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Kemta Lekpa F, Eloundou P, Moulion Tapouh JR, Simeni Njonnou SR, Fojo Talongong B, Same Bebey F, Megne Tamo E, Noukeu D, Enyama D, Abouame PH, Sime Tchouamo AA, Namme Luma H, Ngandeu-Singwe M, Choukem SP. Clinical presentation and imaging findings in juvenile-onset back pain: a ten-year hospital-based retrospective analysis in Douala (Cameroon). Front Pediatr 2024; 12:1424391. [PMID: 39015207 PMCID: PMC11250053 DOI: 10.3389/fped.2024.1424391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Studies exploring the clinical and imaging characteristics of juvenile-onset back pain (JOBP) are scarce. The purpose of this study was to assess the clinical presentation, imaging findings, and factors associated with JOBP. Methods A retrospective record-based study was conducted among all pediatric cases presenting to the Rheumatology unit of the Douala General Hospital, Cameroon, from January 2014 to December 2023. The study did not include children whose back pain began after 16 years of age. Results Of the 216 records of patients under 18 examined, 67 children (31 girls) were diagnosed with JOBP. The median age was 15 [13-16] years. More than two-third of the children included in this study had chronic pain (n = 46; 68.65%). Pain was mild to moderate in intensity in 48 children (71.6%). Radiculopathy was present in 10 children (14.92%). The most common location of back pain was the lumbar region (n = 64; 95.52%). Some children experienced pain in more than one location. The location of the pain was not associated with gender, duration of the pain, radiculopathy, or practice of a competitive sport (p > 0.05). Musculoskeletal abnormalities on imaging were found in 38 children (62.29%). In multivariate analysis, peripheral joint involvement [aOR = 0.253 (0.073-0.878); p = 0.030] and mild pain intensity [aOR = 0.077 (0.014-0.422); p = 0.003], were independently associated with the presence of musculoskeletal abnormalities on imaging. Conclusion JOBP affects a third of children and adolescents of our clinic population. The common musculoskeletal abnormalities found on spine imaging are disc diseases and scoliosis.
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Affiliation(s)
- Fernando Kemta Lekpa
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Paul Eloundou
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Jean Roger Moulion Tapouh
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Sylvain Raoul Simeni Njonnou
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | | | - Francine Same Bebey
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Estelle Megne Tamo
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Diomède Noukeu
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Dominique Enyama
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Palma Haoua Abouame
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | | | - Henry Namme Luma
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | | | - Simeon Pierre Choukem
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
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Liang Z, Zhang M, Wang C, Hao F, Yu Y, Tian S, Yuan Y. The Best Exercise Modality and Dose to Reduce Glycosylated Hemoglobin in Patients with Type 2 Diabetes: A Systematic Review with Pairwise, Network, and Dose-Response Meta-Analyses. Sports Med 2024:10.1007/s40279-024-02057-6. [PMID: 38916824 DOI: 10.1007/s40279-024-02057-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Persistently elevated glycosylated hemoglobin (HbA1c) is associated with a higher risk of long-term vascular complications. OBJECTIVE We evaluated the effect of different exercise modalities and doses on HbA1c levels in patients with type 2 diabetes. METHODS A systematic search for randomized controlled trials involving exercise interventions in patients with type 2 diabetes was conducted across seven electronic databases, encompassing data from their inception up to October 2023. Two independent reviewers assessed the quality of the literature. Pairwise, network, and dose-response meta-analyses using the random-effects model were conducted to analyze the effect of exercise on HbA1c levels. RESULTS A total of 85 randomized controlled trials with 5535 participants were included. The network meta-analysis showed that high-intensity interval training (HIIT) has the highest ranked (MD = - 0.78% [- 8.50 mmol/mol]; 95% CrI: - 1.04, - 0.51), followed by combined aerobic and resistance exercise (CE) (MD = - 0.54% [- 5.90 mmol/mol]; 95% CrI: - 0.69, - 0.40), yoga (MD = - 0.45% [- 4.92 mmol/mol]; 95% CrI: - 0.77, - 0.13), and continuous aerobic exercise (CAE) (MD = - 0.42% [- 4.58 mmol/mol]; 95% CrI: - 0.54, - 0.30). In addition, a significant improvement in HbA1c levels can be observed when the total exercise dose reaches 840 metabolic equivalent of tasks-min/week. CONCLUSIONS There was low-quality evidence that HIIT, CE, yoga, and CAE may be effective treatment modalities for improving HbA1c in patients with type 2 diabetes, and there was no significant difference in efficacy. Moreover, a non-linear dose-response relationship was found for total exercise and HbA1c levels. Future research should further investigate the specific effects of different exercise doses on HbA1c levels in patients with type 2 diabetes and provide a more personalized exercise prescription.
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Affiliation(s)
- Zhide Liang
- School of Sports Science, Qufu Normal University, Qufu, 273165, China
- Cancer Institute of The Affiliated Hospital of Qingdao University and Qingdao Cancer Institute, No. 308 Ningxia Road, Qingdao, 266071, China
- Department of Physical Education, College of Physical Education, Qingdao University, Qingdao, 266071, China
| | - Meng Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, China
| | - Chuanzhi Wang
- School of Physical Education and Sports Exercise, South China Normal University, Guangzhou, 510006, China
| | - Fengwei Hao
- School of Physical Education and Sports Exercise, South China Normal University, Guangzhou, 510006, China
| | - Yingdanni Yu
- School of Physical Education, Shandong University, Jinan, 250061, China
- Department of Physical Education, College of Physical Education, Qingdao University, Qingdao, 266071, China
| | - Shudong Tian
- School of Physical Education, Shandong University, Jinan, 250061, China.
| | - Yang Yuan
- School of Sports Science, Qufu Normal University, Qufu, 273165, China.
- Cancer Institute of The Affiliated Hospital of Qingdao University and Qingdao Cancer Institute, No. 308 Ningxia Road, Qingdao, 266071, China.
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Liang Z, Tian S, Wang C, Zhang M, Guo H, Yu Y, Wang X. The Best Exercise Modality and Dose for Reducing Pain in Adults With Low Back Pain: A Systematic Review With Model-Based Bayesian Network Meta-analysis. J Orthop Sports Phys Ther 2024; 54:1-13. [PMID: 38457134 DOI: 10.2519/jospt.2024.12153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE: To quantify the dose-response relationship between overall and specific exercise modalities and pain, in patients with nonspecific chronic low back pain (LBP). DESIGN: Systematic review with Bayesian network meta-analysis. LITERATURE SEARCH: We searched the Medline, Embase, Web of Science, Cochrane Library, Scopus, and SPORTDiscus databases from inception to June 2023. STUDY SELECTION CRITERIA: We included randomized controlled trials of exercise interventions in adults with nonspecific chronic LBP and at least 1 pain outcome reported at the main trial end point. DATA SYNTHESIS: A random-effects network meta-analysis was conducted. We assessed risk of bias using the Cochrane Risk of Bias Tool 2.0, and used the GRADE approach to judge the certainty of evidence for each outcome. RESULTS: Eighty-two trials were included (n = 5033 participants). We found a nonlinear dose-response relationship between total exercise and pain in patients with nonspecific chronic LBP. The maximum significant response was observed at 920 MET minutes (standardized mean difference = -1.74; 95% credible intervals: -2.43, -1.04). The minimal clinically important difference for achieving meaningful pain improvement was 520 MET minutes per week. The dose to achieve minimal clinically important difference varied by type of exercise; Pilates was the most effective. The certainty of the evidence was very low to moderate for all outcomes. CONCLUSION: The dose-response relationship of different exercise modalities to improve pain in patients with nonspecific chronic LBP had a U-shaped trajectory and low- to moderate-certainty evidence. The clinical effect was most pronounced with Pilates exercise. J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 8 March 2024. doi:10.2519/jospt.2024.12153.
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Farivar D, Illingworth KD, Lin AJ, Nigh ED, Finkel R, Skaggs DL. Subject matter predicts where top pediatric spine articles are shared: citations vs. social media. J Pediatr Orthop B 2024; 33:280-282. [PMID: 37811586 DOI: 10.1097/bpb.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
STUDY DESIGN Systematic review. The purpose of this study was to compare the top 25 articles on pediatric spine surgery by number of citations and Altmetric score. All published articles pertaining to pediatric spine surgery from 2010 to 2021 were assessed for: Altmetric scores, Altmetric score breakdown (e.g. Twitter, News), citation counts, and article topics. The top 25 Altmetric articles and top 25 cited articles were identified. Out of the 50 total articles, only 3 (6.0%) overlapped between the two groups. The top Altmetric articles had averages (mean ± SD) of 167 ± 130 Altmetric score and 66 ± 135 citations, while the top citation articles had averages of 22 ± 45 Altmetric score and 196 ± 114 citations. When evaluating article topics, articles on 'back pain' (36% vs. 4%; P = 0.003) and 'backpacks' (16% vs. 0%; P = 0.030) were published significantly more in the top Altmetric group, while articles on 'scoliosis' (93% vs. 36%; P < 0.001) and 'growth friendly surgery' (24% vs. 4%; P = 0.041) were published significantly more in the top citation group. The total number of citations and online mentions for both groups are presented in Table 2. The biggest differences were the top Altmetric score articles receiving greater percentages of Twitter mentions relative to overall mentions (87% vs. 57%). The most socially popular articles focused on back pain and backpacks, and the most cited articles focused on scoliosis and growth-friendly surgery. Twitter had the most mentions of all social media for both the top cited articles and the top Altmetric articles.
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Affiliation(s)
- Daniel Farivar
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Viana da Silva P, Kamper SJ, Hall A, Yamato TP, Hestbaek L, Lauridsen HH, Williams CM. Developing and assessing the measurement properties of an instrument to assess the impact of musculoskeletal pain in children aged 9 to 12-the pediatric musculoskeletal pain impact summary score. Braz J Phys Ther 2024; 28:101052. [PMID: 38636288 PMCID: PMC11039311 DOI: 10.1016/j.bjpt.2024.101052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Despite the high prevalence of musculoskeletal (MSK) pain in children, there is a lack of instruments to measure the impact of MSK pain on children's activity and participation. OBJECTIVE To assess the reliability and construct validity of the Pediatric MSK Pain Impact summary score in school children (aged 9 to 12) with MSK pain. METHODS We used a pragmatic approach in a reflective framework to assess internal consistency, structural validity, convergent validity, and discriminative validity in a sample of 615 children with MSK pain. RESULTS The confirmatory factor analysis results indicate that the summary score has limited internal consistency and construct validity. The estimated Cronbach's alpha was 0.63, and most goodness of fit indices met the recommended thresholds (SRMR = 0.030; GFI = 0.993, CFI = 0.955, RMSEA 0.073), although they were close to the lower bounds of the thresholds. The convergent validity showed appropriate correlation of the summary score with quality of life (r = -0.33), care-seeking (r = 0.45), and medication intake (r = 0.37). Discriminative validity showed that the instrument can discriminate between the impact of pain on children with frequent and infrequent (2.93; 95% CI: 2.36 - 3.50) MSK pain. CONCLUSION The Pediatric MSK Pain Impact summary showed limited internal consistency and construct validity; however, it can discriminate between children with frequent and infrequent pain. The results are promising for clinical and research practices as it is a short and convenient tool to be used in school-aged children.
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Affiliation(s)
- Priscilla Viana da Silva
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia; Hunter New England Population Health, NSW, Australia; Hunter Medical Research Institute, School of Medicine and Public Health University of Newcastle, NSW, Australia.
| | - Steven J Kamper
- Nepean Blue Mountains Local Health District, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia; Hunter New England Population Health, NSW, Australia; Hunter Medical Research Institute, School of Medicine and Public Health University of Newcastle, NSW, Australia; Priority Research Centre for Health Behaviour, NSW, Australia
| | - Tie P Yamato
- Nepean Blue Mountains Local Health District, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, SP, Brazil
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; The Chiropractic Knowledge Hub, Odense, Denmark
| | - Henrik H Lauridsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Christopher M Williams
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Research and Knowledge Translation Directorate Mid North Coast Local Health District, NSW, Australia
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Lau KKL, Kwan KYH, Cheung JPY, Wong JSH, Shea GKH, Law KKP, Cheung KMC. Incidence of back pain from initial presentation to 3 years of follow-up in subjects with untreated adolescent idiopathic scoliosis. Spine Deform 2024; 12:357-365. [PMID: 38015385 PMCID: PMC10866791 DOI: 10.1007/s43390-023-00794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Although back pain may be present in subjects with adolescent idiopathic scoliosis (AIS), its natural history is unknown. Therefore, this study evaluated the incidence of back pain in scoliotic adolescents longitudinally. METHODS This retrospective analysis examined prospectively collected pain subscale data of the Scoliosis Research Society questionnaire between the initial presentation and up to 3 years of follow-up. Consecutive subjects with AIS aged 10-18 at baseline managed by observation within the study period were included. Study subjects with at least one time point of follow-up data were considered. Alternatively, a group with physiotherapy-treated was also included for comparison. RESULTS We enrolled 428 subjects under observation. The incidence of back pain among study subjects was 14.7%, 18.8%, and 19.0% for the first year, second year, and third year of follow-up, respectively. Most experienced mild pain (1 out of 5 points) throughout the study. Neither incidence nor intensity of pain significantly differed between subjects under observation and received physiotherapy. Additionally, study subjects with a new onset of back pain had poorer function, self-image, and mental health scores than those without pain. CONCLUSION We investigated the incidence of back pain longitudinally in subjects suffering from AIS. Further validation of the current results is warranted.
