Background
Methods
Study selection
Data sources and searches
Data extraction and quality assessment
Effect size index
Data analysis
Results
Descriptive characteristics of the studies
Papers (19) | Studies (23) | Participants | Contents | Interventions | Outcomes |
---|---|---|---|---|---|
Cardon et al., [19] (2000) Belgium | 78 subjects Age: 10.2 E = 42 C = 36 | German Back School Correct realization of different activities of daily life Stretching and strengthening exercises | E: 6 sessions (60 mins) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) + 2 hours with the participation of their parents and teachers | The experimental group obtained higher scores than the control group for the behaviors and knowledge in the posttest | |
C: control | |||||
Cardon et al., [27] (2001) Belgium | (a) | 72 subjects 5th grade Age: 11 E = 38 C = 34 | German Back School Correct realization of different activities of daily life Stretching and strengthening exercises | E: 6 sessions (60 mins; once a week) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) + extra guidelines of their teachers to integrate the learned principles (12 weeks) | The experimental group obtained higher scores than the control group for the behaviors and knowledge |
C: control | |||||
(b) | 82 subjects 5th grade Age: 11 E = 48 C = 34 | German Back School Correct realization of different activities of daily life Stretching and strengthening exercises | E: 6 sessions (60 mins; once a week) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) without extra guidelines of their teachers | The experimental group obtained higher scores than the control group for the behaviors and knowledge | |
C: control | |||||
Cardon et al., [28] (2002a) Belgium | 706 subjects Age: 10.02 (9–11) E = 347 C = 359 | German Back School Correct realization of different activities of daily life Stretching and strengthening exercises | E: 6 sessions (60 mins; once a week) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) + 2 hours with the participation of their parents and teachers | Intervention children showed better back care knowledge than control children, and knowledge gained was retained over a period of one year | |
C: control | |||||
Cardon et al., [29] (2002b) Belgium | 363 subjects 4th, 5th grade Age: 9–12 E = 198 C = 165 | German Back School Correct realization of different activities of daily life Stretching and strengthening exercises | E: 6 sessions (60 mins; once a week) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) + 2 hours with the participation of their parents and teachers | The experimental group obtained higher scores than the control group for the behaviors | |
C: control | |||||
Cardon et al., [30] (2007) Belgium | 362 subjects 4th, 5th grade E = 190 C = 172 | German Back School. Correct realization of different activities of daily life Stretching and strengthening exercises Physical activity: sports, play and active recreation for kids (SPARK) | E: 6 sessions (60 mins; once a week) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) + extra guidelines from their teachers to integrate the principles learned and to increase postural dynamics (2 school years) + physical activity promotion program | The experimental group obtained higher scores than the control group for the behaviors and knowledge | |
C: control | |||||
