Josette Bettany-Saltikov

Musculoskeletal and back health of school aged children is a global health problem, with evidence that the prevalence of these problems is increasing. Many modern school systems require children to assume sedentary positions for extended periods of time, and the increasing use of classroom-based technology adds to the number of hours seated. With the incidence of musculoskeletal pain reported not only in adult populations but increasingly in young people, an understanding of spinal health and posture may be essential for students. The main objective for conducting this review was to conduct a best evidence systematic review. This means we only included the highest quality papers on the effectiveness of school-based education programs on back health for improving knowledge of back health, ergonomics and postural behaviour in school children aged 4-18 years. We searched the following 21 electronic databases from inception till the 20th January 2023: AMED (EBSCOhost), APA PsycINFO (EBSCOhost), Best Evidence Medical Education (BEME) (EBSCOhost), British Education Index (EBSCOhost), CINAHL (EBSCOhost), Cochrane Central Register of Controlled Trials (Wiley), EMBASE (Ovid), ERIC (EBSCOhost), EThOS (British Library), Europe PMC (Europepmc.org), GoogleScholar. Health Technology Assessment (HTA) (INAHTA), Health Management Information Consortium (HMIC) (Ovid), MEDLINE (EBSCOhost), PEDro (pedro.org.au), ProQuest Dissertations & Theses (Proquest), ProQuest Nursing and Allied Health Database (ProQuest), SCOPUS (Elsevier), SportDISCUS (EBSCOhost), Web of Science (Arts and Humanities Citation Index, Science Citation Index Expanded, Social Sciences Citation Index, Emerging Sources Citation Index, Conference Proceedings Citation Index – Science, Conference Proceedings Citation Index – Social Sciences and Humanities; Clarivate), ZEToC (British Library). Selection Criteria The population eligible for the review included all children and young people between 4 and 18 years of age, attending school. Exclusion criteria: Children under 4 years of age and adults over 18 years of age; chronic disease or conditions or co-morbidities. Studies needed to meet the following criteria to be included: any formal educational school-based programme that included back health, ergonomics and postural behaviour that was designed to support the educational performance of students’ knowledge of posture and ergonomics within an educational establishment. We excluded physical activity or exercise only interventions. Included studies were required to have a control group that represented either business-as-usual (no intervention), or a wait-list design. We included studies that examined back care knowledge, knowledge of back care ergonomics, back care behaviours and knowledge of back posture. This was a Best Evidence Systematic Review and only research papers scoring a “good” or “excellent “on the Downs and Black (1998) risk-of-bias form were included. The following research designs were included: randomised controlled trials (RCTs), cluster randomised controlled trials (CRCT) and quasi-randomised controlled trials (QRCTs). We included prospective non-randomised studies (NRSs) with a control group because it was anticipated that very few RCTs would be found. Controlled before-after studies (CBAs), interrupted time series (ITS) studies as well as controlled studies that were non-randomised and included a pre- and post-test were also eligible for inclusion. Titles and abstracts were screened in duplicate. Full texts of studies with seemingly relevant abstracts were retrieved and assessed for eligibility using the pre-specified inclusion criteria. Full texts were also screened in duplicate. Studies were classified as either included or excluded. Two authors independently extracted data from relevant studies. 1,327 potentially relevant papers were found through the searches of the academic databases, while no studies were identified through searches of grey literature and reference lists. After removing 1,256 articles which did not meet the inclusion criteria, 71 studies remained for screening. 37 articles were excluded based on screening the titles and abstracts. This left 34 articles for further examination of full texts. After the full texts had been read, these 34 studies continued to the quality assessment/risk of bias stage using the Downs and Black ROB form. Only two papers scored 20 or over (i.e. good or excellent) and were included in this systematic review. As the outcomes of the two studies differed, it was not possible to conduct a meta-analysis. Therefore, a narrative synthesis was conducted. Each of these studies showed statistically significant improvements on knowledge and behaviour, in the short term (3-8 months) though these need to be interpreted in light of concerns regarding risk of bias. Despite the comprehensive search of electronic databases, grey literature, hand searching, journals and reference lists of included studies, we only found two ‘good’ quality studies (scoring 20-25). No studies achieved an “excellent” score, that provided “excellent” evidence, on the effectiveness of school-based education programs on back health for improving knowledge of back health, ergonomics and postural behaviour in school children aged 4-18 years. This highlights the urgent need for high-quality studies to be conducted to assess the effects of these programmes due to the importance of ergonomics and posture in the activities of daily living of school children.

