Objectives: To identify factors associated with low back pain (LBP) in children and adolescents.
Methods: A systematic review was conducted (Prospero CRD42016038186). Observational studies analyzing LBP risk factors among subjects aged between 9 and 16 were searched for in 13 electronic databases and 8 specialized journals until March 31st, 2016, with no language restrictions. Additionally, references in the identified studies were manually tracked. All identified studies which included >=50 subjects aged 9 to 16, were reviewed. Their methodological quality was assessed by two reviewers separately, using validated tools which scored, from worst to best, 0-100 for cross-sectional and 0-12 for cohort studies. A sensitivity analysis only included studies which had adjusted for confounders, >=500 subjects and a methodological score of >=50%.
Results: 5142 citations were screened and 61 studies, including 137,877 subjects from 5 continents, were reviewed. Their mean (range) methodological scores were 74.56 (50-100) for cross-sectional studies, and 7.36 (5-9) for cohort ones. Studies had assessed 35 demographic, clinical, biological, family, psychological, ergonomic and lifestyle risk factors. Mean (range) prevalence of LBP ranged between 15.25% (3.20,57.00) for point prevalence, and 38.98% (11.60, 85.56) for lifetime prevalence. Results on the association between LBP and risk factors were inconsistent. In the sensitivity analysis, "older age" and "participation in competitive sports" showed a consistent association with LBP.
Discussion: Future studies should focus on muscle characteristics, the relationship between body and backpack weights, duration of carry, characteristics of sport practice, and factors associated with chronic pain.
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