title: Backpacks. Several factors likely to influence design and usage: a systematic literature review.
abstract: OBJECTIVE
  The purpose of this study was to systematically review the literature to answer three questions: 1) what is the best backpack positioning on the spine; 2) what are the human effects of front packs and double packs compared to backpacks; and 3) what is best shoulder strap design.
  
  
  METHODS
  A systematic review of the literature using eight databases was carried out. Studies relevant to backpack design were retrieved. Two independent reviewers assessed the papers; a third party was used for consensus decisions. Descriptive characteristics, type of research design and level of evidence of papers were evaluated with a view to pooling data. The trials were also quality appraised using a modified Crombie tool.
  
  
  RESULTS
  Thirty papers met the inclusion criteria. There were similarities in methods of measurement between some papers but subject's age group, tasks performed and backpack usages were so different between studies that it prevented data pooling and made it difficult to draw firm generic conclusions. Subsequent qualitative analysis shows that there are conflicting results on best backpack placement and shoulder strap design but front packs and double packs provide better posture than backpacks.
  
  
  CONCLUSIONS
  Some recommendations for best practice design are made for children and adults based on elements of design and correct spinal placement.
authors.affiliation: School of Chiropractic and Sports Science, Murdoch University, Murdoch Western Australia, Australia. Samiraa g@yahoo.com
authors.forename: Samira
authors.initials: S
authors.lastname: Golriz
authors.forename: Bruce
authors.initials: B
authors.lastname: Walker
mesh_terms: D000328:Adult; D019567:Back Injuries / Q000517:prevention & control*; D003020:Clothing; D006801:Humans; D004856:Postural Balance; D014195:Travel; D016474:Weight-Bearing