JORR
Journal of Orthopedics Research and Rehabilitation

The Journal of Orthopedics Research and Rehabilitation welcomes scholarly papers in orthopaedic surgery, physical therapy and rehabilitation, physiotherapy, neurology and clinic anesthesiology and reanimation.

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Original Article
Behavioral and psychosocial correlates of multisite musculoskeletal symptoms in university students: green-space use, physical activity, and perceived stress
Abstract
Aims: This study examined behavioral, psychosocial, and environmental correlates of recent multisite musculoskeletal symptom burden among university students, with particular attention to green-space access and use, physical activity, and perceived stress.
Methods: This cross-sectional study included 619 students aged 18–30 years at Selçuk University in Konya, Turkiye. Data were collected in March–April 2026 using an anonymous online questionnaire. The primary outcome was the number of anatomical regions with symptoms during the previous 4 weeks. Perceived green-space access was assessed using a four-item composite, and recent green-space use was measured as the number of visit days during the previous 7 days. Direct associations were evaluated using negative binomial regression, with zero-inflated negative binomial models as sensitivity analyses. Exploratory pathway-oriented analyses estimated indirect statistical associations through physical activity and perceived stress.
Results: Overall, 353 students (57.0%) reported at least one 4-week musculoskeletal symptom. The neck (34.6%), low back (24.7%), shoulders (23.7%), and upper back (23.4%) were the most frequently affected regions. Neither perceived green-space access nor visit frequency was directly associated with symptom burden. Green-space visit frequency was positively associated with log-transformed total physical activity (β = 0.296; p < 0.001). Log-transformed physical activity (IRR = 1.11; p = 0.002) and perceived stress (IRR = 1.05; p < 0.001) were positively associated with symptom burden. A positive indirect statistical association through physical activity was observed (estimate = 0.0306; 95% CI, 0.0114–0.0538; p < 0.001), whereas the indirect association through perceived stress was not significant.
Conclusion: Multisite musculoskeletal symptom burden was common among university students. Green-space access and visit frequency were not directly associated with symptom burden, whereas physical activity and perceived stress showed positive cross-sectional associations. Student musculoskeletal health assessments should therefore consider activity context and psychosocial factors rather than assume a direct protective effect of green-space access or use.

Keywords : Young adult, pain, environment, cross-sectional studies, health behavior

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Ethical Statement

Approved by the Selçuk University Faculty of Health Sciences Non-interventional Clinical Researches Ethics Committee (Date: 04.02.2026, Decision No: 2026/89).

Informed Consent

Electronic informed consent was obtained from all participants through Google Forms before they accessed the anonymous online questionnaire. Participants were informed about the study aims, procedures, and voluntary nature of participation. Only participants who provided electronic consent proceeded to the questionnaire. No handwritten signatures were obtained.

Author Contributions

Concept: MAG, MBG; Design: MAG, MBG; Control: MAG; Resources: MAG, MBG; Data Collection and/or Processing: MAG, MBG; Analysis and/or Interpretation: MAG, MBG; Literature Review: MAG, MBG; Writing the Article: MAG, MBG; Critical Review: MAG, MBG; Final Approval of the Manuscript: MAG, MBG; Visualization: MAG.

Conflict of Interest

The authors declare no conflicts of interest related to this study.

Financial Disclosure

The authors received no financial support for the conduct or publication of this research.


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Article available in :
Volume 4, Issue 4, 2026
Page : 92-100
https://doi.org/10.51271/JORR-0079
Article Information
Received : 04 Ağu 2026
Accepted : 25 Eki 2026
Published : 28 Eki 2026
Corresponding Author :

Mehmet Akif Güler: Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selçuk University, Konya, Turkiye

[email protected]
Citation : Güler MA, Güler MB. Behavioral and psychosocial correlates of multisite musculoskeletal symptoms in university students: green-space use, physical activity, and perceived stress. J Orthop Res Rehabil. 2026;4(4):92-100. doi:10.51271/JORR-0079

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