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Affiliation(s)
- Kenney Ki Lee Lau
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenny Yat Hong Kwan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Janus Siu Him Wong
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Karlen Ka Pui Law
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
- Department of Orthopaedics and Traumatology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.
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Anyachukwu CC, Amarah CC, Atueyi BC, Anthony I, Nweke M, Abaraogu U. Effectiveness of Back care education Programme among school children: a systematic review of randomized controlled trials. BMC Pediatr 2024; 24:95. [PMID: 38308207 PMCID: PMC10835972 DOI: 10.1186/s12887-024-04563-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 01/14/2024] [Indexed: 02/04/2024] Open
Abstract
STUDY DESIGN Systematic review of Randomised controlled trials. OBJECTIVES With the increasing incidence of back pain among children and its untold implications to their future, back education tailored in an effective way would be indicated. However literature appears unsettled. This study aims to review available literature to determine the effect of school-based back education in preventing and managing low back pain in school children. METHODS Randomized controlled trials carried out on elementary and secondary school children of ages 6 to 18 years and published in English language were included. Back education taught in hospitals or other settings were excluded. Primary outcome was back pain prevalence and secondary outcomes were constituted from the study characteristics of selected studies which includes: back behavior, knowledge, postural habits, physical activity, fear-avoidance beliefs, back pack carriage, pain intensity, skills and self efficacy. Databases searched were PEDro, HINARI, PubMed, Cochrane, and Google Scholar. Available stiudies from 2000 to March 2022 were retrieved. Quality of studies were assessed using the PEDro scale. Obtained studies were descriptively analyzed. RESULTS A total 8420 studies were retrieved and 8 studies (with 1239 participants) were included in this review. Four studies each assessed back knowledge and back behavior, and two assessed back pain prevalence. There were improvements in back knowledge and back behaviour, but effectiveness of back care education on back pain prevalence was not conclusive. Forms of education used involved the indirect method of conditioning the environment and the direct method which made use of theory, practical lessons and educational books and materials. CONCLUSION Back care education programmes in schools are effective in improving back care knowledge, behavior and reduction in low back pain frequency. Reduction in back pain prevalence is not conclusive. Back care education could be incorporated as part of schools' education programmes. Limitations include exclusion of non English language studies and inconsistent outcome measures. FUNDING SOURCE None. REGISTRATION This review protocol was registered under the International platform of Registered systematic review and meta-analysis protocol (INPLASY) with the registration number; INPLASY202310044 and DOI number; https://doi.org/10.37766/inplasy2023.1.0044.
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Affiliation(s)
- Canice Chukwudi Anyachukwu
- Department of medical rehabilitation, Faculty of health sciences and technology, College of medicine, University of Nigeria, Enugu state, Nigeria
| | - Confidence Chinemerem Amarah
- Department of medical rehabilitation, Faculty of health sciences and technology, College of medicine, University of Nigeria, Enugu state, Nigeria.
| | - Blessing Chiagozikam Atueyi
- Department of medical rehabilitation, Faculty of health sciences and technology, College of medicine, University of Nigeria, Enugu state, Nigeria
| | - Ifeanyi Anthony
- Department of medical rehabilitation, Faculty of health sciences and technology, College of medicine, University of Nigeria, Enugu state, Nigeria
| | - Martins Nweke
- Department of physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ukachukwu Abaraogu
- Department of medical rehabilitation, Faculty of health sciences and technology, College of medicine, University of Nigeria, Enugu state, Nigeria
- Research Center for Health (ReaCH) Glasgow Caledonian University, Glasgow, UK
- Division of Biological Sciences and Health University of the West of Scotland, Lanarkshire, UK
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Roman-Juan J, Jensen MP, Miró J. Increases in Sleep Difficulties and Psychological Symptoms are Associated With the Increase of Chronic Back Pain in Adolescents: The HBSC Study 2002 to 2018. THE JOURNAL OF PAIN 2024; 25:407-417. [PMID: 37690475 DOI: 10.1016/j.jpain.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/07/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023]
Abstract
Cross-national research using data from the Health Behavior in School-aged Children (HBSC) survey showed an increase in the prevalence of chronic back pain from 2002 to 2014. However, it is unknown if this trend has persisted beyond 2014. The aims of this study were to 1) determine if the prevalence of chronic back pain in girls and boys aged 11, 13, and 15 continued to increase from 2014 to 2018 and if this was the case, 2) examine whether this increase in the prevalence of chronic back pain between 2002 and 2018 was explained indirectly by increases in sleep difficulties and psychological symptoms. Data from 7,89,596 adolescents retrieved from 5 waves of the HBSC survey conducted in 2002, 2006, 2010, 2014, and 2018 in 32 countries/regions were used. Logistic regressions and path analyses were conducted. Results showed an overall increase of .5% in the prevalence of chronic back pain between 2014 and 2018, ranging from .4% for 15-year-old girls to 1.3% for 11-year-old boys, indicating a continued overall increase in chronic back pain in adolescents beyond 2014. For 13-year-old girls and for 15-year-old girls and boys, the increase in the prevalence of chronic back pain between 2002 and 2018 was partially mediated by increases in sleep difficulties, which in turn were associated with increases in psychological symptoms. The findings provide important information that may aid stakeholders in enhancing public health initiatives to prevent or reduce the increasing trend in the prevalence of chronic back pain in adolescents. PERSPECTIVE: This study shows that chronic back pain prevalence continues to increase among adolescents, with sleep difficulties and psychological symptoms contributing significantly to this trend. The findings provide insights that may inform strategies to prevent or reduce the increasing trend of chronic back pain in adolescents.
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Affiliation(s)
- Josep Roman-Juan
- Universitat Rovira i Virgili, Tarragona, Spain; Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Jordi Miró
- Universitat Rovira i Virgili, Tarragona, Spain; Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
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Hatakeyama BA, Camargo BIA, Santos VS, Leite MN, Espirito Santo CDMD, Kamper SJ, Maher CG, Costa LOP, Yamato TP. Prevalence of disabling musculoskeletal pain in children and adolescents in Brazil: A cross-sectional study. Braz J Phys Ther 2024; 28:100593. [PMID: 38394719 PMCID: PMC10906173 DOI: 10.1016/j.bjpt.2024.100593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Estimates of prevalence of musculoskeletal pain in children and adolescents vary considerably and the impact of pain on children's life is often not considered. OBJECTIVE To determine the one-month prevalence of disabling musculoskeletal pain in children and adolescents. The secondary aims are to: 1) determine the body region with the highest prevalence; 2) understand the characteristics of the children with disabling musculoskeletal pain; and 3) describe the parents' perception of the prevalence. METHODS This cross-sectional study was conducted in public and private schools in the states of São Paulo and Ceará, Brazil. Children self-reported presence and impact of pain, pain intensity, psychosomatic symptoms, and quality of life. Parents completed parent-proxy versions and perception of the child's sleep quality. Descriptive statistics were used to summarise the data. RESULTS A total of 2,688 children and adolescents were included in this study. The prevalence of disabling musculoskeletal pain in the previous month was 27.1%. The back was the region most often affected (51.8%). Children with disabling musculoskeletal pain were older, heavier, had worse relationships with their family, perceived their backpacks as heavy, carried their backpacks more with one shoulder, had more negative psychosomatic symptoms, had poorer quality of life, and had higher pain intensity. Parents tended to underestimate the presence of pain in their children. CONCLUSION The one-month prevalence of activity limiting musculoskeletal pain in children and adolescents was 27.1% with the back being the most often affected body region. Parents tended to underestimate the presence of pain in their children.
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Affiliation(s)
- Bruna Alves Hatakeyama
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Brazil
| | | | - Verônica Souza Santos
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Brazil
| | | | | | - Steven J Kamper
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, the Netherlands; School of Health Sciences, University of Sydney, Sydney, Australia
| | - Chris G Maher
- University of Sydney, Sydney Musculoskeletal Health, Sydney, Australia
| | - Leonardo Oliveira Pena Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Brazil; Interdisciplinary Health Sciences Program, Universidade Cruzeiro do Sul, Brazil
| | - Tiê P Yamato
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Brazil; Faculty of Medicine and Health, University of Sydney, Australia; Nepean Blue Mountains Local Health District, NSW, Australia.
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Kaltoft K, Nielsen JL, Andersen AMN, Falch-Joergensen AC. The relation between preterm birth and self-reported spinal pain in pre-adolescence-a study of 47,063 subjects from the Danish National Birth Cohort. Eur J Pediatr 2024; 183:203-211. [PMID: 37861793 PMCID: PMC10857978 DOI: 10.1007/s00431-023-05264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
Repeated exposure to pain and stress in early life may cause alterations in pain sensitivity later in life. Children born preterm are often exposed to painful invasive procedures. This study aimed to explore the relationship between being born preterm and self-report of spinal pain in pre-adolescence. This prospective study was based on the Danish National Birth Cohort and consisted of 47,063 11-14-year-olds. Data from the Danish National Birth Cohort were linked with national registers through Statistics Denmark. Analyses were performed as multiple logistic regression models estimating odds ratios and 95% confidence intervals. Spinal pain (neck, mid back, and/or low back pain) was assessed using a subdivision of the Young Spine Questionnaire. Severe spinal pain was defined as having pain often or once in a while with an intensity of four to six on the Revised Faces Pain Scale. Inverse probability weighting was used to account for potential selection bias. Girls born very preterm (< 34 full weeks of gestation) were less likely to report spinal pain (OR: 0.60; 95% CI: 0.40-0.93) compared with those term-born. The associations were weaker when examining moderate to severe spinal pain and when examining the three spinal regions separately. None of these was statistically significant. CONCLUSION We found no associations for boys. In conclusion, this study indicates that girls born very preterm are seemingly less likely to have severe spinal pain in pre-adolescence than girls born at term. WHAT IS KNOWN • Spinal pain is one of the largest disease burdens globally, and the evidence regarding the etiology of spinal pain in children and adolescents is limited. • Repeated exposure to pain and stress in early life (i.e., being preterm) may cause alterations in pain sensitivity later in life. WHAT IS NEW • Girls born very preterm (< 34 full weeks of gestation) seem less likely to report severe spinal pain in pre-adolescence compared with girls born at full term. • There is no association between gestational age and later experience of spinal pain in pre-adolescent boys.
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Affiliation(s)
- Klara Kaltoft
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Oster Farimagsgade 5, bd. 24, DK-1014, Copenhagen K, Denmark
| | - Jane Lykke Nielsen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Oster Farimagsgade 5, bd. 24, DK-1014, Copenhagen K, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Oster Farimagsgade 5, bd. 24, DK-1014, Copenhagen K, Denmark
| | - Anne Cathrine Falch-Joergensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Oster Farimagsgade 5, bd. 24, DK-1014, Copenhagen K, Denmark.
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Azadvari M, Sarzaeim M, Rajabi S, Yahyaee A, Razavi SZE, Haghparast A, Biderafsh A, Nakhostin-Ansari A, Hosseini M, Ghahvechi M. Associations between exposure to common technology devices and reported neck pain among Iranian school-age adolescents: a cross sectional study. BMC Musculoskelet Disord 2023; 24:883. [PMID: 37957607 PMCID: PMC10644474 DOI: 10.1186/s12891-023-07010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The advancement of technology has contributed to a more sedentary lifestyle, and the extensive use of handheld devices among adolescents may potentially result in neck pain. This study aimed to assess the association between exposure to common technology devices and self-reported neck pain in Iranian school-age adolescents. METHODS This cross-sectional study was conducted between June and October 2021, employing a randomized multi-stage cluster sampling approach. We enrolled 808 adolescent students aged 11 to 19 years old. We asked participants about any neck pain they experienced in the week leading up to the study. Additionally, we gathered demographic information and assessed participants' use of electronic devices using a questionnaire. RESULTS Our study comprised 73.5% female participants with an average age of 15.1 ± 1.7 years and 26.5% male participants with an average age of 14.5 ± 1.5 years. In the regression model, the female gender (p = 0.038), using mobile for more than 6 h (p = 0.04), and using electronic devices while sitting on the floor (p = 0.02) were associated with a higher prevalence of neck pain among participants. CONCLUSION In our study, we observed a relatively high prevalence of neck pain, which was linked to extended daily mobile phone usage and body posture during electronic device use. Policymakers may consider interventions aimed at reducing mobile phone usage and promoting proper body posture while using electronic devices as potential strategies to alleviate the burden of neck pain among Iranian adolescents.
