***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Many authors have reported about the high prevalence rates of  self-reported back pain in children . Nevertheless , little is known about the diagnosis of back disorders - regardless of whether the diagnosis is associated with back pain or not . Therefore , the aim of this study was to analyse the prevalence rates and costs of diagnosis of back disorders in childhood and youth . Methods We conducted a secondary data analysis of a large , population based German data set ( 2,300,980 insurants of statutory health insurance funds ) which allowed for identification of prevalence rates of diagnoses of back disorders in children ( age group 0 - 14 years ) and youths ( age group 15 - 24 years ) using three digit ICD-10 codes for dorsopathies ( M40 - M54 : kyphosis and lordosis ; scoliosis ; spinal osteochondrosis ; other deforming dorsopathies ; ankylosing spondylitis ; other inflammatory spondylopathies ; spondylosis ; other spondylopathies ; spondylopathies in diseases classified elsewhere ; cervical disc disorders ; other intervertebral disc disorders ; other dorsopathies , not elsewhere classified ; dorsalgia ) . Direct treatment costs were calculated based on the real incurred costs for cases with a singular diagnosis of a back disorder . Wherever possible , the results of the r and om sample were extrapolated to all insurants of statutory health insurance funds ( i. e. , about 90 % of the German population ) . Results We found prevalence rates for the diagnosis of back disorders to range between 0.01 - 12.5 % . " Scoliosis " ( M41 ) and " dorsalgia " ( M54 ) were the most frequent diagnoses in both age groups . Based on these results , it was calculated that in 2002 alone , approximately 1.4 million children/youths in Germany were diagnosed with " dorsalgia " ( M54 ) , and that the direct costs for back disorders in childhood and youth accounted for at least 100 million Euros . Conclusions Instead of focusing on the individual , and self-reported disorder or disability , this analysis allowed for the detailed evaluation of medical experts ' opinion on back disorders in childhood and youth and for a more objective or public health oriented insight in the topic of diagnosis of back pain and other back disorders . However , due to the method ological limitations by using ICD-10 coding , st and ardized r and om validity checks of population based data sets should be m and atory Within the scope of primary prevention regarding back functioning in children , research on the stability of intervention effects is indispensable . Along this line , the transition from childhood to adolescence is an important phase to evaluate the potential stability of intervention effects because of the typically mechanical and psychological dem and s related to adolescence . The main aim of the current study was to investigate the effects of a back education program at 2-year follow-up , in youngsters aged 13–14 years , on back posture knowledge , fear-avoidance beliefs and self-reported pain . An additional purpose was to evaluate which aspects of postural behavior were integrated in youngsters ’ lifestyles . At 2-year follow-up , the study sample included 94 secondary schoolchildren in the intervention group ( mean age 13.3 ± 0.8 years ) and 101 controls ( mean age 13.2 ± 0.7 years ) . The back posture program that had been implemented for two school years consisted of back education and the stimulation of postural dynamism in the class through support and environmental changes . A question naire was completed comparable to the pretest , posttest and follow-up evaluations . The current study demonstrated at 2-year follow-up stability of the improved general ( F = 1.590 , ns ) and specific ( F = 0.049 , ns ) back posture knowledge in children who had received early back posture education .  Back posture education did not result in increased fear-avoidance beliefs ( F = 1.163 , ns ) or mounting back and /or neck pain reports ( F = 0.001 , ns ) . Based on self-reports for postural behavior , youngsters who had received the back posture program in the elementary school curriculum integrated crucial sitting and lifting principles conform to biomechanical favorable postural behavior . The steady intervention effects 2-year post-intervention demonstrated that intensive back posture education through the elementary school curriculum is effective till adolescence . Future research on the impact of early school-based back posture promotion in relation to the integration of back posture principles according to a biomechanical favorable lifestyle and back pain prevalence later in life is essential We tested the effects of implementing ergonomically design ed school furniture on measures of comfort , sitting posture and symptoms .  Three classes of fourth grade rs ( 10 years old ) were r and omly assigned either to a control group using traditional furniture or to an experimental group which received the ergonomically design ed furniture . In both groups question naires were completed and sitting behaviour was observed twice before and after the intervention as well as at a five-month follow-up period . Although the experimental groups rated their furniture as being significantly more comfortable , differences in actual sitting behaviour were small . The experimental class experienced a reduction in musculoskeletal symptoms relative to the control group after implementing the ergonomically design ed furniture . Since pupils did not automatically sit ' properly ' in the ergonomic furniture , these results demonstrate the need for proper instructions and adjustment . Increased comfort and decreased symptoms may be used to motivate pupils to sit correctly . Our results suggest that furniture design is one aspect of a multidimensional problem Purpose Population based studies have demonstrated that children and adolescents often complain of low back pain . A group-r and omized controlled trial was carried out to investigate the effects of a postural education program on school backpack habits related to low