Knowledge on health and back care education related to physical activity and exercise in adolescents

Assessment of the Effects of Physiotherapy on Back Care and Prevention of Non-Specific Low Back Pain in Children and Adolescents: A Systematic Review and Meta-Analysis

Non-specific low back pain (NSLBP) in children and adolescents has increased in recent years, and the evidence of the physiotherapy interventions in back care needs to be updated. Our main goal was to quantify the effects of preventive physiotherapy interventions on improving behavior and knowledge related to back care and prevention of NSLBP in children and adolescents. Based on two previous meta-analyses, Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, PsycINFO, and IME databases and several journals were searched. Two researchers independently extracted data and assessed the risk of bias in the studies using the RoB2 tool. Data were described according to PRISMA guidelines. A total of 24 studies (28 reports) were included. In the posttest, the behavior variable obtained an overall effect size of d+ = 1.48 (95%CI: 0.40 to 2.56), and the knowledge variable obtained an effect size of d+ = 1.41 (95%CI: 1.05 to 1.76). Physiotherapy has demonstrated beneficial impacts on behavior and knowledge concerning back care and to prevent NSLBP in children and adolescents. Interventions focusing on postural hygiene and exercise should be preferred, especially those that are shorter in number of weeks, more intense, and incorporate as many intervention hours as possible.

Back-Health-Related Physical Activity and Exercise Knowledge in Adolescents: A Cross-Sectional Study

Knowledge is a determining factor for the development of postural habits; it could be considered as the first step in the establishment of changes. The aim of this study was to analyze the level of specific back-health-related physical activity and exercise knowledge in adolescents. A cross-sectional study was conducted on a sample of 1500 high school students between the ages of 13 and 18 (mean age = 15.18 ± 1.44). Students from the Valencian Community (Spain) were recruited with a confidence level of 95% and an accepted standard error of ± 2.53%. Self-report questionnaires were used to record back-health-related physical activity knowledge. The level of specific knowledge of back-health education related to physical activity and exercise in adolescents was low (X = 2.05 ± 2.26). Only 10.9% of the students passed the specific knowledge test, achieving a score equal or superior to 5. The boys’ average score was higher (X = 2.17 ± 2.31) than the girls’ (X = 1.94 ± 2.21) with statistically significant differences (p = 0.048). The level of specific knowledge increased with age (p < 0.001). Secondary school students show a low level of specific knowledge concerning back health. It is recommended that back care education be a part of school curriculum.

Effectiveness of physiotherapy interventions for back care and the prevention of non-specific low back pain in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Non-specific low back pain in children and adolescents has increased in recent years. The purpose of this study was to upgrade the evidence of the most effective preventive physiotherapy interventions to improve back care in children and adolescents.

METHODS

The study settings were children or adolescents aged 18 years or younger. Data were obtained from the Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, and PsycINFO databases and the specialized journals BMJ and Spine. The included studies were published between May 2012 and May 2020. Controlled trials on children and adolescents who received preventive physiotherapy for back care were considered. Data on all the variables gathered in each individual study were extracted by two authors separately. Two authors assessed risk of bias of included studies using the RoB2 and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines. To calculate the effect size, a standardized mean difference "d" was used and a random-effects model was applied for the following outcome variables: behaviour, knowledge, trunk flexion muscle endurance, trunk extension muscle endurance, hamstring flexibility and posture.

RESULTS

Twenty studies were finally included. The most common physiotherapy interventions were exercise, postural hygiene and physical activity. The mean age of the total sample was 11.79 years. When comparing the change from baseline to end of intervention in treatment and control groups, the following overall effect estimates were obtained: behaviour d+ = 1.19 (95% CI: 0.62 and 1.76), knowledge d+ = 1.84 (0.58 and 3.09), trunk flexion endurance d+ = 0.65 (-0.02 and 1.33), trunk extension endurance d+ = 0.71 (0.38 and 1.03), posture d+ = 0.65 (0.24 and 1.07) and hamstrings flexibility d+ = 0.46 (0.36 and 0.56). At follow-up, the measurement of the behaviour variable was between 1 and 12 months, with an effect size of d+ = 1.00 (0.37 and 1.63), whereas the knowledge variable obtained an effect size of d+ = 2.08 (-0.85 and 5.02) at 3 months of follow-up.

CONCLUSIONS

Recent studies provide strong support for the use of physiotherapy in the improvement of back care and prevention of non-specific low back pain in children and adolescents. Based on GRADE methodology, we found that the evidence was from very low to moderate quality and interventions involving physical exercise, postural hygiene and physical activity should be preferred.

