IEA Maastricht - 12 July 2006 The effects f a tw-schl schl-year multi-factrial back educatin prgram in elementary schlchildren Drs Elisabeth Geldhf Prf Dr D De Clercq Prf Dr I De Burdeaudhuij Prf Dr G Cardn
INTRODUCTION prevalence Epidemilgical studies reprt munting back pain prevalence amng yungsters (Jnes et al. 2003) Back pain ccurrence is recurrent in a subgrup f children (Siivla et al. 2004) Back pain at yung age may persist int adulthd (Harreby et al. 1999, Brattberg 2003) Research int the early stages f the prblem
INTRODUCTION risk factrs The risk fr develping back pain at a yung age multi-factrial (Balagué et al. 1999; Jnes et al. 2005) causative mechanisms undetermined Determinatin f risk factrs fr back pain in children cmplex / asks fr discussin Crss-sectinal: cnflicting results (Cardn and Balagué 2004) Epidemilgical evidence Bimechanical argumentatin related t the cncepts f spinal lading (Mc Gill 2002) relatin between lading and back pain = U-shaped
INTRODUCTION schl envirnment Risk Factrs in the schl envirnment research is limited expses children t the pssible lading factrs prlnged sitting (Murphy et al. 2004) pr pstures (Murphy et al. 2004) absence f apprpriate furniture (Panagitpulu et al. 2004) back packs (Spalszki et al. 2002) Pstural discmfrt in schls Elementary schl is an ideal setting fr preventin ptimizing envirnmental cnditins prlnged feedback large percentage f the ppulatin elementary schlchildren are receptive
INTRODUCTION preventin Effects f schl-based interventins (Cardn and Balagué 2004) nly 5 schl-based interventins better use f back psture principles (Cardn et al. 2002) increased knwledge (Cardn et al. 2002, Mendez et al. 2001) imprved general pstural habits (Mendez et al. 2001) interventins are prmising but t limited (COST B13 2004; Cardn and Balagué 2004) Shrtcmings f existing interventin studies little study sample shrt implementatin time+ shrt term effect interventin by an expert
INTRODUCTION study aim Present interventin study = ptimized the multi-factrial interventin started with back psture educatin sessins by an expert the class-teacher cntinued the prmtin f gd bimechanics the interventin persisted tw schl-years the effects were investigated ver a lng term (2 schlyears) in a quasi-experimental design The purpse f the current interventin study t evaluate the effects f the ptimized multi-factrial back educatin prgram n knwledge and pstural behavir in elementary schlchildren in Flanders
METHODOLOGY subjects 20 class grups f 8 schls INTERVENTION CONTROL 1O 1O classes classes At pre-test : 33 drp uts (9%) At pst-test : 213 children 185 children 193 children 172 children
METHODOLOGY interventin The multi-factrial interventin Back psture principles BACK EDUCATION Skills Reminders Ergnmic material (4 elements) ENVIRONMENT Mvement breaks (daily / 2 times a day) Mvement stimulating envirnment (activating apprach)
METHODOLOGY prcedure Schl year 2002-2003 September-Octber 4th an 5th graders Nvember-June PRE-TESTING Schl year 2003-2004 September-March INTERVENTION 5th an 6th graders April-June INTERVENTION POST-TESTING
METHODOLOGY prcedure Evaluatin (pre-pst design) 1. questinnaire interventin grup n=156, cntrl grup n=161 2. bservatins f pstural behavir classrm (3 randmly selected children/class) interventin grup n=26, cntrl grup n=35 material handling interventin grup n=153, cntrls n=124
