Back education efficacy in elementary schoolchildren: a 1-year follow-up study

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

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

Cultural appropriateness of interventions to prevent and reduce musculoskeletal disorders among students: a systematic review

This systematic review was conducted to identify the types of interventions and cultural appropriateness of intervention studies for preventing and reducing musculoskeletal disorders (MSDs) in students. In this systematic review, articles were retrieved from scientific databases including PubMed, Sciencedirect, Web of Science, Scopus, SAGE journals, and Cochrane library using a search strategy. The types of interventions for preventing and reducing MSDs among students published in English up to 2022 were examined, with a comparison of studies in terms of the cultural appropriateness of strategies. Also, studies were categorised based on six intervention types: physical exercise, education, ergonomics, participatory ergonomics, stress management, and multicomponent. Out of the 29 studies included in this review, ten were randomised controlled trials, fifteen were controlled pre-test/post-test studies, and four were pre-test/post-test studies. The articles measured students' knowledge, beliefs, behaviour, good posture/performance, pain intensity decrease, and back care as outcomes. Only two articles were categorised as having moderate cultural adaptation. The results showed that any type of intervention was successful, and two studies were evaluated as having high quality. Our review found evidence of efficacy for interventions aimed at preventing and reducing MSDs in students.

Practitioner summary: Musculoskeletal disorders are common problems that affect students of all ages. To prevent these problems from getting worse or affecting students' future health, it is important to find effective ways to prevent and reduce musculoskeletal disorders in students.

A Comparison between Different Types and Frequency of Physiotherapy Treatment for Children and Adolescents with Postural Problems and Low Back Pain

AIM

To examine the effect of a once-a-week group physiotherapy session in addition to a once-a-month individual physiotherapy treatment, in comparison to a monthly individual physiotherapy treatment.

METHODS

Fifty children and adolescents aged 10-18 years with poor back posture, some of whom had LBP, met individually with a physiotherapist once a month. The intervention group received an additional once-a-week group physiotherapy session for 12 weeks. Thorax curve angle, postural behavior, and low back pain (LBP) were measured before and after intervention.

RESULTS

The thorax curve angle decreased from 39.2 ± 9.3 to 28.2 ± 6.8 (p < 0.001) in the group + individual therapy group and from 38.9 ± 9.3 to 27.9 ± 7.8 in the individual therapy only group (p < 0.001). LBP decreased from 5.6 ± 2.2 to 1.6 ± 1.9 (p < 0.001) and from 5.5 ± 2.1 to 2.8 ± 2.0 (p < 0.001). A significantly greater improvement in postural behavior was found in the group + individual therapy group (p = 0.04). Moreover, attrition rates were lower in the experimental group.

CONCLUSION

A lower-frequency individual physiotherapy treatment for 12 weeks proved as beneficial as the same program with an additional higher-frequency group physiotherapy in improving thorax curve angle and LBP. However, the higher-frequency group physiotherapy in addition to the lower-frequency individual treatment was significantly more effective in improving postural behavior and adherence to treatment.

Effectiveness of a Back School and Postural Education Program on the improvement of literacy about postures and low back pain in adolescents: A 1-year follow-up study

BACKGROUND

Some health problems can be associated with the school environment and lifestyles, so it is necessary to carry out intervention actions that promote health and problem prevention. This study evaluates the effects of a Back School and Postural Education on improving short-term and long-term ergonomic knowledge of postures adopted at school and home, as well as reducing low back pain (LBP) in adolescents.

METHODS

The sample comprises 98 students, aged 10-16 years (11.61 ± 1.28 years), with 63 (64.3%) girls. The measuring instruments included a theoretical and a practical test, a low back pain (LBP) questionnaire and a scale. The tests and the scale have been applied 1 week before the intervention, 1 week following the Back School and Postural Education Program, and a 1 year later. The questionnaire was applied 1 week before of intervention and after 1 year. The intervention included three sessions of a theoretical and practical nature, each lasting 45 min, with intervals of 1 week.

RESULTS

The values of the theoretical test before the intervention, 1 week, and 1 year after the intervention were, respectively, 8.67 ± 2.64, 11.37 ± 1.93, and 11.11 ± 1.92 (p ≤ 0.001), and the practical test were 6.42 ± 2.47, 12.48 ± 2.25, and 12.83 ± 1.78 (p ≤ 0.001). The presence of LBP fell by 42.9%-25.5% after the 1-year period.

CONCLUSIONS

Our data show an improvement of ergonomic knowledge of postures adopted at school and home as a result of the education program and a decrease of self-reported LBP.

School-based interventions to improve spinal health of children and adolescents: a systematic review

Background: The prevalence of spinal pain is high in children and adolescents attending school. There are no evidence-based guidelines to promote spinal health (spinal pain and spinal well-being) in schoolsPurpose: This study aimed to 1) determine the usefulness of school-based interventions in promoting spinal health in children and adolescents and 2) synthesize the evidence in a user-friendly infographic.Methods: A search was performed across eight databases from the inception of the databases to August 2019 for full-text English-language articles which assessed the effect of school-based interventions on spinal health. Spinal health outcomes included pain limited to the spinal area including lower back, upper back, neck, and neck-shoulder pain, and impacts of spinal pain (e.g., absenteeism from school). Studies were appraised for methodological quality (PEDro scale and Johanna Briggs Institute checklist). The usefulness of interventions was based on meta-analyses; calculated effect size; the number of spinal health outcomes; and the direction of the (summary) effect of the intervention.Results: Twenty-two studies were included. Four interventions were identified: 1) exercise; 2) education; 3) the combination of exercise and education; and 4) furniture.Conclusion: School-based exercise is most useful to promote spinal health in the short term, followed by a combination of exercise and education, and education-only interventions.

