Introduction
Methods
Registration
Criteria for eligibility
Information sources and search
Study selection
Data collection
S/ N | STUDY | COUNTRY | RESIDENTIAL FACILITY | PARTICIPANTS | INTERVENTION MODEL/CARE | CONTROL/COMPARISON | OUTCOME ACCESSED/OUTCOME MEASURE |
---|---|---|---|---|---|---|---|
1. | (Akbari-Chehrehbargh, Tavafian, & Montazeri, 2020) [25] | Tehran, Iran | Elementary schools | 5th grade female school children. Sample size (104 pupils, IG = 52, CG = 52). Age (11 ± 1.0 years for both CG and IG) | Six sessions of T-bak educational program including four components: belief (one session), knowledge (one session), skills (two sessions) and self-efficacy (two sessions).Freq: once a week Dur: 1 hr | No therapy | Primary outcome; Improved back care related behavior (5-point Likert-type scale with total score ranging from 6 to 30). Secondary outcome; enhancement in beliefs (six-item scale), back care knowledge (multiple choice quiz), skills (checklist) and self-efficacy (four point Likert type scale). |
2. | (Dullien, Grifka, & Jansen, 2018) [16] | Germany | Elementary school | 176 pupils aged 10–12 years (mean age = 10.6 ± 0.44). CG = 86, IG = 90 | Five lessons on back care, posture awareness training, back and abdominal muscle exercises | No therapy | Motor skills, back behavior, knowledge. Outcome measures; clinical orthopaedic exam, health questionnaire, motor test, back behaviour trial and knowledge test |
3. | (Rodriguez-Garcia, Lopez-Minarro, & Santonja, 2013) [21] | Spain | Elementary and secondary schools | 41 elementary school children (mean age 10.27 ± 0.31 years), 43 secondary school children (mean age 13.46 ± 0.68).sample size, n = 84, CG = 40, IG = 44 | An organized physical education programme. Dur; 13mins Freq; 2 times a week | No therapy | Back pain frequency Pain intensity (visual analogue scale) |
4. | (Habybabady R. H., et al., 2012) [18] | Iran | Elementary school | 5th grade elementary schoolchildren. Sample size =404, CG = 201, 104 girls ad 97 boys. IG = 203, 101 girls and 102 boys | Education programme using educational pamphlets, Duration; 60 minutes. | No therapy | Knowledge and behavior (questionnaires) |
5. | (Vidal-Conti & Galmes-Panades, 2022) [26] | Spain | Primary school | Schoolchildren aged 10–12 years. Sample size = 224. CG = 5 schools (n = 127), IG = 5 schools (n = 97). | Online training postural on class teachers, implementation of active breaks for classroom teachers, development of a postural education teaching unit, awareness of general school community. | No therapy | Prevalence of LBP (Self-administered questionnaires), daily postural habits {Back pain and body posture evaluation instrument (BackPEI)} |
6. | (Vidal, et al., 2013) [27] | Spain | Primary schools | Primary school children aged 10–12 years AV = 10.7, SD = 0.672. sample size = 137,IG = 63, CG = 74 | 6 sessions of postural education program for 6 weeks(4 theoretical and 2 practical) Dur: 1 hr. Freq: once a week | Usual school curriculum | Try to load the minimum weight possible, school back pack carriage on both shoulders, belief that backpack do not affect the back, use of locker or something similar at school (questionnaires). |
7. | (Cardon, de Clercq, Geldhof, Verstraete, &de Bourdeaudhuij, 2007) [28] | Belgium | Elementary schools | 4th and 5th grade students. Mean age = 9.7 ± 0.7, range 8.1–12.0. sample size = 555, IG 1 = 190, 1G 2 = 193, CG = 172 | IG 1 = Back care education programme consisting 6 lessons with 1 week interval. Physical activity promotion programme, 6 lessons at 1 wk. interval. IG 2 = Back care promotion condition | No therapy | back care behavior (observation), knowledge, fear-avoidance beliefs, back pain prevalence (questionnaire), and physical activity (accelerometer) |