Cardoso [33] (2009) Brazil | 519 subjects Age: 8–21 E = 269 C = 250 | Spinal care principles and how to incorporate this knowledge into everyday life Behavioral intervention | E: 4 sessions (twice week) Lecture, demonstration, hands on practice (2 weeks) | The experimental group obtained higher scores than the control group for the knowledge | |
C: control | |||||
Dolphens et al., [52] (2011) Belgium | 194 subjects Age: 18 E = 96 C = 98 | German Back School Correct realization of different activities of daily life Stretching and strengthening exercises | E: 6 sessions (60 mins; once a week) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) + 2 hours with the participation of their parents and teachers | The experimental group obtained higher scores than the control group for the knowledge | |
C: control | |||||
Geldhof et al., [21] (2006) Belgium | 365 subjects 4th, 5th grade E = 193 C = 172 | German Back School Correct realization of different activities of daily life Stretching and strengthening exercises | E: 6 sessions (60 mins; once a week) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) + extra guidelines of their teachers to integrate the learned principles and to increase postural dynamics (2 school years) | The experimental group obtained higher scores than the control group for the behaviors and knowledge | |
C: control | |||||
Geldhof et al., [53] (2007a) Belgium | 69 subjects Age: 8–11 E = 41 C = 28 | German Back School Correct realization of different activities of daily life Stretching and strengthening exercises | E: 6 sessions (60 mins; once a week) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) + extra guidelines of their teachers to integrate the learned principles and to increase postural dynamics (2 school years) | The effects of 2 years back education showed an increase in trunk flexor endurance in the experimental group compared to a decrease in the controls | |
C: control | |||||
Geldhof et al., [54] (2007b) Belgium | 195 subjects 7th, 8th grade E = 94 C = 101 | German Back School Correct realization of different activities of daily life Stretching and strengthening exercises | E: 6 sessions (60 mins; once a week) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) + extra guidelines of their teachers to integrate the principles learned and to increase postural dynamics (2 school years) | The experimental group obtained higher scores than the control group for the knowledge in the follow-up (2 years) | |
C: control | |||||
Geldhof et al., [55] (2007c) Belgium | 245 subjects 6th,7th grade E = 121 C = 124 | German Back School Correct realization of different activities of daily life Stretching and strengthening exercises | E: 6 sessions (60 mins; once a week) various tasks based on good understanding of basic back care principles (guided discovery and hands-on methods) + extra guidelines of their teachers to integrate the learned principles and to increase postural dynamics (2 school years) | The experimental group obtained higher scores than the control group for the knowledge in the follow-up (1 years) | |
C: control | |||||
Gómez and Méndez [23] (2000a) Spain | 67 subjects 5th grade Age: 11 E = 33 C = 34 | Anatomy, biomechanics, respiratory mechanism and the way to avoid column overload, risk factors for injury, spinal care principles | E: 8 sessions (30 mins; once a week). Lecture to incorporate knowledge about the correct functioning of the body and to avoid vertebral overload and back injuries from childhood. | The experimental group obtained higher scores than the control group for the knowledge in the posttest and the follow up carried out in 6 months time. | |
