title: Daily exercises and education for preventing low back pain in children: cluster randomized controlled trial.
abstract: BACKGROUND
  Children report low back pain (LBP) as young as 8 years. Preventing LBP in children may prevent or delay adult incidence.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether education and daily exercise affect LBP episodes in children compared with education alone.
  
  
  METHODS
  This was a prospective, multicenter cluster randomized controlled trial.
  
  
  METHODS
  The study was conducted at 7 New Zealand primary schools.
  
  
  METHODS
  Children (n=708), aged 8 to 11 years, from 7 schools stratified by sample size (36, 114, 151, 168, 113, 45, 83) were randomized and allocated to 2 masked groups: intervention (4 schools, n=469) or control (3 schools, n=239).
  
  
  METHODS
  Participants in the intervention group were taught 4 spinal movements for daily practice. Both groups participated in education that emphasized "back awareness."
  
  
  METHODS
  Low back pain history at baseline was assessed. Children reported episodes of LBP during the previous week on trial days 7, 21, 49, 105, 161, and 270. Analysis was at the individual participant level, with adjustment for school clusters.
  
  
  RESULTS
  There were no significant differences between groups in the odds of reporting no LBP in the previous week during the study period (odds ratio [OR]=0.72; 95% confidence interval [95% CI]=0.46, 1.14; P=.16). The intervention group reported significantly fewer episodes of LBP (OR=0.54; 95% CI=0.39, 0.74; P<.001) and significantly fewer lifetime first episodes of LBP (n=86 [34%]) compared with the control group (n=58 [47%]) (OR=0.60; 95% CI=0.39, 0.91; P=.02). The odds of an episode of LBP were greater in participants with a history of LBP (OR=4.21; 95% CI=3.07, 5.78; P<.001). Low back pain episodes decreased across the trial period for both groups (OR=0.89; 95% CI=0.84, 0.95; P<.001). Adherence to exercise was poor.
  
  
  CONCLUSIONS
  Replication in other settings is needed.
  
  
  CONCLUSIONS
  Regular exercise and education appear to reduce LBP episodes in children aged 8 to 11 years compared with education alone.
authors.affiliation: J.J. Hill, MScManipTher, Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, PO Box 527, Frankston, Victoria, 3199 Australia. jjhil2@student.monash.edu.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Hill
authors.affiliation: J.L. Keating, PhD, Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Keating
mesh_terms: D002648:Child; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000517:prevention & control*; D008297:Male; D010353:Patient Education as Topic; D011446:Prospective Studies; D016896:Treatment Outcome