Pstures Trunk flexin Trunk trsin Neck flexin Neck trsin Arm supprt Use f backrest Activities Static sitting Dynamical sitting Standing Walking arund Reading/writing METHODOLOGY 1. Questinnaire 2. Observatin Specific and general knwledge 10 questins + multiple chice quiz f 11 questins utput = scre (max sp knwl=10 + gen knwl=11) Prevalence f back pain instruments back r neck pain during the last week (intensity, frequency) utput = pain r n pain Pstural behavir in the classrm (PEO) registratin f bdy pstures and activities 30 minutes during a regular lessns (mathematics, language) utput = percentages bserved time interval ( categries) Material handling encding lifting tasks qualitatively 3 tasks: bench, light bject, heavy bject utput = perfrmance scres n bimechanical items
METHODOLOGY data analysis SPSS 11.0 Inter-rater agreement (PEO + material handling) Intra-class crrelatin cefficients Effects f the interventin pre-pst design Repeated Measures ANOVA Time = within-subjects factr pre versus pst Cnditin = between-subjects factr interventin versus cntrl grup Gender = between-subjects factr bys versus girls
RESULTS inter-rater agreement Inter-rater agreement (2 bservers) 1. PEO bservatin Fr 7 categries: ICC s between 0.83 and 0.94 Fr 4 categries: lwer ICC s (between 0.61 and 0.78) 2. Observatin f material handling Fr all categries: ICC s between 0.81 and 1.00
RESULTS (1) knwledge A psitive interactin effect fr specific and general back psture related knwledge a significantly higher increase in the interventin grup SPECIFIC BACK POSTURE KNOWLEDGE GENERAL BACK POSTURE KNOWLEDGE Scre max. 10 10 9 8 7 6 5 4 3 2 1 0 4.9 5 7.5 6.3 Scre max. 11 11 10 9 8 7 6 5 4 3 2 1 0 1 0.7 5.1 2.7 F=11.554 P<.001 pre pst Interventin Grup Cntrls F=18.984 P<.001 pre pst Interventin Grup Cntrls The effects n knwledge = bys and girls
RESULTS (2) bservatin in the classrm 1. Activities during lessn time N psitive interactin effects fr pstural activities STATIC SITTING DYNAMIC SITTING Duratin (%) 100 90 80 70 60 50 40 30 20 10 0 F=.559 P>.05 READING AND WRITING 66,3 67,8 66,4 60,7 pre pst Interventin Grup Cntrls Duratin (%) Duratin (% ) 100 90 80 70 60 50 40 30 20 10 0 F=1.383 P>.05 100 90 80 70 60 50 40 30 20 10 0 F=.410 P>.05 86,8 84,3 76,5 77,9 pre pst Interventin Grup Cntrls 2,4 3,1 1,2 1,3 pre pst Interventin Grup Cntrls STANDING Duratin (%) Duratin (%) 100 90 80 70 60 50 40 30 20 10 0 F=.641 P>.05 100 90 80 70 60 50 40 30 20 10 0 F=2.590 P>.05 8,8 8,7 17,5 15,6 pre pst Interventin Grup Cntrls WALKING AROUND 0,9 1,5 1,3 1,1 pre pst Interventin Grup The effects n classrm activities = bys and girls Cntrls
RESULTS 2. Pstures (2) bservatin in the classrm Psitive interactin effect fr trunk flexin and neck trsin a decrease in duratin in the interventin grup Tendency twards significance trunk trsin decreased mre in interventin grup TRUNK FLEXION NECK TORSION TRUNK TORSION Duratin ( % ) 100 90 80 70 60 50 40 30 20 10 0 36 16,5 18,1 25,5 Duratin ( % ) 100 90 80 70 60 50 40 30 20 10 0 15,9 9,8 13,9 14,5 Duratin ( % ) 100 90 80 70 60 50 40 30 20 10 0 4,2 2,3 1,1 1,3 pre pst Interventin Grup Cntrls F=8.931 P<.05 pre pst Interventin Grup Cntrls F=4.207 P<.05 pre pst Interventin Grup Cntrls F=3.452 P<.07 The effects n classrm pstures = bys and girls
