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Low back pain in children and adolescents: a systematic review and meta-analysis evaluating the effectiveness of conservative interventions

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Abstract

Purpose

To identify and evaluate the effectiveness of conservative treatment approaches used in children and adolescents to manage and prevent low back pain (LBP).

Methods

Five electronic databases and the reference lists of systematic reviews were searched for relevant studies. Randomised controlled trials (RCTs) were considered eligible for inclusion if they enrolled a sample of children or adolescents (<18 years old) and evaluated the effectiveness of any conservative intervention to treat or prevent LBP. Two authors independently screened search results, extracted data, assessed risk of bias using the PEDro scale, and rated the quality of evidence using the GRADE criteria.

Results

Four RCTs on intervention and eleven RCTs on prevention of LBP were included. All included studies had a high risk of bias scoring ≤7 on the PEDro scale. For the treatment of LBP, a supervised exercise program compared to no treatment improved the average pain intensity over the past month by 2.9 points (95 % CI 1.6–4.1) measured by a 0–10 scale (2 studies; n = 125). For the prevention of LBP, there was moderate quality evidence to suggest back education and promotion programs are not effective in reducing LBP prevalence in children and adolescents.

Conclusions

While exercise interventions appear to be promising to treat LBP in children and adolescents, there is a dearth of research data relevant to paediatric populations. Future studies conducted in children and adolescents with LBP should incorporate what has been learnt from adult LBP research and be of rigorous methodological quality.

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Conflict of interest

None of the authors involved in the preparation of this manuscript have any potential, perceived or real conflict to disclose.

Author information

Authors and Affiliations

  1. The George Institute for Global Health and Sydney Medical School, The University of Sydney, Kent Street, Sydney, 2000, Australia

    Zoe A. Michaleff, Steven J. Kamper & Christopher G. Maher

  2. EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands

    Steven J. Kamper

  3. Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, Minneapolis, USA

    Roni Evans

  4. School of Medical Sciences, UNSW Medicine, Children’s Hospital Institute of Sports Medicine, University of New South Wales, Sydney Children’s Hospital Network, Sydney, Australia

    Carolyn Broderick

  5. Institute of Public Health, University of Heidelberg, Heidelberg, Germany

    Nicholas Henschke

Authors
  1. Zoe A. Michaleff
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  2. Steven J. Kamper
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  3. Christopher G. Maher
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  4. Roni Evans
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  5. Carolyn Broderick
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  6. Nicholas Henschke
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Corresponding author

Correspondence to Zoe A. Michaleff.

Electronic supplementary material

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Supplementary material 1 (DOC 66 kb).

Appendix 1

Appendix 1

Example search strategy for MEDLINE (OVID). The search terms were modified slightly for other databases. These are available on request from the authors.

Part A: generic search for randomised controlled trials and controlled clinical trials

1. randomised controlled trial.pt.

2. controlled clinical trial.pt.

3. comparative study.pt.

4. clinical trial.pt.

5. randomised.ab.

6. placebo.ab,ti.

7. drug therapy.fs.

8. randomly.ab,ti.

9. trial.ab,ti.

10. groups.ab,ti.

11. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10

12. (animals not (humans and animals)).sh.

13. 11 not 12

Part B: specific search for thoracic, low back, sacrum and coccyx problems

14. dorsalgia.ti,ab.

15. exp Back Pain/

16. backache.ti,ab.

17. exp Low Back Pain/

18. (lumbar adj pain).ti,ab.

19. coccyx.ti,ab.

20. coccydynia.ti,ab.

21. sciatica.ti,ab.

22. sciatic neuropathy/

23. spondylosis.ti,ab.

24. lumbago.ti,ab.

25. back disorder$.ti,ab.

26. or/14‐25

Part C: sensitive search for children and adolescents

27. child$.ti,ab.

28. adolesce$.ti,ab.

29. youth$.ti,ab.

30. school$.ti,ab.

31. student$.ti,ab.

32. teena$.ti,ab.

33. young.ti,ab.

34. 27 or 28 or 29 or 30 or 31 or 32 or 33

Part D: combined search

35. 13 AND 26 AND 34

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Michaleff, Z.A., Kamper, S.J., Maher, C.G. et al. Low back pain in children and adolescents: a systematic review and meta-analysis evaluating the effectiveness of conservative interventions. Eur Spine J 23, 2046–2058 (2014). https://doi.org/10.1007/s00586-014-3461-1

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  • DOI: https://doi.org/10.1007/s00586-014-3461-1

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