Physical therapy treatments for low back pain in children and adolescents: a meta-analysis

Abstract

BackgroundLow back pain (LBP) in adolescents is associated with LBP in later years. In recent years treatments have been administered to adolescents for LBP, but it is not known which physical therapy treatment is the most efficacious. By means of a meta-analysis, the current study investigated the effectiveness of the physical therapy treatments for LBP in children and adolescents.MethodsStudies in English, Spanish, French, Italian and Portuguese, and carried out by March 2011, were selected by electronic and manual search. Two independent researchers coded the moderator variables of the studies, and performed the effect size calculations. The mean effect size index used was the standardized mean change between the pretest and posttest, and it was applied separately for each combination of outcome measures, (pain, disability, flexibility, endurance and mental health) and measurement type (self-reports, and clinician assessments).ResultsEight articles that met the selection criteria enabled us to define 11 treatment groups and 5 control groups using the group as the unit of analysis. The 16 groups involved a total sample of 334 subjects at the posttest (221 in the treatment groups and 113 in the control groups). For all outcome measures, the average effect size of the treatment groups was statistically and clinically significant, whereas the control groups had negative average effect sizes that were not statistically significant.ConclusionsOf all the physical therapy treatments for LBP in children and adolescents, the combination of therapeutic physical conditioning and manual therapy is the most effective. The low number of studies and control groups, and the methodological limitations in this meta-analysis prevent us from drawing definitive conclusions in relation to the efficacy of physical therapy treatments in LBP.

Pain and Moderate to Vigorous Physical Activity in Adolescence: An International Population-Based Survey

“…Presumably primary prevention strategies can be initiated during childhood and adolescence. However, there is a lack of effective management strategies for pain in children and adolescents [33][34][35], with few randomized studies and numerous methodological limitations [33]. Given our findings, it is reasonable to speculate that pain might affect children's physical activity, this means identifying effective pain management strategies in adolescents is of even greater importance.…”

Understanding Adolescent Low Back Pain From a Multidimensional Perspective: Implications for Management

“…Metaanalysis showed a positive effect for these inter ventions over control interventions, al though the low number of studies and methodological limitations prevent de finitive conclusions from being made. 10 Based on contemporary evidence, we contend that once red flags and specific lumbar pathology are excluded, adoles cents with LBP require a flexible and targeted multidimensional approach to assessment and management (FIGURE 2). 44 A strong therapeutic relationship is con sidered central to this process, 40 and ado lescents' primary caregivers should also be included in the management.…”

The Effectiveness of a Home Exercise Program for a Young Athlete with Schmorl's Nodes: A Case Report

“…A meta-analysis by Calvo-Muñoz, Gómez-Conesa, and Sánchez-Meca investigated whether physical therapy treatment is effective for LBP in children and adolescents. This meta-analysis included eight studies, consisting of 334 subjects, ages 11 to 18, that used several outcome measures (pain, disability, flexibility, endurance, and mental health) to determine the effectiveness of different physical therapy interventions in the treatment of LBP in adolescents [27]. Interventions included exercise (2 studies), manual therapy (1 study), combined treatment of back education and therapeutic physical conditioning (1 study) and exercise combined with other treatments such as manual therapy, modalities, and education (7 studies) [27].…”

“…This meta-analysis included eight studies, consisting of 334 subjects, ages 11 to 18, that used several outcome measures (pain, disability, flexibility, endurance, and mental health) to determine the effectiveness of different physical therapy interventions in the treatment of LBP in adolescents [27]. Interventions included exercise (2 studies), manual therapy (1 study), combined treatment of back education and therapeutic physical conditioning (1 study) and exercise combined with other treatments such as manual therapy, modalities, and education (7 studies) [27]. The results of this meta-analysis concluded that physical therapy is beneficial for the treatment of LBP in adolescents, and that the combination of physical exercise and manual therapy is most effective (predicted, estimated effect of 10.55) [27].…”

“…Interventions included exercise (2 studies), manual therapy (1 study), combined treatment of back education and therapeutic physical conditioning (1 study) and exercise combined with other treatments such as manual therapy, modalities, and education (7 studies) [27]. The results of this meta-analysis concluded that physical therapy is beneficial for the treatment of LBP in adolescents, and that the combination of physical exercise and manual therapy is most effective (predicted, estimated effect of 10.55) [27]. Given the findings of this meta-analysis, the treatment conducted in this case study may have been effective given that the HEP included physical conditioning exercises.…”