Effects of a non-randomized educational intervention on knowledge, postural habits and trunk muscle endurance related to back health: A 6-month follow-up study

Back Health intervention


  • Vicente Miñana Body Languages Didactics Department. Academic Unit of Physical Education. Teacher Training Faculty. University of Valencia. Valencia. Spain.
  • Manuel Monfort-Pañego Body Languages Didactics Department. Academic Unit of Physical Education. Teacher Training Faculty. University of Valencia. Valencia. Spain.




adolescents, secondary school, back health, back pain, intervention, Physical Education


Low back pain (LBP) prevalence in children and adolescents is high during their lives. School-based interventions have reported effectiveness on back health. The study aimed to determine the effect of an educational back-health intervention on knowledge, postural habits and trunk muscle endurance regarding low back pain prevention for a group of 12 to 13-year-old students using a 6-month follow-up. A non-randomized experimental design. Three groups of 1st-grade secondary school students were selected. A control group (CG), and two experimental groups (EG1 and EG2) who participated in a back-health educational program (BHEP); only one of the experimental groups was given a follow-up learning contract (EG2). Assessments were performed at three different time points: before the intervention (baseline), after (post-test) and 6 months after (follow-up). The level of general knowledge of the experimental groups improved after the intervention. The level of postural habits improved in EG1 and EG2 compared to the CG after the follow-up period (p < .001 in both). An improvement in the level of endurance of the trunk musculature after the intervention was observed only for boys between EG2 and the CG (p < .05). A lower percentage of problems in the lumbar area in EG2 was observed after the 6-month follow-up. Teaching students to take care of their spines seems to have positive effects concerning knowledge, postural habits, and back health


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Ahlqwist, A., Hagman, M., Kjellby-Wendt, G., & Beckung, E. (2008). Physical therapy treatment of back complaints on children and adolescents. Spine, 33(20), 721. doi:10.1097/BRS.0b013e318182c347

Akbari-Chehrehbargh, Z., Tavafian, S. S., & Montazeri, A. (2020). Effectiveness of a theory-based back care intervention on spine-related behavior among pupils: A school-based randomised controlled trial (T-bak study). BMC Public Health, 20, 1-15. doi:rg/10.1186/s12889-020-08566-z

Balague, F., Ferrer, M., Rajmil, L., Pont Acuna, A., Pellise, F., & Cedraschi, C. (2012). Assessing the association between low back pain, quality of life, and life events as reported by schoolchildren in a population-based study. European Journal of Pediatrics, 171(3), 507-514. doi:10.1007/s00431-011-1596-1

Balague, F., Nordin, M., Dutoit, G., & Waldburger, M. (1996). Primary prevention, education, and low back pain among school children. Bulletin (Hospital for Joint Diseases (New York, N.Y.)), 55(3), 130-134.

Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143-164. doi:10.1177/1090198104263660

Bernard, J. C., Bard, R., Pujol, A., Combey, A., Boussard, D., Begue, C., & Salghetti, A. M. (2008). Muscle assessment in healthy teenagers, comparison with teenagers with low back pain. Annales De Readaptation Et De Medecine Physique: Revue Scientifique De La Societe Francaise De Reeducation Fonctionnelle De Readaptation Et De Medecine Physique, 51(4), 263-283. doi:10.1016/j.annrmp.2008.03.010

Bettany-Saltikov, J., Kandasamy, G., Van Schaik, P., McSherry, R., Hogg, J., Whittaker, V., . . . Racero, G. A. (2019). School‐based education programmes for improving knowledge of back health, ergonomics and postural behaviour of school children aged 4–18: A systematic review. Campbell Systematic Reviews, 15(1-2), 1-11. doi:10.1002/cl2.1014

Biering-Sorensen, F. (1984). Physical measurements as risk indicators for low-back trouble over a one-year period. Spine, 9(2), 106-119.

Brusseau, T. A., Kulinna, P. H., & Cothran, D. J. (2011). Health and physical activity content knowledge of pima children. The Physical Educator,

Brynteson, P., & Adams, T. M. (1993). The effects of conceptually based physical education programs on attitudes and exercise habits of college alumni after 2 to 11 years of follow-up. Research Quarterly for Exercise and Sport, 64(2), 208-212. doi:10.1080/02701367.1993.10608798

Calvo-Muñoz, I., Gómez-Conesa, A., & Sánchez-Meca, J. (2013). Prevalence of low back pain in children and adolescents: A meta-analysis. BMC Pediatrics, 13, 14-14. doi:10.1186/1471-2431-13-14; 10.1186/1471-2431-13-14