8. | (Kovacs, et al., 2011) [19] | Spain | Elementary schools | School children. Age = 8 years, sample size = 497, CG = 231, 1G = 266. | Comic book of the back | no intervention | Knowledge (questionnaires) |
S/ N | Pre intervention measures | Post intervention measures | Pre control measures | Post control measures | RESULTS | CONCLUSION | QUALITY SCORE |
---|---|---|---|---|---|---|---|
1. | Behaviour (17.26 ± 4.97,p value- 0.36) Knowledge(4.16 ± 1.53, p value-0.65) Skills (13.26 ± 9.37, p value- 0.95) Self efficacy(10.66 ± 2.86, p value- 0.66) Beliefs (19.16 ± 4.19, p value- 0.24) | Behaviour (26.35 ± 3.61) Knowledge(4.30 ± 1.46) Skills(13.70 ± 10.18), Self efficacy(14.22 ± 2.17) Beliefs(26.31 ± 4.39) | Behaviour (18.30 ± 5.00) Knowledge(4.30 ± 1.46) Skills(13.70 ± 10.18) Self efficacy(10.2 ± 2.97) Beliefs(18.08 ± 4.83) | Behaviour (17.02 ± 5.59) Knowledge(4.16 ± 1.61) Skills(13.53 ± 10.18), Self efficacy(10.80 ± 2.73) Beliefs(18.18 ± 4.42) | There was a significant improvement on behaviour, beliefs, skills, self-efficacy and knowledge in the intervention group. No significant difference on outcomes assessed in the control group | T-bak educational program is effective in improving back care related behaviour among pupils | 7 |
2. | Knowledge(14.42 ± 3.03, p- 0.001) behaviour (5.7 ± 1.9, p value- 0.005) motor skills (3.4 ± 3.8, p value< 0.001) | Knowledge(17.17 ± 2.84), behaviour (8.2 ± 2.0) motor skills (5.6 ± 3.9) | Knowledge(14.80 ± 5.05), behaviour (6.1 ± 1.7) motor skills (2.2 ± 3.0) | Knowledge(14.57 ± 4.42), behaviour (7.7 ± 2.1) motor skills (4.9 ± 4.0) | Improvement on back behaviour& knowledge among the IG. Increased Posture performance and improvement in spinal deformity seen in both IG and CG. no significant difference in back pain frequency & core muscle endurance in both groups | Teacher led back education programme should be included in schools. | 6 |
3. | Pain frequency (9.5%) | Pain frequency 2.4% | Pain frequency 11.9% | Pain frequency 22.6% | Decrease in low back pain frequency in the IG and an increase in the CG | Children and adolescents subjected to the school physical education programme showed a reduction in low back pain frequency | 8 |
4. | Knowledge (43.4 ± 12.93) Behaviour (53.3 ± 16.34) | Knowledge (74.5 ± 19.60) Behaviour (75.8 ± 18.58) | Knowledge (47.0 ± 12.76) Behaviour (54.7 ± 13.57) | Knowledge (48.1 ± 13.78) Behaviour (56.0 ± 16.43) | Significant increase in knowledge and behavior in the IG after one week and 3 months as compared to the CG. | Knowledge and behavior of children can be improved through educational programmes. It should be included in schools’ curriculum to ensure its sustainability | 6 |
5. | Postural habits (2.86 ± 1.000) Last week prevalence (17.4%) | Postural habits (2.56 ± 1.108) Last week prevalence(15.5%) | Postural habits (2.93 ± 1.142) Last week prevalence (17.4%) | Postural habits (2.64 ± 1.067) Last week prevalence(18.6%) | No significant difference in low back pain prevalence and healthy postural habits both in CG ad IG | Postural education did not improve postural habits in children | 5 |
6. | Last week LBP (19 ± 13.9%) Min wt (114 ± 83.2) Belief (19 ± 13.9) Carry backpack (121 ± 88.3) | Last week LBP (6 ± 9.5%) Min wt (48 ± 76.2) Belief (5 ± 7.9) Carry backpack (54 ± 85.7) | Last week LBP (19 ± 13.9%) Min wt (114 ± 83.2) Belief (19 ± 13.9) Carry backpack (121 ± 88.3) | Last week LBP (13 ± 17.6%) Min wt (66 ± 89.2) Belief (14 ± 18.9) Carry backpack (121 ± 88.3) | Repeated ANCOVA shows a significant increase in healthy backpack use in the IG | Children are able to learn healthy backpack habits which could prevent future LBP. | 5 |
