1 Cancelliere C, et al. BMJ Open 2020;10:e038534. doi:10.1136/bmjopen-2020-038534 Open access Rehabilitative management of back pain in children: protocol for a mixed studies systematic review Carol Cancelliere , 1,2 Jessica J Wong, 1,2,3,4 Hainan Yu, 1,2,4 Silvano Mior , 2,4 Ginny Brunton, 1,5,6 Heather M Shearer, 1,2,7 David Rudoler, 1 Lise Hestbæk, 8,9 Efrosini Papaconstantinou, 1 Christine Cedraschi, 10,11 Michael Swain, 12 Gaelan Connell, 1,2,13 Leslie Verville, 1,2 Anne Taylor-Vaisey, 2,4 Pierre Côté 1,2,3,7 To cite: Cancelliere C, Wong JJ, Yu H, et al. Rehabilitative management of back pain in children: protocol for a mixed studies systematic review. BMJ Open 2020;10:e038534. doi:10.1136/ bmjopen-2020-038534 ► Prepublication history and additional materials for this paper is available online. To view these fles, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2020- 038534). Received 13 March 2020 Revised 03 September 2020 Accepted 08 September 2020 For numbered affliations see end of article. Correspondence to Dr Carol Cancelliere; carolina.cancelliere@ ontariotechu.ca Protocol © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Introduction Little is known about effective, effcient and acceptable management of back pain in children. A comprehensive and updated evidence synthesis can help to inform clinical practice. Objective To inform clinical practice, we aim to conduct a systematic review of the literature and synthesise the evidence regarding effective, cost–effective and safe rehabilitation interventions for children with back pain to improve their functioning and other health outcomes. Methods and analysis We will search MEDLINE, Embase, PsycINFO, CINAHL, the Index to Chiropractic Literature, the Cochrane Controlled Register of Trials and EconLit for primary studies published from inception in all languages. We will include quantitative studies (randomised controlled trials, cohort and case–control studies), qualitative studies, mixed-methods studies and full economic evaluations. To augment our search of the bibliographic electronic databases, we will search reference lists of included studies and relevant systematic reviews, the WHO International Clinical Trials Registry Platform and consult with content experts. We will assess the risk of bias using appropriate critical appraisal tools. We will extract data about study and participant characteristics, intervention type and comparators, context and setting, outcomes, themes and methodological quality assessment. We will use a sequential approach at the review level to integrate data from the quantitative, qualitative and economic evidence syntheses. Ethics and dissemination Ethics approval is not required. We will disseminate fndings through activities, including (1) presentations in national and international conferences; (2) meetings with national and international decision makers; (3) publications in peer-reviewed journals and (4) posts on organisational websites and social media. PROSPERO registration number CRD42019135009. INTRODUCTION Rationale A significant proportion of children over 10 years of age suffer from back pain. 1–5 The prevalence of back pain in children ranges between 4% and 74%; the wide range is due to heterogeneous populations studied, outcome measurements and methodologies used. 6 7 Data from the WHO Global Burden of Disease study in 2017 shows that low back pain is the leading cause of global years lived with disability. 8 Back pain begins early in life with physical, mental and social consequences (eg, impact on school-related and sporting activities, general physical activity and well- being) that extend into adulthood. 9–11 Most episodes of spinal pain are brief; however, in a 3-year prospective cohort study of 1465 school children in Denmark, up to 25% of children had three or more episodes over 1 year, and approximately 13% of children reported episodes lasting 5 or more weeks. 12 Two recent systematic reviews assessed the effectiveness of manual therapy to treat a number of conditions including back pain in children, but low-quality evidence precludes drawing conclusions. 13 14 A previous system- atic review and meta-analysis which evaluated the effectiveness of conservative interven- tions for low back pain in children under 18 years of age reported that exercise inter- ventions may be promising for improving pain scores in children compared with no Strengths and limitations of this study ► A systematic review integrating quantitative, quali- tative and economic evidence to examine the reha- bilitative management of back pain in children. ► Includes studies with a broad range of rehabil- itation interventions as described by the WHO, and outcomes as described by the International Classifcation of Functioning, Disability and Health framework. ► Implements the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. ► There is no language restriction in articles. ► Our search strategies, while comprehensive, may miss relevant studies. on August 28, 2022 by guest. 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