Cardon, G., De Clercq, D., De Bourdeaudhuij, I., & Breithecker, D. (2004). Sitting habits in elementary schoolchildren: A traditional versus a "moving school". Patient Education and Counseling, 54(2), 133-142. doi:10.1016/S0738-3991(03)00215-5

Cardon, G., De Bourdeaudhuij, I., & De Clercq, D. (2002). Knowledge and perceptions about back education among elementary school students, teachers, and parents in belgium. Journal of School Health, 72(3), 100-106. doi:10.1111/j.1746-1561.2002.tb06524.x

Castillo, J., Felip, N., Quintana, A., & Tort, A. (2014). ¿Hay lugar para las familias en la educación secundaria? percepciones y propuestas para una transformación del programa institucional de los centros educativos. Profesorado. Revista De Currículum Y Formación De Profesorado, 18(2)

Chaturvedi, S., & Shweta, R. C. (2015). Evaluation of inter-rater agreement and inter-rater reliability for observational data: An overview of concepts and methods. Journal of the Indian Academy of Applied Psychology, 41(3), 20-27.

Cohen, J. (1973). Eta-squared and partial eta-squared in fixed factor ANOVA designs. Educational and Psychological Measurement, 33(1), 107-112. doi:rg/10.1177/001316447303300111

de Barros, E. N., & Alexandre, N. M. (2003). Cross-cultural adaptation of the nordic musculoskeletal questionnaire. International Nursing Review, 50(2), 101-108. doi:rg/10.1046/j.1466-7657.2003.00188.x

Demetriou, Y., Sudeck, G., Thiel, A., & Hoener, O. (2015). The effects of school-based physical activity interventions on students' health-related fitness knowledge: A systematic review. Educational Research Review, 16, 19-40. doi:rg/10.1016/j.edurev.2015.07.002

Dullien, S., Grifka, J., & Jansen, P. (2018). Cluster-randomized, controlled evaluation of a teacher led multi factorial school based back education program for 10 to 12-year old children. BMC Pediatrics, 18(1), 1-10.

Ennis, C. D. (2007). 2006 CH McCloy research lecture: Defining learning as conceptual change in physical education and physical activity settings. Research Quarterly for Exercise and Sport, 78(3), 138-150. doi:rg/10.1080/02701367.2007.10599411

Fontecha, C. G., Balague, F., Pellise, F., Rajmil, L., Aguirre, M., Pasarin, M., . . . Ferrer, M. (2011). Low back pain in adolescents: Is quality of life poorer in those seeking medical attention? Spine, 36(17), 1154. doi:10.1097/BRS.0b013e318203ed5b

Greenwood, S. C., & McCabe, P. P. (2008). How learning contracts motivate students. Middle School Journal, 39(5), 13-22.

Habybabady, R. H., Ansari-Moghaddam, A., Mirzaei, R., Mohammadi, M., Rakhshani, M., & Khammar, A. (2012). Efficacy and impact of back care education on knowledge and behaviour of elementary schoolchildren. JPMA.the Journal of the Pakistan Medical Association, 62(6), 580-584.

Hall, P., & Weaver, L. (2001). Interdisciplinary education and teamwork: A long and winding road. Medical Education, 35(9), 867-875.

Hill, J. J., & Keating, J. L. (2015). Daily exercises and education for preventing low back pain in children: Cluster randomized controlled trial. Physical Therapy, 95(4), 507-516. doi:10.2522/ptj.20140273

Hwang, J., Louie, P. K., Phillips, F. M., An, H. S., & Samartzis, D. (2019). Low back pain in children: A rising concern. Eur Spine J, 28(2), 211. doi:rg/10.1007/s00586-018-5844-1

Jeffries, L. J., Milanese, S. F., & Grimmer-Somers, K. A. (2007). Epidemiology of adolescent spinal pain: A systematic overview of the research literature. Spine, 32(23), 2630-2637. doi:10.1097/BRS.0b013e318158d70b

Jones, M., Stratton, G., Reilly, T., & Unnithan, V. (2007). The efficacy of exercise as an intervention to treat recurrent nonspecific low back pain in adolescents. Pediatric Exercise Science, 19(3), 349-359.

Keating, X. D. (2003). The current often implemented fitness tests in physical education programs: Problems and future directions. Quest, 55(2), 141-160. doi:10.1080/00336297.2003.10491796

Keating, X. D., Harrison, L., Chen, L., Xiang, P., Lambdin, D. D., Dauenhauer, B., . . . Pinero, J. C. (2009). An analysis of research on student health-related fitness knowledge in K-16 physical education programs. Journal of Teaching in Physical Education, 28(3), 333-349.