back pain in children aged 10–12 year . Methods The study sample included 137 children aged 10.7 years ( SD = 0.672 ) . Six classes from two primary schools were r and omly allocated into experimental group ( EG ) ( N = 63 ) or control group ( CG ) ( N = 74 ) . The EG received a postural education program over 6 weeks consisting of six sessions , while the CG followed the usual school curriculum . A question naire was fulfilled by the participants at pre-test , post-test , and 3 months after the intervention finished . The outcomes collected were : ( 1 ) try to load the minimum weight possible , ( 2 ) carry school backpack on two shoulders , ( 3 ) belief that school backpack weight does not affect to the back , and ( 4 ) the use of locker or something similar at school . A sum score was computed from the four items . Results Single healthy items mostly improved after the intervention and remained improved after 3-month follow-up in EG , while no substantial changes were observed in the CG . Healthy backpack use habits score was significantly increased at post-test compared to baseline in the EG ( P < 0.000 ) , and remained significantly increased after 3-month , compared to baseline ( P = 0.001 ) . No significant changes were observed in the CG ( P > 0.2 ) . Conclusions The present study findings confirm that children are able to learn healthy backpack habits which might prevent future low back pain Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists PURPOSE The effect of education on proper wearing of a backpack was studied to determine whether or not a middle school population would improve posture during load carriage by maintaining a more natural posture and to determine if schoolchildren would comply with proper backpack wearing . METHOD 17 middle school children with a mean age of 12.7 years were r and omized into control and intervention groups . Participants were videotaped in four conditions from an anterior view and from a lateral view . Members of both groups participated in Sessions A and C , which consisted of videotaping of the four conditions . Intervention members additionally participated in Session B , consisting of education on how to wear a backpack properly . All participants were interviewed concerning their participation and its effect on how they wore their backpack . Video footage was analyzed to calculate the change in skeletal angles as a result of different methods of load carriage . Interview data was coded and analyzed . RESULTS No quantitative significance was found between control and intervention groups in regards to education on proper backpack wearing improving posture . Interviews revealed that intervention group members benefited from the education on proper wearing of a backpack . 87.5 % of the intervention group members proceeded to continue wearing the backpack properly after the education intervention . CONCLUSIONS Education regarding proper wearing of a backpack may impact the middle school aged child by improving quality of life as noted through decrease in reports of musculoskeletal pain by participants BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVES No previous r and omised controlled trials had been undertaken investigating the effect of school seating on back pain in 14 to 16 year olds . This study was design ed to test the effect of the use of a high-density foam wedge on normal school seating on the intensity of back pain . DESIGN R and omised controlled trial . SETTING Suffolk , a predominantly rural county in eastern Engl and . PARTICIPANTS One hundred and eighty-five students with back pain were recruited from 12 schools . R and omisation was stratified by school . The control and intervention groups included 92 and 83 students , respectively . INTERVENTION Following a 1-week baseline observation period , each student in the intervention group was given a wedge to use on their school chairs . OUTCOME MEASURE The primary outcome measure was pain intensity ( numerical rating scale , 0 to 10 ) recorded in pain diaries over 4 weeks . R and om effects models were used to analyse the pain intensity data . RESULTS Ninety-seven students ( 46 control group , 51 intervention group ) completed the trial . For the intervention group , pain intensity was reduced significantly over the 3 weeks of wedge use . The average reduction in pain intensity was estimated to be 0.709 points ( 95 % confidence interval 0.341 to 1.077 ) , representing a 58 % reduction in back pain for those in the intervention group . CONCLUSION Use of a wedge reduced the intensity of back pain significantly , especially in the evenings . The results suggest that further research into the longer-term effect of seating on pain intensity in adolescents should be considered QUESTION Does an eight-week exercise program reduce the intensity and prevalence of low back pain in 12 - 13 year old children ? Does it decrease the childhood physical risk factors for low back pain and promote a sense of well-being ? DESIGN R and omised trial with concealed allocation and assessor blinding . PARTICIPANTS Seventy-two 12 - 13 year old children , who had complained of low back pain in the past three months . INTERVENTION The experimental group completed eight exercise classes of 40 - 45 minutes duration over eight weeks conducted by a physiotherapist , whilst the control group received no intervention . OUTCOME MEASURES The primary outcome was pain intensity measured on a 10-cm visual analogue scale . Secondary outcomes included 3-month prevalence of pain , childhood physical risk factors for low back pain , and sense of well-being . Measures were taken at baseline ( Month 0 ) , post-intervention ( Month 3 ) , and three months later ( Month 6 ) . RESULTS Pain intensity over the past month had decreased by 2.2 cm ( 95 % CI 1.0 to 3.5 ) more for the experimental group than the control group at Month 3 and was still 2.0 cm 
    Output:
    
For the prevention of LBP , there was moderate quality evidence to suggest back education and promotion programs are not effective in reducing LBP prevalence in children and adolescents .