Knowledge of Low Back Pain among Primary School Teachers

Low back pain (LBP) is a prevalent musculoskeletal disease that affects a large percentage of the working population, including teachers. The World Health Organization has identified the school as an effective environment for improving child health. For this reason, the figure of the teacher is a fundamental piece in the process of knowledge acquisition about postural education and prevention of LBP among schoolchildren. The present study aims to determine the knowledge of postural education and back pain prevention among primary school teachers. This cross-sectional study evaluated 85 primary school teachers from Majorca (Spain), of whom 17.6% were physical education teachers and 82.4% were classroom teachers. The study was based on two different structured and self-administered questionnaires to investigate into specific knowledge about LBP: Low Back Pain Knowledge Questionnaire (LKQ) and COSACUES-AEF Questionnaire. The results demonstrated a lifetime prevalence of LBP of 96.5% with significant differences determined by sex. The knowledge of participants about LBP was 17.3 in LKQ (range scale 0-24) and 4.3 in COSACUES (range scale 1-10). In conclusion, the teachers knowledge is insufficient to carry out an efficient and useful health promotion program among schoolchildren to prevent LBP.

Health questionnaire on back care knowledge and spine disease prevention for 6-10 years old children: development and psychometric evaluation

Background

Back school programs, that improve back care and spine disease prevention knowledge are recommended at the age of 4-14 years. There is Health Questionnaire on Back Care Knowledge in the literature for children aged 14-17 years. At other ages, there is no questionnaire examining this knowledge. We aimed to develop a Health Questionnaire on Back Care and Spine Disease Prevention Knowledge for 6-10 years old children and validate its psychometric properties (internal consistency, test-retest reliability, agreement, convergent validity, discriminant validity) in 6-10 years old children, who attended back school program or not.

Methods

463 children took part in the research (6-10 years old). The development was performed according to the Delphi method. The final version contained 7 questions. 463 participants completed the questionnaire twice with an interval of 7 days to evaluate test-retest reliability. The internal consistency was tested by Cronbach’s alpha value, test–retest reliability was calculated by Intraclass Correlation Coefficients (ICC), Standard Error of Measurement (SEM) and 95% of Minimal Detectable Change (MDC95) and Bland–Altman plots. Convergent validity was tested against the age variable and discriminant validity was tested by Kruskal-Wallis tests among the different subgroups.

Results

Cronbach’s alpha of the total score was (α=0.797), showed a strong internal consistency with minimal SEM (0.606) and MDC95 (1.680). The test-retest result for the total score was strong (0.989), for the questions showed moderate to strong results (0.742-0.975), the limits of agreement of the Bland-Altman plot showed a narrow error of measurement range (-3.49-1.29), and the value of mean differences was −1.10 (SD ± 1.22). The convergent validity showed a weak, but significant relationship between total score and age (R=0.171; p < 0.001). The discriminant validity showed significantly different mean scores in non-back school and back school groups.

Conclusion

For the examination of back care and spine disease prevention knowledge of 6-10 years old children, the questionnaire proved to be a valid and reliable tool. The knowledge requested in the questionnaire covers the knowledge material of the theoretical part of the back school for children aged 4-10 years.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04667-x.

Perspectives of spinal health within the school setting in a South African rural region: A qualitative study

BACKGROUND

Spinal pain is one of the leading causes of morbidity globally. There is an increase in the number of children and adolescents who experience spinal pain and the lifetime prevalence of adolescent spinal pain varies between countries. In Africa, one in two adolescents experiences spinal pain and the prevalence is increasing.

OBJECTIVE

This study reports on the knowledge and perspectives of school-attending children, adolescents, teachers, and parents/guardians regarding spinal health.

METHODS

We conducted a descriptive qualitative case study with an interpretative and phenomenological approach. Data coding, management and analysis was done using ATLAS.ti computer software.

RESULTS

Ninety-three participants (66 women and 27 men) were enrolled in the study. The barriers associated with students' spinal health were multifactorial, including low levels of physical activity, dangerous gameplay, sports risks, poor ergonomics, school bags, insufficient knowledge, and pregnancy risks. Participants proposed strategies to improve spinal health including the provision of students' lockers, advice on appropriate school bag types, embedding spinal education in the curriculum, general advocacy for spinal health, and integration of technology in teaching and learning.

