Back Pain: Cardon G

Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Müller G, van der Beek AJ, Anonymous00001. · No affiliation provided · Eur Spine J. · Pubmed #16550446 No free full text.

This publication has no abstract.

Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Müller G, van der Beek AJ, Anonymous00032. · Centre for Health and Social Care Research, University of Huddersfield, 30 Queen Street, Huddersfield HD1 2SP, UK. · Best Pract Res Clin Rheumatol. · Pubmed #15949775 No free full text.

Abstract: This chapter summarizes the European Guidelines for Prevention in Low Back Pain, which consider the evidence in respect of the general population, workers and children. There is limited scope for preventing the incidence (first-time onset) of back pain and, overall, there is limited robust evidence for numerous aspects of prevention in back pain. Nevertheless, there is evidence suggesting that prevention of various consequences of back pain is feasible. However, for those interventions where there is acceptable evidence, the effect sizes are rather modest. The most promising approaches seem to involve physical activity/exercise and appropriate (biopsychosocial) education, at least for adults. Owing to its multidimensional nature, no single intervention is likely to be effective at preventing the overall problem of back pain, although there is likely to be benefit from getting all the players onside. However, innovative studies are required to better understand the mechanisms and delivery of prevention in low back pain.

Cardon G, Balagué F. · Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Gent, Belgium. · Eur Spine J. · Pubmed #15662541 No free full text.

Abstract: Given the high prevalence rates of back pain, as early as in childhood, there has been a call for early preventive interventions. To determine which interventions are used to prevent back problems in schoolchildren, as well as what the evidence is for their utility, the literature was searched to locate all investigations that used subjects under the age of 18 and not seeking treatment. Included investigations were specifically designed as an intervention for low back pain (LBP) prevention. Additionally, a literature search was performed for modifiable risk factors for LBP in schoolchildren. The literature-update search was performed within the scope of the "COST Action B13" of the European Commission, approved for the development of European guidelines for the management of LBP. It was concluded that intervention studies in schoolchildren focusing on back-pain prevention are promising but too limited to formulate evidence-based guidelines. On the other hand, since the literature shows that back-pain reports about schoolchildren are mainly associated with psychosocial factors, the scope for LBP prevention in schoolchildren may be limited. However, schoolchildren are receptive to back-care-related knowledge and postural habits, which may play a preventive role for back pain in adulthood. Further studies with a follow-up into adulthood are needed to evaluate the long-term effect of early interventions and the possible detrimental effect of spinal loading at young age.

Geldhof E, Cardon G, De Bourdeaudhuij I, De Clercq D. · Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium. · Eur Spine J. · Pubmed #17013655 links to  free full text

Abstract: Within the scope of primary prevention regarding back functioning in children, research on the stability of intervention effects is indispensable. Along this line, the transition from childhood to adolescence is an important phase to evaluate the potential stability of intervention effects because of the typically mechanical and psychological demands related to adolescence. The main aim of the current study was to investigate the effects of a back education program at 2-year follow-up, in youngsters aged 13-14 years, on back posture knowledge, fear-avoidance beliefs and self-reported pain. An additional purpose was to evaluate which aspects of postural behavior were integrated in youngsters' lifestyles. At 2-year follow-up, the study sample included 94 secondary schoolchildren in the intervention group (mean age 13.3 +/- 0.8 years) and 101 controls (mean age 13.2 +/- 0.7 years). The back posture program that had been implemented for two school years consisted of back education and the stimulation of postural dynamism in the class through support and environmental changes. A questionnaire was completed comparable to the pretest, posttest and follow-up evaluations. The current study demonstrated at 2-year follow-up stability of the improved general (F = 1.590, ns) and specific (F = 0.049, ns) back posture knowledge in children who had received early back posture education. Back posture education did not result in increased fear-avoidance beliefs (F = 1.163, ns) or mounting back and/or neck pain reports (F = 0.001, ns). Based on self-reports for postural behavior, youngsters who had received the back posture program in the elementary school curriculum integrated crucial sitting and lifting principles conform to biomechanical favorable postural behavior. The steady intervention effects 2-year post-intervention demonstrated that intensive back posture education through the elementary school curriculum is effective till adolescence. Future research on the impact of early school-based back posture promotion in relation to the integration of back posture principles according to a biomechanical favorable lifestyle and back pain prevalence later in life is essential.

