aimed to evaluate the effect of a structured school-based posture correction program on musculoskeletal pain and postural behavior among schoolchildren in Hyderabad, Sindh.

Methods: A cluster randomized controlled trial was conducted across ten schools in Hyderabad over an eight-month period. Schools were randomized into intervention and control clusters. Children aged 9–14 years reporting musculoskeletal pain were included. The intervention group received a physiotherapist-led posture correction program comprising posture education, ergonomic advice, and simple corrective exercises delivered twice weekly for 12 weeks, while the control group continued routine school activities. Musculoskeletal pain prevalence and intensity were assessed using a modified Nordic Musculoskeletal Questionnaire and Visual Analog Scale. Postural behavior was evaluated using a standardized posture behavior questionnaire. Data were analyzed using chi-square tests, t-tests, and generalized estimating equations, assuming normal distribution.

Results: A total of 612 students completed the study. Pain prevalence in the intervention group reduced from 46.4% to 26.3%, compared with a marginal reduction from 45.1% to 41.8% in the control group (p < 0.001). Mean pain intensity decreased significantly in the intervention group (4.7 ± 1.6 to 2.3 ± 1.4), while minimal change was observed in controls. Postural behavior scores improved significantly only in the intervention group (p < 0.001).

Conclusion: School-based posture correction programs effectively reduced musculoskeletal pain and improved postural habits among schoolchildren. Integrating preventive physiotherapy into school health initiatives may support early musculoskeletal health promotion.

Keywords: Children, Musculoskeletal Pain, Posture, Preventive Physiotherapy, School Health Services, Students, Syndromes