School-based educational interventions for improving knowledge of back health, ergonomics and postural behaviour of school children aged 4-18 years: a best evidence systematic review

Background: 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. Objectives: 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. Main Results: 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. Authors Conclusions: 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.

Citation

Bettany-Saltikov, J., Mcsherry, R., Duangkaew, R., Kandasamy, G., Aristegui Racero, G., van Schaik, P., Hogg, J., Salman, M., & McPherson, F. (2026). School-based educational interventions for improving knowledge of back health, ergonomics and postural behaviour of school children aged 4-18 years: a best evidence systematic review. Campbell Systematic Reviews, 22(2), 18911803261443227. https://doi.org/10.1177/18911803261443227

Publisher

SAGE Publications

Journal

Campbell Systematic Reviews

URI

https://chesterrep.openrepository.com/handle/10034/630043

DOI

10.1177/18911803261443227

Type

Article

Description

EISSN

1891-1803

Additional Links

https://journals.sagepub.com/doi/10.1177/18911803261443227