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      Prevalence of low back pain in children and adolescents: a meta-analysis

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          Abstract

          Background

          Low back pain (LBP) is common in children and adolescents, and it is becoming a public health concern. In recent years there has been a considerable increase in research studies that examine the prevalence of LBP in this population, but studies exhibit great variability in the prevalence rates reported. The purpose of this research was to examine, by means of a meta-analytic investigation, the prevalence rates of LBP in children and adolescents.

          Methods

          Studies were located from computerized databases (ISI Web of Knowledge, MedLine, PEDro, IME, LILACS, and CINAHL) and other sources. The search period extended to April 2011. To be included in the meta-analysis, studies had to report a prevalence rate (whether point, period or lifetime prevalence) of LBP in children and/or adolescents (≤ 18 years old). Two independent researchers coded the moderator variables of the studies, and extracted the prevalence rates. Separate meta-analyses were carried out for the different types of prevalence in order to avoid dependence problems. In each meta-analysis, a random-effects model was assumed to carry out the statistical analyses.

          Results

          A total of 59 articles fulfilled the selection criteria. The mean point prevalence obtained from 10 studies was 0.120 (95% CI: 0.09 and 0.159). The mean period prevalence at 12 months obtained from 13 studies was 0.336 (95% CI: 0.269 and 0.410), whereas the mean period prevalence at one week obtained from six studies was 0.177 (95% CI: 0.124 and 0.247). The mean lifetime prevalence obtained from 30 studies was 0.399 (95% CI: 0.342 and 0.459). Lifetime prevalence exhibited a positive, statistically significant relationship with the mean age of the participants in the samples and with the publication year of the studies.

          Conclusions

          The most recent studies showed higher prevalence rates than the oldest ones, and studies with a better methodology exhibited higher lifetime prevalence rates than studies that were methodologically poor. Future studies should report more information regarding the definition of LBP and there is a need to improve the methodological quality of studies.

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          Most cited references73

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          The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins.

          Prospective study with 8-year follow-up. To describe the evolution of low back pain from adolescence into adulthood. High prevalence rates of low back pain among children and adolescents have been demonstrated in several studies, and it has been theorized that low back pain in childhood may have important consequences for future low back pain. It is important to understand the nature of such a link if effective preventive programs are to be established. Almost 10,000 Danish twins born between 1972 and 1982 were surveyed by means of postal questionnaires in 1994 and again in 2002. The questionnaires dealt with various aspects of general health, including the prevalence of low back pain, classified according to number of days affected (0, 1-7, 8-30, >30). Low back pain in adolescence was found to be a significant risk factor for low back pain in adulthood with odds ratios as high as four. We also demonstrated a dose-response association: the more days with low back pain at baseline, the higher the risk of future low back pain. Twenty-six percent of those with low back pain for more than 30 days during the baseline year also had more than 30 days with low back pain during the follow-up year. This was true for only 9% of the rest of the sample. Our study clearly demonstrates correlations between low back pain in childhood/adolescence and low back pain in adulthood. This should lead to a change in focus from the adult to the young population in relation to research, prevention, and treatment.
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            Epidemiology of adolescent spinal pain: a systematic overview of the research literature.

            Systematic literature review. To explore the available research literature, and provide an up-to-date synthesis of the epidemiology of idiopathic adolescent spinal pain (IASP). IASP and its potential causes have been a concern to researchers for over 2 decades. Because it has been suggested that IASP is related to the incidence of adult spinal pain, it appears important to synthesize what is currently known about IASP. A systematic meta-synthesis approach was used to identify secondary review articles and primary epidemiological studies regarding any type of IASP (neck, upper back, or low back). A total of 56 primary epidemiological (cross-sectional or longitudinal) studies were identified. Spinal or back pain was the most commonly reported measure, with the lifetime prevalence figures ranging from 4.7% to 74.4%. The lifetime prevalence of low back pain had a similar range, 7% to 72%. The prevalence of pain in other areas of the spine (i.e., thoracic spine and neck) was variably reported, as were incidence rates for all areas of the adolescent spine. IASP is thus a significant problem, and the prevalence figures approach those of adults. There is some evidence that IASP is a risk factor for spinal pain in adulthood. However, there was considerable variation in how back pain was defined, the areas of the spine that were reported on, the manner in which data were collected and reported, thus preventing any significant comparisons of prevalence or incidence rates across studies. Although there is wide discrepancy in the manner in which adolescent spinal pain is reported, it is evident that lifetime prevalence rates increase steadily with age and approximate adult levels by around the age of 18 years. There is an opportunity for further longitudinal research, with standardized methodology, to be undertaken that builds on the findings from this large group of studies.
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              Low back pain in schoolchildren: occurrence and characteristics.

              Low back pain in adolescents is perceived to be uncommon in the clinic setting. However, previous studies have suggested that it may be an important and increasing problem in this age-group. The aim of this study was to determine the prevalence and important symptom characteristics of low back pain such as duration, periodicity, intensity, disability and health seeking behaviour at young ages. A population-based cross-sectional study was conducted including 1446 children aged 11-14 years in the North-West of England. A self-complete questionnaire was used to assess low back pain prevalence, symptom characteristics, associated disability and health seeking behaviour. An additional self-complete questionnaire amongst parents sought to validate pain reporting. The 1-month period prevalence of low back pain was 24%. It was higher in girls than boys (29 vs. 19%; 2=14.7, P<0.001) and increased with age in both sexes (P<0.001). Of those reporting low back pain, 94% experienced some disability, with the most common reports being of difficulty carrying school bags. Despite this high rate of disability, few sought medical attention. Adolescent low back pain is common although medical attention is rarely sought. Such symptoms in childhood, particularly as they are so common, may have important consequences for chronic low back pain in adulthood.
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                Author and article information

                Contributors
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central
                1471-2431
                2013
                26 January 2013
                : 13
                : 14
                Affiliations
                [1 ]Department Physiotherapy, Faculty of Medicine, Espinardo Campus, University of Murcia, Murcia, 30100, Spain
                [2 ]Department of Physiotherapy, University of Murcia, Murcia, Spain
                [3 ]Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain
                Article
                1471-2431-13-14
                10.1186/1471-2431-13-14
                3571904
                23351394
                383ef91e-c239-4564-bb00-506c1f27e2d7
                Copyright ©2013 Calvo-Muñoz et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 5 September 2012
                : 17 January 2013
                Categories
                Research Article

                Pediatrics
                low back pain,children,adolescents,prevalence,meta-analysis
                Pediatrics
                low back pain, children, adolescents, prevalence, meta-analysis

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