7. | Knowledge (1.0 ± 3.9) Behaviour (17.36 ± 4.82) | Knowledge (5.1 ± 2.9) Behaviour (25.44 ± 4.66) | Knowledge(0.7 ± 3.4) Behaviour (16.46 ± 4.20) | Knowledge (2.7 ± 3.0) Behaviour (18.48 ± 5.43) | Significant increase in back care behavior in both intervention groups than the control group Increase in fear avoidance in the control group different from the intervention groups. Increase in physical activity in the back care + physical activity promotion group. | It is important to incorporate back care education in the training of teachers. It should be also be integrated into the school curriculum | 8 |
8. | Total median score; 8 (p value < 0.001) | 9 | 7 | 9 | Slight increase in knowledge in the IG | Small but valuable effects of the comic book of the back in improving children’s knowledge of appropriate methods for preventing and managing LBP | 8 |
Quality appraisal
s/n | STUDIES | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Q10 | Q11 | TOTAL |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | (Akbari-Chehrehbargh, Tavafian, & Montazeri, 2020) [25] | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7 |
2 | (Dullien, Grifka, & Jansen, 2018) [16] | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 6 |
3 | (Rodriguez-Garcia, Lopez-Minarro, & Santonja, 2013) [21] | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 8 |
4 | (Habybabady R. H., et al., 2012) [18] | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 6 |
5 | (Vidal-Conti & Galmes-Panades, 2022) [26] | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 1 | 5 |
6 | (Vidal, et al., 2013) [27] | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 1 | 5 |
7 | (Cardon, de Clercq, Geldhof, Verstraete, & de Bourdeaudhuij, 2007) [28] | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 8 |
8 | (Kovacs, et al., 2011) [19] | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 8 |
Data synthesis
Results
Quality appraisal
METHODOLOGICAL QUALITY | NO OF STUDIES | PERCENTAGES |
---|---|---|
PEDRO SCALE | ||
Eligibility criteria | 4 | 50% |
Radom allocation | 8 | 100% |
Concealed allocation | 3 | 37.5% |
Groups similar at baseline | 8 | 100% |
Subject blinding | 3 | 37.5% |
Therapist blinding | 1 | 12.5% |
Assessor blinding | 2 | 25% |
Less than 15% dropouts | 8 | 100% |
Intention to treat analysis | 6 | 75% |
Between groups statistical comparisons | 8 | 100% |
Point measure and variability data | 4 | 50% |
PEDRO TOTAL SCORE | ||
Excellent quality (9, 10) | 0 | 0% |
Good quality (6–8) | 6 | 75% |
Fair quality (4, 5) | 2 | 25% |
Poor quality(0–4) | 0 | 0% |
SAMPLE SIZE | ||
≤100 | 1 | 12.5 |
≥100 | 7 | 87.5% |
LEVEL OF EVIDENCE | ||
Level 1 | 5 | 62.5% |
Level 2 | 3 | 37.5% |
Distribution of studies based on location and regional economic classification
Outcomes assessed and their outcome measures
S/N | OUTCOMES | OUTCOME MEASURES | FREQUENCY | % |
---|---|---|---|---|
1. | Pain intensity | Visual analogue scale (VAS) | 1 | 12.5% |
2. | Knowledge | Questionnaires | 4 | 50% |
3. | Back care behavior | 5point scale, questionnaires, observation | 4 | 50% |
4. | Back pain prevalence | Questionnaires | 2 | 25% |
5. | Postural habits | Back pain and body posture evaluation instrument | 1 | 12.5% |
6. | Back pack carriage | Questionnaires | 1 | 12.5% |
7. | Physical activity | Accelerometer | 1 | 12.5% |
8. | Fear-avoidance | Questionnaires | 1 | 12.5% |
9. | Beliefs | 6point scale | 1 | 12.5% |
10. | Use of locker or alternate means | Questionnaires | 1 | 12.5% |
11. | Minimum weight loading of back packs | Questionnaires | 1 | 12.5% |
12. | Skills | Checklist | 1 | 12.5% |
13. | Self-efficacy | 4point scale | 1 | 12.5% |