CONCLUSION

There is a need for further engagement on school-based spinal health promotion programs that consider local socio-economic, educational, and cultural factors.

Prevalence of Low Back Pain and Associated Risks in School-Age Children

BACKGROUND

Low back pain (LBP) is highly prevalent in children and adolescents, while psychosocial, anthropometric, developmental, and lifestyle factors have been associated. However, the evidence is inconsistent from a biological point of view, so identifying predictors of LBP in the 6-12 years children through physical examination should be appropriate.

AIMS

To estimate the prevalence of LBP and associated factors in schoolchildren in a Brazilian population.

DESIGN

Cross-sectional study.

SETTING

Three schools in Botucatu, Brazil.

PARTICIPANTS/SUBJECTS

377 students from 6-12 years.

METHODS

Data collection consisted of questions regarding personal history, socioeconomic and anthropometric information, kinesiologic evaluation with anthropometry, lumbar biophotogrammetry, and backpack weight and use. Descriptive analyses were performed, and simple and multiple logistic regression models were used for risk factors.

RESULTS

The prevalence of LBP was 27.32% (confidence interval [CI] 95% = 23.07-32.03). The mean age was 8.85 years (± 1.83) in the group with LBP and 8 years (± 1.76) in the group without LBP (p = .006). Variables such as backpack weight (odds ratio [OR] = 1.45, CI 95% = 1.018-2.064) and exceeding 3 hours per day in front of the television (OR = 7.97, CI 95% = 1.957-32.515) increased the chance of LBP in these students.

CONCLUSION

LBP is prevalent in younger schoolchildren, and the factors associated with this outcome can be effectively addressed through the promotion of health measures. LBP in schoolchildren is a musculoskeletal discomfort that negatively affects the quality of life of these individuals and persists in adulthood.

Musculoskeletal Pain, Related Factors, and Posture Profiles Among Adolescents: A Cross-Sectional Study From Turkey

PURPOSE

The aim of the study was to evaluate musculoskeletal pain due to mechanical reasons and related risk factors in adolescents and to define posture profiles of adolescents.

DESIGN

A cross-sectional study.

METHODS

The study was conducted with 2221 adolescents between February 2015 and May 2015. The questionnaire used to collect data consisted of three parts: (1) descriptive characteristics of the participants, (2) pain assessment of 14 parts of the body, and (3) Back Pain and Body Posture Evaluation Instrument (BackPEI).

RESULTS

The prevalence of low back pain among the participants was 73.3% (n = 1,343), while the prevalence of back pain was 68.4% (n = 1,254). The participants attributed their pain to their poor sitting postures at school (38.1%, n = 847) and carrying school backpacks (84.1%, n = 1,713). There was a statistically significant difference in the physical activities of adolescents and the BackPEI score (z = 4.40; p = .001). Posture factors of the BackPEI score increased while school desk comfort score increased (Spearman's rho = 0.148; p = .001), but it decreased while the school grades of the adolescents increased (Spearman's rho [ρ] = -0.161; p = .001).

CONCLUSIONS

According to this study, body posture was related to musculoskeletal pain and was correlated with physical activities, school desk comfort, and school grades of the adolescents. It is suggested that correct posture and ergonomic positions should be taught to adolescents when using computers, carrying school backpacks, and sitting in school chairs to prevent musculoskeletal pain.

Caring-Related Chronic Low Back Pain and Associated Factors among Mothers of Children with Cerebral Palsy

BACKGROUND

Literature indicated some risk factors for low back pain; however, there is insufficient knowledge on the effect of caring-related physical activities and individual characteristics on Chronic Low Back Pain (CLBP) in mothers of children with Cerebral Palsy (CP).

OBJECTIVE

The main aim of the current study was to determine the association between caring-related physical activities, Body Mass Index (BMI), education level, and CLBP in mothers of children with CP.

DESIGN

Case-control observational study. Setting. Pediatric rehabilitation clinics. Participants. Mothers of children with CP. Main Outcome Measures. Measures is comprised of a self-administered questionnaire that included the demographic characteristics items, pain visual analog scale, and three items of the job-related physical demands questionnaire. The logistic regression model served to assess the association.