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Affiliation(s)
- Mohaddeseh Azadvari
- Department of Physical Medicine and Rehabilitation, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojdeh Sarzaeim
- School of Medicine, Tehran University of Medical Sciences, Poursina Avenue, Enqelab sq, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarvin Rajabi
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Alireza Yahyaee
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyede Zahra Emami Razavi
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Haghparast
- School of Medicine, Tehran University of Medical Sciences, Poursina Avenue, Enqelab sq, Tehran, Iran.
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azam Biderafsh
- Department of Epidemiology and BioStatistics, Health faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Hosseini
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masood Ghahvechi
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Growth and Development Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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12
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Corser J, Caes L, Bateman S, Noel M, Jordan A. 'A whirlwind of everything': The lived experience of adolescents with co-occurring chronic pain and mental health symptoms. Eur J Pain 2023; 27:981-994. [PMID: 37211969 DOI: 10.1002/ejp.2140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Co-occurring chronic pain and mental health issues are prevalent in adolescents, costly to society and can lead to increased risk of complications throughout the lifespan. While research has largely examined paediatric chronic pain and mental health in isolation, little is known about the unique challenges faced by adolescents who experience these co-occurring symptoms. This idiographic study examined the lived experience of adolescents with co-occurring chronic pain and mental health symptoms to identify salient issues for this population. METHODS Semi-structured telephone interviews were conducted with seven adolescents (11-19 years) self-reporting diagnoses of both pain and mental health issues for a duration of 3 months or longer. Participants were recruited from UK-based schools, pain clinics and charities. Interview transcripts were analysed using interpretative phenomenological analysis. RESULTS Analyses generated two themes 'a whirlwind of everything' and 'putting up fronts', which describe how the experience of co-occurring chronic pain and mental health symptoms typically disrupted adolescents' ability to regulate their physical, psychological and social wellbeing and identity. Adolescents described their symptom experience as like an internal storm over which they had no control. Such experiences required adolescents to embrace a variety of symptom management strategies, with adolescents reporting deliberate efforts to minimize their symptoms to external individuals. CONCLUSION Co-occurring pain and mental health symptoms may be experienced in similar ways to individually experienced pain or mental health symptoms, but together, the experience may be both more difficult to manage and more socially isolating. SIGNIFICANCE Adolescents with co-occurring chronic pain and mental health symptoms describe the experience as if there was a storm inside of them disrupting their sense of physical, emotional and social wellbeing. This inner chaos interferes with their self-identity and relationships with others. Challenges articulating their experiences, and negative encounters associated with their symptoms, further impact feelings of isolation and difficulties accessing support.
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Affiliation(s)
- Jenny Corser
- Department of Psychology, University of Bath, Bath, UK
| | - Line Caes
- Division of Natural Sciences, University of Stirling, Stirling, UK
| | | | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
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13
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Nascimento Leite M, Kamper SJ, O'Connell NE, Michaleff ZA, Fisher E, Viana Silva P, Williams CM, Yamato TP. Physical activity and education about physical activity for chronic musculoskeletal pain in children and adolescents. Cochrane Database Syst Rev 2023; 7:CD013527. [PMID: 37439598 PMCID: PMC10339856 DOI: 10.1002/14651858.cd013527.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Chronic pain is a major health and socioeconomic burden, which is prevalent in children and adolescents. Among the most widely used interventions in children and adolescents are physical activity (including exercises) and education about physical activity. OBJECTIVES To evaluate the effectiveness of physical activity, education about physical activity, or both, compared with usual care (including waiting-list, and minimal interventions, such as advice, relaxation classes, or social group meetings) or active medical care in children and adolescents with chronic musculoskeletal pain. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PEDro, and LILACS from the date of their inception to October 2022. We also searched the reference lists of eligible papers, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared physical activity or education about physical activity, or both, with usual care (including waiting-list and minimal interventions) or active medical care, in children and adolescents with chronic musculoskeletal pain. DATA COLLECTION AND ANALYSIS Two review authors independently determined the eligibility of the included studies. Our primary outcomes were pain intensity, disability, and adverse events. Our secondary outcomes were depression, anxiety, fear avoidance, quality of life, physical activity level, and caregiver distress. We extracted data at postintervention assessment, and long-term follow-up. Two review authors independently assessed risk of bias for each study, using the RoB 1. We assessed the overall certainty of the evidence using the GRADE approach. We reported continuous outcomes as mean differences, and determined clinically important differences from the literature, or 10% of the scale. MAIN RESULTS We included four studies (243 participants with juvenile idiopathic arthritis). We judged all included studies to be at unclear risk of selection bias, performance bias, and detection bias, and at high risk of attrition bias. We downgraded the certainty of the evidence for each outcome to very low due to serious or very serious study limitations, inconsistency, and imprecision. Physical activity compared with usual care Physical activity may slightly reduce pain intensity (0 to 100 scale; 0 = no pain) compared with usual care at postintervention (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -0.82 to -0.08; 2 studies, 118 participants; recalculated as a mean difference (MD) -12.19, 95% CI -21.99 to -2.38; I² = 0%; very low-certainty evidence). Physical activity may slightly improve disability (0 to 3 scale; 0 = no disability) compared with usual care at postintervention assessment (MD -0.37, 95% CI -0.56 to -0.19; I² = 0%; 3 studies, 170 participants; very low-certainty evidence). We found no clear evidence of a difference in quality of life (QoL; 0 to 100 scale; lower scores = better QoL) between physical activity and usual care at postintervention assessment (SMD -0.46, 95% CI -1.27 to 0.35; 4 studies, 201 participants; very low-certainty evidence; recalculated as MD -6.30, 95% CI -18.23 to 5.64; I² = 91%). None of the included studies measured adverse events, depression, or anxiety for this comparison. Physical activity compared with active medical care We found no studies that could be analysed in this comparison. Education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison. Physical activity and education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison. AUTHORS' CONCLUSIONS We are unable to confidently state whether interventions based on physical activity and education about physical activity are more effective than usual care for children and adolescents with chronic musculoskeletal pain. We found very low-certainty evidence that physical activity may reduce pain intensity and improve disability postintervention compared with usual care, for children and adolescents with juvenile idiopathic arthritis. We did not find any studies reporting educational interventions; it remains unknown how these interventions influence the outcomes in children and adolescents with chronic musculoskeletal pain. Treatment decisions should consider the current best evidence, the professional's experience, and the young person's preferences. Further randomised controlled trials in other common chronic musculoskeletal pain conditions, with high methodological quality, large sample size, and long-term follow-up are urgently needed.
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Affiliation(s)
- Mariana Nascimento Leite
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Steven J Kamper
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Zoe A Michaleff
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
- Centre for Pain Research, University of Bath, Bath, UK
| | | | | | - Tiê P Yamato
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Bade S, Lona G, Infanger D, Endes K, Roth R, Faude O, Hanssen H. Prospective associations of physical fitness with spinal flexibility in childhood: implications for primary prevention of non-specific back pain. Front Pediatr 2023; 11:1180690. [PMID: 37469683 PMCID: PMC10352488 DOI: 10.3389/fped.2023.1180690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Objectives Early predictors for back pain need to be identified for the development of prevention strategies starting as early as childhood. For this purpose, the relationship between physical fitness and spinal flexibility at the age of six years and its prediction for the development of non-specific back pain (BP) during childhood were analyzed. Methods In this prospective cohort study with 4-year follow-up, school children from the Swiss Canton Basel-Stadt, aged 6-8 (2014) at baseline and 10-12 years (2018) at follow-up, were recruited from 26 primary schools (n = 238) within a mandatory evaluation of motor skills. Data for spinal flexibility were collected by use of a hand-held computer-assisted device and physical fitness was assessed by shuttle run performance at both time points. Occurrence of non-specific BP was determined by use of a questionnaire at follow-up. Results Children with higher physical fitness at baseline achieved a better spinal flexibility four years later (β [95% CI] 3.75 [2.19-5.3] degree per 1 stage increase, p < 0.001). Higher spinal flexibility by 1 degree at baseline was associated with 2% less odds for non-specific BP at follow-up (OR [95% CI] 0.98 [0.97-0.99] per 1 degree increase, p = 0.032). There was little evidence for a direct association between physical fitness at baseline and development of non-specific BP at follow-up (OR [95% CI] 1.13 [0.96-1.34] per 1 stage increase, p = 0.128). Conclusion Fitness performance is associated with the development of better childhood spinal flexibility over four years. Moreover, a better spinal flexibility at baseline was associated with less non-specific BP at follow-up. This study suggests that physical fitness may be a key modulator of spinal flexibility which itself is a main determinant of non-specific BP during childhood development. Further long-term studies are warranted to confirm our assumptions and to prove trajectories into adolescents and adulthood.
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15
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van den Heuvel MM, Chiarotto A, Oei EH, van Middelkoop M. Low Back Pain in Adolescents: Associations With Demographics, Physical and Psychosocial Factors, and Magnetic Resonance Imaging Features of the Spine. Spine (Phila Pa 1976) 2023; 48:E216-E218. [PMID: 37195001 PMCID: PMC10249599 DOI: 10.1097/brs.0000000000004690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/11/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Marleen M. van den Heuvel
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H.G. Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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16
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Hestbæk L, Kamper SJ, Hartvigsen J, Falch-Joergensen AC. Motor skills at 7 years of age and spinal pain at 11 years of age: a cohort study of 26,000 preadolescents. Eur J Pediatr 2023:10.1007/s00431-023-04964-8. [PMID: 37043072 PMCID: PMC10257602 DOI: 10.1007/s00431-023-04964-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/13/2023]
Abstract
This study aims to investigate the relationship between motor skills at age 7 and spinal pain at age 11. The study included participants from the Danish National Birth Cohort. Data on motor skills were obtained from the Developmental Coordination Disorder Questionnaire, completed by the mothers when the children were 7 years old, and spinal pain was self-reported at age 11 for frequency and intensity of neck, mid back, and low back pain. This was categorized into "no," "moderate," or "severe" pain, based on frequency and pain intensity. Associations were estimated using multinomial logistic regression models. Data on both motor skills and spinal pain was available for 25,000 children. There was a consistent pattern of reporting more neck or mid back pain at age 11 for those with lower levels of fine motor skills and coordination scores at age 11. The relationship was significant for severe pain (the highest relative risk ratio being 1.87 and the lowest 1.18), but not for moderate pain (the highest relative risk ratio being 1.22 and the lowest 1.07). Gross motor skills were not associated with spinal pain, and there was no relationship between low back pain and motor skills. Conclusion: Our results indicate a link between motor development at 7 years of age and neck and mid back pain, but not low back pain, at 11 years of age. Improvement of motor skills in young children might reduce the future burden of neck and mid back pain and should be a target of future research. What is Known: • Spinal pain in preadolescence and adolescence is common and predisposes to spinal pain in adulthood. • Motor skills influence the biomechanics of movement and therefore has a potential impact on musculoskeletal health. What is New: • Poor fine motor- and coordination skills in childhood were associated with increased risk of severe neck- or mid back pain, but not low back pain, four 4 years later. • Poor gross motor skills were not associated with higher risk of later spinal pain.
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Affiliation(s)
- L Hestbæk
- The Chiropractic Knowledge Hub, Campusvej 55, 5230, Odense, Denmark.
- Dept. of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - S J Kamper
- University of Sydney & Nepean Blue Mountains Local Health District, Sydney, Australia
| | - J Hartvigsen
- The Chiropractic Knowledge Hub, Campusvej 55, 5230, Odense, Denmark
- Dept. of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - A C Falch-Joergensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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17
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Hauber SD, Robinson K, Kirby E, Kamper S, Lennox NN, O'Sullivan K. Describing the nonsurgical, nonpharmacological interventions offered to adolescents with persistent back pain in randomized trials: A scoping review. Eur J Pain 2023; 27:459-475. [PMID: 36587243 DOI: 10.1002/ejp.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Persistent nonspecific back pain is now established as a biopsychosocial phenomenon that can be meaningfully affected by individuals' cognitions, emotions, lifestyle factors and family and social relationships. Recent guidelines for the treatment of adolescents with persistent nonspecific back pain, as well as those for youth with mixed chronic pain, strongly recommend interdisciplinary care in which adolescents receive treatment for both mind and body. The objective of this scoping review was to examine the interventions evaluated in randomized trials for adolescents with persistent back pain to determine whether they correspond to these guidelines and to reveal future research priorities. DATABASES AND DATA TREATMENT The review protocol was registered in March 2022. We followed the PRISMA guidelines for scoping reviews. Twelve electronic databases were searched for relevant study reports. Data were charted on study characteristics, participant characteristics and intervention details using the Template for Intervention Description and Replication (TIDieR) checklist. RESULTS The search yielded 1952 records, of which eight reports representing seven randomized trials were eligible. The most common interventions were exercise therapy (n = 6) and back education (n = 4). Five studies employed multiple intervention components, but none was multidisciplinary. Studies primarily targeted posture or biomechanical factors. One study included an intervention addressing participants' fears and beliefs about pain. CONCLUSIONS Randomized trials for adolescents with persistent back pain have primarily relied upon an outdated, biomechanical explanation of persisting pain. Future randomized trials should align with current treatment recommendations and measure outcomes across multiple biopsychosocial domains. SIGNIFICANCE This scoping review describes in detail the interventions included in randomized trials for adolescents with persistent, nonspecific back pain. The review is important because it reveals discrepancies between those interventions and the interventions recommended for this population.