Cardon G, De Clercq D, De Bourdeaudhuij I, Breithecker D. · Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium. · Patient Educ Couns. · Pubmed #15288906 No free full text.

Abstract: This study evaluated differences in sitting habits in the classroom between the project "Moving school" and a traditional school in 8-year-old children. Twenty-two children, since 1.5 years involved in the project were compared to 25 children in a traditional school. Making use of the Portable Ergonomic Observation (PEO) method, it was observed that children from a traditional school spend an average of 97% of the lesson time sitting statically, from which one-third with the trunk bend over 45 degrees. In the "Moving school" this posture was replaced by dynamic sitting (53%), standing (31%) and walking around (10%), while trunk flexion over 45 degrees was nearly not observed. Children from the "Moving school" also showed significantly less neck and trunk rotation. Additionally, accelerometric data showed significantly more physical activity in lessons of the "Moving school". Rates of self-reported back or neck pain did not differ significantly between both study groups. Results show that sitting habits are more favourable in a "Moving school". Further research is needed to study the impact of implementing "Moving school" concepts in traditional schools on sitting habits.

Cardon G, De Bourdeaudhuij I, De Clercq D. · Ghent University, Dept. of Movement and Sports Sciences, Watersportlaan 2, 9000 Ghent, Belgium. · J Sch Health. · Pubmed #11962225 No free full text.

Abstract: A back education program for Belgian elementary school children was evaluated using self-reported questionnaires before intervention and at three follow-up points during one year. Most children found the program interesting, important, and amusing. Intervention children (n = 347) showed better back care knowledge than control children (n = 359), and knowledge gained was retained over a period of one year. Back education did not result in increased fear-avoidance beliefs about physical activity, and intervention children reported more checking of their book bag weight than controls at all test moments. Self-reported behavior in relation to posture-related and back care related self-efficacy were affected only minimally by the program, possibly due to poor self-judgment. Involvement, fear-avoidance beliefs, and back care knowledge of teachers and parents of the intervention children showed low correlation with the children's perceptions and knowledge. Sufficient promise exists to justify further development and evaluation of early back education.

Cardon G, De Bourdeaudhuij I, De Clercq D. · Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Belgium. · Patient Educ Couns. · Pubmed #11722858 No free full text.

Abstract: This study investigated the efficacy of guidelines for a motivated class teacher to enhance the application of back care principles, taught by a physical therapist, in fifth-grade elementary schoolchildren. Testing consisted of a practical test before and a practical test, knowledge test and candid camera evaluation 11 weeks after the program. Three groups were compared: an intervention group of 38 pupils, with extra guidelines for the teacher, an intervention group of 48 pupils, without extra guidelines and 34 controls. The intervention plus guidelines group, compared to the intervention group without extra teacher guidelines, obtained significantly higher posttest-pretest gain scores for five of the seven practical test items and scored significantly higher for seven of the nine items of the candid camera evaluation. Knowledge test scores did not differ significantly between the two intervention groups. Study results indicate that guidelines to a motivated class teacher improve efficacy of back care education in elementary schoolchildren.

Geldhof E, De Clercq D, De Bourdeaudhuij I, Cardon G. · Department of Movement and Sports Sciences, Ghent University, Belgium. · Ergonomics. · Pubmed #17917898 No free full text.

Abstract: This study examined classroom postures of 8-12 year old school children in Flanders and related the outcomes to self-reported back or neck pain. Postural behaviours using the portable ergonomic observation (PEO) method and self-reported one-week back and neck pain were studied in 105 children from 41 different class groups. Pupils sat statically for 85% of the time, 28% of which the trunk was bent or flexed forward. For 9% of the time, children sat dynamically and for 36% they used a back rest. Children who spent more time sitting with a flexed trunk reported significantly more thoraco-lumbar pain compared to pain-free children and to children with cervical pain (p < 0.05). Children reporting pain stood for a longer period of time than pain-free children (p < 0.05). It is concluded that prolonged static kyphotic sitting without use of a backrest is common in elementary school children in Flanders.