RESULTS

The control group included 81 healthy mothers, with a mean (SD) age of 39 (8.45) years, and the case group contained 90 mothers who suffered from CLBP, with a mean (SD) age of 37 (8.64) years. Performing lifting movements (OR 13.73, β = 2.62, p < .001), BMI (OR 11.85, β = 2.47, p = .011), repetitive bending (OR 7.67, β = 2.04, p = .010), forward-flexion (OR 6.71, β = 1.91, p = .033), and level of education (OR .21, β = -1.53, p = .020), in descending order of odds ratios, were found to be significant predictors of the CLBP in mothers of children with CP.

CONCLUSION

Avoiding caring-related harmful physical activities, maintaining body weight within a healthy range, and increasing knowledge for accurate lifting/handling techniques can be helpful to prevent the CLBP in mothers of children with CP.

Back Pain Related with Age, Anthropometric Variables, Sagittal Spinal Curvatures, Hamstring Extensibility, Physical Activity and Health Related Quality of Life in Male and Female High School Students

Spinal pain (SP) is widely extended among adolescents. The origin of SP can be multifactorial; thus, the present study aimed to estimate the prevalence and risk of SP in high school students and to determine the differences in sagittal spinal curvatures and pelvic tilt, hamstring extensibility, age, anthropometric variables and healthy lifestyle habits dependent on SP between sexes. Two hundred seventy-three teenagers took part in this cross-sectional study. Age, sagittal spinal curvatures, hamstring extensibility, physical activity, sedentary lifestyle, anthropometric variables and health related quality of life (HRQL) were recorded. SP was reported by 16.12% of adolescents. Differences were observed in the HRQL according to SP (p < 0.05). Participants without SP were less sedentary (22.12%) and younger (13.10 years old) than participants with SP (40.91% and 13.66, respectively) (p < 0.05). A logistic regression model showed that both variables were significantly collinear (VIF = 1.01; Durbin-Watson = 2.10). Subjects with low back pain (LBP) had a higher weight, body max index, and hip girth than subjects without pain (p < 0.05). A misalignment in the lumbar spine was associated with LBP for males (Cramer’s V = 0.204, p = 0.022). In conclusion, adolescents with SP were older and had a lower HRQL in all dimensions. SP could be predicted according to age and sedentary habits.

Back Pain and Knowledge of Back Care Related to Physical Activity in 12 to 17 Year Old Adolescents from the Region of Murcia (Spain)

Knowledge on back care is important to prevent back problems. The purpose of this study was to a) describe back pain and knowledge on back care related to physical activity in adolescents and b) determine the association between these two factors. This was a cross-sectional study. A total of 276 students (aged from 12 to 17 years old), from three Spanish public secondary schools, had to complete a survey about back pain and another one about their knowledge on back care related to physical activity. The results showed a mean score of 2.54 ± 1.85 (out of 10), and 90.58% of students failed the knowledge test. Those who suffered from back pain in the week before scored higher (2.91 ± 1.66) than non-sufferers (2.42 ± 1.90), with statistically significant differences (Z = −2.109; p = 0.035; r = 0.127), although with no academically relevant differences. Finally, despite the relationship between a higher mean score in the knowledge test and back pain within the previous week, it has been found that there was not a significant association because most of the students got very low scores in the knowledge test. It also shows an important lack of knowledge about physical activity for back care in adolescents.

How does the activity level of the parents influence their children's activity? The contemporary life in a world ruled by electronic devices

INTRODUCTION

Apart from many positive changes associated with technical civilization, there are also - from the health point of view - some threats. The reduction in the level of physical activity is one of them. The aim of the study was to investigate whether there are any relationships between children's physical activity and behaviors, and to assess the impact of the adults' activity on their children's habits.

MATERIAL AND METHODS

The study involved a group of 340 children aged 7-12 years (mean age: 9.81 ±1.7) and their parents. In order to evaluate children's physical activity and the amount of time that they spend with electronic devices, an original questionnaire and the IPAQ questionnaire were used.

RESULTS

Children usually use electronic devices between 2 and 7 days per week (mean: 4.74 ±0.86), regardless of sex (p > 0.09) and spend between 5 and 1620 min per week (mean: 459.46 ±308.1) with their mobile phone, tablet, PCs and TVs. 67.92% of boys and 69.61% of girls lead an active lifestyle. The children's activity level depends on their parents' level of activity (p < 0.000001). Parents of semi-active children lead a lifestyle with a moderate level of physical activity.

CONCLUSIONS

The level of physical activity in younger children depends on the children's relationship with their parents and their level of activity. Children spend a lot of free time with their electronic devices. It is necessary to develop and implement activities intended to raise awareness of children and their families about the effects of hypokinesis.