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Affiliation(s)
- Sara D Hauber
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Edward Kirby
- Essex Partnership University NHS Foundation Trust, Runwell, UK
| | - Steven Kamper
- School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Noirin Nealon Lennox
- Faculty of Life and Health Sciences, Ulster University, Belfast, UK
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Santos EDS, Bernardes JM, Vianna LS, Ruiz-Frutos C, Gómez-Salgado J, Alonso MS, Noll M, Dias A. The Impact of Low Back Pain on the Quality of Life of Children between 6 and 12 Years of Age. Healthcare (Basel) 2023; 11:healthcare11070948. [PMID: 37046874 PMCID: PMC10094538 DOI: 10.3390/healthcare11070948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
This study aimed to evaluate the impact of low back pain on the perceived health-related quality of life of children between 6 and 12 years of age. This is a cross-sectional study of three hundred seventy-seven students from three schools (two private and one public) located in the city of Botucatu, São Paulo. Data were collected using the Pediatric Quality of Life Inventory (PedsQL, version 4.0), a questionnaire comprising questions on personal background, sociodemographic and socioeconomic information, and a questionnaire about quality of life. Comparisons were made between groups with and without low back pain. The chi-squared test was used for analyzing categorical variables, and the non-parametric Mann–Whitney test was used for continuous variables. According to the findings obtained in this study, it was observed that low back pain in the last month was reported by 27.3% of the total participants. The perceived health-related quality of life was lower among individuals who had low back pain, and the scores of physical and emotional functioning domains were also lower in the presence of low back pain. The prevalence of low back pain among children and adolescents is relatively high. Furthermore, the repercussions of low back pain may lead to a lower overall perception of the health-related quality of life in this population and affect aspects of physical and emotional functioning.
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Affiliation(s)
- Elisiane de Souza Santos
- Public/Collective Health Graduate Program, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618687, Brazil (J.M.B.)
| | - João Marcos Bernardes
- Public/Collective Health Graduate Program, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618687, Brazil (J.M.B.)
- Department of Public Health, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618687, Brazil
| | - Luana Schneider Vianna
- Medical School, Centro Universitário de Jaguariúna, (UNIFAJ), Jaguariúna 13820000, São Paulo, Brazil
| | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil 092301, Ecuador
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil 092301, Ecuador
- Correspondence: (J.G.-S.); (M.N.); Tel.: +34-959-219-700 (J.G.-S.); +55-(62)-3307-7100 (M.N.)
| | - Melissa Spröesser Alonso
- Public/Collective Health Graduate Program, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618687, Brazil (J.M.B.)
| | - Matias Noll
- Health and Physical Examination Laboratory, Instituto Federal Goiano, Ceres 76300000, Goiás, Brazil
- Physical Education Graduate Program, Universidade Federal de Goiás, Goiânia 74690900, Goiás, Brazil
- Correspondence: (J.G.-S.); (M.N.); Tel.: +34-959-219-700 (J.G.-S.); +55-(62)-3307-7100 (M.N.)
| | - Adriano Dias
- Public/Collective Health Graduate Program, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618687, Brazil (J.M.B.)
- Department of Public Health, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618687, Brazil
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Back Pain without Disease or Substantial Injury in Children and Adolescents: A Twin Family Study Investigating Genetic Influence and Associations. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020375. [PMID: 36832504 PMCID: PMC9955700 DOI: 10.3390/children10020375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/22/2022] [Accepted: 01/06/2023] [Indexed: 02/17/2023]
Abstract
This twin family study first aimed to investigate the evidence for genetic factors predicting the risk of lifetime prevalence of non-specific low back pain of at least three months duration (LBP (life)) and one-month current prevalence of thoracolumbar back pain (TLBP (current)) using a study of children, adolescents, and their first-degree relatives. Secondly, the study aimed to identify associations between pain in the back with pain in other regions and also with other conditions of interest. Randomly selected families (n = 2479) with child or adolescent twin pairs and their biological parents and first siblings were approached by Twins Research Australia. There were 651 complete twin pairs aged 6-20 years (response 26%). Casewise concordance, correlation, and odds ratios were compared for monozygous (MZ) and dizygous (DZ) pairs to enable inference about the potential existence of genetic vulnerability. Multivariable random effects logistic regression was used to estimate associations between LBP (life) or TLBP (current) as an outcome with the potentially relevant condition as predictors. The MZ pairs were more similar than the DZ pairs for each of the back pain conditions (all p values < 0.02). Both back pain conditions were associated with pain in multiple sites and with primary pain and other conditions using the combined twin and sibling sample (n = 1382). Data were consistent with the existence of genetic influences on the pain measures under the equal environments assumption of the classic twin model and associations with both categories of back pain were consistent with primary pain conditions and syndromes of childhood and adolescence which has research and clinical implications.
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Yue C, Wenyao G, Xudong Y, Shuang S, Zhuying S, Yizheng Z, Linlin Z, Jinxin C, Xingqi W, Yujia L. Dose-response relationship between daily screen time and the risk of low back pain among children and adolescents: a meta-analysis of 57831 participants. Environ Health Prev Med 2023; 28:64. [PMID: 37899211 PMCID: PMC10613558 DOI: 10.1265/ehpm.23-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/30/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND The risk of low back pain (LBP) increases steeply during adolescence, and adolescents with LBP are more likely to have low back pain in their adult years. This study aimed to investigate the dose-response relationship between daily screen time and the risk of low back pain among children and adolescents. METHODS PubMed, the Cochrane Library, Embase, and Web of Science were searched to collect relevant studies on daily screen time and the risk of low back pain from the establishment of the database up to December 2022. Two investigators independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata16.0 was used to perform a dose-response meta-analysis and the methodological quality evaluation of the included studies. RESULTS The results of the meta-analysis showed that there is a positive correlation between daily computer time (OR = 1.32, 1.05-1.60), daily mobile phone time (OR = 1.32, 1.00-1.64), daily TV watching (OR = 1.07, 1.04-1.09) and the risk of low back pain, separately. The dose-response meta-analysis showed that there is a linear relationship between daily computer use and low back pain. The risk of low back pain increased by 8.2% for each 1-hour of daily computer use. CONCLUSIONS Screen time is related to the risk of low back pain, and there is a linear relationship between daily computer use and the risk of low back pain. A number of strategic measures should be taken to prevent adolescents from developing severe low back pain.
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Affiliation(s)
- Cheng Yue
- Department of Physical Education, Jiangsu Normal University, Xuzhou, Jiangsu Province, 221116, China
| | - Guo Wenyao
- Department of Physical Education, Jiangsu Normal University, Xuzhou, Jiangsu Province, 221116, China
| | - Ya Xudong
- Department of Physical Education, Jiangsu Normal University, Xuzhou, Jiangsu Province, 221116, China
| | - Shao Shuang
- Department of Physical Education, Jiangsu Normal University, Xuzhou, Jiangsu Province, 221116, China
| | - Shao Zhuying
- Department of Physical Education, Jiangsu Normal University, Xuzhou, Jiangsu Province, 221116, China
| | - Zhu Yizheng
- Department of Physical Education, Jiangsu Normal University, Xuzhou, Jiangsu Province, 221116, China
| | - Zhou Linlin
- Department of Physical Education, Jiangsu Normal University, Xuzhou, Jiangsu Province, 221116, China
| | - Chen Jinxin
- Yancheng Xinyang Youth Development Service Center, Yancheng, Jiangsu Province, 224000, China
| | - Wang Xingqi
- Biomedical R&d Center, School of Life Science, Jiangsu Normal University, Xuzhou, Jiangsu Province, 221116, China
| | - Liu Yujia
- Department of Physical Education, Jiangsu Normal University, Xuzhou, Jiangsu Province, 221116, China
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21
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Relation between Physical Fitness Components and the Occurrence and Subjective Intensity of Back Pain in Secondary School Adolescents. Behav Sci (Basel) 2022; 12:bs12100353. [PMID: 36285922 PMCID: PMC9598372 DOI: 10.3390/bs12100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Despite the well documented benefits of physical fitness (PF) on general health, its role in back pain (BP) is still unclear. The objective of this study was to assess the association between different PF profiles and BP in a sample of adolescents. The study assessed PF and BP in a sample of 919 youth (age = 15.5 ± 1.3 years) from North and South Tyrol. A total of 531 participants (57.8%) reported no BP, whereas 4.7% (n = 43) reported severe BP. A two-step cluster analysis detected three main groups: the “less fit”, with significantly lower scores in all PF tests (p < 0.001); the “strong sprinters”, with higher speed and muscular strength than the others (p < 0.001); and the “flexible marathoners”, with higher flexibility and cardiorespiratory fitness (p < 0.001). The “flexible marathoners” showed significantly better BP scores than the “less fit” (p = 0.029). Cardiorespiratory fitness and trunk flexibility are potential preventive components of BP in adolescents. Since the decline in flexibility starts very early in life, it is recommended to put a particular emphasis on this component of PF. The role of other components of PF should be further investigated in the future.
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22
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Wall J, Meehan WP, Trompeter K, Gissane C, Mockler D, van Dyk N, Wilson F. Incidence, prevalence and risk factors for low back pain in adolescent athletes: a systematic review and meta-analysis. Br J Sports Med 2022; 56:1299-1306. [PMID: 36150752 DOI: 10.1136/bjsports-2021-104749] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the incidence, prevalence, risk factors and morphological presentations of low back pain (LBP) in adolescent athletes. DESIGN Systematic review with meta-analysis. DATA SOURCES Medline, Embase, CINAHL via EBSCO, Web of Science, Scopus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies evaluating the incidence and/or prevalence of LBP in adolescent athletes across all sports. RESULTS There were 80 studies included. The pooled incidence estimate of LBP in adolescent athletes was 11% (95% CI 8% to 13%, I2=0%) for 2 years, 36.0% (95% CI 4% to 68%, I2=99.3%) for 12 months and 14% (95% CI 7% to 22%, I2=76%) for 6 months incidence estimates. The pooled prevalence estimate of LBP in adolescent athletes was 42% (95% CI 29% to 55%, I2=96.6%) for last 12 months, 46% (95% CI 41.0% to 52%, I2=56%) for last 3 months and 16% (95% CI 9% to 23%, I2=98.3%) for point prevalence. Potential risk factors were sport participation, sport volume/intensity, concurrent lower extremity pain, overweight/high body mass index, older adolescent age, female sex and family history of LBP. The most common morphology reported was spondylolysis. Methodological quality was deemed high in 73% of cross-sectional studies and in 30% of cohort studies. Common reasons for downgrading at quality assessment were use of non-validated survey instruments and imprecision or absence of LBP definition. SUMMARY/CONCLUSION LBP is common among adolescent athletes, although incidence and prevalence vary considerably due to differences in study methodology, definitions of LBP and data collection. PROSPERO REGISTRATION NUMBER CRD42020157206.
