Hill Julia J, Keating Jennifer L
J.J. Hill, MScManipTher, Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, PO Box 527, Frankston, Victoria, 3199 Australia.
J.L. Keating, PhD, Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University.
Phys Ther. 2015 Apr;95(4):507-16. doi: 10.2522/ptj.20140273. Epub 2014 Dec 11.
Children report low back pain (LBP) as young as 8 years. Preventing LBP in children may prevent or delay adult incidence.
The purpose of this study was to determine whether education and daily exercise affect LBP episodes in children compared with education alone.
This was a prospective, multicenter cluster randomized controlled trial.
The study was conducted at 7 New Zealand primary schools.
Children (n=708), aged 8 to 11 years, from 7 schools stratified by sample size (36, 114, 151, 168, 113, 45, 83) were randomized and allocated to 2 masked groups: intervention (4 schools, n=469) or control (3 schools, n=239).
Participants in the intervention group were taught 4 spinal movements for daily practice. Both groups participated in education that emphasized "back awareness."
Low back pain history at baseline was assessed. Children reported episodes of LBP during the previous week on trial days 7, 21, 49, 105, 161, and 270. Analysis was at the individual participant level, with adjustment for school clusters.
There were no significant differences between groups in the odds of reporting no LBP in the previous week during the study period (odds ratio [OR]=0.72; 95% confidence interval [95% CI]=0.46, 1.14; P=.16). The intervention group reported significantly fewer episodes of LBP (OR=0.54; 95% CI=0.39, 0.74; P<.001) and significantly fewer lifetime first episodes of LBP (n=86 [34%]) compared with the control group (n=58 [47%]) (OR=0.60; 95% CI=0.39, 0.91; P=.02). The odds of an episode of LBP were greater in participants with a history of LBP (OR=4.21; 95% CI=3.07, 5.78; P<.001). Low back pain episodes decreased across the trial period for both groups (OR=0.89; 95% CI=0.84, 0.95; P<.001). Adherence to exercise was poor.
Replication in other settings is needed.
Regular exercise and education appear to reduce LBP episodes in children aged 8 to 11 years compared with education alone.
儿童早在8岁时就会报告下背部疼痛（LBP）。预防儿童的LBP可能会预防或延迟成人期发病。
本研究的目的是确定与单纯教育相比，教育和日常锻炼是否会影响儿童的LBP发作。
这是一项前瞻性、多中心整群随机对照试验。
该研究在新西兰的7所小学进行。
来自7所学校的708名8至11岁儿童，按样本量分层（36、114、151、168、113、45、83），被随机分配到2个盲法组：干预组（4所学校，n = 469）或对照组（3所学校，n = 239）。
干预组的参与者学习了4种脊柱运动以便日常练习。两组都参与了强调“背部意识”的教育。
评估基线时的下背部疼痛病史。儿童在试验第7、21、49、105、161和270天报告前一周的LBP发作情况。分析在个体参与者层面进行，并对学校集群进行了调整。
在研究期间，两组在前一周报告无LBP的几率没有显著差异（优势比[OR]=0.72；95%置信区间[95%CI]=0.46，1.14；P = 0.16）。与对照组相比，干预组报告的LBP发作明显更少（OR = 0.54；95%CI = 0.39，0.74；P <.001），并且终生首次LBP发作明显更少（n = 86 [34%]），而对照组为n = 58 [47%]（OR = 0.60；95%CI = 0.39，0.91；P = 0.02）。有LBP病史的参与者发生LBP发作的几率更高（OR = 4.21；95%CI = 3.07，5.78；P <.001）。两组在整个试验期间LBP发作均减少（OR = 0.89；95%CI = 0.84，0.95；P <.001）。运动依从性较差。
需要在其他环境中进行重复研究。
与单纯教育相比，规律运动和教育似乎能减少8至11岁儿童的LBP发作。
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