Children and Adolescents With Low Back Pain: A Descriptive Study of Physical Examination and Outcome Measurement

Abstract

Study Design: A retrospective, cohort study of children and adolescents with low back pain (LBP) referred to physical therapy. Objectives: To describe the clinical presentation, examination findings, and classification of children and adolescent patients with LBP, and to explore the concurrent validity of the Oswestry questionnaire as a disability measure in this group. Background: Little information is available regarding the clinical presentation, physical examination findings, and outcome assessment in children and adolescents with LBP. Methods and Measures: Charts were reviewed for historical, diagnostic, physical examination, and outcome information. Diagnoses given by the referring physicians were recorded. A treatmentbased classification was made for each subject. Descriptive statistics were calculated for all variables. The validity of the Oswestry questionnaire was examined. Results: The children and adolescents included in this study represented 5% (n = 25) of all cases of LBP referred to physical therapy. A greater percentage of patients had difficulty with extension than with flexion range of motion (ROM). Initial pain scores were lower if a specific pathology was present (P = .001). Initial pain and Oswestry scores were poorly correlated (r = 0.16). Forty-four percent (n = 11) of patients scored under the floor value of 12% on the Oswestry. Conclusion:The referral rate of children and adolescents with LBP seems to be low. Compared to adults, children and adolescents appear more likely to have a specific diagnosis given to them by their physician. The physical examination findings appear to indicate that spinal stabilization approaches may be beneficial for many patients. The Oswestry questionnaire may not be a valid tool for documenting changes in disability in these patients. Further research is needed on the conservative management of children and adolescents with LBP. J Orthop Sports Phys Ther 2003;33:513-522. Key Words: Clinical presentation, low back pain, lumbar spine, Oswestry, retrospective study O nce thought to be a rare occurrence almost always resulting from a serious etiology, recent studies suggest that low back pain (LBP) among children and adolescents is not uncommon. 2,3,5,10,11,34,43,58,66,72 This change in traditional thought has led to an increased emphasis on research into LBP in this population. 7 The predominance of this research has focused primarily on developing epidemiological profiles, examining prevalent risk factors, and identifying important prognostic Shannon N. Clifford, 6035 Forbes Tower, Pittsburgh, PA 15260. E-mail: sncst16@pitt.edu indicators related to children and adolescents with LBP. 2,3,5,7,45,64

Mechanical factors and vitamin D deficiency in schoolchildren with low back pain: biochemical and cross-sectional survey analysis

“…A prevalidated Pain Rating Scale of 0–10 and a modified Oswestry Low Back Pain Disability Questionnaire (OSW) were used to evaluate LBP and pain scores among all schoolchildren as previously reported 48–50. LBP disability was quantified during school year season from October 2013 to May 2014 using the OSW scale (a 10-item scale) with scores ranging from 0 to 100; higher scores indicated greater disability.…”

Changes in gait kinematics and posture with the use of a front pack

“…9, 15 July 2006, 885 -894 such loads may be detrimental over the long term (Pascoe et al 1997, Negrini et al 1999, Grimmer 2000. Reports on adolescent low back pain have appeared more commonly, and some physicians and therapists have noted that the rate of adolescent low back pain is approaching that of adults (Clifford and Fritz 2003). School backpacks are felt to be heavy by 79.1% of children, to cause fatigue by 65.7% and to cause back pain by 46.1% (Negrini et al 2002).…”

Diagnosis and Treatment of 2 Adolescent Female Athletes With Transient Abdominal Pain During Running

“…Recently, it has been used to document functional change in response to interventions for individuals with thoracic-spine pathology including idiopathic adolescent scoliosis. 41,50,52 Unfortunately, the use of the mODI to document change in adolescents with spine impairments has not been validated. 50 Currently there are no other outcome measures available that have been validated for adolescent athletes who present with thoracic-spine impairments.…”

“…41,50,52 Unfortunately, the use of the mODI to document change in adolescents with spine impairments has not been validated. 50 Currently there are no other outcome measures available that have been validated for adolescent athletes who present with thoracic-spine impairments. The mODI scores for both our patients improved by more than 6 points, demonstrating a clinically detectable level of change.…”