Back School Postural Education Program: Comparison of Two Types of Interventions in Improving Ergonomic Knowledge about Postures and Reducing Low Back Pain in Adolescents

This study aimed to compare the impact of two Back School Postural Education Programs on improving ergonomic knowledge of postures adopted at school and home, as well as on reducing low back pain (LPB) in adolescents. The sample was constituted by 153 students, aged 10–16 years, with 96 (62.7%) girls, divided into 2 intervention groups (GA, GB). Two tests (theoretical and practical) and LBP questionnaire were applied 1 week before and 1 year after the end of the program. In GA, three sessions were performed for each class separately, on theoretical and practical issues, lasting 45 min and at intervals of 1 week, and in GB, only one theoretical session (90 min) was given to all students. Statistically differences on GA were obtained between the values 1 week before and after 1 year of evaluation in both theoretical and practical tests (p ≤ 0.001). In GB, only the values of the practical test present a statistical difference (p ≤ 0.001). GA obtained higher values on both tests after 1 year of follow-up compared with GB (p ≤ 0.001). The number of students with LBP decreased on GA (p ≤ 0.001). The program with longer duration, higher weekly frequency, and more practical and individualized character promotes better effects.

Sedentariness and Back Health in Western Cape Primary School Students: Protocol for a Pragmatic Stepped-Wedge Feasibility Randomized Controlled Trial

Background

Despite growing evidence of deleterious health outcomes associated with sedentary behavior, prolonged static sitting in classrooms remains ubiquitous in primary schools. Sedentary behavior is associated with the development of cardio-metabolic conditions and poor back health. Preventative strategies to reduce sedentary behavior and its negative health effects may be required in a resource-constrained environment such as South Africa.

Objective

The primary objective of this study is to assess the feasibility of conducting a full trial to evaluate the effects of a multifaceted intervention comprising novel multifunctional classroom furniture and a video-based curriculum versus usual care on sedentary behavior among students aged 10-11 years in primary schools. The secondary objective is to assess the preliminary effects of the intervention on sedentary behavior and postural dynamism.

Methods

Eighty grade 5 or 6 students, aged 10 and 11 years, in mixed-gender schools within the Western Cape metropolitan urban area in Cape Town, South Africa are eligible to participate in this pilot cluster stepped-wedge trial design with classroom as the unit of randomization. Data will be collected at the schools. The intervention will comprise multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum on sedentary behavior. Usual practice is the absence of the intervention. The primary outcomes assessed will be (1) adherence to the intervention and (2) project pragmatics. The secondary outcomes will be (1) sedentariness measured using activPAL3 microsensors and (2) postural dynamism measured using Noraxon Myomotion inertial measurement units. We randomized the school to the first or second start of the intervention. This is an open-label trial and therefore blinding will not be possible for any group. Descriptive analysis of the feasibility and physiological outcomes will be presented. We will report the preliminary estimates of the effects of the intervention on sedentariness and postural dynamism using the mean difference and 95% CI.

Results

At the time of submission, two classrooms have been recruited into the study. Baseline physical activity and postural dynamism data have been collected from 10 participants from each class.

Conclusions

The results of this feasibility stepped-wedge cluster randomized controlled trial will be useful in informing the design of the main trial to assess whether this multifaceted intervention of multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum versus usual care has any effect on sedentary behavior in low-resource-setting primary schools.

Trial Registration

Pan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8

International Registered Report Identifier (IRRID)

RR1-10.2196/18522

EFFECTS OF POSTURAL EDUCATION IN ELEMENTARY SCHOOL CHILDREN: A SYSTEMATIC REVIEW

Objective:

To determine the effect of postural education on the learning and postural habits of elementary school children without physical intervention.

Methods:

We searched PubMed, Lilacs, SciELO, Cochrane, and Science Direct data bases and reference lists of studies in February 2020. The eligibility criteria were randomized clinical trials related to the effect of postural education in children aged between 6 and 12 years old. Two authors independently assessed trials for inclusion and risk of bias: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. Data were extracted in standardized tables including information on author, publication year, country, sample size, age, sex, intervention characteristics, outcome measurements and results.

Results:

We found seven clinical trials (involving 2,568 children) for the review. The studies were conducted between 2000 and 2018: four in Belgium, two in Spain, and one in Germany. All seven included trials underwent evaluation: only one had a clear process of randomization and allocation concealment. All included studies were judged as having high risk of bias in at least one domain or have concerns for multiple domains.

Conclusions:

The positive effects of acquired knowledge and postural habits found in the studies cannot be used to reliably support postural education in elementary school children due to a high risk of bias in the evaluated studies.

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

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

Questionnaire on body awareness of postural habits in young people: construction and validation

Abstract Introduction: The postural deviations associated with the changes in the habits of young people have increased over the last decades. Investigating the subject by way of a self-perception questionnaire allows one to understand the level of awareness the individual has concerning his/her postural habits. Objective: Designing a self-perception evaluation questionnaire about the postural habits of young people and to validate, pre-test, verify the reliability and the internal consistency of this instrument. Methods: The validity of the content was determined by 10 judges. The study involved young people (15 - 18 years old) from Florianopolis/Brazil. The questionnaire was pre-tested, applied to 15 youthful who provided qualitative information about it. The reproducibility was analyzed by way of a test-retest with 40 students, in a one-week gap, and was analyzed by interclass correlation coefficient. The internal consistency was analyzed by Cronbach’s alpha with 679 students. A 5% significance level was adopted. Results: Concerning to the validation of content, the questionnaire presented a total coefficient of 0.28 and 72% concordance was observed amongst the reviewers. The interclass correlation coefficient (test-retest) indicated acceptable reproducibility values (R = 0.66, 0.74 and 0.59; p < 0.001), with a decrease in the object-carrying dimension (R = 0.32; p = 0.04). The questionnaire was considered suitable, quick and easy to fill in. The internal consistency presented a value of 0.80. Conclusion: The questionnaire on body awareness of postural habits in young people is a valid instrument with good repeatability and reliability, its use can be recommended with teenagers showing the same profile as those used in this study.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Guidelines for schoolbag carriage: An appraisal of safe load limits for schoolbag weight and duration of carriage

BACKGROUND

There is no global agreement on a schoolbag weight limit and little assessment of its utility. The duration of carriage is another factor yet there is no previous systematic assessment of the utility of cut-off values for it in identifying schoolbag-related discomfort.

