title: Physical therapy treatments for low back pain in children and adolescents: a meta-analysis.
abstract: BACKGROUND
  Low 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.
  
  
  METHODS
  Studies 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).
  
  
  RESULTS
  Eight 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.
  
  
  CONCLUSIONS
  Of 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.
authors: Department of Physiotherapy, Faculty of Medicine, Espinardo Campus, University of Murcia, Murcia 30100, Spain. inmaculada.calvo@um.es
authors: Inmaculada
authors: I
authors: Calvo-Muñoz
authors: Antonia
authors: A
authors: Gómez-Conesa
authors: Julio
authors: J
authors: Sánchez-Meca
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D016896:Treatment Outcome
references: Knee Surg Sports Traumatol Arthrosc. 2011 Jan;19(1):20-9
references: 20549188
references: Spine (Phila Pa 1976). 2001 Dec 1;26(23):2629-36
references: 11725246
references: Eur Spine J. 2011 Jan;20(1):94-9
references: 20582557
references: Ergonomics. 2010 Dec;53(12):1455-60
references: 21108082
references: Arch Pediatr Adolesc Med. 2009 Jan;163(1):65-71
references: 19124706
references: Spine (Phila Pa 1976). 1998 Dec 1;23(23):2625-30
references: 9854762
references: Arthritis Rheum. 2009 Oct 15;61(10):1359-66
references: 19790124
references: Scand J Rehabil Med. 1988;20(4):175-9
references: 2976526
references: Spine (Phila Pa 1976). 2008 Sep 15;33(20):E721-7
references: 18794746
references: Spine J. 2009 Feb;9(2):134-41
references: 18495545
references: Spine (Phila Pa 1976). 1996 Oct 15;21(20):2323-8
references: 8915066
references: Acta Paediatr. 2000 Aug;89(8):1010-7
references: 10976848
references: J Spinal Disord. 1994 Oct;7(5):374-9
references: 7819636
references: Am J Epidemiol. 2001 Jul 1;154(1):30-6
references: 11427402
references: Am J Sports Med. 2010 Apr;38(4):791-6
references: 20051500
references: Health Educ Res. 2004 Jun;19(3):284-9
references: 15140848
references: Spine J. 2003 Jul-Aug;3(4):270-6
references: 14589185
references: BMJ. 1999 Jul 31;319(7205):279-83
references: 10426734
references: Spine (Phila Pa 1976). 2007 Nov 15;32(24):E713-7
references: 18007232
references: Pain. 2003 Jun;103(3):259-268
references: 12791432
references: Aust J Physiother. 2009;55(2):97-104
references: 19463080
references: BMC Musculoskelet Disord. 2006 Mar 16;7:29
references: 16539740
references: J Orthop Sports Phys Ther. 2003 Sep;33(9):513-22
references: 14524510
references: Pain. 2002 May;97(1-2):87-92
references: 12031782
references: Knee Surg Sports Traumatol Arthrosc. 2007 Oct;15(10):1264-71
references: 17594077
references: J Orthop Sports Phys Ther. 1994 Feb;19(2):105-10
references: 8148863
references: Phys Ther. 1984 Jul;64(7):1055-61
references: 6739547
references: Spine (Phila Pa 1976). 1997 May 15;22(10):1132-6
references: 9160472
references: Spine (Phila Pa 1976). 2001 Jun 1;26(11):1280-6
references: 11389399
references: Spine (Phila Pa 1976). 2004 Jul 1;29(13):1483-91; discussion 1492
references: 15223944
references: Value Health. 2004 Jul-Aug;7(4):413-22
references: 15449633
references: BMJ. 2005 May 28;330(7502):1233
references: 15911537
references: Arch Dis Child. 2003 Jan;88(1):12-7
references: 12495949
references: Eur Spine J. 2007 Jan;16(1):125-33
references: 16636816
references: Spine (Phila Pa 1976). 2003 Mar 15;28(6):525-31; discussion 531-2
references: 12642755
references: Spine (Phila Pa 1976). 2003 Jun 15;28(12):1290-9
references: 12811274
references: J Clin Rheumatol. 2010 Mar;16(2):55-60
references: 20130481
references: Spine (Phila Pa 1976). 2005 Oct 1;30(19):2153-63
references: 16205340
references: Acta Paediatr. 1992 Dec;81(12):1035-9
references: 1290849
references: Spine (Phila Pa 1976). 2004 Jul 15;29(14):1567-72
references: 15247580
references: Pediatr Exerc Sci. 2007 Aug;19(3):349-59
references: 18019593