Geldhof E, Cardon G, De Bourdeaudhuij I, De Clercq D. · Department of Movement and Sport Sciences, Ghent University, Gent, Belgium. · Eura Medicophys. · Pubmed #17464273 links to  free full text

Abstract: AIM: The study's first objective was to evaluate class teachers' efforts to promote good body mechanics after a structured back education program was finished and to evaluate whether their support during follow-up resulted in better intervention effects at 1-year follow-up. Secondary, the stability of intervention effects on children's back posture knowledge, fear-avoidance beliefs and back pain reports following a 2-school-year multi-factorial back education program was evaluated at 1-year follow-up. An additional focus was put on what young children learned about good body mechanics in the obligatory school curriculum compared to intensive back posture promotion. METHODS: The quasi-experimental study included at baseline 398 elementary schoolchildren aged 8-11 years. The back education program consisted of 13 h back education and the stimulation of postural dynamism in the class through support and environmental changes lasting 2 school-years. Controls received the obligatory curriculum, not including back education. Evaluation consisted of a questionnaire, which was filled out by 121 intervention children and 124 controls at baseline, post-test and follow-up. Teachers were interviewed at the end of the follow-up school-year. RESULTS: Teachers continued with initiatives to increase postural dynamism in the class when they had been instructed about that matter. However, teachers' efforts to continue the promotion of good body mechanics showed no additional effect on children's knowledge. Improved back posture knowledge demonstrated stability at 1-year follow-up. Whereas the obligatory curriculum provided children with fundamental postural knowledge, the back posture program added important aspects. Fear-avoidance beliefs and self-reported pain were not increased at 1-year follow-up. CONCLUSION: The stable intervention effects point out that intensive implementation of a structured multifactorial back education program in the elementary school curriculum is effective.

Geldhof E, Cardon G, De Bourdeaudhuij I, De Clercq D. · Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium. · Spine (Phila Pa 1976). · Pubmed #16924215 No free full text.

Abstract: STUDY DESIGN: A quasi-experimental pre/post design. OBJECTIVE: To investigate effects of a 2-school-year multifactorial back education program on back posture knowledge and postural behavior in elementary schoolchildren. Additionally, self-reported back or neck pain and fear-avoidance beliefs were evaluated. SUMMARY OF BACKGROUND DATA: Epidemiologic studies report mounting nonspecific back pain prevalence among youngsters, characterized by multifactorial risk factors. Study findings of school-based interventions are promising. Furthermore, biomechanical discomfort is found in the school environment. METHODS: The study sample included 193 intervention children and 172 controls (baseline, 9-to-11-year-olds). The multifactorial intervention consisted of a back education program and the stimulation of postural dynamism in the class through support and environmental changes. Evaluation consisted of a questionnaire, an observation of postural behavior in the classroom, and an observation of material handling during a movement session. RESULTS: The intervention resulted in increased back posture knowledge (P < 0.001), improved postural behavior during material handling (P < 0.001), and decreased duration of trunk flexion (P < 0.05) and neck torsion (P < 0.05) during lesson time. The intervention did not change fear-avoidance beliefs. There was a trend for decreased pain reports in boys of the intervention group (P < 0.09). CONCLUSIONS: The intervention resulted in improved postural aspects related to spinal loading. The long-term effect of improved postural behavior at young age on back pain prevalence later in life is of interest for future research.

Geldhof E, Cardon G, De Bourdeaudhuij I, Danneels L, Coorevits P, Vanderstraeten G, De Clercq D. · Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium. · Eur J Pediatr. · Pubmed #16738867 No free full text.