OBJECTIVES

The objectives were to establish if there was a threshold for musculoskeletal discomfort based on (i) percentage bodyweight (% BW) of the schoolbag; (ii) duration of carriage; or (iii) combined % BW and duration.

METHODS

Using data from 462 primary school children, a novel experimental approach was used to explore the utility of conventional schoolbag weight limit guidelines and duration of carriage. A receiver operating characteristic (ROC) curve was constructed to examine the predictive performance of schoolbag weight and duration of carriage.

RESULTS

The mean schoolbag weight (4.8±1.43  kg) represented a mean 12.4±4.18% BW. Only 30.7% of the sample carried schoolbags that were ≤10% BW. The majority (76%) carried schoolbags to school for ≤10 minutes. No % BW, duration of carriage or mechanical burden criterion provided a threshold cut-off point for accurately predicting schoolbag-related discomfort.

CONCLUSIONS

Guidelines for safe schoolbag carriage that are based on mechanical factors alone could not be upheld. The association between duration of carriage and back discomfort warrants further investigation.

School-based education programmes for the prevention of unintentional injuries in children and young people

BACKGROUND

Unintentional injuries are the leading cause of death in children aged four to 18 years and are a major cause of ill health. The school setting offers the opportunity to deliver preventive interventions to a large number of children and has been used to address a range of public health problems. However, the effectiveness of the school setting for the prevention of different injury mechanisms in school-aged children is not well understood.

OBJECTIVES

To assess the effects of school-based educational programmes for the prevention of injuries in children and evaluate their impact on improving children's safety skills, behaviour and practices, and knowledge, and assess their cost-effectiveness.

SEARCH METHODS

We ran the most recent searches up to 16 September 2016 for the following electronic databases: Cochrane Injuries Group Specialised Register; Cochrane Central Register of Controlled Trials; Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations; Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R); Embase and Embase Classic (Ovid); ISI Web of Science: Science Citation Index Expanded; ISI Web of Science Conference Proceedings Citation Index-Science; ISI Web of Science: Social Sciences Citation Index; ISI Web of Science: Conference Proceedings Citation Index - Social Sciences & Humanities; and the 14 October 2016 for the following electronic databases: Health Economics Evaluations Database (HEED); Health Technology Assessment Database (HTA); CINAHL Plus (EBSCO); ZETOC; LILACS; PsycINFO; ERIC; Dissertation Abstracts Online; IBSS; BEI; ASSIA; CSA Sociological Abstracts; Injury Prevention Web; SafetyLit; EconLit (US); PAIS; UK Clinical Research Network Study Portfolio; Open Grey; Index to Theses in the UK and Ireland; Bibliomap and TRoPHI.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), non-randomised controlled trials (non-RCTs), and controlled before-and-after (CBA) studies that evaluated school-based educational programmes aimed at preventing a range of injury mechanisms. The primary outcome was self-reported or medically attended unintentional (or unspecified intent) injuries and secondary outcomes were observed safety skills, observed behaviour, self-reported behaviour and safety practices, safety knowledge, and health economic outcomes. The control groups received no intervention, a delayed injury-prevention intervention or alternative school-based curricular activities. We included studies that aimed interventions at primary or secondary prevention of injuries from more than one injury mechanism and were delivered, in part or in full, in schools catering for children aged four to 18 years.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Two review authors identified relevant trials from title and abstracts of studies identified in searches and two review authors extracted data from the included studies and assessed risk of bias. We grouped different types of interventions according to the outcome assessed and the injury mechanism targeted. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies.

MAIN RESULTS

The review included 27 studies reported in 30 articles. The studies had 73,557 participants with 12 studies from the US; four from China; two from each of Australia, Canada, the Netherlands and the UK; and one from each of Israel, Greece and Brazil. Thirteen studies were RCTs, six were non-RCTs and eight were CBAs. Of the included studies, 18 provided some element of the intervention in children aged four to 11 years, 17 studies included children aged 11 to 14 years and nine studies included children aged 14 to 18 years.The overall quality of the results was poor, with the all studies assessed as being at high or unclear risks of bias across multiple domains, and varied interventions and data collection methods employed. Interventions comprised information-giving, peer education or were multi-component.Seven studies reported the primary outcome of injury occurrence and only three of these were similar enough to combine in a meta-analysis, with a pooled incidence rate ratio of 0.73 (95% confidence interval (CI) 0.49 to 1.08; 2073 children) and substantial statistical heterogeneity (I² = 63%). However, this body of evidence was low certainty, due to concerns over this heterogeneity (inconsistency) and imprecision. This heterogeneity may be explained by the non-RCT study design of one of the studies, as a sensitivity analysis with this study removed found stronger evidence of an effect and no heterogeneity (I² = 0%).Two studies report an improvement in safety skills in the intervention group. Likewise, the four studies measuring observed safety behaviour reported an improvement in the intervention group relative to the control. Thirteen out of 19 studies describing self-reported behaviour and safety practices showed improvements, and of the 21 studies assessing changes in safety knowledge, 19 reported an improvement in at least one question domain in the intervention compared to the control group. However, we were unable to pool data for our secondary outcomes, so our conclusions were limited, as they were drawn from highly diverse single studies and the body of evidence was low (safety skills) or very low (behaviour, safety knowledge) certainty. Only one study reported intervention costs but did not undertake a full economic evaluation (very low certainty evidence).

