title: Evaluation of chiropractic management of pediatric patients with low back pain: a prospective cohort study.
abstract: BACKGROUND
  Recent epidemiologic studies have estimated that the lifetime prevalence of low back pain (LBP) in children is approximately 50%, with almost 15% of children experiencing frequent or continual pain. A literature search revealed no published studies addressing conservative treatment of childhood LBP.
  
  
  OBJECTIVE
  To describe chiropractic management of LBP in patients between the ages of 4 and 18 years, as well as outcomes and factors associated with the outcomes.
  
  
  METHODS
  Prospective cohort study of consecutive pediatric patients with LBP seeing randomly selected chiropractors within the cities of Calgary, Alberta, and Toronto, Ontario, Canada. Follow-up data collection included the type and extent of treatment rendered and its outcome, which was measured with a 5-point subjective rating scale and a self-report pediatric visual analogue scale.
  
  
  RESULTS
  Fifteen chiropractors provided data on 54 consecutive pediatric patients with LBP. The average age of the patients was 13.1 years, 57% were male, 61% were acute, with 47% attributing onset to a traumatic event (most commonly sports-related); 24% reported an episode duration of greater than 3 months. Almost 90% of cases presented with uncomplicated mechanical LBP, most frequently diagnosed as lumbar facet dysfunction or subluxation. Patients were managed with manipulation, with a minority (7.7%) receiving some form of active management. "Important" improvement was seen in 62% and 87% on the visual analogue and subjective scales, respectively, within a 6-week course of management (Kaplan-Meier survival analysis). Patients with chronic LBP were less likely to respond within the median number of treatments (relative risk = 2.1).
  
  
  CONCLUSIONS
  Patients responded favorably to chiropractic management, and there were no reported complications. Future investigations should establish the natural history and compare chiropractic management with other forms of treatment to gain knowledge about the effectiveness of chiropractic in managing pediatric LBP.
authors.affiliation: Institute for Work and Health, 481 University Avenue, 8th Floor, Toronto M5G 2E9, Ontario, Canada.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Hayden
authors.forename: Silvano A
authors.initials: SA
authors.lastname: Mior
authors.forename: Marja J
authors.initials: MJ
authors.lastname: Verhoef
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D026882:Manipulation, Chiropractic; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000503:physiopathology