Is puberty a risk factor for back pain in the young? a systematic critical literature review
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CHIROPRACTIC & MANUAL THERAPIES
SYSTEMATIC REVIEW
Open Access
Is puberty a risk factor for back pain in the young? a systematic critical literature review Arnaud Lardon1,2*, Charlotte Leboeuf-Yde1,2,3, Christine Le Scanff1 and Niels Wedderkopp4
Abstract Background: Back pain is a common condition that starts early in life and seems to increase markedly during puberty. A systematic review was performed in order to investigate the link between puberty and back pain, using some Bradford Hill criteria for causality. Objectives: We sought to obtain answers to the following questions: 1) Is there an association between puberty and back pain? If so, how strong is this association? And do the results remain unchanged also when controlling for age and sex? 2) Are the results of the studies consistent? 3) Is there a dose–response, showing a link between the increasing stages of puberty and the subsequent prevalence of back pain? 4) Is there a temporal link between puberty and back pain? Design: A systematic critical literature review. Methods: Systematic searches were made in March 2014 in PubMed, Embase, CINAHL and PsycINFO including longitudinal or cross-sectional studies on back pain for subjects one BP = duration day or more) (>1 month)
Prevalence estimate Prevalence estimate Prevalence estimate in relation to in relation to in relation to puberty stages puberty stages puberty stages
BL = baseline, FU = follow up, Itw = interview, PDS = pubertal development scales, BP = back pain.
free and preferably, if they had never previously had back pain, in order to establish temporality. 5. Potential modifiers/confounders. We also investigated if associations between puberty and back pain were controlled for possible confounders or modifiers, particularly age and sex. These are the only ones known to be linked with back pain in children, as back pain accelerates at this time in life and girls are more likely to report back pain than boys. 6. Finally, in the cases where the biological gradient (dose–response) was investigated, it was assessed if it had been submitted to a statistical test for trend and if the assumption for making such a test had been met. A summary of the results is shown in Table 3. These items related to various aspects of causality, using the method for causal assessment developed by Roffey et al.
[20-24] and Wai et al. [25-27], which in turn was based on relevant criteria for causality previously described by Bradford Hill [28]. As in their reviews, the following elements were considered: strength of the association, dose response, and temporality (further described below). “Plausibility” was not taken into consideration, as this was evident, and also not “experiment”, as this was irrelevant in observational studies, but “consistency” was added. Dose–response was taken into account both in cross-sectional and longitudinal studies but temporality could only be investigated in longitudinal studies, provided that the back pain variable had been defined clearly in terms of prior absence of pain. Each arti
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