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine whether school-based educational programmes can prevent unintentional injuries. More high-quality studies are needed to evaluate the impact of educational programmes on injury occurrence. There is some weak evidence that such programmes improve safety skills, behaviour/practices and knowledge, although the evidence was of low or very low quality certainty. We found insufficient economic studies to assess cost-effectiveness.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Postural education and behavior among students in a city in southern Brazil: student postural education and behavior

[Purpose] The aim of the present study was to assess the knowledge of the spine and posture among adolescent female students and to determine if they had access to postural education in or outside school. [Subjects and Methods] This was an epidemiological survey of a representative sample of 495 female students aged 14 to 18 years attending a regular secondary school in São Leopoldo, RS, Brazil. Data were collected through a questionnaire. [Results] The results showed that 16.8% of teens did not know what a spine was, 8.3% had no knowledge of posture, and 61% reported receiving no posture education. Posture awareness was associated only with posture while using a computer, while having postural education class was not associated with any postural behavior. [Conclusion] The results showed that, although most students are familiar with the spine and posture, a sizable group is not, and over half had no postural education. These findings suggest that inclusion of postural education programs in schools should be encouraged in order to promote health and prevent diseases related to the spine.

Prevalence and management of back pain in adolescent idiopathic scoliosis patients: A retrospective study

BACKGROUND

Back pain (BP) has often been associated with adolescent idiopathic scoliosis (AIS), which is a three-dimensional deviation of the vertebral column. In adolescents, chronic pain appears to be a predictor of health care utilization and has a negative impact on physical, psychological and family well-being. In this population, BP tends to be persistent and may be a predictor of BP in adulthood.

OBJECTIVE

To document the prevalence and management of BP in AIS patients.

METHODS

A retrospective chart review of AIS patients who were referred to Sainte-Justine University Teaching Hospital (Montreal, Quebec) from 2006 to 2011 was conducted.

RESULTS

A total of 310 randomly selected charts were reviewed. Nearly one-half of the patients (47.3%) mentioned that they experienced BP, most commonly in the lumbar (19.7%) and thoracic regions (7.7%). The type of BP was documented in only 36% (n=112) of the charts. Pain intensity was specified in only 21% (n=65) of the charts. In approximately 80% (n=248) of the charts, no pain management treatment plan was documented.

CONCLUSIONS

The prevalence of BP was moderately high among the present sample of adolescents with AIS. An improved system for documenting BP assessment, type, treatment plan and treatment effectiveness would improve pain management for these patients.

Primary prevention of disc degeneration-related symptoms

INTRODUCTION

It has been shown previously that a history of low back pain often begins in childhood or adulthood. Indeed, the prevalence of severe back symptoms among schoolchildren is not insignificant. Possibilities for the primary prevention of intervertebral disc degeneration-related conditions are poorly reported in the literature despite the assumed socio-economical impact of the prevention of these conditions.

METHODS

In this review, the authors have collated published data on the prevalence and risk factors of childhood low back pain as well as the structure and results of published primary prevention programs.

RESULTS

The prevalence of self-reported low back pain is 7-65% among children and it increases with age. Several lifestyle factors have been reported as significant risk factors for back pain, many of which are related to the schools. Current educational primary prevention programs in schools show no clear or long-term stable effect.

CONCLUSION

Considering the growing evidence about the importance of normal and bad posture, an exercise-based posture correction program is suggested as a school-based primary prevention of disc degeneration-related symptoms. Further, prospective randomized studies with more than 20 years follow-up, however, are strongly required to confirm it.

Instrumentos de avaliação da postura dinâmica: aplicabilidade ao ambiente escolar

INTRODUÇÃO: Para que a avaliação da postura dinâmica seja efetivada é necessário, primeiramente, conhecer os diversos instrumentos, disponíveis e validados na literatura, apropriados para esse fim. OBJETIVO: O objetivo deste artigo de revisão sistemática foi descrever, sintetizar e analisar criticamente os instrumentos encontrados na literatura que objetivem avaliar a postura dinâmica, tanto em adultos quanto em escolares, e refletir sobre a possibilidade de utilização desses métodos no ambiente escolar. MATERIAIS E MÉTODOS: Foi realizada uma busca sistemática de artigos em bases de dados (Scopus, ScienceDirect, PubMed, SciELO) publicados a partir da década de 1980 e no Banco de Teses e Dissertações da Capes. As palavras-chave utilizadas na busca pelos artigos foram back, spine, back injuries, school, back school, postural hygiene program, education, child, student, posture, em combinação com as palavras-chave evaluation, assessment, measurement, e os respectivos termos em português. Os instrumentos propostos deveriam preencher os seguintes critérios: (a) avaliar a postura corporal durante a realização de atividades da vida diária (AVDs); (b) utilizar critérios pré-definidos de avaliação da postura dinâmica; e (c) avaliar a postura a partir de observação, direta ou a partir de filmagem. RESULTADOS: Foram identificados oito artigos originais que apresentam instrumentos de avaliação da postura dinâmica, avaliando a execução de AVDs a partir de critérios biomecânicos pré-definidos por escalas numéricas; destes, apenas quatro instrumentos foram elaborados com o propósito de avaliar a execução de AVDs de escolares. CONSIDERAÇÕES FINAIS: Em geral, os instrumentos apresentam algumas limitações metodológicas, embora sejam de fácil aplicabilidade.

Effects of a postural education program on school backpack habits related to low back pain in children

PURPOSE

Population based studies have demonstrated that children and adolescents often complain of low back pain. A group-randomized controlled trial was carried out to investigate the effects of a postural education program on school backpack habits related to low back pain in children aged 10-12 year.

