Low back pain prevention's effect in schoolchildren: What is the evidence?

Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Gent, Belgium.
European Spine Journal (Impact Factor: 2.07). 01/2005; 13(8):663-79. DOI: 10.1007/s00586-004-0749-6
Source: PubMed


Given the high prevalence rates of back pain, as early as in childhood, there has been a call for early preventive interventions. To determine which interventions are used to prevent back problems in schoolchildren, as well as what the evidence is for their utility, the literature was searched to locate all investigations that used subjects under the age of 18 and not seeking treatment. Included investigations were specifically designed as an intervention for low back pain (LBP) prevention. Additionally, a literature search was performed for modifiable risk factors for LBP in schoolchildren. The literature-update search was performed within the scope of the "COST Action B13" of the European Commission, approved for the development of European guidelines for the management of LBP. It was concluded that intervention studies in schoolchildren focusing on back-pain prevention are promising but too limited to formulate evidence-based guidelines. On the other hand, since the literature shows that back-pain reports about schoolchildren are mainly associated with psychosocial factors, the scope for LBP prevention in schoolchildren may be limited. However, schoolchildren are receptive to back-care-related knowledge and postural habits, which may play a preventive role for back pain in adulthood. Further studies with a follow-up into adulthood are needed to evaluate the long-term effect of early interventions and the possible detrimental effect of spinal loading at young age.

