物理治疗干预对儿童和青少年背部护理和预防非特异性下腰痛的有效性：系统评价和荟萃分析。

BACKGROUND: Non-specific low back pain in children and adolescents has increased in recent years. The purpose of this study was to upgrade the evidence of the most effective preventive physiotherapy interventions to improve back care in children and adolescents. METHODS: The study settings were children or adolescents aged 18 years or younger. Data were obtained from the Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, and PsycINFO databases and the specialized journals BMJ and Spine. The included studies were published between May 2012 and May 2020. Controlled trials on children and adolescents who received preventive physiotherapy for back care were considered. Data on all the variables gathered in each individual study were extracted by two authors separately. Two authors assessed risk of bias of included studies using the RoB2 and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines. To calculate the effect size, a standardized mean difference "d" was used and a random-effects model was applied for the following outcome variables: behaviour, knowledge, trunk flexion muscle endurance, trunk extension muscle endurance, hamstring flexibility and posture. RESULTS: Twenty studies were finally included. The most common physiotherapy interventions were exercise, postural hygiene and physical activity. The mean age of the total sample was 11.79 years. When comparing the change from baseline to end of intervention in treatment and control groups, the following overall effect estimates were obtained: behaviour d = 1.19 (95% CI: 0.62 and 1.76), knowledge d = 1.84 (0.58 and 3.09), trunk flexion endurance d = 0.65 (-0.02 and 1.33), trunk extension endurance d = 0.71 (0.38 and 1.03), posture d = 0.65 (0.24 and 1.07) and hamstrings flexibility d = 0.46 (0.36 and 0.56). At follow-up, the measurement of the behaviour variable was between 1 and 12 months, with an effect size of d = 1.00 (0.37 and 1.63), whereas the knowledge variable obtained an effect size of d = 2.08 (-0.85 and 5.02) at 3 months of follow-up. CONCLUSIONS: Recent studies provide strong support for the use of physiotherapy in the improvement of back care and prevention of non-specific low back pain in children and adolescents. Based on GRADE methodology, we found that the evidence was from very low to moderate quality and interventions involving physical exercise, postural hygiene and physical activity should be preferred.

背景：近年来，儿童和青少年的非特异性下腰痛有所增加。本研究旨在升级最有效的预防性物理治疗干预措施的证据，以改善儿童和青少年的背部护理。

方法：研究场所为年龄在 18 岁或以下的儿童或青少年。数据来自 Cochrane 图书馆、MEDLINE、PEDro、Web of Science、LILACS、IBECS 和 PsycINFO 数据库以及专业期刊 BMJ 和 Spine。纳入的研究发表于 2012 年 5 月至 2020 年 5 月。考虑了接受预防性物理治疗以进行背部护理的儿童和青少年的对照试验。由两位作者分别提取每一项研究中收集的所有变量的数据。两位作者使用 RoB2 评估纳入研究的偏倚风险，并使用 GRADE 方法评估证据质量。数据按照 PRISMA 指南进行描述。为了计算效应大小，使用标准化均数差“d”，并对以下结局变量应用随机效应模型：行为、知识、躯干前屈肌耐力、躯干伸展肌耐力、腘绳肌柔韧性和姿势。

结果：最终纳入了 20 项研究。最常见的物理治疗干预措施是运动、姿势卫生和体育活动。总样本的平均年龄为 11.79 岁。当比较治疗组和对照组从基线到干预结束时的变化时，获得了以下总体效应估计值：行为 d = 1.19（95%CI：0.62 和 1.76），知识 d = 1.84（0.58 和 3.09），躯干前屈肌耐力 d = 0.65（-0.02 和 1.33），躯干伸展肌耐力 d = 0.71（0.38 和 1.03），姿势 d = 0.65（0.24 和 1.07）和腘绳肌柔韧性 d = 0.46（0.36 和 0.56）。在随访时，行为变量的测量时间为 1 至 12 个月，效应大小为 d = 1.00（0.37 和 1.63），而知识变量在 3 个月随访时的效应大小为 d = 2.08（-0.85 和 5.02）。

结论：最近的研究为物理治疗在改善儿童和青少年的背部护理和预防非特异性下腰痛方面的应用提供了有力支持。基于 GRADE 方法，我们发现证据质量从极低到中等，涉及体育锻炼、姿势卫生和体育活动的干预措施应优先考虑。