OBJECTIVE: To compare the different physiotherapy treatments and determine the most effective treatment to reduce the nonspecific low back pain (NSLBP) intensity in children and adolescents.
DATA SOURCES: Eight databases (Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, PsycINFO, and SCOPUS), and 2 health-specialized journals (BMJ and Spine) were searched from inception to May 2023, with no language restriction.
STUDY SELECTION: Individuals aged 6-18 years with NSLBP were selected, and physical therapy treatments were considered. Studies were required to be controlled clinical trials with pretest and posttest evaluations, and to report pain intensity.
DATA EXTRACTION: Data extraction and risk of bias assessment were performed independently by 2 reviewers.
DATA SYNTHESIS: A meta-analysis of 11 controlled trials with 827 participants found that physiotherapy treatments effectively reduced NSLBP intensity on posttest measurement (d+=0.75; 95% confidence interval [CI], 0.30-1.20) and 6-month follow-up (d+=0.35; 95% CI, -0.72 to 1.40). Network meta-analysis showed both therapeutic exercise (d+=1.11; 95% CI, 0.48-1.74) and a combination of therapeutic exercise and manual therapy (d+=1.45; 95% CI, 0.40-2.49) were effective compared to no treatment. There were no significant differences between therapeutic exercise and the combination of therapeutic exercise and manual therapy.
CONCLUSIONS: Physical exercise has proven to be the most effective treatment for addressing the intensity of NSLBP in children and adolescents. While combining it with manual therapy may yield even better results, it is crucial to emphasize that physical exercise should serve as the cornerstone in the physiotherapeutic approach to managing NSLBP intensity in this age group.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Rehab Clinician (OT/PT) | |
Physician rater
Low back pain is far less common in children and adolescents than in adults. Often enough, the concept of altered morphological conditions (disc prolapse) still prevails here, which, including the corresponding therapy, has been refuted in most cases. In this respect, it seems important that it has now also been proven in children and adolescents that physical training can help against non-specific low back pain. However, the studies included in the systematic review were quite small, with a total of just over 800 patients.
Rehab Clinician (OT/PT) rater
The title only mentions therapeutic exercise being effective; however, the systematic review was for all physiotherapy interventions. The authors state, "The only study with statistically significant results at follow-up performed education, therapeutic exercise, and manual therapy." Although the conclusions state "combining it (exercise) with manual therapy may yield even better results," yet the authors state: "it is crucial to emphasize that physical exercise should serve as the cornerstone in the physiotherapeutic approach to managing NSLBP intensity in this age group." It is difficult to understand how this conclusion is justified by the study unless it was a preconceived opinion of the authors.
, McMaster University