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    • "Consequently, in a future study, two hours of media consumption should be used as the cut-off point. According to the present study, the type of schoolbag was reported to have no influence on LBP [7,15,29]. However, the presence of back pain in general was conversely influenced for girls and boys in the present study. "
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    ABSTRACT: The key to a better understanding of the immense problem of spinal pain seems to be to investigate its development in adolescents. Based on the data of Spine Day 2012 (an annual action day where Swiss school children were examined by chiropractors on a voluntary basis for back problems), the aim of the present study was to gain systematic epidemiologic data on adolescent spinal pain in Switzerland and to explore risk factors per gender and per spinal area. Data (questionnaires and physical examinations) of 836 school children were descriptively analyzed for prevalence, recurrence and severity of spinal pain. Of those, 434 data sets were included in risk factor analysis. Using logistic regression analysis, psycho-social parameters (presence of parental back pain, parental smoking, media consumption, type of school bag) and physical parameters (trunk symmetry, posture, mobility, coordination, BMI) were analyzed per gender and per spinal area. Prevalence of spinal pain was higher for female gender in all areas apart from the neck. With age, a steep increase in prevalence was observed for low back pain (LBP) and for multiple pain sites. The increasing impact of spinal pain on quality of life with age was reflected in an increase in recurrence, but not in severity of spinal pain. Besides age and gender, parental back pain (Odds ratio (OR)=3.26, p=0.011) and trunk asymmetry (OR=3.36, p=0.027) emerged as risk factors for spinal pain in girls. Parental smoking seemed to increase the risk for both genders (boys: OR=2.39, p=0.020; girls: OR=2.19, p=0.051). Risk factor analysis per spinal area resulted in trunk asymmetry as risk factor for LBP (OR=3.15, p=0.015), while parental smoking increased the risk for thoracic spinal pain (TSP) (OR=2.83, p=0.036) and neck pain (OR=2.23, p=0.038). The risk for TSP was further enhanced by a higher BMI (OR=1.15, p=0.027). This study supports the view of adolescent spinal pain as a bio-psycho-social problem that should be investigated per spinal area, age and gender. The role of trunk asymmetry and passive smoking as risk factors as well as the association between BMI and TSP should be further investigated, preferably in prospective studies.
    Full-text · Article · Oct 2013 · BMC Pediatrics
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    • "Programs for the prevention of LBP and discomfort have mainly been carried out on the adult population [12-15], fundamentally due to the associated expenses that this disorder generates. In recent decades, as a result of the increase in morbidity of back problems in children and adolescents, a need has been detected to develop preventive interventions for this population group [16]. In answer to this need, the European Region of the World Confederation for Physical Therapy (ER-WCPT) has recently published the results of a study carried out in the European Union [17]. "
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    ABSTRACT: Background Preventive interventions improve healthy behaviours and they also increase knowledge regarding back care in children and adolescents, but studies exhibit great variability in their contents, duration and number of sessions, and in the assessment methods. The purpose of this study was to review the empirical evidence regarding preventive physiotherapy interventions for back care in children and adolescents, and to ascertain the most efficacious treatments, in what way and under which circumstances. Methods Studies were located from computerized databases (Cochrane Library, Medline, PEDro, Web of Science and IME) and other sources. The search period extended to May 2012. To be included in the meta-analysis, studies had to use physical therapy methodologies of preventive treatment on children and adolescents, and to compare a treatment and a control group. Treatment, participant, methodological, and extrinsic characteristics of the studies were coded. Two researchers independently coded all of the studies. As effect size indices, standardized mean differences were calculated for measures of behaviours and knowledge, both in the posttest and in the follow-up. The random and mixed-effects models were used for the statistical analyses and sensitivity analyses were carried out in order to check the robustness of the meta-analytic results. Results A total of 19 papers fulfilled the selection criteria, producing 23 independent studies. On average, the treatments reached a statistically significant effectiveness in the behaviours acquired, both in the posttest and in the follow-up (d+ = 1.33 and d+ = 1.80, respectively), as well as in measures of knowledge (posttest; d+ = 1.29; follow-up: d+ = 0.76). Depending on the outcome measure, the effect sizes were affected by different moderator variables, such as the type of treatment, the type of postural hygiene, the teaching method, or the use of paraprofessionals as cotherapists. Conclusions The interventions were successful in significantly increasing the behaviours and knowledge acquired both in the posttest and in the follow-up. The combined treatment of postural hygiene with physiotherapy exercise exhibited the best results. The small number of studies limits the generalizability of the results.
    Full-text · Article · Aug 2012 · BMC Musculoskeletal Disorders
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    • "Durante muchos años, se ha considerado el dolor lumbar inespecífico (DLI) como poco común en la infancia, llegándose a pensar que dicho síntoma era casi siempre debido a serias enfermedades subyacentes (King, 1986; citado en Salminen et al., 1992b; Combs & Caskey, 1997; Cardon & Balagué, 2004). "
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    ABSTRACT: Objetivo. Evaluar el nivel de conocimiento sobre la salud y cuidado de la espalda relacionado con la práctica de ejercicio físico en chicas y chicos de ESO y Bachillerato de la Comunidad Valenciana. Antecedentes. Actualmente, se estima que la prevalencia del dolor lumbar inespecífico en niños y adolescentes es elevada. Este índice incrementa constantemente con la edad, apareciendo más pronto y de forma más común en las chicas que en los chicos [ ]. Programas de intervención en escolares que incluyeron la evaluación de los conocimientos sobre el cuidado de la espalda [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20], ratifican que la educación de la espalda a través del currículum de primaria resulta ser una estrategia eficaz para mejorar el aspecto cognitivo del cuidado de la espalda hasta la adolescencia. A pesar de ello, no existen guías o pautas específicas para enseñar la mecánica del cuerpo y la postura en la escuela primaria [2, 3] y la literatura existente es escasa [10]. Métodos. Una muestra de 440 alumnos de ESO y Bachiller cumplimentó el cuestionario de conocimientos sobre la salud y el cuidado de la espalda relacionado con la práctica de ejercicio físico (CoSaCuEs-EF). Resultados. Las chicas obtuvieron una media de resultados de 3.15 (DT= 2.35), mientras que los chicos obtuvieron una media de resultados de 3.20 (DT= 2.51). Los alumnos con peores resultados fueron los de 13 años (1.90; DT= 2.66) y los que mejores resultados consiguieron fueron los alumnos de 17 años (3.67; DT= 2.47). Conclusión. Los alumnos de ESO y Bachiller poseen un nivel de conocimientos específicos sobre la salud y el cuidado de la espalda relacionados con la práctica de ejercicio físico bajos. Palabras calve. Adolescentes, conocimientos, salud de la espalda, ejercicio físico.
    Full-text · Conference Paper · Jun 2012
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