Background/Objectives: The Spinal Appearance Questionnaire (SAQ) assesses the self-perception of appearance of adolescents with idiopathic scoliosis (AIS). Due to originally scoring too many domains and producing prevalent ceiling effects when treated conservatively, the SAQv1.1, has been introduced. This study aimed to compare the test–retest reliability, convergent validity, and ceiling and floor effects of the two versions of the SAQ in patients with AIS. Methods: Conservatively treated females with AIS, aged 10–18 years old, were consecutively recruited from a scoliosis clinic. The Scoliosis Research Society-22 refined (SRS-22r), SAQ, and SAQv1.1 were collected, in English, with radiographic measurements (Cobb angle, Coronal Balance, and Vertebral Rotations). Nine domain scores were obtained from the original SAQ. Appearance, Expectations, and Total scores were calculated for SAQ v.1.1. Questionnaires were re-administered electronically after one week. Results: One hundred females, aged 13.9 ± 1.8 years with curve angles of 28.8° ± 13.9°, were included. The test–retest reliability for SAQ varied between domains (ICC_3,1 = 0.72 to 0.94). The Total, Appearance, and Expectation ICCs_3,1 for the SAQv1.1 were 0.92, 0.94, and 0.86, respectively. Convergent validity was demonstrated between seven SAQ domains and the SRS-22r Total and Cobb angle (|r| = 0.32 to 0.59). The SAQv1.1 Total correlated with the SRS-22r Total (r = −0.50) and with the Cobb angle (r = 0.56). All SAQ domains presented ceiling (Curve = 11% to Kyphosis = 68%) and floor effects (Chest = 8% and Waist = 4%). The SAQv1.1 Total and Appearance had low ceiling effects (≤5%), while Expectations presented both ceiling (14%) and floor effects (10%). Conclusions: The SAQv1.1 is recommended because of its stronger reliability, superior convergent validity, and fewer ceiling and floor effects in AIS.

Background: This study aimed to (a) determine how frequently chiropractors use postural assessment when treating patients with back or neck pain, (b) determine the rationale for the use of postural assessment by chiropractors, (c) examine the assessment methods employed, (d) explore which specific aspects of posture are assessed and (e) determine the types of back and neck conditions being treated. Methods: An 11-item online questionnaire was developed. A link to this survey was distributed using SurveyMonkey to the entire membership of the Royal College of Chiropractors. Results: There were 272 respondents to the survey. Of the respondents, 79% ‘almost always’ used postural assessment when treating patients with back or neck pain. Respondents reported using postural assessment to help determine whether a patient was making progress (61.8%), provide an outcome measure (57.1%) and help inform the diagnosis (89.2%) and treatment plan (81.8%); almost all respondents (98.1%) reported carrying out a postural assessment visually, with no aids. Most respondents reported assessing their patients posteriorly, anteriorly and from both left and right sides, observing 44 specific anatomical items. The conditions treated included sacroiliac pain (96.7%), stiff neck (95.6%), non-specific lowback pain (92.6%), lumbar disc herniation (91.5%), cervical arthritis (89.7%), lumbar strain (87.1%), lumbar arthritis (86.4%), thoracic pain (86.4%), neck strain (84.9%) and whiplash (79.8%). Conclusions: The findings suggest that the unaided visual assessment of posture using a large range of anatomical points is used by UK chiropractors for the purposes of aiding diagnosis and treatment of patients with back and neck pathologies.

Background: This study aimed to (a) determine how frequently chiropractors are using postural assessment when treating patients with back or neck pain, (b) determine the rationale for the use of postural assessment by chiropractors, (c) examine the assess-ment methods employed, (d) explore which specific aspects of posture are assessed and (e) determine the types of back and neck conditions being treated. Methods: An 11-item online questionnaire was developed. A link to this survey was distributed using Sur-veyMonkey to the entire membership of the Royal College of Chiropractors. Results: There were 272 respondents to the survey. Of the respondents, 79% ‘almost always’ used postural assessment when treating patients with back or neck pain. Respondents reported using postural assessment to help determine whether a patient was making progress (61.8%), provide an outcome measure (57.1%) and help inform the diagnosis (89.2%) and treatment plan (81.8%); almost all respondents (98.1%) reported carrying out a postural assessment visually, with no aids. Most respondents reported assessing their patient posteriorly, anteriorly and from both left and right sides, observing 44 specific anatomical items. The conditions treated included sacroiliac pain (96.7%), stiff neck (95.6%), non-specific low-back pain (92.6%), lumbar disc herniation (91.5%), cer-vical arthritis (89.7%), lumbar strain (87.1%), lumbar arthritis (86.4%), thoracic pain (86.4%), neck strain (84.9%) and whiplash (79.8%). Conclusions: The findings suggest that the unaided visual assessment of posture using a large range of anatomical points is used by UK chiropractors for the purposes of aiding diagnosis and treatment of patients with back and neck pathologies.

