Developing a guideline framework for school-based interventions to improve spinal health of children and adolescents in South Africa

Maart, Rentia (2018-03)

Thesis (MScPhysio)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : Background: Spinal pain prevalence in children and adolescents is high, increases with age and may lead to spinal pain in adulthood. Potential predisposing factors for spinal pain in children and adolescents are the usage of schoolbags; posture; sitting duration; psychosocial factors; age; gender and school furniture. Purpose: 1) To determine the effectiveness of school-based interventions in promoting spinal health in children and adolescents; 2) to present a schematic presentation of the effective interventions as part of development of an evidence-based framework. Methods: This study had two phases: 1) conducting a systematic review on the effectiveness of school-based interventions to promote spinal health in children and adolescents, 2) developing a schematic presentation of the evidence-based framework depicting the effective school-based interventions. Two comprehensive search strategies for primary research (strategy A) and grey literature (strategy B) respectively, were performed. School-based interventions which aims were to prevent poor spinal health and/or improve spinal health in school children and adolescents were considered. Spinal health outcomes included levels of pain or discomfort limited to the spinal area and other measurable components which is a direct result of the spinal pain/discomfort and which affects the individual’s optimal experience of a sense of well-being. Results: Search strategy A yielded 24 eligible articles and search strategy B, six documents of grey literature. Four main themes of intervention were identified i.e. exercise, education, exercise and education combined and furniture, which resulted in significant positive effects on different aspects of spinal health i.e. exercise only was most effective to address low back pain; education only was most effective to address spinal pain; exercise and education combined influenced neck and lower back pain the most and furniture adjustments impacted mostly neck and spinal pain. However, the grey literature lacked the scientific evidence base of support and the content of only two documents containing education on schoolbag weight and carriage could be incorporated in the schematic presentation of the evidence-based framework. Conclusion: There was a trend that certain school-based interventions might be more beneficial to address certain aspects of spinal health in children and adolescents, despite conflicting results in the literature. The findings from the review can be used towards formulating recommendations for guidelines to be implemented in schools in future.

AFRIKAANSE OPSOMMING : Inleiding: Die prevalensie van spinaalpyn in kinders and adolosente is hoog en vermeerder met ouderdom. Kinders wat pyn ervaar tydens ‘n vroeë ouderdom, is geneig om pyn tydens adolosensie en selfs volwassenheid te ervaar. Risikofaktore wat moontlik kan bydra tot die ontwikkeling van spinalepyn sluit in die gebruik van skoolsakke, postuur, psigososiale faktore, ouderdom, geslag en skool meubels. Doelwit: 1) Om die effektiwiteit van skool-gebasseerde intervensies op spinale gesondheid in kinders en adolosente te bepaal, 2) om die effektiewe intervensies voor te lê in die vorm van ‘n skets as deel van die ontwikkeling van ‘n bewysgesteunde raamwerk. Metode: Die studie bestaan uit twee fases: 1) ‘n sistematiese oorsig is uitgevoer om die effektiwiteit van die skool-gebasseerde intervensies op spinale gesondheid in kinders en adolosente te bepaal; 2) om ‘n skematiese voorlegging van die mees effektiewe intervensies te ontwikkel. Twee deeglike soektogte vir primêre navorsing (strategie A) en grys literatuur (strategie B), respektiewelik was uitgevoer vanaf die ontstaan van die databases tot en met Julie 2017. Slegs studies wat fokus op skool-gebasseerde intervensies wat beoog om spinale pyn in kinders en adolesente te voorkom, was in ag geneem. Die uitkomste in terme van spinale gesondheid, waarop gefokus is, sluit in vlakke van pyn of ongemak in die spinale area en enige meetbare komponente wat direk verwant is aan die spinale pyn of ongemak wat die individu se algehele welstand affekteer. Resultate: Vier en twintig artikels is geidentifiseer in soektog A en ses grys literatuur dokumente is gevind met soektog B. Vier hoof intervensie temas is geidentifiseer naamlik: oefening, opvoeding alleen, oefening en opvoeding gekombineerd en vernaderinge aan skoolmeubels. Hierdie intervensies het almal beduidende veranderinge veroorsaak op verskeie aspekte van spinaal gesondheid soos volg: oefening het ‘n beduidende positiewe effek op laerugpyn gehad; opvoeding het spinalepyn beduidend verminder; oefening en opvoeding gekombineerd het nekpyn en laerugpyn die meeste geaffekteer en die veranderinge in skoolmeubels het nekpyn en spinalepyn die meeste geaffekteer. Die grys literatuur het geen bewysgesteunde ondersteuning gehad nie en die inhoud van slegs twee van die dokumente, wat betrekking het tot opvoeding in terme van korrekte gebruik van skoolsakke kon by die skematiese voorlegging ingesluit word. Gevolgtrekking: Daar is ‘n tendens van skool-gebasseerde intervensies wat ‘n positiewe impak op sekere aspekte van spinale gesondheid kan hê, selfs met die kontrasterende resultate in die literatuur. Die bevindinge van hierdie studie kan gebruik word om aanbevelings te maak vir riglyne wat by skole geimplementeer kan word om spinale gesondheid te bevorder.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103582
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