C: performed with their academic tutor-teacher about related matters. | |||||
Gómez and Méndez [40] (2000b) Spain | (a) | 65 subjects 5th grade Age: 11 E = 33 C = 32 | Postural hygiene, how to incorporate this knowledge into everyday life Behavioral intervention | E: Information and training from a physiotherapist + parents were given information about postural hygiene, training in observation and healthy motive habits registration (2 hours) | The experimental group obtained higher scores than the control group for the behaviors |
C: parents were given information about postural hygiene, training in observation and healthy motive habits registration (2 hours) | |||||
(b) | 66 subjects 5th grade Age: 11 E = 34 C = 32 | Postural hygiene, how to incorporate this knowledge into everyday lifeBehavioral intervention | E: Piece of ergonomics advice from a tutor + parents were given information about postural hygiene, training in observation and healthy motive habits registration (2 hours) | The experimental group obtained higher scores than the control group for the behaviors | |
C: parents were given information about postural hygiene, training in observation and healthy motive habits registration (2 hours) | |||||
Kovacs et al., [56] (2011) Spain | 574 subjects Age: 8 E = 320 C = 254 | Comic Book of the Back | E: Comic Book of the Back handed over by teachers | The experimental group obtained higher scores than the control group for the knowledge | |
C: control | |||||
Martínez [34] (2007) Spain | 579 subjects (3rd- 6th grade) Age: 7–12 E = 314 C = 265 | Spinal care principles and how to incorporate this knowledge into everyday life Behavioral intervention | E: 5 sessions (once week) Lecture, demonstration, hands on practice (5 weeks) | The experimental group obtained higher scores than the control group for the behaviors and knowledge in the posttest | |
C: control | |||||
Méndez and Gómez [20] (2001) Spain | 70 subjects 3rd grade Age: 9 E = 35 C = 35 | Anatomy, biomechanics, risk factors for injury, spinal care principles Behavioral intervention Correct realization of different activities of daily life Stretching and strengthening exercises | E: 11 sessions (60 mins; once a week): 8 sessions (postural hygiene knowledge and behaviors; each lasted 2 hours) and 3 sessions (physiotherapy exercise; each lasted 1 hour), total of 19 hours | The experimental group obtained higher scores than the control group for the knowledge and behaviors in the posttest and the follow up carried out after 12 months | |
C: took part in different academic activities with related themes | |||||
Park and Kim [41] (2011) South Korea | (a) | 59 subjects 5th grade Age: 11 E = 28 C = 31 | Web-based spinal health education program (anatomy, functions of the spine, spinal care principles, stretching and strengthening exercises, backpack use) | E: 4 sessions (30 mins; once a week) Web-based program 3 parts (learning, formative evaluation, learning summary sections) (4 weeks) | The changes for spinal health knowledge were significantly higher than those of the control group. |
C: control | |||||