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Affiliation(s)
- Julia Wall
- Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Boston Children's Hospital, Waltham, Massachusetts, USA
| | - Katharina Trompeter
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit Bochum, Bochum, Nordrhein-Westfalen, Germany.,Department of Sports Medicine and Sports Nutrition, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Conor Gissane
- Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Fiona Wilson
- Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland
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23
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Shaygan M, Jaberi A. The experience of chronic pain among adolescents: suffering and attempt to overcome pain? BMC Pediatr 2022; 22:554. [PMID: 36123721 PMCID: PMC9487047 DOI: 10.1186/s12887-022-03617-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 09/15/2022] [Indexed: 11/12/2022] Open
Abstract
Background Chronic pain (CP) among adolescents has received less attention than adultsandthere is limited qualitative studies about it in Iran. This study explored the experience of CP among adolescents. Methods This exploratory qualitative study was conducted in April–October 2019. Participants were 14 adolescent students purposively recruited from schools in Shiraz, Iran. Semi-structured interviews were conducted for data collection and data analysis was done through conventional content analysis. Findings Adolescents’ experiences of CP came into nine subcategories and three main categories, namely perceived suffering, attempt to overcome pain, and attempt to find sources of support. Conclusion Adolescents with CP experience physical and mental suffering and attempt to manage their pain and its associated suffering through different physical and psychological strategies and using different sources of support such as family, peers, healthcare providers, and school staff.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Center, Nursing Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Jaberi
- Community Based Psychiatric Care Research Center, Nursing Department, Shiraz University of Medical Sciences, Shiraz, Iran. .,Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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24
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Shinde N, Kanabar DJ, Miles LJ. Narrative review of the prevalence and distribution of acute pain in children in the self-care setting. PAEDIATRIC & NEONATAL PAIN 2022; 4:169-191. [PMID: 36618510 PMCID: PMC9798044 DOI: 10.1002/pne2.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/16/2022] [Accepted: 07/20/2022] [Indexed: 01/11/2023]
Abstract
Acute pain among children is common, yet it may be underestimated and undertreated if the pain is not recognized. Assessing and managing pediatric pain can be complicated, and as such, measuring the prevalence of acute pain in children can be challenging. We sought to provide a consolidated review of the available data on the prevalence of commonly occurring acute pain in children in the self-care setting. An extensive literature search was performed to determine the prevalence of acute pain at multiple bodily locations in children aged between 3 months and 18 years. We considered the influence of age, sex, and sociodemographic factors on prevalence estimates. We also sought to identify some of the challenges involved in assessing and managing pediatric pain, thus shedding light on areas where there may be clinical and medical unmet needs. In general, a high prevalence of acute pain in children was detected, particularly headache, menstruation-related pain, and dental and back pain. Older age, female sex, and lower socioeconomic status were associated with increased pain prevalence. Risk factors were identified for all pain types and included psychological issues, stress, and unhealthy lifestyle habits. Owing to the heterogeneity in study populations, the prevalence estimates varied widely; there was also heterogeneity in the pain assessment tools utilized. The paucity of information regarding pain prevalence appears to be out of proportion with the burden of acute pain in children. This could indicate that clinicians may not be equipped with an optimal pain management strategy to guide their practice, especially regarding the use of developmentally appropriate pain assessment tools, without which prevalence data may not be captured. If acute pain is not accurately identified, it cannot be optimally treated. Further investigation is required to determine how the information from prevalence studies translates to the real-world setting.
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Affiliation(s)
- Nutan Shinde
- Reckitt Benckiser plc (Global Headquarters)BerkshireUK
| | | | - Lisa J. Miles
- Reckitt Benckiser plc (Global Headquarters)BerkshireUK
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25
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Three in Every 10 School-aged Children in Brazil Report Back Pain in Any Given Year: 12-Month Prospective Cohort Study of Prevalence, Incidence, and Prognosis. J Orthop Sports Phys Ther 2022; 52:554-562. [PMID: 35722760 DOI: 10.2519/jospt.2022.10819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the prevalence, incidence, and prognosis of back pain in children and adolescents. DESIGN Prospective cohort study. METHODS We followed children and adolescents between the ages of 8 and 18 years with and without back pain over 12 months (3, 6, and 12 months) from public and private schools. At baseline, parents (or guardians) answered questionnaires including sociodemographic characteristics and perception of sleep quality of their children and adolescents. Children and adolescents answered questionnaires including sociodemographic characteristics, presence of back pain, pain intensity, quality of life, and psychosomatic symptoms. At follow-up, children and adolescents answered questions about the presence of back pain. RESULTS Six hundred fifteen children and adolescents were included, 163 of whom had back pain and 452 of whom had no back pain at baseline. The mean age of participants was 11.6 years (SD = 2.5), and the majority were female (n = 362; 59%). The 1-month prevalence of back pain was 26% (95% confidence interval: 23%-30%). The incidence rate of back pain was 35% (31%-40%) over 12 months. Of the 163 participants who had back pain at baseline, 83% had recovered by 12 months. Of those who recovered within 6 months, 31% had a recurrence of back pain at the 12-month follow-up. CONCLUSION Two to 3 in every 10 children and adolescents reported back pain in the last month. New cases of back pain were reported by 3-4 in every 10 children and adolescents for a period of 12 months. Nearly all children recover within 12 months, but recurrence seems to be common. J Orthop Sports Phys Ther 2022;52(8):554-562. Epub: 19 June 2022. doi:10.2519/jospt.2022.10819.
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da Rosa BN, Noll M, Candotti CT, Loss JF. Risk Factors for Back Pain among Southern Brazilian School Children: A 6-Year Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148322. [PMID: 35886179 PMCID: PMC9322503 DOI: 10.3390/ijerph19148322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 01/27/2023]
Abstract
Risk factors associated with back pain vary in different countries. Given the lack of studies in Latin America, our study aimed to assess back pain and its associated factors for six years in Southern Brazilian school children. All children attending the fifth grade of Teutônia, Brazil, were invited to participate in the study. Only schoolchildren who did not report back pain were included in the first assessment. The schoolchildren completed the Back Pain and Body Posture Evaluation Instrument (BackPEI) during three assessments (2011, 2014, and 2017). BackPEI assesses the presence of back pain and possible associated risk factors (postural, behavioral, and sociodemographic). Generalized estimated equations (GEE) were used to perform a Poisson regression model with robust variance for longitudinal analysis. After six years of follow-up, 75 schoolchildren completed all the assessments. The risk factors associated with back pain were spending more than six hours daily watching television, lifting objects from the ground adopting an inadequate posture, using another backpack type different from those with two straps, and carrying a backpack in an asymmetric way. These results are important in guiding the planning of public policies to minimize this public health problem.
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Affiliation(s)
- Bruna Nichele da Rosa
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre 90010-150, Brazil; (C.T.C.); (J.F.L.)
- Correspondence:
| | - Matias Noll
- Instituto Federal Goiano, Goiânia 76300-000, Brazil;
| | - Cláudia Tarragô Candotti
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre 90010-150, Brazil; (C.T.C.); (J.F.L.)
| | - Jefferson Fagundes Loss
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre 90010-150, Brazil; (C.T.C.); (J.F.L.)
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27
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What Works When Treating Children and Adolescents With Low Back Pain? J Orthop Sports Phys Ther 2022; 52:419-424. [PMID: 35584032 DOI: 10.2519/jospt.2022.10768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Low back pain is a common health condition for all ages. One quarter to a third of children report persistent pain, including low back pain. CLINICAL QUESTION The aim of this Clinical Commentary is to provide an overview of evidence-based treatment approaches for children and adolescents with low back pain. KEY RESULTS Physical, psychological, and pharmacological interventions are effective in reducing pain intensity and disability. Interdisciplinary and patient- and family-centered treatment approaches are the gold standard for persistent pain in children and adolescents. Communication between health professionals, children, and parents is a key part of a therapeutic alliance. The use of holistic and complementary therapies is not supported by compelling evidence. CLINICAL APPLICATION Physical interventions can be delivered alone or as a component of other interventions. The interventions are delivered over 8 to 12 weeks. Psychological therapies are mostly delivered as a component of a multidisciplinary treatment program: cognitive behavioral therapy is most often used, and interventions usually run from 4 to 10 weeks. Pharmacological interventions should be delivered in combination with physical and psychological interventions. Tailor family-centered interventions to personal aspects, such as age, gender, and family structure. When communicating with children and adolescents, use simple language that is clear and direct. Aim to support trust between health professionals and parents to facilitate family decision making. J Orthop Sports Phys Ther 2022;52(7):419-424. Epub: 18 May 2022. doi:10.2519/jospt.2022.10768.
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Stapp EK, Cui L, Guo W, Paksarian D, Merikangas KR. Comorbidity and familial aggregation of back/neck pain in the NIMH Family Study of Affective Spectrum Disorders. J Psychosom Res 2022; 158:110927. [PMID: 35526400 DOI: 10.1016/j.jpsychores.2022.110927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Back pain is associated with substantial Global Burden of Disease and is highly comorbid with mood and anxiety symptoms and syndromes. However, mechanisms underlying this association have not been well-elucidated. Here we apply data from the NIMH Family Study of Affective Spectrum Disorders to investigate the comorbidity, familial aggregation, and cross-aggregation of back/neck pain with mood disorder subtypes. METHODS The sample includes 519 probands and 560 interviewed first-degree relatives. Lifetime DSM-IV Bipolar I, Bipolar II, and Major Depressive Disorder [MDD] were derived from semi-structured diagnostic interviews. Lifetime history of back or neck pain and its age of onset were self-reported retrospectively. Familial aggregation and cross-aggregation were estimated via mixed effects models in probands and interviewed first-degree relatives, while heritability and co-heritability (endophenotypic ranking value [ERV]) were estimated using full pedigrees. RESULTS Over 45% of participants endorsed a history of back/neck pain. Back/neck pain was familial (adjusted odds ratio [aOR] 1.5, p = 0.04; h2 = 0.24, p = 0.009). Back/neck pain in probands was associated with MDD in relatives (aOR 1.5, p = 0.04; ERV = 0.17, p = 0.024), but not with bipolar disorder. Onset of back/neck pain occurred earlier in those with bipolar disorder compared to controls. CONCLUSION Findings suggest common familial risk factors underlying back/neck pain with MDD, whereas there was within-individual comorbidity of bipolar with back/neck pain. Future studies that identify common factors that lead to either back/neck pain or MDD can inform prevention and interventions.
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Affiliation(s)
- Emma K Stapp
- Genetic Epidemiology Branch, Intramural Research Program, NIMH, Bethesda, MD, USA
| | - Lihong Cui
- Genetic Epidemiology Branch, Intramural Research Program, NIMH, Bethesda, MD, USA
| | - Wei Guo
- Genetic Epidemiology Branch, Intramural Research Program, NIMH, Bethesda, MD, USA
| | - Diana Paksarian
- Genetic Epidemiology Branch, Intramural Research Program, NIMH, Bethesda, MD, USA
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29
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Azevedo N, Ribeiro JC, Machado L. Balance and Posture in Children and Adolescents: A Cross-Sectional Study. SENSORS 2022; 22:s22134973. [PMID: 35808468 PMCID: PMC9269686 DOI: 10.3390/s22134973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023]
Abstract
Balance and posture are two topics that have been extensively studied, although with some conflicting findings. Therefore, the aim of this work is to analyze the relationship between the postural angles of the spine in the sagittal plane and the stable static balance. A cross-sectional study was conducted with children and adolescents from schools in northern Portugal in 2019. An online questionnaire was used to characterize the sample and analyze back pain. Spinal postural angle assessment (pelvic, lumbar, and thoracic) was performed using the Spinal Mouse®, while stabilometry assessment was performed using Namrol® Podoprint®. Statistical significance was set as α = 0.05. The results showed that girls have better balance variables. There is a weak correlation between the anthropometric variables with stabilometry variables and the postural angles. This correlation is mostly negative, except for the thoracic spine with anthropometric variables and the lumbar spine with BMI. The results showed that postural angles of the spine are poor predictors of the stabilometric variables. Concerning back pain, increasing the postural angle of the thoracic spine increases the odds ratio of manifestation of back pain by 3%.
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Affiliation(s)
- Nelson Azevedo
- CICS, ISAVE, Faculdade de Desporto da Universidade do Porto, 4200-450 Porto, Portugal;
| | - José Carlos Ribeiro
- CIAFEL, ITR, Faculdade de Desporto da Universidade do Porto, 4200-450 Porto, Portugal;
| | - Leandro Machado
- CIFI2D, LABIOMEP, Faculdade de Desporto da Universidade do Porto, 4200-450 Porto, Portugal
- Correspondence:
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30
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Roman-Juan J, Roy R, Jensen MP, Miró J. The Explanatory Role of Sedentary Screen Time and Obesity in the Increase of Chronic Back Pain among European Adolescents: The HBSC Study 2002-2014. Eur J Pain 2022; 26:1781-1789. [PMID: 35761772 PMCID: PMC9543407 DOI: 10.1002/ejp.2003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/15/2022] [Accepted: 06/26/2022] [Indexed: 11/17/2022]
Abstract
Background Previous research has shown that chronic back pain amongst European adolescents is increasing. Determining the factors associated with this increasing trend is crucial for developing prevention strategies. In this study, we used data from the Health Behaviour in School‐aged Children (HBSC) survey to examine whether increases in screen time and/or obesity between 2002 and 2014 were associated with the increase in the prevalence of chronic back pain amongst European adolescents during the 12‐year period. Methods Data from 423,092 adolescents from 27 European countries/regions were drawn from the HBSC questionnaire‐based surveys conducted in 2002, 2006, 2010 and 2014. The Karlson–Holm–Breen method was used to examine the explanatory role of increases in screen time and obesity on the increase in the prevalence of chronic back pain whilst controlling for sex and age. Results Increases in both screen time and obesity between 2002 and 2014 were associated with increases in the prevalence of chronic back pain (p < 0.001). The percent of chronic back pain prevalence increase accounted for by screen time and obesity was 3.98% and 1.65%, respectively. Conclusions The increase in the prevalence of chronic back pain amongst European adolescents may be explained, in part, by the rising trends in both sedentary screen time and obesity. The fact that screen time and obesity only accounted for a small part of the increase in the prevalence of chronic back pain indicates that other unmeasured factors also play a role. Significance More screen time and obesity are slightly associated with more chronic back pain (CBP) prevalence in adolescents across the WHO European Region. The findings may be used to identify ways to prevent or reduce the rising trend of CBP in adolescents.