METHODS

The study sample included 137 children aged 10.7 years (SD = 0.672). Six classes from two primary schools were randomly allocated into experimental group (EG) (N = 63) or control group (CG) (N = 74). The EG received a postural education program over 6 weeks consisting of six sessions, while the CG followed the usual school curriculum. A questionnaire was fulfilled by the participants at pre-test, post-test, and 3 months after the intervention finished. The outcomes collected were: (1) try to load the minimum weight possible, (2) carry school backpack on two shoulders, (3) belief that school backpack weight does not affect to the back, and (4) the use of locker or something similar at school. A sum score was computed from the four items.

RESULTS

Single healthy items mostly improved after the intervention and remained improved after 3-month follow-up in EG, while no substantial changes were observed in the CG. Healthy backpack use habits score was significantly increased at post-test compared to baseline in the EG (P < 0.000), and remained significantly increased after 3-month, compared to baseline (P = 0.001). No significant changes were observed in the CG (P > 0.2).

CONCLUSIONS

The present study findings confirm that children are able to learn healthy backpack habits which might prevent future low back pain.

Preventive physiotherapy interventions for back care in children and adolescents: a meta-analysis

BACKGROUND

Preventive interventions improve healthy behaviours and they also increase knowledge regarding back care in children and adolescents, but studies exhibit great variability in their contents, duration and number of sessions, and in the assessment methods. The purpose of this study was to review the empirical evidence regarding preventive physiotherapy interventions for back care in children and adolescents, and to ascertain the most efficacious treatments, in what way and under which circumstances.

METHODS

Studies were located from computerized databases (Cochrane Library, Medline, PEDro, Web of Science and IME) and other sources. The search period extended to May 2012. To be included in the meta-analysis, studies had to use physical therapy methodologies of preventive treatment on children and adolescents, and to compare a treatment and a control group. Treatment, participant, methodological, and extrinsic characteristics of the studies were coded. Two researchers independently coded all of the studies. As effect size indices, standardized mean differences were calculated for measures of behaviours and knowledge, both in the posttest and in the follow-up. The random and mixed-effects models were used for the statistical analyses and sensitivity analyses were carried out in order to check the robustness of the meta-analytic results.

RESULTS

A total of 19 papers fulfilled the selection criteria, producing 23 independent studies. On average, the treatments reached a statistically significant effectiveness in the behaviours acquired, both in the posttest and in the follow-up (d+ = 1.33 and d+ = 1.80, respectively), as well as in measures of knowledge (posttest; d+ = 1.29; follow-up: d+ = 0.76). Depending on the outcome measure, the effect sizes were affected by different moderator variables, such as the type of treatment, the type of postural hygiene, the teaching method, or the use of paraprofessionals as cotherapists.

CONCLUSIONS

The interventions were successful in significantly increasing the behaviours and knowledge acquired both in the posttest and in the follow-up. The combined treatment of postural hygiene with physiotherapy exercise exhibited the best results. The small number of studies limits the generalizability of the results.

Efeitos de um programa de educação postural para crianças e adolescentes após oito meses de seu término

OBJETIVO: Avaliar os efeitos de um Programa de Educação Postural (PEP) para crianças e adolescentes oito meses após seu término. MÉTODOS: Estudo experimental com 34 participantes divididos em Grupo Controle (GC) e Grupo Experimental (GE). Somente os integrantes do GE participaram do PEP. Os 34 participantes foram submetidos - no início, no término e oito meses após o término do PEP - a três procedimentos de avaliação: (1) postura estática por meio de fotografia; (2) postura dinâmica, por filmagem da execução de atividades da vida diária (AVDs); e (3) questionário sobre os conhecimentos teóricos da coluna vertebral. Para verificar as diferenças entre o GC e o GE e entre as etapas de avaliação, foram utilizados os testes de Mann-Whitney e de Wilcoxon para os escores das AVDs e do questionário e o qui-quadrado para comparar a frequência de alterações posturais. RESULTADOS: O PEP, quando avaliado imediatamente após seu término, promoveu efeito positivo apenas no conhecimento teórico e na postura das AVDs. Entretanto, o efeito positivo do PEP não foi estendido ao período de follow-up, após oito meses do término do programa. CONCLUSÕES: Especula-se que o conhecimento da importância da boa postura durante as AVDs não foi efetivamente incorporado aos hábitos das crianças e dos adolescentes.

Long-term effectiveness of a back education programme in elementary schoolchildren: an 8-year follow-up study

The purpose of this study was to investigate the long-term effectiveness of a spine care education programme conducted in 9- to 11-year-old schoolchildren. The study sample included 96 intervention subjects and 98 controls (9- to 11-year-olds at baseline). Intervention consisted of a 6-week school-based back education programme (predominantly biomechanically oriented) and was implemented by a physical therapist. Self-reported outcomes on back care knowledge, spinal care behaviour, self-efficacy towards favourable back care behaviour, prevalence of back and neck pain during the week and fear-avoidance beliefs were evaluated by the use of questionnaires. Post-tests were performed within 1 week after programme completion, after 1 year and after 8 years. Whereas the educational back care programme resulted in increased back care knowledge up to adulthood (P < 0.001), intervention did not change spinal care behaviour or self-efficacy. Pain prevalence figures increased less in the experimental group compared to the controls over the 8-year time span, yet statistical significance was not reached. Dropout analysis revealed spinal pain prevalence rates to be different in both groups throughout the study, including at baseline. Back education at young age did not reinforce fear-avoidance beliefs up to adulthood. Predominantly biomechanical oriented back education in elementary schoolchildren is effective in improving the cognitive aspect of back care up to adulthood, yet not in changing actual behaviour or self-efficacy. The current study does not provide evidence that educational back care programmes have any impact on spinal pain in adulthood. The true long-term impact of school-based spinal health interventions on clinically relevant outcome measures merits further attention.