(b) | 60 subjects 5th grade Age: 11 E = 29 C = 31 | Face-to-face spinal health education program (anatomy, functions of the spine, spinal care principles, stretching and strengthening exercises, backpack use) | E: 4 sessions (30 mins; once a week) Face-to-face instruction 3 parts (learning, formative evaluation, learning summary sections) (4 weeks) | The changes for spinal health knowledge were significantly higher than those of the control group. | |
C: control | |||||
Spence et al., [22] (1984) US | (a) | 50 subjects 3rd, 5th grade E = 25 C = 25 | Safe lifting techniques | E: 1 session: lecture demonstration (5 mins videotape), review of the major principles presented in the tape (5 mins) | Showed significantly higher knowledge in the experimental group versus the control group in the posttest, but no significant differences between groups in the follow-up (2 months) Behaviours: Provided inconclusive or statistically insignificant results |
C: without intervention | |||||
(b) | 51 subjects 3rd, 5th grade E = 26 C = 25 | Safe lifting techniques | E: 1 session: guided self discovery (15 mins) | Showed significantly higher knowledge in the experimental group versus the control group in the posttest, but no significant differences between groups in the follow-up (2 months) Behaviours: Provided inconclusive or statistically insignificant results | |
C: without intervention | |||||
Vidal et al., [24] (2009) Spain | 137 subjects Age: 10–12 E = 63 C = 74 | Anatomy, biomechanics, risk factors for injury, spinal care principles, respiratory mechanism, postural hygiene Behavioral intervention Exercise | E: 6 sessions: 4 sessions (knowledges: anatomy, biomechanics, risk factors for injury, spinal care principles, respiratory mechanism, postural hygiene) and 2 sessions (behavioral intervention, exercise); total of 4 weeks | The experimental group obtained higher scores than the control group for the knowledge | |
C: without intervention |
Mean effect size and heterogeneity analysis
Time point / Outcome measure |
k
|
d
+
| 95% C. I |
Q
|
df
|
p
|
I
2
| |
---|---|---|---|---|---|---|---|---|
d
l
|
d
u
| |||||||
Posttest: Behaviours | 14 | 1.328 | 0.756 | 1.901 | 402.12 | 13 | < .001 | 97% |
Posttest: Knowledge | 16 | 1.288 | 0.898 | 1.679 | 387.23 | 15 | < .001 | 96% |
Follow-up: Behaviours | 6 | 1.795 | 0.672 | 2.919 | 236.48 | 5 | < .001 | 98% |
Follow-up: Knowledge | 9 | 0.762 | 0.473 | 1.050 | 41.97 | 8 | < .001 | 81% |
Analyzing publication bias
Analyzing moderator variables
Outcome variable: behaviours in the posttest
Cluster / Moderator variable |
k
|
d
+
| 95% C. I. | ANOVA results | |
---|---|---|---|---|---|
d
l
|
d
u
| ||||
(A) Treatment characteristics: | |||||
Type of treatment:
|
Q
B(2) = 1.29, p = .525 | ||||
Postural hygiene (PH) | 11 | 0.853 | 0.256 | 1.451 |
R
2 = 0.0 |
PH + Physiotherapy exercise (PE) | 1 | 1.858 | −0.114 | 3.831 |
Q
W(10) = 247.72, p < .001 |
PH + Physical activity | 1 | 0.316 | −1.594 | 2.227 | |
Type of postural hygiene:
|
Q
B(2) = 6.16, p = .046 | ||||
Acquisition of knowledge (AK) | 4 | −0.126 | −1.135 | 0.884 |
R
2 = 0.0 |
AK + Posture training habits (PTH) | 7 | 1.466 | 0.715 | 2.217 |
Q
W(10) = 250.24, p < .001 |
AK + PTH + Stimulat. dynamic postures | 2 | 0.820 | −0.541 | 2.181 | |
Teaching method of postural hygiene:
|
Q
B(1) = 6.63, p = .010 | ||||
Theoretical teaching (TT) | 5 | 0.051 | −0.751 | 0.853 |
R
2 = 0.033 |
TT + Practical teaching | 8 | 1.378 | 0.764 | 1.992 |
Q
W(11) = 259.97, p < .001 |
External agents:
|
Q
B(1) = 0.85, p = .393 | ||||
Yes | 7 | 1.095 | 0.438 | 1.752 |
R
2 = 0.037 |
No | 6 | 0.636 | −0.088 | 1.360 |
Q
W(11) = 235.80, p < .001 |
Parents as paraprofessionals:
|
Q
B(1) = 0.16, p = .688 | ||||
Parental involvement | 2 | 0.642 | −0.660 | 1.944 |
R
2 = 0.0 |
No parental involvement | 11 | 0.931 | 0.383 | 1.478 |
Q
W(11) = 283.70, p < .001 |
Teachers as paraprofessionals:
|
Q
B(1) = 0.76, p = .383 | ||||
Teacher involvement | 4 | 1.258 | 0.252 | 2.265 |
R
2 = 0.0 |
No teacher involvement | 9 | 0.719 | 0.043 | 1.395 |
Q
W(11) = 283.97, p < .001 |
Mode of application:
|
Q
B(2) = 1.04, p = .594 | ||||
Indirect intervention | 1 | 0.741 | −1.354 | 2.837 |
R
2 = 0.0 |
Direct intervention | 9 | 0.718 | 0.025 | 1.412 |
Q
W(10) = 283.94, p < .001 |
Mixed intervention | 3 | 1.427 | 0.239 | 2.616 | |
(B) Methodological characteristics: | |||||
Use of pretest measures:
|
Q
B(1) = 0.15, p = .702 | ||||
Yes | 12 | 0.915 | 0.392 | 1.439 |
R
2 = 0.0 |
No | 1 | 0.542 | −1.293 | 2.377 |
Q
W(11) = 283.51, p < .001 |
Type of control group:
|
Q
B(1) = 0.16, p = .688 | ||||
Active control | 2 | 0.642 | −0.660 | 1.944 |
R
2 = 0.0 |
Nonactive control | 11 | 0.931 | 0.383 | 1.478 |
Q
W(11) = 283.70, p < .001 |
Evaluator blinding:
|
Q
B(1) = 7.10, p = .008 | ||||
Blinded evaluator | 9 | 1.310 | 0.737 | 1.882 |
R
2 = 0.062 |
Not blinded evaluator (or not reported) | 4 | −0.125 | −1.011 | 0.762 |
Q
W(11) = 254.47, p < .001 |
Cluster / Moderator variable |
k
| Min. | Max. | Mean |
SD
|
b
j
|
Q
R
|
Q
E(df) |
R
2
|
---|---|---|---|---|---|---|---|---|---|
(A) Treatment characteristics: | |||||||||
Treatment duration (weeks) | 13 | 1.0 | 96.0 | 20.4 | 33.8 | 0.001 | 0.02 | 283.61(11)*** | 0.0 |
Treatment intensity (hours/week) | 10 | 0.2 | 1.0 | 0.6 | 0.4 | 1.784 | 3.51a
| 199.91(8)*** | 0.0 |
Treatment magnitude (total hours) | 10 | 0.2 | 6.0 | 3.2 | 2.5 | 0.324 | 4.87* | 192.62(8)*** | 0.0 |
(B) Subject characteristics: | |||||||||
Mean age (years) | 11 | 10.0 | 12.0 | 11.0 | 0.7 | −0.662 | 1.84 | 251.97(9)*** | 0.0 |
Gender (% male) | 11 | 43.3 | 58.2 | 50.1 | 5.2 | −0.033 | 0.29 | 253.92(9)*** | 0.0 |
(C) Methodological characteristics: | |||||||||
Differential attrition | 13 | 0.0 | 0.033 | 0.003 | 0.009 | 11.265 | 0.14 | 272.07(11)*** | 0.0 |
Quality score | 13 | 5.0 | 6.5 | 6.1 | 0.6 | 1.040 | 5.87* | 259.63(11)*** | 0.035 |
(D) Extrinsic characteristic: | |||||||||
Publication year | 13 | 1984 | 2011 | 2000 | 8.4 | 0.036 | 1.20 | 282.19(11)*** | 0.0 |
Research team |
k
|
d
+
| 95% C. I. | ANOVA results | |
---|---|---|---|---|---|
d
l
|
d
u
| ||||
Cardon, Geldhof et al. (Belgium) | 7 | 1.504 | 0.706 | 2.302 |
Q
B(3) = 14.36, p = .002 |
Gómez, Méndez et al. (Spain) | 3 | 3.145 | 1.786 | 4.503 |
R
2 = 0.0 |
Spence et al. (USA) | 2 | −0.463 | −2.001 | 1.074 |
Q
W(10) = 366.01, p < .001 |
Park & Kim (South Korea) | 2 | 0.205 | −1.318 | 1.728 | |
Excluding the Méndez and Gómez’s (2001) study[20]: | |||||
Cardon, Geldhof et al. (Belgium) | 7 | 1.492 | 0.828 | 2.156 |
Q
B(3) = 8.60, p = .035 |
Gómez, Méndez et al. (Spain) | 2 | 0.642 | −0.634 | 1.917 |
R
2 = 0.003 |
Spence et al. (USA) | 2 | −0.463 | −1.759 | 0.832 |
Q
W(9) = 249.56, p < .001 |
Park & Kim (South Korea) | 2 | 0.205 | −1.074 | 1.483 |
Outcome variable: knowledge in the posttest
Cluster / Moderator variable |
k
|
d
+
| 95% C. I. | ANOVA results | |
---|---|---|---|---|---|
d
l
|
d
u
| ||||
(A) Treatment characteristics: | |||||
Type of treatment:
|
Q
B(2) = 1.08, p = .583 | ||||
Postural hygiene (PH) | 12 | 1.301 | 0.821 | 1.781 |
R
2 = 0.0 |
PH + Physiotherapy exercise (PE) | 3 | 1.521 | 0.562 | 2.479 |