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Affiliation(s)
- Josep Roman-Juan
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Rubén Roy
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
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31
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Heikkala E, Karppinen J, Mikkola I, Hagnäs M, Oura P. Association Between Family History of Surgically Treated Low Back Pain and Adolescent Low Back Pain. Spine (Phila Pa 1976) 2022; 47:649-655. [PMID: 35194000 DOI: 10.1097/brs.0000000000004345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVE To study the associations between a family history of surgically treated low back pain (LBP) and adolescent LBP. SUMMARY OF BACKGROUND DATA A family history of LBP is related to adolescent LBP, but whether a family history of back surgery is relevant to adolescent LBP is not known. METHODS A subpopulation of the Northern Finland Birth Cohort 1986 was contacted when they were aged between 18 and 19years. The postal questionnaire asked the participants to report their LBP and a relative's (mother, father, sibling) LBP and back surgery, and to provide data on potential covariates. The association between a family history of LBP ("no family history of LBP," "family history of LBP but no surgery," and "family history of LBP and surgery") and adolescent LBP (no LBP, occasional LBP, and frequent LBP) were evaluated using logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for sex, smoking, and psychological distress. RESULTS Of the 1374 adolescents in the study, 33% reported occasional LBP and 9% frequent LBP. Both the "family history of LBP but no surgery" and "family history of LBP and surgery" categories were associated with frequent LBP (adjusted OR [aOR] 2.09, 95% CI 1.38-3.16; aOR 2.23, 95% CI 1.02-4.90, respectively). Occasional LBP was associated with the "family history of LBP and surgery" category. A subgroup analysis of adolescents with a family history of LBP found no statistically significant associations between family history of back surgery and adolescent LBP. CONCLUSION Our findings suggest that adolescents who report a family history of LBP have higher odds of frequent LBP irrespectively of a family history of back surgery.Level of evidence: 4.
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Affiliation(s)
- Eveliina Heikkala
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Rovaniemi Health Center, Koskikatu 25, Rovaniemi, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Rehabilitation Services of South Karelia Social and Health Care District, Valto Käkelän katu 3, Lappeenranta, Finland
| | - Ilona Mikkola
- Rovaniemi Health Center, Koskikatu 25, Rovaniemi, Finland
| | - Maria Hagnäs
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Rovaniemi Health Center, Koskikatu 25, Rovaniemi, Finland
| | - Petteri Oura
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
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Treatment of Unspecific Back Pain in Children and Adolescents: Results of an Evidence-Based Interdisciplinary Guideline. CHILDREN 2022; 9:children9030417. [PMID: 35327789 PMCID: PMC8947172 DOI: 10.3390/children9030417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/17/2022] [Accepted: 03/12/2022] [Indexed: 01/08/2023]
Abstract
Using a structured approach and expert consensus, we developed an evidence-based guideline on the treatment and prevention of non-specific back pain in children and adolescents. A comprehensive and systematic literature search identified relevant guidelines and studies. Based on the findings of this literature search, recommendations on treatment and prevention were formulated and voted on by experts in a structured consensus-building process. Physical therapy (particularly physical activity) and psychotherapy (particularly cognitive behavioral therapy) are recommended for treating pediatric non-specific back pain. Intensive interdisciplinary treatment programs should be provided for chronic and severe pain. Drug therapy should not be applied in children and adolescents. Further research on non-specific back pain in childhood and adolescence is strongly needed to reduce the imbalance between the high burden of non-specific back pain in childhood and adolescence and the low research activity in this field.
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Chronic backpain among adolescents in Denmark: trends 1991-2018 and association with socioeconomic status. Eur J Pediatr 2022; 181:691-699. [PMID: 34529135 DOI: 10.1007/s00431-021-04255-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Chronic backpain among adolescents is important because the prevalence is high, above 10%, and more than 10% of all adolescents experience impacts on important day-to-day activities. Chronic backpain tracks into adulthood and is associated with several health problems. The objective was to study trends in the prevalence of chronic backpain among adolescents 1991-2018, to examine the association with socioeconomic status (SES), and whether this association changed over time. The study used data from eight comparable cross-sectional school surveys of nationally representative samples of 11-15-year-olds in 1991, 1994, 1998, 2002, 2006, 2010, 2014, and 2018, which constitute the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study. The participation rate was 74.6% of the eligible study population, n = 29,952. Chronic backpain was defined as self-reported backpain daily or several days a week during the last 6 months. The prevalence of chronic backpain was 11.1%, significantly increasing from 8.9% in 1991 to 11.7% in 2018. The OR for chronic backpain was 1.20 (95% CI: 1.10-1.31) in middle, and 1.56 (95% CI: 1.41-1.73) in low compared to high SES. Sensitivity analyses with two other cut-points for backpain frequency showed similar associations.Conclusion: Chronic backpain is common among adolescents and the prevalence increased from 1991 to 2018. The prevalence was highest in lower SES families. We recommend increased efforts to prevent chronic backpain. What is Known: • Chronic backpain among adolescents is common, has a high burden of disability, is associated with several health problems, and tracks into adulthood. What is New: • The prevalence of chronic backpain among adolescents in Denmark increased from 8.9% in 1991 to 11.7% in 2018. • The prevalence was highest among adolescents from lower SES families.
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Montgomery LRC, Kamper SJ, Hartvigsen J, French SD, Hestbaek L, Troelsen J, Swain MS. Exceeding 2-h sedentary time per day is not associated with moderate to severe spinal pain in 11- to 13-year-olds: a cross-sectional analysis. Eur J Pediatr 2022; 181:653-659. [PMID: 34510234 DOI: 10.1007/s00431-021-04258-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Neck, mid-back and low back pain, collectively known as spinal pain, become more common with increasing age across childhood and adolescence. A common belief among the general community is that sedentary time, including screen time, in adolescents is associated with spinal pain. We aimed to investigate whether exceeding 2-h of sedentary time per day is associated with moderate to severe spinal pain in a sample of Danish adolescents aged 11-13 years. We performed a cross-sectional analysis of the SPACE study baseline data (2010). Adolescents self-reported their spinal pain (outcome) via the Young Spine Questionnaire and duration of engagement in sedentary behaviours (exposure). We provide estimates of associations as odds ratios with 95% confidence intervals, stratified by age and sex. The sample comprised 1,303 adolescents (48.7% female, mean age 12.5 years, range 10.9-14.3 years). Approximately 9 out of 10 adolescents exceeded 2-h sedentary time on weekdays outside of school (88.9%) and weekend days (89.9%). Close to one-quarter, 23.3% (95%CI: 21.0-25.6), of participants experienced moderate to severe spinal pain. We found no association between exceeding 2-h sedentary time per day and experiencing moderate to severe spinal pain; odds ratios ranged from 0.34 (95%CI: 0.04-3.20) to 4.65 (95%CI: 0.26-82.44).Conclusion: We found no association between exceeding 2- or 5-h of sedentary time per day and moderate to severe spinal pain in this sample of 11-13-year-old Danish adolescents. Our cross-sectional analysis does not consider the longitudinal or complex sequences of events necessary to address predictive or causal questions. What is Known: • Up to a third of adolescents experience moderate to severe spinal pain, predisposing them to chronic spinal pain in adulthood. • Frequent and excessive sedentary time is associated with poor overall health in adolescents; there is conflicting evidence to suggest whether it is also related to spinal pain. What is New: • We found no association between sedentary time and moderate to severe spinal pain in 11- to 13-year-old Danes.
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Affiliation(s)
- Laura R C Montgomery
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia.
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Steven J Kamper
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
- Centre for Pain, Health and Lifestyle, New Lambton Heights, NSW, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Jens Troelsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Michael S Swain
- Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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da Rosa BN, Candotti CT, Pivotto LR, Noll M, Silva MG, Vieira A, Loss JF. Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA): Expansion, Content Validation, and Reliability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031398. [PMID: 35162421 PMCID: PMC8835607 DOI: 10.3390/ijerph19031398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 12/04/2022]
Abstract
The Back Pain and Body Posture Evaluation Instrument (BackPEI) was created in 2013 to assess back pain and its risk factors in school children. However, it does not assess neck pain or the habits of mobile device usage, which are aspects that are often part of school children’s lives. Therefore, we aimed to update the BackPEI questionnaire to include new questions assessing aspects related to neck pain and the use of mobile devices and to test the content validity and reliability of the new questions. The updated questionnaire was named Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA). The content was validated by eight experts using the content validity index (CVI). To assess reliability, the BackPEI-CA questionnaire was applied at two different times in 105 school children, and Cohen’s kappa (k) and intraclass correlation coefficient (ICC) were calculated. All aspects assessed regarding content validity had a CVI higher than 0.8. The new questions presented moderate and good kappa values and excellent ICC values. The updated version of BackPEI-CA can be used as a clinic tool for assessing the presence, frequency, and intensity of back and neck pain and their risk factors.
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Affiliation(s)
- Bruna Nichele da Rosa
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre 90690-200, Brazil; (C.T.C.); (L.R.P.); (M.G.S.); (A.V.); (J.F.L.)
- Correspondence:
| | - Cláudia Tarragô Candotti
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre 90690-200, Brazil; (C.T.C.); (L.R.P.); (M.G.S.); (A.V.); (J.F.L.)
| | - Luiza Rampi Pivotto
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre 90690-200, Brazil; (C.T.C.); (L.R.P.); (M.G.S.); (A.V.); (J.F.L.)
| | - Matias Noll
- Postgraduate Program in Health Sciences, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia 74605-050, Brazil;
- Campus Ceres, Instituto Federal Goiano, Ceres 76300-000, Brazil
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark
| | - Marcelle Guimarães Silva
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre 90690-200, Brazil; (C.T.C.); (L.R.P.); (M.G.S.); (A.V.); (J.F.L.)
| | - Adriane Vieira
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre 90690-200, Brazil; (C.T.C.); (L.R.P.); (M.G.S.); (A.V.); (J.F.L.)
| | - Jefferson Fagundes Loss
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre 90690-200, Brazil; (C.T.C.); (L.R.P.); (M.G.S.); (A.V.); (J.F.L.)
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Dario AB, Kamper SJ, Williams C, Straker L, O'Sullivan P, Schütze R, Smith A. Psychological distress in early childhood and the risk of adolescent spinal pain with impact. Eur J Pain 2021; 26:522-530. [PMID: 34695280 DOI: 10.1002/ejp.1878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/14/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Spinal pain (SP), including neck and back pain, is common and often associated with poor mental health and reduced quality of life of adolescents. Contemporary understanding of SP favours a biopsychosocial approach, and emerging evidence suggests the stronger influence of psychological rather than other factors. OBJECTIVES We aimed to investigate if experiencing psychological distress in early childhood increases the risk of spinal pain with impact during adolescence. METHODS 1175 adolescents from a prospective cohort study (Raine Study Gen2) were included. Psychological distress was assessed at ages 2, 5, 8 and 10 using Child Behaviour Check List (CBCL). CBCL total and subscale scores (internalizing and externalizing symptoms) were converted to age-standardized scores and dichotomized according to t-scores (>60=high distress). Life-time spinal pain, including low back, mid back, or neck/shoulder, was measured at age 17. We were interested in adolescent SP with impact (care seeking, medication use, school absenteeism, daily activity interference, leisure activity interference) and defined cases as SP with impact (one or more) or greater impact (two or more) impacts. We investigated the longitudinal associations between childhood psychological distress and adolescent SP using univariate and multivariable logistic regression models. RESULTS Psychological distress in childhood increased the odds of adolescent SP with impact by 33% (OR 1.33; 95% CI 1.01-1.76), but not spinal pain with greater impact (OR 1.22; 95% 0.83-1.80). Internalizing symptoms were associated with SP with greater impact and externalizing symptoms with SP with impact after adjusting for a range of potential child and family confounders. CONCLUSION Psychological distress in childhood increases the risk of SP with impact in adolescence and may be a promising prevention target. SIGNIFICANCE Our findings provide evidence that psychological distress early in life is an independent risk factor for spinal pain with impact during adolescence. As psychological distress during childhood is potentially modifiable, it may be a promising target for research on the prevention of consequential spinal pain in adolescence. Identifying and addressing psychological distress in children may be an important component of best practice to reduce consequential spinal pain in adolescents.