Keogh-Brown, M. R., Bachmann, M. O., Shepstone, L., Hewitt, C., Howe, A., Ramsay, C. R., . . . Miles, S. (2007). Contamination in trials of educational interventions. Health Technolology Assessment, 11(43) doi:10.3310/hta11430

Kim, J., & Shin, W. (2014). How to do random allocation (randomization). Clinics in Orthopedic Surgery, 6(1), 103-109.

Kovacs, F., Gestoso, M., Gil del Real, M. T., Lopez, J., Mufraggi, N., & Mendez, J. I. (2003). Risk factors for non-specific low back pain in schoolchildren and their parents: A population based study. Pain, 103(3), 259-268.

Kovacs, F., Oliver-Frontera, M., Plana, M. N., Royuela, A., Muriel, A., Gestoso, M., & and the Spanish Back Pain Research Network. (2011). Improving schoolchildren's knowledge of methods for the prevention and management of low back pain: A cluster randomized controlled trial. Spine, 36(8), 505. doi:10.1097/BRS.0b013e3181dccebc

Kuorinka, I., Jonsson, B., Kilbom, A., Vinterberg, H., Biering-Sørensen, F., Andersson, G., & Jørgensen, K. (1987). Standardised nordic questionnaires for the analysis of musculoskeletal symptoms. Applied Ergonomics, 18(3), 233-237. doi:10.1016/0003-6870(87)90010-X

Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, , 159-174.

Leboeuf-Yde, C., & Kyvik, K. O. (1998). At what age does low back pain become a common problem? A study of 29,424 individuals aged 12-41 years. Spine, 23(2), 228-234.

Lee, J. H., Hoshino, Y., Nakamura, K., Kariya, Y., Saita, K., & Ito, K. (1999). Trunk muscle weakness as a risk factor for low back pain. A 5-year prospective study. Spine, 24(1), 54-57.

Lloyd, M., Colley, R. C., & Tremblay, M. S. (2010). Advancing the debate on ‘fitness testing’for children: Perhaps we’re riding the wrong animal. Pediatric Exercise Science, 22(2), 176-182. doi:rg/10.1123/pes.22.2.176

Mascolo, M. F. (2009). Beyond student-centered and teacher-centered pedagogy: Teaching and learning as guided participation. Pedagogy and the Human Sciences, 1(1), 3-27.

McGill, S. M., Childs, A., & Liebenson, C. (1999). Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normal database. Archives of Physical Medicine and Rehabilitation, 80(8), 941-944.

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377.

Mendez, F. J., & Gomez-Conesa, A. (2001). Postural hygiene program to prevent low back pain. Spine, 26(11), 1280-1286.

Michaleff, Z. A., Kamper, S. J., Maher, C. G., Evans, R., Broderick, C., & Henschke, N. (2014). Low back pain in children and adolescents: A systematic review and meta-analysis evaluating the effectiveness of conservative interventions. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 23(10), 2046-2058. doi:10.1007/s00586-014-3461-1 [doi]

Miñana-Signes, V., & Monfort-Pañego, M. (2015a). Back health in adolescents between 12-18 years of the valencian community, spain: Prevalence and consequences. J Spine, 4(237), 2. doi:rg/10.4172/2165-7939.1000237

Miñana-Signes, V., & Monfort-Pañego, M. (2015b). Design and validation of a health questionnaire about knowledge for health and back care related to the practice of physical activity and exercise for adolescents: COSACUES-AEF. Journal of Spine, 2015

Miñana-Signes, V., Monfort-Pañego, M., & Rosaleny-Maiques, S. (2019). Improvement of knowledge and postural habits after an educational intervention program in school students. Journal of Human Sport and Exercise, 14(1) doi:10.14198/jhse.2019.141.04

Miñana-Signes, V., & Monfort-Pañego, M. (2020). The conditioning of the trunk muscles and back health in physical education.

Miñana-Signes, V., Monfort-Pañego, M., & Valiente, J. (2021). Teaching back health in the school setting: A systematic review of randomized controlled trials doi:10.3390/ijerph18030979

Monfort-Pañego, M., & Miñana-Signes, V. (2020). Psychometric study and content validity of a questionnaire to assess back-health-related postural habits in daily activities. Measurement in Physical Education and Exercise Science, 1-10. doi:rg/10.1080/1091367X.2020.1784899

Monfort-Pañego, M., Molina-García, J., Miñana-Signes, V., Bosch-Biviá, A. H., Gómez-López, A., & Munguía-Izquierdo, D. (2016). Development and psychometric evaluation of a health questionnaire on back care knowledge in daily life physical activities for adolescent students. European Spine Journal, 1-6. doi:rg/10.1007/s00586-016-4627-9

Mosston, M. (1966). Teaching physical education: From command to discovery MacMillan Publishing Company.