Q
W(13) = 359.20, p < .001 |
PH + Physical activity | 1 | 0.537 | −1.060 | 2.134 | |
Type of postural hygiene:
|
Q
B(2) = 3.67, p = .159 | ||||
Acquisition of knowledge (AK) | 6 | 1.394 | 0.810 | 1.979 |
R
2 = 0.251 |
AK + Posture training habits (PTH) | 8 | 1.432 | 0.954 | 1.911 |
Q
W(13) = 210.58, p < .001 |
AK + PTH + Stimulat. dynamic postures | 2 | 0.449 | −0.472 | 1.369 | |
Teaching method of postural hygiene:
|
Q
B(1) = 0.18, p = .669 | ||||
Theoretical teaching (TT) | 6 | 1.407 | 0.736 | 2.077 |
R
2 = 0.0 |
TT + Practical teaching | 10 | 1.225 | 0.730 | 1.720 |
Q
W(14) = 341.28, p < .001 |
External agents:
|
Q
B(1) = 1.63, p = .201 | ||||
Yes | 10 | 1.119 | 0.694 | 1.545 |
R
2 = 0.244 |
No | 6 | 1.592 | 1.005 | 2.178 |
Q
W(14) = 268.85, p < .001 |
Parents as paraprofessionals:
|
Q
B(1) = 0.76, p = .384 | ||||
Parental involvement | 1 | 1.972 | 0.385 | 3.559 |
R
2 = 0.003 |
No parental involvement | 15 | 1.244 | 0.842 | 1.647 |
Q
W(14) = 377.45, p < .001 |
Teachers as paraprofessionals:
|
Q
B(1) = 6.77, p = .009 | ||||
Teacher involvement | 5 | 0.730 | 0.231 | 1.230 |
R
2 = 0.497 |
No teacher involvement | 11 | 1.544 | 1.189 | 1.898 |
Q
W(14) = 173.17, p < .001 |
Mode of application:
|
Q
B(2) = 11.15, p = .004 | ||||
Indirect intervention | 1 | 0.289 | −0.793 | 1.371 |
R
2 = 0.481 |
Direct intervention | 12 | 1.578 | 1.234 | 1.923 |
Q
W(13) = 144.57, p < .001 |
Mixed intervention | 3 | 0.534 | −0.118 | 1.185 | |
(B) Methodological characteristics: | |||||
Type of control group:
|
Q
B(1) = 1.65, p = .198 | ||||
Active control | 2 | 1.972 | 0.860 | 3.083 |
R
2 = 0.028 |
Nonactive control | 14 | 1.194 | 0.783 | 1.605 |
Q
W(14) = 367.82, p < .001 |
Evaluator blinding:
|
Q
B(1) = 0.35, p = .553 | ||||
Blinded evaluator | 10 | 1.372 | 0.902 | 1.841 |
R
2 = 0.078 |
Not blinded evaluator (or not reported) | 6 | 1.133 | 0.503 | 1.764 |
Q
W(14) = 305.94, p < .001 |
Cluster / Moderator variable |
k
| Min. | Max. | Mean |
SD
|
b
j
|
Q
R
|
Q
E(df) |
R
2
|
---|---|---|---|---|---|---|---|---|---|
(A) Treatment characteristics: | |||||||||
Treatment duration (weeks) | 15 | 1.0 | 96.0 | 17.5 | 32.1 | −0.012 | 6.60** | 144.46(13)*** | 0.430 |
Treatment intensity (hours/week) | 12 | 0.2 | 2.4 | 0.9 | 0.6 | −0.059 | 0.03 | 142.28(10)*** | 0.0 |
Treatment magnitude (total hours) | 12 | 0.2 | 19.0 | 5.0 | 5.0 | −0.001 | 0.00 | 128.72(10)*** | 0.026 |
(B) Subject characteristics: | |||||||||
Mean age (years) | 14 | 8.0 | 12.0 | 1.2 | 1.2 | 0.130 | 0.48 | 345.18(12)*** | 0.0 |
Gender (% male) | 14 | 45.8 | 58.2 | 3.7 | 3.7 | 0.029 | 0.20 | 384.63(12)*** | 0.0 |
(C) Methodological characteristics: | |||||||||
Differential attrition | 16 | 0.0 | 0.033 | 0.004 | 0.009 | −24.205 | 1.14 | 355.39(14)*** | 0.0 |
Quality score | 16 | 3.4 | 7.5 | 6.0 | 1.1 | 0.282 | 2.71 | 267.05(14)*** | 0.177 |
(D) Extrinsic characteristic: | |||||||||
Publication year | 16 | 1984 | 2011 | 2003 | 8.4 | −0.014 | 0.28 | 370.92(14)*** | 0.0 |
Research team |
k
|
d
+
| 95% C. I. | ANOVA results | |
---|---|---|---|---|---|
d
l
|
d
u
| ||||
Cardon, Geldhof et al. (Belgium) | 6 | 0.901 | 0.541 | 1.261 |
Q
B(5) = 26.49, p < .001 |
Gómez, Méndez et al. (Spain) | 4 | 2.043 | 1.600 | 2.485 |
R
2 = 0.718 |
Spence et al. (USA) | 2 | 1.450 | 0.681 | 2.219 |
Q
W(10) = 71.28, p < .001 |
Vidal et al. (Spain) | 1 | 0.469 | −0.388 | 1.327 | |
Park & Kim (South Korea) | 2 | 1.739 | 0.985 | 2.492 | |
Kovacs et al. (Spain) | 1 | 0.289 | −0.516 | 1.094 |