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Affiliation(s)
| | - Steven James Kamper
- Sydney School of Health Science, University of Sydney, Sydney, Australia.,Nepean Blue Mountains Local Health District, Penrith, Australia.,School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - Christopher Williams
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia.,Centre for Pain, Health and Lifestyle, New Lambton Heights, Australia
| | - Leon Straker
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Robert Schütze
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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Fourré A, Fierens A, Michielsen J, Ris L, Dierick F, Roussel N. An interactive e-learning module to promote bio-psycho-social management of low back pain in healthcare professionals: a pilot study. J Man Manip Ther 2021; 30:105-115. [PMID: 34678129 DOI: 10.1080/10669817.2021.1988397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Introduction: Low back pain (LBP) is ranked as the first musculoskeletal disorder considering years lived with disability worldwide. Despite numerous guidelines promoting a bio-psycho-social (BPS) approach in the management of patients with LBP, many health care professionals (HCPs) still manage LBP patients mainly from a biomedical point of view. Objective: The purpose of this pilot study was to evaluate the feasibility of implementing an interactive e-learning module on the management of LBP in HCPs. Methods: In total 22 HCPs evaluated the feasibility of the e-learning module with a questionnaire and open questions. Participants filled in the Back Pain Attitude Questionnaire (Back-PAQ) before and after completing the module to evaluate their attitudes and beliefs about LBP. Results: The module was structured and easy to complete (91%) and met the expectations of the participants (86%). A majority agreed that the module improved their knowledge (69%). Some participants (77%) identified specific topics that might be discussed in more detail in the module. HCPs knowledge, beliefs and attitudes about LBP significantly improved following module completion (t = -7.63, P < .001) with a very large effect size (ds = -1.63). Conclusion: The module seems promising to change knowledge, attitudes and beliefs of the participants. There is an urgent need to develop and investigate the effect of educational interventions to favor best practice in LBP management and this type of e-learning support could promote the transition from a biomedical to a bio-psycho-social management of LBP in HCPs.
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Affiliation(s)
- Antoine Fourré
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (Movant), University of Antwerp, Belgium
| | | | - Jef Michielsen
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (Movant), University of Antwerp, Belgium.,Orthopaedic Department, University Hospital, Antwerp, Belgium
| | - Laurence Ris
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Frédéric Dierick
- Laboratoire d'Analyse du Mouvement et de la Posture, Centre National De Rééducation Fonctionnelle Et De Réadaptation - Rehazenter, Luxembourg, Luxembourg.,CeREF, Haute Ecole Louvain En Hainaut, Mons, Belgium
| | - Nathalie Roussel
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (Movant), University of Antwerp, Belgium
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Nyirö L, Potthoff T, Siegenthaler MH, Riner F, Schweinhardt P, Wirth B. Translation and validation of the German version of the Young Spine Questionnaire. BMC Pediatr 2021; 21:359. [PMID: 34429090 PMCID: PMC8383347 DOI: 10.1186/s12887-021-02804-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Background Back pain in childhood and adolescence increases the risk for back pain in adulthood, but validated assessment tools are scarce. The aim of this study was to validate the Young Spine Questionnaire (YSQ) in a German version (G-YSQ) in children and adolescents. Methods Children and adolescents between 10 and 16 years (N = 240, 166 females, mean age = 13.05 ± 1.70 years), recruited in chiropractic practices and schools, completed the G-YSQ (translated according to scientific guidelines) and the KIDSCREEN-10 (assessing health-related quality of life) at three time points. Test-retest reliability was determined calculating intraclass correlation coefficients [ICC(3,1)] using start and two week-data. Construct validity was investigated testing a priori hypotheses. To assess responsiveness, the patients additionally filled in the Patient Global Impression of Change (PGIC) after three months and the area under the curve (AUC) of receiver operating curves was calculated. Results The ICC(3,1) was 0.88 for pain intensity and pain frequency, indicating good reliability, 0.68 for week prevalence and 0.60 for point prevalence, indicating moderate reliability. Pain intensity, frequency and prevalence differed between patients and controls (p < 0.001) and, except point prevalence, between older (> 12 years) and younger control participants (p < 0.01). Health-related quality of life of participants with severe pain (in one or several spinal regions) was lower (KIDSCREEN-10, total score: F(4,230) = 7.26, p < 0.001; KIDSCREEN-10, self-rated general health: H(4) = 51.94, p < 0.001) than that of participants without pain or with moderate pain in one spinal region. Thus, altogether these findings indicate construct validity of the G-YSQ. The AUC was 0.69 (95 % CI = 0.57–0.82) and 0.67 (95 % CI = 0.54–0.80) for week and point prevalence, respectively, indicating insufficient responsiveness of the G-YSQ. Conclusions Apart from the question on point prevalence, construct validity and sufficient test-retest reliability was shown for the G-YSQ. However, its responsiveness needs to be improved, possibly by asking for pain frequency during the last week instead of (dichotomous) week prevalence. Trial registration ClinicalTrials.gov, NCT02955342, registered 07/09/2016, https://clinicaltrials.gov/ct2/results?cond=&term=NCT02955342&cntry=CH&state=&city=Zurich&dist=. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02804-y.
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Affiliation(s)
- Luana Nyirö
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland
| | - Tobias Potthoff
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland
| | - Mette Hobaek Siegenthaler
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland.,Holbeinpraxis, Holbeinstrasse 65, 4051, Basel, Switzerland
| | - Fabienne Riner
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland
| | - Brigitte Wirth
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland. .,Winterthur Institute of Health Economics, School of Management and Law, University of Applied Sciences, Gertrudstr. 15, 8400, Winterthur, Switzerland.
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Daily activity limitations and physical activity encouragement influence adolescents seeking health care for neck and low back pain. Musculoskelet Sci Pract 2021; 54:102385. [PMID: 33965773 DOI: 10.1016/j.msksp.2021.102385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Understanding the factors associated with care-seeking behaviour in adolescents with spinal pain will inform health care professionals and guide a better decision-making. OBJECTIVE To identify factors, including parents' habits and behaviour, related to care-seeking in adolescents with neck pain or low back pain (LBP). STUDY DESIGN A cross-sectional study. METHODS Adolescents between 10 and 17 years were randomly recruited from public schools. The proportion of adolescents with neck or LBP and those who had sought care for neck and LBP were assessed with the Nordic Musculoskeletal questionnaire. Daily activity limitation and the frequency of parents' habits and behaviour were collected using self-reported questions. Logistic regression analyses were performed to investigate if the following factors were associated with adolescents' care-seeking behaviour due to neck or LBP: daily activity limitations, physical activity (PA) domains, items of the social support scale. RESULTS The prevalence of adolescents reporting neck or LBP was 31.4% (318 out of 1011). Of these, 35.8% (n = 114) sought care for neck or low back pain. Activity limitations related to neck or LBP (OR: 5.83, 95% CI: 3.46 to 9.84), higher PA levels at school (OR: 1.67, 95% CI: 1.02 to 2.75), and PA encouragement (OR: 2.73, 95% CI: 1.27 to 5.85) were associated with care-seeking in adolescents with neck or LBP. CONCLUSION Adolescents with activity limitations due to neck or LBP, higher PA levels at school and encouraged by parents or friends to practice PA were more likely to seek care for their neck or LBP.
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Roy R, Galán S, Sánchez-Rodríguez E, Racine M, Solé E, Jensen MP, Miró J. Cross-national trends of chronic back pain in adolescents: results from the HBSC study, 2001-2014. THE JOURNAL OF PAIN 2021; 23:123-130. [PMID: 34339858 DOI: 10.1016/j.jpain.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/26/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
Chronic back pain is a common problem that negatively impacts the wellbeing of many adolescents. Prior research suggests that the prevalence of chronic back pain has increased over the last decades, but research on this issue is scarce, single country-based, and has yielded inconsistent results. This study aimed to examine trends in the prevalence of chronic back pain over time in adolescents aged 11, 13 and 15, using data from the Health Behavior in School-aged Children (HBSC) survey. We conducted a secondary analysis of data from 650,851 adolescents, retrieved from four waves (2001/02, 2005/06, 2009/10 and 2013/14) of HBSC data from 33 countries or regions. The prevalence of back pain was higher (1) in each successive survey over time (18.3% in 2001/02, 19.3% in 2005/06, 20.4% in2009/10 and 21.6% in 2013/14), (2) in girls (21.9%) compared to boys (17.8%), and (3) in older adolescents compared to younger ones (14.5% in 11-year-olds, 19.6% in 13-year-olds and 25.5% in 15-year-olds). The increase in prevalence from 2001/02 to 2013/14 was more marked in older girls compared to younger girls, and in older boys compared to younger boys, and it ranged between 1% for 11-year-old boys and 7% for 15-year-old girls. More resources should be allocated to the prevention and treatment of chronic back pain in adolescents, especially for older girls.
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Affiliation(s)
- Rubén Roy
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Santiago Galán
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Mélanie Racine
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Ester Solé
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain.
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Prathivadi Bhayankaram N, Lacey RJ, Barnett LA, Jordan KP, Dunn KM. Musculoskeletal consultations from childhood to adulthood: a longitudinal study. J Public Health (Oxf) 2021; 42:e428-e434. [PMID: 31774535 DOI: 10.1093/pubmed/fdz141] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Global Burden of Disease reports indicate that musculoskeletal conditions are important causes of disability worldwide. Such conditions may originate in childhood, but studies investigating changes longitudinally and from childhood to adulthood are infrequent. METHODS Nine birth cohorts of children (starting at ages 7-15 years) were followed. Participants were identified from Consultations in Primary Care Archive, an electronic health record database of 11 English general practices. Musculoskeletal consultation prevalence figures were calculated, and reasons for consultation evaluated. RESULTS Annual musculoskeletal consultation prevalence was similar across cohorts for each age. Prevalence increased from 6 to 16% between ages 7 and 22 and was higher in males until age 15, after which prevalence was higher in females. Pain was the most common reason for consultation. Back pain consultations increased from 1 consultation/1000 7 year olds to 84 consultations/1000 22 year olds. Lower limb pain consultations increased from 21 consultations/1000 7 year olds to 56 consultations/1000 22 year olds. CONCLUSIONS This study shows that from childhood, individuals are more likely to seek healthcare for musculoskeletal consultations as they age, but rates are not increasing over time. Changes in consultation rates by age, gender and pain region may inform studies on the development of chronic musculoskeletal pain over the life-course.
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Affiliation(s)
- N Prathivadi Bhayankaram
- Primary Care Centre Versus Arthitis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, UK
| | - R J Lacey
- Primary Care Centre Versus Arthitis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, UK
| | - L A Barnett
- Primary Care Centre Versus Arthitis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, UK
| | - K P Jordan
- Primary Care Centre Versus Arthitis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, UK
| | - K M Dunn
- Primary Care Centre Versus Arthitis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, UK
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Rossi MK, Pasanen K, Heinonen A, Äyrämö S, Leppänen M, Myklebust G, Vasankari T, Kannus P, Parkkari J. The standing knee lift test is not a useful screening tool for time loss from low back pain in youth basketball and floorball players. Phys Ther Sport 2021; 49:141-148. [PMID: 33689988 DOI: 10.1016/j.ptsp.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 10/22/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between pelvic kinematics during the standing knee lift (SKL) test and low back pain (LBP) in youth floorball and basketball players. DESIGN A prospective cohort study. SETTING Finnish elite youth floorball and basketball players. PARTICIPANTS Finnish elite youth female and male floorball and basketball players (n = 258, mean age 15.7 ± 1.8). MAIN OUTCOME MEASURES LBP resulting in time loss from practice and games was recorded over a 12-month period and verified by a study physician. Associations between LBP and sagittal plane pelvic tilt and frontal plane pelvic obliquity during the SKL test as measured at baseline were investigated. Individual training and game hours were recorded, and Cox's proportional hazard models with mixed effects were used for the analysis. RESULTS Cox analyses revealed that sagittal plane pelvic tilt and frontal plane pelvic obliquity were not associated with LBP in floorball and basketball players during the follow-up. The hazard ratios for pelvic tilt and pelvic obliquity ranged between 0.93 and 1.08 (95% CIs between 0.91 and 1.07 and 0.83 and 1.29), respectively. CONCLUSIONS Pelvic movement during the SKL test is not associated with future LBP in youth floorball and basketball players.
