Table 1 Data Extraction for included studies (I.G- Intervention group, C.G- Control group, LBP – low back pain)

1.

(Akbari-Chehrehbargh, Tavafian, & Montazeri, 2020) [25]

Tehran, Iran

Elementary schools

5th grade female school children. Sample size (104 pupils, IG = 52, CG = 52). Age (11 ± 1.0 years for both CG and IG)

Six sessions of T-bak educational program including four components: belief (one session), knowledge (one session), skills (two sessions) and self-efficacy (two sessions).Freq: once a week Dur: 1 hr

No therapy

Primary outcome; Improved back care related behavior (5-point Likert-type scale with total score ranging from 6 to 30).

Secondary outcome; enhancement in beliefs (six-item scale), back care knowledge (multiple choice quiz), skills (checklist) and self-efficacy (four point Likert type scale).

2.

(Dullien, Grifka, & Jansen, 2018) [16]

Germany

Elementary school

176 pupils aged 10–12 years (mean age = 10.6 ± 0.44). CG = 86, IG = 90

Five lessons on back care, posture awareness training, back and abdominal muscle exercises

No therapy

Motor skills, back behavior, knowledge. Outcome measures; clinical orthopaedic exam, health questionnaire, motor test, back behaviour trial and knowledge test

3.

(Rodriguez-Garcia, Lopez-Minarro, & Santonja, 2013) [21]

Spain

Elementary and secondary schools

41 elementary school children (mean age 10.27 ± 0.31 years), 43 secondary school children (mean age 13.46 ± 0.68).sample size, n = 84, CG = 40, IG = 44

An organized physical education programme.

Dur; 13mins

Freq; 2 times a week

No therapy

Back pain frequency

Pain intensity (visual analogue scale)

4.

(Habybabady R. H., et al., 2012) [18]

Iran

Elementary school

5th grade elementary schoolchildren. Sample size =404, CG = 201, 104 girls ad 97 boys. IG = 203, 101 girls and 102 boys

Education programme using educational pamphlets, Duration; 60 minutes.

No therapy

Knowledge and behavior (questionnaires)

5.

(Vidal-Conti & Galmes-Panades, 2022) [26]

Spain

Primary school

Schoolchildren aged 10–12 years. Sample size = 224. CG = 5 schools (n = 127), IG = 5 schools (n = 97).

Online training postural on class teachers, implementation of active breaks for classroom teachers, development of a postural education teaching unit, awareness of general school community.

No therapy

Prevalence of LBP (Self-administered questionnaires), daily postural habits {Back pain and body posture evaluation instrument (BackPEI)}

6.

(Vidal, et al., 2013) [27]

Spain

Primary schools

Primary school children aged 10–12 years AV = 10.7, SD = 0.672. sample size = 137,IG = 63, CG = 74

6 sessions of postural education program for 6 weeks(4 theoretical and 2 practical)

Dur: 1 hr.

Freq: once a week

Usual school curriculum

Try to load the minimum weight possible, school back pack carriage on both shoulders, belief that backpack do not affect the back, use of locker or something similar at school (questionnaires).

7.

(Cardon, de Clercq, Geldhof, Verstraete, &de Bourdeaudhuij, 2007) [28]

Belgium

Elementary schools

4th and 5th grade students. Mean age = 9.7 ± 0.7, range 8.1–12.0. sample size = 555, IG 1 = 190, 1G 2 = 193, CG = 172

IG 1 = Back care education programme consisting 6 lessons with 1 week interval.

Physical activity promotion programme, 6 lessons at 1 wk. interval.

IG 2 = Back care promotion condition

No therapy

back care behavior (observation), knowledge, fear-avoidance beliefs, back pain prevalence (questionnaire), and physical activity (accelerometer)

8.

(Kovacs, et al., 2011) [19]

Spain

Elementary schools

School children. Age = 8 years, sample size = 497, CG = 231, 1G = 266.

Comic book of the back

no intervention

Knowledge (questionnaires)

1.

