title: Low back pain in children and adolescents: a systematic review and meta-analysis evaluating the effectiveness of conservative interventions.
abstract: OBJECTIVE
  To identify and evaluate the effectiveness of conservative treatment approaches used in children and adolescents to manage and prevent low back pain (LBP).
  
  
  METHODS
  Five electronic databases and the reference lists of systematic reviews were searched for relevant studies. Randomised controlled trials (RCTs) were considered eligible for inclusion if they enrolled a sample of children or adolescents (<18 years old) and evaluated the effectiveness of any conservative intervention to treat or prevent LBP. Two authors independently screened search results, extracted data, assessed risk of bias using the PEDro scale, and rated the quality of evidence using the GRADE criteria.
  
  
  RESULTS
  Four RCTs on intervention and eleven RCTs on prevention of LBP were included. All included studies had a high risk of bias scoring ≤7 on the PEDro scale. For the treatment of LBP, a supervised exercise program compared to no treatment improved the average pain intensity over the past month by 2.9 points (95 % CI 1.6-4.1) measured by a 0-10 scale (2 studies; n = 125). For the prevention of LBP, there was moderate quality evidence to suggest back education and promotion programs are not effective in reducing LBP prevalence in children and adolescents.
  
  
  CONCLUSIONS
  While exercise interventions appear to be promising to treat LBP in children and adolescents, there is a dearth of research data relevant to paediatric populations. Future studies conducted in children and adolescents with LBP should incorporate what has been learnt from adult LBP research and be of rigorous methodological quality.
authors: The George Institute for Global Health and Sydney Medical School, The University of Sydney, Kent Street, Sydney, 2000, Australia, zmichaleff@georgeinstitute.org.au.
authors: Zoe A
authors: ZA
authors: Michaleff
authors: Steven J
authors: SJ
authors: Kamper
authors: Christopher G
authors: CG
authors: Maher
authors: Roni
authors: R
authors: Evans
authors: Carolyn
authors: C
authors: Broderick
authors: Nicholas
authors: N
authors: Henschke
mesh_terms: D000293:Adolescent; D002648:Child; D005081:Exercise Therapy; D006801:Humans; D017116:Low Back Pain / Q000517:prevention & control* / Q000628:therapy*; D057832:Watchful Waiting