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Affiliation(s)
- Marleena Katariina Rossi
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Faculty of Sport and Health Sciences, P.O. Box 35 40014, University of Jyväskylä, Jyväskylä, Finland.
| | - Kati Pasanen
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada; Alberta Children's Hospital Research Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2n 4N1, Canada; McCaig Institute for Bone and Joint Health, 3280 Hospital Drvie NW, Calgary, AB, T2N 4Z6, Canada
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, P.O. Box 35 40014, University of Jyväskylä, Jyväskylä, Finland
| | - Sami Äyrämö
- Faculty of Information Technology, P.O. Box 35 40014, University of Jyväskylä, Jyväskylä, Finland
| | - Mari Leppänen
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Grethe Myklebust
- Oslo Sports Trauma Research Center, Department of Sports Sciences, Norwegian School of Sport Sciences, Sognsveien 220, 0806, Oslo, Norway
| | - Tommi Vasankari
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Pekka Kannus
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Department of Orthopedics & Traumatology, Central Hospital, PO BOX 2000, FI-33521, Tampere, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Tampere University Hospital, Central Hospital, PO BOX 2000, FI-33521, Tampere, Finland
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Santos EDS, Bernardes JM, Noll M, Gómez-Salgado J, Ruiz-Frutos C, Dias A. Prevalence of Low Back Pain and Associated Risks in School-Age Children. Pain Manag Nurs 2021; 22:459-464. [PMID: 33648851 DOI: 10.1016/j.pmn.2021.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Elisiane De Souza Santos
- Graduate Program in Collective/Public Health, Botucatu Faculty of Medicine, Universidade Estadual Paulista/UNESP, Botucatu, São Paulo, Brazil
| | - João Marcos Bernardes
- Graduate Program in Collective/Public Health, Botucatu Faculty of Medicine, Universidade Estadual Paulista/UNESP, Botucatu, São Paulo, Brazil
| | - Matias Noll
- Goiano Federal Institute, Ceres, Goiás, Brazil
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain; Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador.
| | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain; Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Adriano Dias
- Graduate Program in Collective/Public Health, Botucatu Faculty of Medicine, Universidade Estadual Paulista/UNESP, Botucatu, São Paulo, Brazil
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Dhanjani S, Marrache M, Puvanesarajah V, Pakpoor J, Jain A. Annual Trends and Geographic Variation in the Utilization of Imaging in Pediatric Patients with Low Back Pain in the United States. World Neurosurg 2020; 146:e972-e978. [PMID: 33220471 DOI: 10.1016/j.wneu.2020.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Low back pain (LBP) is increasing in the pediatric population. Advanced imaging, such as computed tomography and magnetic resonance imaging, performed for LBP imposes significant costs with little benefit. We investigated annual trends and demographic and geographic variation in spinal imaging for first-time pediatric presenters with LBP in primary care clinics. METHODS We queried a private administrative claims database for patients presenting with LBP who underwent plain radiography, computed tomography, and magnetic resonance imaging from 2011 to 2017. We used a Cochrane Armitage test of trend to determine significant annual variation in diagnostic imaging utilization during the study period. The χ2 test was used to determine demographic and geographic variation. RESULTS The study included 67,423 patients with mean age 15.2 ± 3 years. There was no significant change in radiography (34.8% in 2011 vs. 35.5% in 2017, P = 0.795) or computed tomography (1.6% in 2011 vs. 1.1% in 2017, P = 0.073), but there was a significant increase in magnetic resonance imaging (3.3% in 2011 vs. 4.5% in 2017, P = 0.017). Overall, there was no significant change in total imaging use (P = 0.895). Boys had higher rates of imaging compared with girls (40.2% vs. 35.6%, P < 0.001). Imaging rates significantly varied between regions across the United States (P < 0.001). The Midwest had the highest imaging rates (41%), while the Northeast had the lowest rates (31%). CONCLUSIONS There was significant demographic and geographic variation but no significant annual change in total diagnostic spinal imaging for pediatric patients with LBP between 2011 and 2017, with rates of advanced imaging remaining relatively low.
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Affiliation(s)
- Suraj Dhanjani
- Department of Orthopaedic Surgery, Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Majd Marrache
- Department of Orthopaedic Surgery, Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Jina Pakpoor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University Hospital, Baltimore, Maryland, USA.
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Cancelliere C, Wong JJ, Yu H, Mior S, Brunton G, Shearer HM, Rudoler D, Hestbæk L, Papaconstantinou E, Cedraschi C, Swain M, Connell G, Verville L, Taylor-Vaisey A, Côté P. Rehabilitative management of back pain in children: protocol for a mixed studies systematic review. BMJ Open 2020; 10:e038534. [PMID: 33055118 PMCID: PMC7559046 DOI: 10.1136/bmjopen-2020-038534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Little is known about effective, efficient and acceptable management of back pain in children. A comprehensive and updated evidence synthesis can help to inform clinical practice. OBJECTIVE To inform clinical practice, we aim to conduct a systematic review of the literature and synthesise the evidence regarding effective, cost-effective and safe rehabilitation interventions for children with back pain to improve their functioning and other health outcomes. METHODS AND ANALYSIS We will search MEDLINE, Embase, PsycINFO, CINAHL, the Index to Chiropractic Literature, the Cochrane Controlled Register of Trials and EconLit for primary studies published from inception in all languages. We will include quantitative studies (randomised controlled trials, cohort and case-control studies), qualitative studies, mixed-methods studies and full economic evaluations. To augment our search of the bibliographic electronic databases, we will search reference lists of included studies and relevant systematic reviews, the WHO International Clinical Trials Registry Platform and consult with content experts. We will assess the risk of bias using appropriate critical appraisal tools. We will extract data about study and participant characteristics, intervention type and comparators, context and setting, outcomes, themes and methodological quality assessment. We will use a sequential approach at the review level to integrate data from the quantitative, qualitative and economic evidence syntheses. ETHICS AND DISSEMINATION Ethics approval is not required. We will disseminate findings through activities, including (1) presentations in national and international conferences; (2) meetings with national and international decision makers; (3) publications in peer-reviewed journals and (4) posts on organisational websites and social media. PROSPERO REGISTRATION NUMBER CRD42019135009.
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Affiliation(s)
- Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Jessica J Wong
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Hainan Yu
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Silvano Mior
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Ginny Brunton
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- EPPI-Centre, UCL Institute of Education, University College London, England, United Kingdom
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Heather M Shearer
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Rudoler
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Lise Hestbæk
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | | | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Michael Swain
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Gaelan Connell
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Verville
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Anne Taylor-Vaisey
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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A systematic review highlights the need to improve the quality and applicability of trials of physical therapy interventions for low back pain. J Clin Epidemiol 2020; 126:106-115. [DOI: 10.1016/j.jclinepi.2020.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 11/22/2022]
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The Prevalence of Abnormalities in the Pediatric Spine on MRI: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2020; 45:E1185-E1196. [PMID: 32355138 DOI: 10.1097/brs.0000000000003527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE The aim of this study was to provide an overview of the prevalence of reported musculoskeletal abnormalities on magnetic resonance imaging (MRI) of the pediatric spine. SUMMARY OF BACKGROUND DATA Back pain is a common complaint and significant health issue, already in children. Several studies have investigated musculoskeletal abnormalities of the pediatric spine as possible cause of low back pain (LBP). However, it is not clear which abnormalities are the most prevalent among children. METHODS A systematic literature search on the prevalence of musculoskeletal spinal abnormalities on MRI in children was conducted in the Embase, Medline Ovid, and Cochrane CENTRAL databases. Risk of bias (RoB) was assessed using a checklist based on the Downs and Black checklist. General information on study and patient characteristics and the prevalence of spinal abnormalities were extracted from the studies. Prevalence data were presented in three subgroups: nonathletes without LBP, participants with LBP, and athletes. Prevalence data of the most reported abnormalities were pooled using random-effects proportion meta-analysis. The study protocol was prospectively registered in PROSPERO (CRD42017080543). RESULTS The search resulted in 16,783 articles, of which 31 articles (2373 participants) were included in this systematic review. Two-thirds of the studies had a low RoB. The pooled prevalence in nonathletes without LBP, participants with LBP, and athletes without LBP was respectively 22%, 44%, and 22% for disc degeneration, 1%, 38%, and 13% for herniated discs, 5%, 22%, and 11% for endplate changes, and 0%, 30%, and 6% for pars fractures. CONCLUSION Disc degeneration, herniated discs, endplate changes, and spondylolysis are the most reported spinal abnormalities on MRI in children in literature. Spinal abnormalities seen in adults are already prevalent in children with LBP, with the highest prevalence for disc degeneration and herniated discs. LEVEL OF EVIDENCE 2.
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Family history of pain and risk of musculoskeletal pain in children and adolescents: a systematic review and meta-analysis. Pain 2020; 160:2430-2439. [PMID: 31188266 DOI: 10.1097/j.pain.0000000000001639] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Emerging evidence suggests that musculoskeletal (MSK) pain should be viewed from a biopsychosocial perspective and consider the influence of family factors. We conducted a review with meta-analysis to provide summary estimates of effect of family history of pain on childhood MSK pain and explore whether specific family pain factors influence the strength of the association (PROSPERO CRD42018090130). Included studies reported associations between family history of pain and nonspecific MSK pain in children (age <19 years). The outcome of interest was MSK pain in children. We assessed the methodological quality using a modified version of the Quality in Prognosis Studies instrument and quality of evidence for the main analyses using the GRADE criteria. After screening of 7281 titles, 6 longitudinal and 23 cross-sectional studies were included. Moderate quality evidence from 5 longitudinal studies (n = 42,131) showed that children with a family history of MSK pain had 58% increased odds of experiencing MSK pain themselves (odds ratio [OR] 1.58, 95% confidence interval 1.20-2.09). Moderate quality evidence from 18 cross-sectional studies (n = 17,274) supported this finding (OR 2.02, 95% 1.69-2.42). Subgroup analyses showed that the relationship was robust regardless of whether a child's mother, father, or sibling experienced pain. Odds were higher when both parents reported pain compared with one ([mother OR = 1.61; father OR = 1.59]; both parents OR = 2.0). Our findings show moderate quality evidence that children with a family history of pain are at higher risk of experiencing MSK pain. Understanding the mechanism by which this occurs would inform prevention and treatment efforts.
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Kędra A, Plandowska M, Kędra P, Czaprowski D. Physical activity and low back pain in children and adolescents: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:946-956. [PMID: 32845380 DOI: 10.1007/s00586-020-06575-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Due to a high prevalence of low back pain (LBP) among children and adolescents, it is significant to seek effective prevention and therapeutic procedures. One idea for the programmes is a potential relation between the occurrence of LBP and the level of physical activity. The aim of this review was to analyse the current knowledge regarding the association between physical activity and LBP among children and adolescents. METHODS Publications were retrieved by searching the following databases: PubMed, The Cochrane library, Web of Science, Medline and SportDiscus with Full Text (EBSCO). The search strategy included keywords related to physical activity and LBP. The studies included were assessed for methodological quality. PRISMA guidelines were followed for the systematic review. RESULTS The total sample size of the nine included studies consisted of 75,233 subjects, with an age range of 9-19 years. All the studies were assessed to be of high quality. One cohort study and five cross-sectional studies found the association between physical activity and LBP in children and adolescents. The remaining studies found no relationship between physical activity and LBP. These findings showed that both extremes of activity levels (i.e. being very low and very high physically active) are associated with LBP. CONCLUSION There is moderate evidence for the association between physical activity and LBP in children and adolescents. The results highlight the need for continued research. It seems that for clear evaluation of the analysed association the prospective cohort studies should be conducted.
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Affiliation(s)
- Agnieszka Kędra
- Faculty of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland
| | - Magdalena Plandowska
- Faculty of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland.
| | - Przemysław Kędra
- Faculty of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland
| | - Dariusz Czaprowski
- Physiotherapy Unit, Department of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland.,Department of Health Sciences, Olsztyn University, Olsztyn, Poland
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Akbari-Chehrehbargh Z, Sadat Tavafian S, Montazeri A. The Back-care Behavior Assessment Questionnaire (BABAQ) for schoolchildren: development and psychometric evaluation. BMC Public Health 2020; 20:1283. [PMID: 32842995 PMCID: PMC7448470 DOI: 10.1186/s12889-020-09318-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Back pain is an important public health problem and the leading cause of adult disability worldwide and is rising among schoolchildren populations. Despite numerous studies reporting on back care interventions in pediatric population; there is currently no existing theory-based instrument to assess impact and outcome of these programs. This paper reports on development and psychometric testing of a theory based back-care behavior instrument for use among elementary schoolchildren. Methods This was a three-phases study that included the following steps: a) a literature research to review existing instruments that assess healthy spine-related behavior in elementary schoolchildren; b) development of a new instrument namely the Back-care Behavior Assessment Questionnaire (BABAQ) based on the Social Cognitive Theory and existing instruments, and c) conducting a cross sectional study to test psychometric properties of the BABAQ by estimating the content validity ratio (CVR), the content validity index (CVI), performing confirmatory factor analysis (CFA), reliability analysis, and convergent validity as estimated by the Average Variance Extracted (AVE). Results First, a questionnaire (the BABAQ) was developed. It contained of 49 items tapping into 5 pre-defined constructs (skills, knowledge, self-efficacy, expectation beliefs, and behavior). Then, 610 fifth-grade female schoolchildren were entered into a cross sectional study and they completed the BABAQ. The CVR and the CVI of the questionnaire was found to be ≥0.54 and > 0.7, respectively. The CFA confirmed the five constructs and showed good fit for the data. The intraclass correlation (ICC) and the Cronbach’s alpha coefficients for the BABAQ were 0.84 (P < 0.001) and 0.93, respectively. The convergent validity as measured by the AVE also showed satisfactory results. Conclusion The findings suggest that the Back-care Behavior Assessment Questionnaire (BABAQ) is a valid instrument for measuring healthy spine-related behaviors among schoolchildren.
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Affiliation(s)
- Zahra Akbari-Chehrehbargh
- Department of Health Education, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sedigheh Sadat Tavafian
- Department of Health Education, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Ali Montazeri
- Health Metrics Research Center, Iranian Institutes for Health Sciences Research, ACECR, Tehran, Iran.,Faculty of Humanity Sciences, University of Science &Culture, ACECR, Tehran, Iran
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