Behaviour (17.26 ± 4.97,p value- 0.36)

Knowledge(4.16 ± 1.53, p value-0.65)

Skills (13.26 ± 9.37, p value- 0.95)

Self efficacy(10.66 ± 2.86, p value- 0.66)

Beliefs (19.16 ± 4.19, p value- 0.24)

Behaviour (26.35 ± 3.61)

Knowledge(4.30 ± 1.46)

Skills(13.70 ± 10.18),

Self efficacy(14.22 ± 2.17)

Beliefs(26.31 ± 4.39)

Behaviour (18.30 ± 5.00)

Knowledge(4.30 ± 1.46)

Skills(13.70 ± 10.18)

Self efficacy(10.2 ± 2.97)

Beliefs(18.08 ± 4.83)

Behaviour (17.02 ± 5.59)

Knowledge(4.16 ± 1.61)

Skills(13.53 ± 10.18),

Self efficacy(10.80 ± 2.73)

Beliefs(18.18 ± 4.42)

There was a significant improvement on behaviour, beliefs, skills, self-efficacy and knowledge in the intervention group.

No significant difference on outcomes assessed in the control group

T-bak educational program is effective in improving back care related behaviour among pupils

7

2.

Knowledge(14.42 ± 3.03, p- 0.001)

behaviour (5.7 ± 1.9, p value- 0.005)

motor skills (3.4 ± 3.8, p value< 0.001)

Knowledge(17.17 ± 2.84),

behaviour (8.2 ± 2.0)

motor skills (5.6 ± 3.9)

Knowledge(14.80 ± 5.05),

behaviour (6.1 ± 1.7)

motor skills (2.2 ± 3.0)

Knowledge(14.57 ± 4.42),

behaviour (7.7 ± 2.1)

motor skills (4.9 ± 4.0)

Improvement on back behaviour& knowledge among the IG. Increased Posture performance and improvement in spinal deformity seen in both IG and CG.

no significant difference in back pain frequency & core muscle endurance in both groups

Teacher led back education programme should be included in schools.

6

3.

Pain frequency (9.5%)

Pain frequency 2.4%

Pain frequency 11.9%

Pain frequency 22.6%

Decrease in low back pain frequency in the IG and an increase in the CG

Children and adolescents subjected to the school physical education programme showed a reduction in low back pain frequency

8

4.

Knowledge (43.4 ± 12.93)

Behaviour (53.3 ± 16.34)

Knowledge (74.5 ± 19.60)

Behaviour (75.8 ± 18.58)

Knowledge (47.0 ± 12.76)

Behaviour (54.7 ± 13.57)

Knowledge (48.1 ± 13.78)

Behaviour (56.0 ± 16.43)

Significant increase in knowledge and behavior in the IG after one week and 3 months as compared to the CG.

Knowledge and behavior of children can be improved through educational programmes. It should be included in schools’ curriculum to ensure its sustainability

6

5.

Postural habits (2.86 ± 1.000)

Last week prevalence (17.4%)

Postural habits (2.56 ± 1.108)

Last week prevalence(15.5%)

Postural habits (2.93 ± 1.142)

Last week prevalence (17.4%)

Postural habits (2.64 ± 1.067)

Last week prevalence(18.6%)

No significant difference in low back pain prevalence and healthy postural habits both in CG ad IG

Postural education did not improve postural habits in children

5

6.

Last week LBP (19 ± 13.9%)

Min wt (114 ± 83.2)

Belief (19 ± 13.9)

Carry backpack (121 ± 88.3)

Last week LBP (6 ± 9.5%)

Min wt (48 ± 76.2)

Belief (5 ± 7.9)

Carry backpack (54 ± 85.7)

Last week LBP (19 ± 13.9%)

Min wt (114 ± 83.2)

Belief (19 ± 13.9)

Carry backpack (121 ± 88.3)

Last week LBP (13 ± 17.6%)

Min wt (66 ± 89.2)

Belief (14 ± 18.9)

Carry backpack (121 ± 88.3)

Repeated ANCOVA shows a significant increase in healthy backpack use in the IG

Children are able to learn healthy backpack habits which could prevent future LBP.

5

7.

Knowledge (1.0 ± 3.9)

Behaviour (17.36 ± 4.82)

Knowledge (5.1 ± 2.9)

Behaviour

(25.44 ± 4.66)

Knowledge(0.7 ± 3.4)

Behaviour

(16.46 ± 4.20)

Knowledge (2.7 ± 3.0)

Behaviour

(18.48 ± 5.43)

Significant increase in back care behavior in both intervention groups than the control group

Increase in fear avoidance in the control group different from the intervention groups.

Increase in physical activity in the back care + physical activity promotion group.

It is important to incorporate back care education in the training of teachers. It should be also be integrated into the school curriculum

8

8.

Total median score; 8 (p value < 0.001)

9

7

9

Slight increase in knowledge in the IG

Small but valuable effects of the comic book of the back in improving children’s knowledge of appropriate methods for preventing and managing LBP

8