The weight of pupils' schoolbags in early school age and its influence on body posture

BACKGROUND

Postural development progresses through a series of stages (growth spurts, development of balance and coordination, postural stability) which occur when children are at school age. The reduction in the level of physical activity, increased body weight, overloaded school bags, asymmetry of the backpack straps, the method of putting on and taking off the backpacks and increased usage of electronic devices have negative side effects such as bad body posture habits.

METHODS

A prospective cohort study in the group of 155 pupils at early school age 7-9 years old has been conducted. Examinations have been conducted twice: first, at the beginning of the school year (initial examination) and second - after 10-11 months (final examination). Age, gender, BMI, weight of school bag carried to school and the length of straps have been assessed. Body posture measurement (using Adams' test), the evaluation of the plumb line deflection from the gluteal cleft, the angle values of kyphosis and lordosis (according to Dobosiewicz methodology) and the pelvis and shoulder blades position (using a ruler and pediscoliometer) have been also measured.

RESULTS

The mean weight of a school bag in the initial study was 6.3 ± 0.8 (range between 4,7 and 9 kg). A tendency to carry slightly heavier school bags was noted in boys (6.7 vs. 5.9 kg; p = 0,00001). This tendency has linearly changed with age (R = 0.68; p < 0,001). In 3.2% of all school bags of children, weights exceeded norms with regard to the weight of the pupil. The increase of torso rotation exceeding norms was observed in 35.3% of girls (mean 2.7 ± 1.2) and in 60.9% of boys (mean 2.3 ± 1.3). The increase of kyphosis angle was noted in 48.5% of girls and in 36.8% of boys. The difference of straps length had a significant influence on the increase of rotation in upper thoracic spine, thoracolumbar junction and it also had influence on the decrease of lumbar lordosis in the group of girls.

CONCLUSIONS

Differences in the weight of school bags after one school year have influenced changes in body posture abnormalities, especially in rotation parameters. Backpack straps asymmetry was noticeably stronger in the group of girls and the difference between braces may have an impact on some posturometric parameters. Lack of proper backpack lifting skills tends to create programs and training systems in this regard.

Development and psychometric evaluation of a health questionnaire on back care knowledge in daily life physical activities for adolescent students

PURPOSE

The most relevant musculoskeletal problems are related with back health. Study instruments have been designed for adult patient population but not for school-aged children. The aim of this study was to develop and evaluate the psychometric properties of a questionnaire to assess adolescents' level of back care knowledge in daily life physical activities.

METHODS

Participants were 171 adolescents from secondary schools. The questionnaire was made up of 24 questions. A Delphi method was used for test validation. Cronbach's alpha, test-retest, Wilcoxon signed-rank and Bland-Altman graph were used to evaluate the instrument reliability.

RESULTS

Cronbach's alpha (α = 0.82) showed a strong internal consistency. Test-retest was excellent for total score (0.76) and moderate to excellent (0.54-0.76) for seven score conceptual categories with good results of standard error of the mean and minimal detectable change. No differences were found between test 1 and test 2 except for the standing posture scores.

CONCLUSION

The questionnaire showed acceptable psychometric values. Results showed that this questionnaire is a good instrument to assess adolescent's back care knowledge.

Low back pain and physical activity--A 6.5 year follow-up among young adults in their transition from school to working life

BACKGROUND

The association between leisure time physical activity and low back pain in young adults is unclear and is in the need of prospectively obtained evidence. This study examined the course of low back pain and the association between low back pain and leisure time physical activity in a cohort of young adults in their transition from school to working life.

METHODS

Both low back pain and leisure time physical activity was monitored over a 6.5 year period in 420 subjects starting out as students within hairdressing, electrical installation and media/design. The association between physical activity and low back pain was investigated through the follow-up period by using linear mixed models analysis.

RESULTS

Low back pain was significantly influenced by time and overall there was a decreasing trend of low back pain prevalence throughout the follow-up. Analysis showed a weak trend of decreasing low back pain with moderate/high physical activity levels, but this association was not significant.

CONCLUSIONS

Low back pain decreased during follow-up with baseline as reference. Findings in our study did show non-significant trends of reduced low back pain with increased leisure time physical activity. Still, we could not support the theory of moderate/high levels of physical activity acting protective against low back pain in young adults entering working life. Our results, in combination with previous relevant research, cannot support a clear relationship between physical activity and low back pain for young adults. Thus, recommendations regarding effect of physical activity on reducing low back pain for this group are not clear.