Numerous scoliosis research studies have investigated postural control changes in adolescents with idiopathic scoliosis and compared them to healthy controls. However, the results have been controversial. Therefore, the present study aimed to compare whether postural control in adolescent idiopathic scoliosis (AIS) patients is different from their age-matched healthy counterparts. An exploratory cross-sectional study was conducted comprising 121 adolescents (11 to 17 years) divided into five groups, including those diagnosed with idiopathic scoliosis (n = 95) and healthy control peers (n = 26). According to the type (single or double), location (thoracic or lumbar), and severity (mild = Cobb's angle ≤ 25°, moderate = 26° ≤ Cobb's angle ≥ 45°) of AIS, the groups included: group 1: mild single curve in the thoracic region, group 2: mild single curve in the lumbar region, group 3: mild double curves, group 4: moderate double curves, and group 5: healthy control. Computerized Dynamic Posturography (CDP)/ /NeuroCom International, Inc., Clackamas, OR, USA was used to assess the postural control parameters. The assessment included the Sensory Organization Test (SOT), the Adaptation Test (ADT), the Motor Control Test (MCT), the Weight-Bearing Squat test (WBS), and finally the Unilateral Stance Test (UST). The study analyzed data from 121 participants (36 boys, 85 girls) across five groups. No significant differences were found between the AIS and control groups concerning the type of curve or when comparing single and double curves. A one-way ANOVA indicated that variables related to the SOT were normally distributed, while other tests did not show normal distribution. Comparisons controlled for BMI, curve type (single or double), and severity of the major curve revealed no significant differences in postural control variables between AIS and control groups. Notable p-values include SOT 1 (p = 0.964), SOTstrategy 1 (p = 0.192), SOT 2 (p = 0.733), SOTstrategy 2 (p = 0.497), SOT 3 (p = 0.057), SOTstrategy 3 (p = 0.693), MCT (p = 0.089), USleftOpen (p = 0.087), and USrightOpen (p = 0.057). This study's findings indicated that there were no statistically significant differences in postural control when performing activities of daily living among adolescents with idiopathic scoliosis compared to their healthy aged-matched peers. Therefore, there is no need for additional training to improve postural control in these adolescents with idiopathic scoliosis. However, the importance of identifying the postural control mechanisms in these populations is considerable for treating scoliosis.

This is the protocol for a Campbell systematic review. This review's objectives are to find out (in relation to health and/or social care): (1) What is known about the outcomes and impact of completing (or not completing) a professional doctorate in health and/or social care on the individual professional? (2) What is known about the outcome and impact of completing (or not completing) a professional doctorate in health and/or social care on the employing organisation? (3) What is known about the outcome and impact of completing (or not completing) a professional doctorate in health and/or social care on the profession? (4) What is known about the outcome and impact of completing (or not completing) a professional doctorate in health and/or social care on service users and the wider society? (5) How do we use the findings from this review to inform educators, higher education institutions, professionals, investors in employing organisations and policymakers? (6) What further research will be needed to answer any knowledge gaps or recommendations? (7) Where possible, we will identify and report on any demographic data and discuss their relevance to the impact and outcomes from professional doctorates.

Background: Thorough knowledge of the management of age-related hyperkyphosis is crucial to physiotherapists’ effective handling of complex spinal deformities. Objective: This cross-sectional study investigated the knowledge, attitudes, and confidence of Thai physiotherapists regarding age-related hyperkyphosis. Methods: An online questionnaire with demographic, work-related, knowledge, attitude, and confidence questions was employed. The data analysis involved descriptive statistics, chi-square tests, and independent t-tests. Results: Complete responses were obtained from 314 physiotherapists. The correct responses amounted to 68.79% for the definition, 90.00% for causes, 14.97% for age of onset, 22.38% for prevalence, and 64.65% for the gold-standard diagnosis of hyperkyphosis. Most of the diagnostic methods involved visual examination. The respondents reported that hyperkyphosis disrupts respiratory function. The aim of treatment, according to 88.85%, was to increase spine mobility. Corrective posture exercises were the most common treatment strategy, but the range of treatments was diverse. Many cited undergraduate education as their primary evidence source. Respondents had conflicting attitudes towards “age-related hyperkyphosis is a normal aging process” but mostly positive attitudes towards the need for physiotherapy treatment. Approximately 22% reported fair confidence in treating hyperkyphosis. Conclusions: This study highlights the importance of raising awareness and enhancing knowledge, attitudes, and confidence among physiotherapists to improve care for older adults with hyperkyphosis.