Abstract: INTRODUCTION: Based on the literature, reliability reports and normative data for bilateral stance assessments in elementary schoolchildren are limited. The present study was designed to report test-retest reliability and reference values for postural stability in 9 to 10 years old schoolchildren using the Balance Master system. MATERIALS AND METHODS: Twenty children participated in the reproducibility study (mean age 10.1+/-0.7) including test and retest measurement with a one-week interval. The modified clinical test of sensory interaction on balance (mCTSIB) quantified children's static standing balance. The test for the limits of stability (LOS) measured dynamic standing balance. The study sample to determine reference values consisted of 99 children (mean age 9.8+/0.5). RESULTS: The ICCs for inter-item reliability of the four sensory conditions of the mCTSIB showed fair to excellent reliability (ICCs between 0.62 and 0.80). The reproducibility between test and retest was non-significant for the condition 'firm surface with eyes closed' (ICC of 0.37), fair to good for the three other sensory conditions (ICCs between 0.59 and 0.68), and excellent for the composite sway velocity (ICC of 0.77). For all LOS parameters, the significant ICCs showed fair to good reproducibility (ICCs between 0.44 and 0.62), with the exception of the non-significant ICC for the composite reaction time. The ICCs for the separate LOS parameters showed fair to good and excellent reliability for nine parameters (ICCs between 0.46 and 0.81), while 11 separate LOS scores did not demonstrate significant ICCs. DISCUSSION: Analysing reference values, girls performed better on all the composite balance parameters compared to boys, with the exception of reaction time and movement velocity. No differences were found on standing balance scores between 9 and 10 year olds. CONCLUSION: In conclusion, the Balance Master showed fair to good reliability for most postural parameters in 9 to 10 year olds. The current data on postural control in children aged 9 to 10 years are relevant for research in other domains within the clinical field, like obesitas and developmental coordination disorder or in relation to back pain prevalence at early age.

Cardon G, De Bourdeaudhuij I, De Clercq D. · Department of Movement and Sports Sciences, Ghent University, Belgium. · Acta Paediatr. · Pubmed #11236042 No free full text.

Abstract: The efficacy of back education in elementary school children was shown using a practical test. Similar results in a candid camera evaluation were questioned. The purposes of this study were (i) to explore the relationship between the results of a practical test and the results of a candid camera procedure when evaluating back education principles, and (ii) to investigate whether in a candid camera procedure scores are still better in pupils who followed a back education programme than in controls. A candid camera evaluation followed by a practical test was performed in 71 pupils who had participated in a back education programme and 60 controls. Correlations between the two evaluation methods were significant but weak for 5 of the 9 test items in the intervention group (Rs 0.26-0.46) and for 7 test items in the control group (Rs 0.38-0.58). The difference in sum scores between the evaluation methods was significantly higher in the intervention group than in the control group (p < 0.001). The intervention group scored higher than the control group for 8 practical test items and 7 candid evaluation items. Conclusion: The study results question the use of a practical test for the individual evaluation of back education principles but show the usefulness of a practical test to study programme efficacy. As some principles seem to have become a habit, while for the implementation of others the pupils need external stimuli, the effects of more specific guidelines for parents and teachers to generalize back education principles require further study.

Cardon G, De Clercq D, De Bourdeaudhuij I. · Department of Movement and Sports Sciences, Ghent University, Belgium. · Acta Paediatr. · Pubmed #10976848 No free full text.

Abstract: The purpose of this study was to investigate the effects of a back care education programme, consisting of six sessions of 1 h each, in fourth- and fifth-grade elementary schoolchildren. Testing consisted of a practical performance and a back care knowledge test. Forty-two subjects and 36 controls performed a pre-test and were tested within 1 wk after the programme. To monitor effects and follow-up effects on a larger sample, 82 different pupils were tested within 1 wk after the programme and 116 other children 3 mo after. Both larger samples were compared with one group of 129 controls. Interrater reliability for the test items of the practical assessment was high; intraclass correlation coefficients varied from 0.785 to 0.980. In the pre/post design study, interaction between time and condition was significant for the sum score of the practical assessment and for the knowledge test (p < 0.001), with higher scores for the intervention group (15% improvement for the knowledge test score, 31.6% for the practical sum score). Significantly higher sum scores for the knowledge test and for all practical assessment items were found in the intervention groups, tested within 1 wk and 3 mo after the programme, in comparison with the control group (p < 0.001). CONCLUSION: The effectiveness of a primary educational prevention programme on back care principles was demonstrated in this study. Effectiveness, long-term outcomes and behavioural changes need further evaluation to optimize back care prevention programmes for elementary schoolchildren.