Effects of spinal health educational programs for elementary school children

PURPOSE

This study examined the effects of spinal health educational programs.

DESIGN AND METHODS

A nonequivalent control-group pretest-posttest design was used. Participants were 88 fifth-grade elementary schoolchildren. Three groups were compared: a Web-based program group, a traditional face-to-face program group, and a control group.

RESULTS

In both intervention groups, the changes for spinal health knowledge and self-efficacy were significantly higher than those of the control group. However, the changes of spinal health practices were not significantly different.

PRACTICE IMPLICATIONS

A Web-based spinal health education program is a convenient and flexible health educational approach that was as effective in this study as traditional face-to-face instruction.

Benefícios de um programa de educação postural para alunos de uma escola municipal de Garibaldi, RS

A fisioterapia tem importante papel no meio escolar, pois estudantes desenvolvem maus hábitos e alterações posturais que, a longo prazo, podem gerar restrição funcional. O objetivo deste estudo foi analisar os efeitos de um programa de educação postural em estudantes do ensino fundamental da cidade de Garibaldi, RS. Participaram 48 alunos com idade entre 8 e 10 anos, que responderam um questionário sobre hábitos posturais e foram submetidos à avaliação de peso, modelo e modo de transporte da mochila antes e após uma sessão educativa; quatro semanas mais tarde foi feita uma reavaliação. Os pais participaram do estudo respondendo um questionário sobre a postura dos filhos. Quanto aos hábitos escolares, constatou-se mudança positiva na adoção de postura adequada dos pés na posição sentada (p=0,001); e, nas atividades de vida diária, mudanças na posição ao ver televisão (p<0,0001), dormir (p=0,019), pegar objetos no chão (p<0,0001) e costume de ler e/ou escrever na cama (p=0,002). Em relação ao peso da mochila obteve-se redução significativa após a intervenção (p=0,002), enquanto no modelo e modo de transporte não houve diferença. Segundo os pais, os filhos têm bons hábitos de postura e costumam utilizá-los no dia-a-dia. Concluiu-se que a realização de uma sessão de educação postural para alunos promoveu o conhecimento de hábitos posturais saudáveis e modificação de algumas posturas, mas não se pode afirmar que provocou mudanças nos hábitos posturais.

Estratégias para ensino de hábitos posturais em crianças: história em quadrinhos versus experiência prática

Este estudo experimental verificou os efeitos de um programa de educação postural comparando duas estratégias de ensino, a utilização de uma história em quadrinhos (HQ) e a experiência prática de posturas corretas e incorretas (EP). O programa de educação postural foi aplicado em três encontros com escolares das 2ª e 3ª séries, com idades entre 7 e 11 anos; 40 meninas e 40 meninos foram divididos igualmente em dois grupos, cada um submetido a uma estratégia de ensino: GHQ e GEP. O conhecimento dos hábitos posturais foi verificado por meio de questionários aplicados antes e após 6 meses do término das sessões. Foram ensinadas as posturas corretas em pé, sentado, de transportar mochilas, de abaixar, de mudar objetos de lugar e jeito de dormir. Os resultados do estudo indicaram que, para todas as variáveis estudadas houve aumento significativo no aprendizado e memorização dos hábitos posturais corretos em ambos os grupos, e que não houve diferença significativa entre as duas estratégias educativas. Não foram detectadas diferenças no aprendizado e memorização dos hábitos posturais corretos em crianças de ambos os sexos submetidas às duas metodologias de ensino.

Physical therapy treatment of back complaints on children and adolescents

STUDY DESIGN

A randomized controlled trial was performed.

OBJECTIVES

To evaluate how 2 different treatment options affect perception of health, pain, and physical functioning over time among children and adolescents with low back pain (LBP).

SUMMARY OF BACKGROUND DATA

LBP among children and adolescents has increased. The literature shows that children with LBP also suffer from this condition as adults. Thus, it is important to prevent and treat LBP in children and adolescents.

METHODS

Forty-five children and adolescents were consecutively randomized into one of 2 treatment groups and were studied for 12 weeks. Group 1 was given individualized physical therapy and exercise and a standardized self-training program and back education. Group 2 was given self-training program and back education but no individualized therapy. The children and adolescents were tested before and after the treatment period. Child Health Questionnaire Child Form 87, Roland & Morris Disability Questionnaire, Painometer, Back Saver Sit and Reach, and test of trunk muscle endurance were used to evaluate the interventions.

RESULTS

Both groups improved statistically significant in most parameters over time. On comparison between the groups the physical function measured by Roland & Morris Disability Questionnaire and the duration of pain measured by Painometer improved statistically significant in Group 1.

CONCLUSION

An individual assessment by a knowledgeable physiotherapist and an active treatment model improve how children and adolescents experience their back problems with respect to health and physical function, pain, strength, and mobility, regardless of whether treatment consists of a home exercise program with follow-up or home exercise combined with exercise and treatment supervised by a physiotherapist.

Classroom postures of 8-12 year old children

This study examined classroom postures of 8-12 year old school children in Flanders and related the outcomes to self-reported back or neck pain. Postural behaviours using the portable ergonomic observation (PEO) method and self-reported one-week back and neck pain were studied in 105 children from 41 different class groups. Pupils sat statically for 85% of the time, 28% of which the trunk was bent or flexed forward. For 9% of the time, children sat dynamically and for 36% they used a back rest. Children who spent more time sitting with a flexed trunk reported significantly more thoraco-lumbar pain compared to pain-free children and to children with cervical pain (p < 0.05). Children reporting pain stood for a longer period of time than pain-free children (p < 0.05). It is concluded that prolonged static kyphotic sitting without use of a backrest is common in elementary school children in Flanders.