Back-care knowledge and behaviour may play a vital role in preventing musculoskeletal current and future discomfort and injuries. The aim of the current survey was to explore the level of knowledge regarding ergonomics and posture together with postural behaviour and the incidence of musculoskeletal pain (MSP) in university students in the northeast of England. A mixed methods survey was conducted on a convenience sample of 55 university students. The 32-item valid and reliable questionnaire contains questions on socio-demographics, MSP, knowledge regarding ergonomics and posture (8 closed ended and 8 open-ended items) as well as postural behaviour. Nearly 1.8%, 20% and 78.2% of the university students had poor, fair and good knowledge of ergonomics and posture respectively. Among the 37 students who carried a backpack, 51.4% were found to have poor postural behaviour, 37.8% had fair behaviour and 10.8% had good postural behaviour. Of the 18 students who did not carry a backpack, 55.6% were found to have poor postural behaviour, 27.8% had fair behaviour and 16.6% had good postural behaviour. 70.9% of the students experienced MSP with the most prevalent site of pain being the lower back region. The key themes that emerged from qualitative data (8 open-ended questions) were: “Comfortable posture”, “Correct spinal alignment”, “Spine support”, “less pain and injuries”, “Use knees not the back”, “Keep the object close to body”, “Hands on desk”, “Feet flat on floor” as well as “eyes at screen level”. The findings of this study can be used to develop targeted interventions aimed at educating university students about ergonomics and posture in order to prevent the incidence of MSP. Future research in this field with a large and more representative sample of the university students’ population is strongly recommended to fully understand their knowledge of ergonomics and posture, postural behaviour as well as incidence of MSP.

Background: Good posture is characterised by neutral spinal alignment with high physiological and biomechanical efficiency together with low stress and strain. The purpose of this study was to assess the validity and reproducibility of the adult version of the Aristegui questionnaire in university students. Materials and methods: The study was conducted in two parts. The first part assessed content validity of the questionnaire where five experts provided their feedback on the content of the questionnaire. The second part evaluated the reliability of the questionnaire among a convenience sample of 10 university students in a test–retest study. Results: The content validity of the questionnaire was found to be excellent. Twenty-five out of twenty-seven items had an item content validity index higher than 0.79 (appropriate) and the scale content validity index was 0.93 (high). For the reliability, almost perfect agreements were found for nine items, substantial agreement for three questions, moderate agreement for one item and fair agreement for one item. The kappa coefficients ranged from 0.00 (slight) to 1.00 (perfect) for the items on behaviour. Conclusions: The questionnaire was found to be a valid and reliable tool to measure the university students’ knowledge regarding ergonomics and posture and postural behaviour as well as prevalence of musculoskeletal pain.

Postural and spinal deformities are major contributing factors to musculoskeletal (MSK) disorders. Posture screening and assessment can help to identify early morphological deformities, thereby preventing progression and reducing or correcting them with effective treatments. The study evaluates both intra- and inter-repeatability of using a mobile structured light sensor with a structured light pattern for building an accurate 3D human model and its use in postural screening. 16 young males (age: 25 ± 5.6 years, height: 172 ± 5.3 cm, mass: 69 ± 8.6 kg) participated without any musculoskeletal pain or pre-existing leg or spinal abnormalities. An iPad-based 3D mobile scanning tool, Structure Sensor^TM (2018 version), was used to capture the participants’ back and whole-body shape. The collected data (3D model) were realigned and processed in the open-source software, Netfabb Basic^TM (7.2 version). For each participant, five trained raters individually measured three trials of standing back and body posture on two separate occasions to calculate both intra- and inter-rater reliability. With the use of this software, nine postural variables and angular displacements were individually measured by the raters. The results indicated good to excellent intra-rater and good to moderate inter-rater reliability for measuring 78% (7 out of 9) of postural variables with an ICC ranging from 0.70 to 0.98. The remaining 22% of variables (2 out of 9; lateral pelvic tilt and right frontal knee angle) showed moderate to low inter- and intra-rater reliability, with ICCs ranging from 0.26 to 0.79.