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Effect of School-Based Posture Screening on Postural Abnormality Detection among Secondary School Students in Nigeria

Abstract

Postural abnormalities remain an important musculoskeletal health concern among secondary school students in Nigeria and may be associated with prolonged sitting, inappropriate school furniture, heavy schoolbags, poor sitting and standing habits, inadequate physical activity, and other lifestyle and environmental factors. During adolescence, rapid physical growth and changes in musculoskeletal development may increase the importance of early identification of abnormal posture. Postural abnormalities that remain undetected may contribute to back pain, neck discomfort, muscular imbalance, reduced physical function, and other musculoskeletal problems later in life. School-based posture screening provides an opportunity to identify postural abnormalities among students through systematic assessment conducted within schools by trained healthcare professionals, physiotherapists, or other qualified personnel. Early detection may facilitate posture education, corrective exercises, ergonomic adjustments, physical activity recommendations, and referral for further clinical assessment where necessary. However, inadequate school health programmes, limited availability of trained personnel, insufficient screening equipment, low awareness among students and parents, and weak referral and follow-up systems may limit the effectiveness of school-based posture screening in Nigeria. Against this background, this study investigates the effect of school-based posture screening on postural abnormality detection among secondary school students in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and the Health Systems Framework. The Health Belief Model explains how students' and parents' perceptions of susceptibility to postural abnormalities, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in posture screening. The Social Ecological Model emphasizes the influence of individual, interpersonal, school, community, and environmental factors on posture-related behaviours and musculoskeletal health. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective school-based health screening programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how school-based posture screening may influence postural abnormality detection among secondary school students in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise students enrolled in selected public and private secondary schools across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, schools, classes, and eligible students. School-based posture screening will be measured using indicators such as availability of posture screening programmes, screening coverage, frequency of screening activities, postural assessment procedures, availability of trained physiotherapists or other qualified healthcare personnel, screening equipment, posture education, ergonomic assessment of school furniture, physical activity education, and referral arrangements. Postural abnormality detection will be assessed using indicators such as abnormal spinal alignment, forward head posture, rounded shoulders, excessive thoracic kyphosis, excessive lumbar lordosis, scoliosis-related signs, pelvic asymmetry, lower-limb alignment abnormalities, newly identified postural abnormalities, severity of detected abnormalities, referrals for further assessment, and recommendations for corrective intervention. Data will be collected using structured questionnaires, school screening registers, postural assessment forms, student health records, physiotherapy assessment records, referral registers, and relevant school health programme documents. Descriptive statistics will be used to summarize students' characteristics, screening coverage, postural assessment findings, and patterns of postural abnormality detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of school-based posture screening on postural abnormality detection. Where appropriate, postural abnormality detection rates before and after implementation of school-based posture screening programmes may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that school-based posture screening has a significant positive effect on postural abnormality detection among secondary school students in Nigeria. Students who participate in school-based posture screening are expected to have a higher likelihood of having previously unrecognized postural abnormalities identified than students without access to routine posture screening. Systematic assessment may facilitate early recognition of abnormal spinal and body alignment and provide opportunities for posture education, corrective exercises, ergonomic modifications, physical activity recommendations, and appropriate clinical referral. Screening within schools may reduce geographical, financial, and time-related barriers while providing access to preventive musculoskeletal health services during an important stage of physical development. School-based screening may also increase students' awareness of appropriate sitting, standing, lifting, and schoolbag practices. Conversely, inadequate screening coverage, shortage of trained personnel, limited assessment resources, low student participation, insufficient parental awareness, and weak referral and follow-up systems may reduce the effectiveness of school-based posture screening. The study therefore expects accessible and well-organized school-based posture screening to contribute significantly to improved detection and early management of postural abnormalities among secondary school students in Nigeria. The study is expected to contribute to the literature on school-based posture screening, postural abnormality detection, adolescent musculoskeletal health, physiotherapy, school health services, ergonomic health, preventive healthcare, physical activity, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Federal Ministry of Education, state ministries of health and education, secondary schools, physiotherapists, healthcare providers, school health coordinators, parents, development partners, and policymakers regarding strategies for improving musculoskeletal health among students. The study will also provide evidence-based recommendations for expanding school-based posture screening programmes, strengthening training and deployment of physiotherapists and other qualified healthcare personnel, improving posture and ergonomic education, promoting appropriate school furniture and seating arrangements, encouraging physical activity, strengthening referral and follow-up systems, increasing student and parental awareness, and integrating posture assessment into comprehensive school health programmes across Nigeria.

Keywords: School-based posture screening, postural abnormality detection, secondary school students, adolescent musculoskeletal health, posture assessment, physiotherapy, ergonomic health, school health services, preventive healthcare, physical activity, Nigeria, public health.