Naylor, P., Nettlefold, L., Race, D., Hoy, C., Ashe, M. C., Higgins, J. W., & McKay, H. A. (2015). Implementation of school based physical activity interventions: A systematic review. Preventive Medicine, 72, 95-115.

Olfert, M. D., Barr, M. L., Charlier, C. M., Famodu, O. A., Zhou, W., Mathews, A. E., . . . Colby, S. E. (2018). Self-reported vs. measured height, weight, and BMI in young adults. International Journal of Environmental Research and Public Health, 15(10), 2216.

Pellise, F., Balague, F., Rajmil, L., Cedraschi, C., Aguirre, M., Fontecha, C. G., . . . Ferrer, M. (2009). Prevalence of low back pain and its effect on health-related quality of life in adolescents. Archives of Pediatrics & Adolescent Medicine, 163(1), 65-71. doi:10.1001/archpediatrics.2008.512

Ponte, P. R., Gross, A. H., Milliman-Richard, Y. J., & Lacey, K. (2010). Interdisciplinary teamwork and collaboration an essential element of a positive practice environment. Annual Review of Nursing Research, 28(1), 159-189.

Powell, M. A., & Graham, A. (2017). Wellbeing in schools: Examining the policy–practice nexus. The Australian Educational Researcher, 44(2), 213-231. doi:10.1007/s13384-016-0222-7

Rosa, B. N. d., Furlanetto, T. S., Noll, M., Sedrez, J. A., Schmit, E. F. D., & Candotti, C. T. (2017). 4-year longitudinal study of the assessment of body posture, back pain, postural and life habits of schoolchildren. Motricidade, 13(4), 3-12.

Salminen, J. J., Erkintalo, M., Laine, M., & Pentti, J. (1995). Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain. Spine, 20(19), 2101-7; discussion 2108.

Sjolie, A. N., & Ljunggren, A. E. (2001). The significance of high lumbar mobility and low lumbar strength for current and future low back pain in adolescents. Spine, 26(23), 2629-2636.

Steele, E. J., Dawson, A. P., & Hiller, J. E. (2006). School-based interventions for spinal pain: A systematic review. Spine, 31(2), 226-233. doi:10.1097/01.brs.0000195158.00680.0d

Steffens, D., Maher, C. G., Pereira, L. S., Stevens, M. L., Oliveira, V. C., Chapple, M., . . . Hancock, M. J. (2016). Prevention of low back pain: A systematic review and meta-analysis. JAMA Internal Medicine, 176(2), 199-208.

Strand, S. L., Hjelm, J., Shoepe, T. C., & Fajardo, M. A. (2014). Norms for an isometric muscle endurance test. Journal of Human Kinetics, 40(1), 93-102.

Trevelyan, F. C., & Legg, S. J. (2006). Back pain in school children—Where to from here? Applied Ergonomics, 37(1), 45-54. doi:10.1016/j.apergo.2004.02.008

Vera-García, F. J., Arroyo Fenoll, N., López Elvira, J. L., Alonso Roque, J. I., Flores-Parodi, B., & Sarti, M. A. (2005). Eficacia de cuatro juegos motores para el acondicionamiento de los músculos del abdomen. Motricidad.European Journal of Human Movement 14, 79, 91

Vera-García, F. J., Roque, J. I. A., Fenoll, N. A., Martínez, M. J. S., Elvira, J. L. L., & Flores-Parodi, B. (2005). Juegos motores: Una alternativa para fortalecer los músculos del abdomen. Apunts: Educación Física Y Deportes, (79), 80-85.

Vidal, J., Borras, P. A., Ortega, F. B., Cantallops, J., Ponseti, X., & Palou, P. (2011). Effects of postural education on daily habits in children. International Journal of Sports Medicine, 32(4), 303-308. doi:10.1055/s-0030-1270469

Vidal, J., Borras, P. A., Ponseti, F. J., Cantallops, J., Ortega, F. B., & Palou, P. (2013). Effects of a postural education program on school backpack habits related to low back pain in children. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 22(4), 782-787. doi:10.1007/s00586-012-2558-7; 10.1007/s00586-012-2558-7

Wohlfarth, D., Sheras, D., Bennett, J. L., Simon, B., Pimentel, J. H., & Gabel, L. E. (2008). Student perceptions of learner-centered teaching. Insight: A Journal of Scholarly Teaching, 3, 67-74.






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