Back posture education in elementary schoolchildren: a 2-year follow-up study

Within the scope of primary prevention regarding back functioning in children, research on the stability of intervention effects is indispensable. Along this line, the transition from childhood to adolescence is an important phase to evaluate the potential stability of intervention effects because of the typically mechanical and psychological demands related to adolescence. The main aim of the current study was to investigate the effects of a back education program at 2-year follow-up, in youngsters aged 13-14 years, on back posture knowledge, fear-avoidance beliefs and self-reported pain. An additional purpose was to evaluate which aspects of postural behavior were integrated in youngsters' lifestyles. At 2-year follow-up, the study sample included 94 secondary schoolchildren in the intervention group (mean age 13.3 +/- 0.8 years) and 101 controls (mean age 13.2 +/- 0.7 years). The back posture program that had been implemented for two school years consisted of back education and the stimulation of postural dynamism in the class through support and environmental changes. A questionnaire was completed comparable to the pretest, posttest and follow-up evaluations. The current study demonstrated at 2-year follow-up stability of the improved general (F = 1.590, ns) and specific (F = 0.049, ns) back posture knowledge in children who had received early back posture education. Back posture education did not result in increased fear-avoidance beliefs (F = 1.163, ns) or mounting back and/or neck pain reports (F = 0.001, ns). Based on self-reports for postural behavior, youngsters who had received the back posture program in the elementary school curriculum integrated crucial sitting and lifting principles conform to biomechanical favorable postural behavior. The steady intervention effects 2-year post-intervention demonstrated that intensive back posture education through the elementary school curriculum is effective till adolescence. Future research on the impact of early school-based back posture promotion in relation to the integration of back posture principles according to a biomechanical favorable lifestyle and back pain prevalence later in life is essential.

Effects of a two-school-year multifactorial back education program in elementary schoolchildren

STUDY DESIGN

A quasi-experimental pre/post design.

OBJECTIVE

To investigate effects of a 2-school-year multifactorial back education program on back posture knowledge and postural behavior in elementary schoolchildren. Additionally, self-reported back or neck pain and fear-avoidance beliefs were evaluated.

SUMMARY OF BACKGROUND DATA

Epidemiologic studies report mounting nonspecific back pain prevalence among youngsters, characterized by multifactorial risk factors. Study findings of school-based interventions are promising. Furthermore, biomechanical discomfort is found in the school environment.

METHODS

The study sample included 193 intervention children and 172 controls (baseline, 9-to-11-year-olds). The multifactorial intervention consisted of a back education program and the stimulation of postural dynamism in the class through support and environmental changes. Evaluation consisted of a questionnaire, an observation of postural behavior in the classroom, and an observation of material handling during a movement session.

RESULTS

The intervention resulted in increased back posture knowledge (P < 0.001), improved postural behavior during material handling (P < 0.001), and decreased duration of trunk flexion (P < 0.05) and neck torsion (P < 0.05) during lesson time. The intervention did not change fear-avoidance beliefs. There was a trend for decreased pain reports in boys of the intervention group (P < 0.09).

CONCLUSIONS

The intervention resulted in improved postural aspects related to spinal loading. The long-term effect of improved postural behavior at young age on back pain prevalence later in life is of interest for future research.

Back education in elementary schoolchildren: the effects of adding a physical activity promotion program to a back care program

Promoting a physically active lifestyle whilst optimizing the spinal load at a young age seems to be advocated within the scope of early back pain prevention efforts. The present study aimed at evaluating the effects of combining a back care program with a physical activity promotion program in elementary schoolchildren. In a pre-post design over two school years, back care knowledge, back care behavior, fear avoidance beliefs and back pain reports were evaluated in children classified into three categories--those who received a back care and a physical activity promotion program (n=190), those who received only a back care program (n=193) and those in a control group (n=172) (mean age at baseline: 9.7 years+/-0.7). Physical activity levels were evaluated in a sub-sample of 26 pupils in each group. The back care program and the physical activity promotion program were both comprehensive ones. In both intervention groups, the scores for back care related knowledge and back care behavior were significantly higher than the control group. The increase in the sum score for back care behavior was significantly higher in the back care group than in the back care plus physical activity promotion group. Significant interaction effects showed an increase in fear-avoidance beliefs between pre- and post-tests in the control group, significantly different from the better scores in both intervention groups. Interaction effects were not significant for pain reports. In the back care plus physical activity promotion group, the daily moderate to vigorous physical activity levels decreased by 8 min per day while a decrease by 31 min per day was found in the back care group and a decrease by 36 min per day in the control group. However, group differences were not significant. The present study findings favor the addition of a physical activity promotion program to a back care program in elementary schools within the scope of early back pain prevention efforts. However, the findings also emphasize the disadvantages of implementing both programs simultaneously in a school curriculum that is already full.

School-based interventions for spinal pain: a systematic review

STUDY DESIGN

Systematic review.

OBJECTIVES

To establish the effectiveness of school-based spinal health interventions in terms of: 1) improving knowledge about the spine/spinal care; 2) changing spinal care behaviors; and 3) decreasing the prevalence of spinal pain.

SUMMARY OF BACKGROUND DATA

Spinal pain is a significant problem in children and adolescents that has been addressed through school-based spinal health interventions. No systematic review has been carried out on this topic to date.

METHODS

A systematic literature review sought studies that evaluated school-based spinal health interventions. Using clearly defined study inclusion criteria, 11 databases were searched from their inception to March 2004. To identify further literature, three relevant journals were hand searched, reference lists were checked, and authors of included papers were contacted. Two reviewers independently appraised the quality of identified papers and extracted data regarding intervention and study characteristics, statistical analyses performed, and study results. Data were examined using a narrative synthesis of results, and the outcomes of interest were considered individually (knowledge, behaviors, pain prevalence).

