School-based interventions to improve spinal health of children and adolescents: a systematic review

Background: The prevalence of spinal pain is high in children and adolescents attending school. There are no evidence-based guidelines to promote spinal health (spinal pain and spinal well-being) in schools Purpose: This study aimed to 1) determine the usefulness of school-based interventions in promoting spinal health in children and adolescents and 2) synthesize the evidence in a user-friendly infographic. Methods: A search was performed across eight databases from the inception of the databases to August 2019 for full-text English-language articles which assessed the effect of school-based interventions on spinal health. Spinal health outcomes included pain limited to the spinal area including lower back, upper back, neck, and neck-shoulder pain, and impacts of spinal pain (e.g., absenteeism from school). Studies were appraised for methodological quality (PEDro scale and Johanna Briggs Institute checklist). The usefulness of interventions was based on meta-analyses; calculated effect size; the number of spinal health outcomes; and the direction of the (summary) effect of the intervention. Results: Twenty-two studies were included. Four interventions were identified: 1) exercise; 2) education; 3) the combination of exercise and education; and 4) furniture. Conclusion: School-based exercise is most useful to promote spinal health in the short term, followed by a combination of exercise and education, and education-only interventions.