RESULTS (3) bservatin f material handling Psitive interactin effects n all evaluated pstural items interventin scred better n knee bending while lifting a bench (F=40.797, P<.001) knee bending while lifting a heavy bject (F=14.264, P<.001) knee bending while putting dwn bench (F=55.299, P<.001) n twisting lifting a bench (F=6.065, P<.05) n twisting putting dwn a bench (F=21.855, P<.001) bdy psture while mving a bench (F=9.115, P<.05) excepted fr back psitin while lifting a bench (F=.027, P>.05) picking up a light bject (F=.167, P>.05) n twisting while mving a heavy bject (F=2.770, P>.05) Psitive interactin effect ttal scre n material handling higher imprvement interventin grup Effects n perfrming lifting tasks = bys and girls Scre max. 36 36 24 12 0 TOTAL SCORE n POSTURAL BEHAVIOR during LIFTING 17,4 16,5 25,4 18,5 pre pst Interventin Grup Cntrls F= 72.130 P<.001
RESULTS (4) prevalence Tendency twards significance fr back pain reprting lwer in bys f the interventin grup n significant interactin effect in girls BACK AND NECK PAIN PREVALENCE in BOYS BACK AND NECK PAIN PREVALENCE in GIRLS 100 100 PERCENTAGE 80 60 40 20 0 32 22 27 34 PERCENTAGE 80 60 40 20 0 29 39 34 33 pre pst F=2.933 pre pst F=0.853 Interventin Grup Cntrls P<.09 Interventin Grup Cntrls P>.05 Trend self-reprted back and neck pain bys and girls
RESULTS (4) prevalence The self-reprted pain within the last week was a mild pain ccurring nt frequently (nly nce r several times)
DISCUSSION interventin The present multi-factrial back psture prgram ver a lng term (2 schl-years) prmtin f gd bdy mechanics cntinued after back psture educatin (6 sessins by expert) envirnment class teacher ergnmic material mvement breaks activating apprach (didactical guidelines) reminders prmting gd bdy mechanics
DISCUSSION knwledge The interventin resulted in increased general and specific back psture knwledge
DISCUSSION material handling Pstural behavir during material handling imprved cnfrm t the learned skills The remarkable evlutin f the ttal scre n handling material in an unfrced playing situatin shwed that the learned pstural skills became generalized (cfr Mendez 2001)
DISCUSSION classrm pstures Sitting pstures f children wh participated in the interventin imprved fr trunk flexin and neck trsin There was a trend fr a decrease f trunk trsin in the interventin grup
DISCUSSION pstural activities in the class N increase in pstural activities in the class Absence f effect: Restrictins in classrm space Teachers difficulties t change traditinal didactic Insufficient knwledge and experience cfr activating The inclusin f applied bimechanics in the prfessinal training f future teachers with fcus n the class envirnment and the rle f the class teacher might play a part in the imprvement f pstural activity in the class
DISCUSSION prevalence After 2-year prmtin fr gd bdy mechanics bys reprted decreased back r neck pain cmpared t the cntrl grup In girls the pain reprts did nt differ between the interventin and the cntrl grup after tw years One culd questin self reprted back r neck pain as the right utcme f a back psture educatin prgram in elementary schls Back pain prevalence culd be apprached as a lng term interventin effect while the evaluatin f a back educatin prgram shuld fcus n the direct effects n knwledge and mdificatins in risk factrs
DISCUSSION cnclusin The current study findings demnstrated that several pstural aspects related t daily bimechanical lad imprved Back psture educatin thrugh the schl curriculum seems t be an effective strategy t prmte gd bimechanics in a yung ppulatin The lng term effect f imprved pstural behavir at yung age n back pain prevalence later in life is f interest fr future research
THANK YOU! THIS STUDY WAS PART OF A BROADER RESEARCH PROJECT ENTITLED SPORT, PHYSICAL ACTIVITY AND HEALTH, CARRIED OUT BY THE RESEARCH CENTRE, AND FUNDED BY THE FLEMISH GOVERNEMENT.