RESULTS

Twelve papers were included in this review; all papers received a "weak" quality rating. Results of these studies indicate that school-based spinal health interventions may be effective in increasing spinal care knowledge and decreasing the prevalence of spinal pain. However, overall the evidence is inconclusive regarding spinal care behaviors.

CONCLUSIONS

The poor quality of the reviewed studies limits the conclusions that can be made regarding the effectiveness of school-based spinal health interventions.

Back pain in school children--where to from here?

Back pain is now recognised to occur early in childhood and is associated with high prevalence rates when estimated by survey. This review paper considers the risk factors associated with back pain in children aged 11-14 years, and particularly those present in a school setting. The risk factors most significantly associated with back pain are primarily characteristics of the individual with less strong associations with factors present in the school environment. The majority of intervention studies undertaken in a school setting have focussed on the effect of school furniture on posture and comfort and were of short-term duration. There is a need for further research in order to achieve a better understanding of the risk factors present in a school environment and to address ways to reduce the currently recognised perceived problem of back pain among school children. A strategy for an evidence-based longitudinal intervention study is proposed, with the content outlined under the headings: policy, school equipment and furniture, individual and family.

How to prevent low back pain

This chapter summarizes the European Guidelines for Prevention in Low Back Pain, which consider the evidence in respect of the general population, workers and children. There is limited scope for preventing the incidence (first-time onset) of back pain and, overall, there is limited robust evidence for numerous aspects of prevention in back pain. Nevertheless, there is evidence suggesting that prevention of various consequences of back pain is feasible. However, for those interventions where there is acceptable evidence, the effect sizes are rather modest. The most promising approaches seem to involve physical activity/exercise and appropriate (biopsychosocial) education, at least for adults. Owing to its multidimensional nature, no single intervention is likely to be effective at preventing the overall problem of back pain, although there is likely to be benefit from getting all the players onside. However, innovative studies are required to better understand the mechanisms and delivery of prevention in low back pain.

Persistence and change in nonspecific low back pain among adolescents: a 3-year prospective study

STUDY DESIGN

This is a 3-year prospective study of juvenile low back pain (LBP).

OBJECTIVES

To investigate persistence and change in LBP.

SUMMARY OF BACKGROUND DATA

Earlier episodes of LBP are a strong risk factor for LBP in adults, while the persistence of LBP through adolescence is not known.

METHODS

The material comprised all pupils in eighth and ninth grades (N = 105, mean age 14.7 years), living within two geographic areas in Eastern Norway in January 1997. The analyses included 88 adolescents at baseline, and 85 at follow-up. The questionnaire, which identified LBP as pain or ache in the low back during the preceding year, was answered at baseline in the classroom and at follow-up by post.

RESULTS

LBP was reported by 58% at baseline and by 39% at follow-up, and LBP provoked by manual work by 40% at baseline and 26% at follow-up. Thirty-one percent reported LBP at both occasions. LBP more than 7 days was reported by 32% at baseline, by 26% at follow-up, and by 18% at both occasions. Twenty-two percent of those reporting LBP at baseline rejected ever LBP at follow-up. Baseline reports of LBP predicted corresponding reports of LBP at follow-up: Odds ratio was 4.7 (95% confidence interval 1.7-12.7) for LBP generally, 9.1 (3.0-27.2) for LBP more than 7 days, 9.2 (2.9-28.8) for LBP provoked by manual work, and 3.8 (1.3-11.3) for LBP provoked by sitting at school.

CONCLUSION

The findings indicate a persistent, but changeable, trend in LBP from midadolescence until late adolescence. The consistency and the high rates of reports of LBP provoked by manual work and sitting imply needs for more research on the persistence of LBP, and on relevant interventions during school age.

Sitting habits in elementary schoolchildren: a traditional versus a "Moving school"

This study evaluated differences in sitting habits in the classroom between the project "Moving school" and a traditional school in 8-year-old children. Twenty-two children, since 1.5 years involved in the project were compared to 25 children in a traditional school. Making use of the Portable Ergonomic Observation (PEO) method, it was observed that children from a traditional school spend an average of 97% of the lesson time sitting statically, from which one-third with the trunk bend over 45 degrees. In the "Moving school" this posture was replaced by dynamic sitting (53%), standing (31%) and walking around (10%), while trunk flexion over 45 degrees was nearly not observed. Children from the "Moving school" also showed significantly less neck and trunk rotation. Additionally, accelerometric data showed significantly more physical activity in lessons of the "Moving school". Rates of self-reported back or neck pain did not differ significantly between both study groups. Results show that sitting habits are more favourable in a "Moving school". Further research is needed to study the impact of implementing "Moving school" concepts in traditional schools on sitting habits.

Low back pain prevention's effects in schoolchildren. What is the evidence?

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

Pain syndromes in children

This review discusses the recent literature on pain conditions in children that should be of interest to rheumatologists. The focus of the review is therefore on musculoskeletal pains in children, particularly chronic or recurrent musculoskeletal pain. Articles that have a broader focus on pain are discussed when these are likely to be of general interest to rheumatologists. Chronic or recurrent pain in childhood is common and can be caused by a wide variety of conditions, several of which are discussed here. The importance of being able to measure pain in children has been emphasized repeatedly in the recent literature. With increased understanding of how to evaluate pain in children has come the recognition that pain in children is multifactorial and that even when there are obvious "organic" causes of the pain (such as arthritis), psychosocial factors are critical in how pain is perceived, and they influence the extent to which pain leads to dysfunction. There is also increasing evidence that cognitive-behavioral therapies are effective in managing chronic pain in children. The frequency of back pain in children is increasingly recognized, and the role of children's work and play, carrying heavy backpacks, and sitting for long periods of time at computers in causing back pain is of interest. The studies reviewed here add to an increasingly rich and informative literature on musculoskeletal and other chronic pain in children, and they help emphasize the importance of proper evaluation and management of pain in children.