Pain Smart Education research output

O’Sullivan, Isobel C.; da Costa, Nathalia Cordeiro; Smith, Melinda M. Franettovich; Vicenzino, Bill; Crossley, Kay M.; Kamper, Steven J.; van Middelkoop, Marienke; Menz, Hylton B.; Tucker, Kylie; O’Leary, Karina T.; Collins, Natalie J.

Adolescent perspectives on participating in a feasibility trial investigating shoe inserts for patellofemoral pain Journal Article

In: J Foot Ankle Res, vol. 15, no. 1, 2022, ISSN: 1757-1146.

Abstract | Links | BibTeX | Tags: Knee Pain, Orthopedics and Sports Medicine

@article{O’Sullivan2022,

title = {Adolescent perspectives on participating in a feasibility trial investigating shoe inserts for patellofemoral pain},

author = {Isobel C. O’Sullivan and Nathalia Cordeiro da Costa and Melinda M. Franettovich Smith and Bill Vicenzino and Kay M. Crossley and Steven J. Kamper and Marienke van Middelkoop and Hylton B. Menz and Kylie Tucker and Karina T. O’Leary and Natalie J. Collins},

url = {https://painsmart-education.sydney.edu.au/wp-content/uploads/2024/03/Adolescent-perspectives-on-participating-in-a-.pdf, PDF},

doi = {10.1186/s13047-022-00537-4},

issn = {1757-1146},

year  = {2022},

date = {2022-12-00},

urldate = {2022-12-00},

journal = {J Foot Ankle Res},

volume = {15},

number = {1},

publisher = {Wiley},

abstract = {<jats:title>Abstract</jats:title><jats:sec>

                <jats:title>Background</jats:title>

                <jats:p>Patellofemoral pain (PFP) affects one-quarter of adolescents, yet there are few evidence-informed recommendations to treat PFP in this population. HAPPi Kneecaps! is a randomised, controlled, participant- and assessor-blind, parallel-group feasibility trial of shoe inserts for adolescents with PFP. The aim of this qualitative study was to explore adolescents’ perspectives of participating in HAPPi Kneecaps!.</jats:p>

              </jats:sec><jats:sec>

                <jats:title>Methods</jats:title>

                <jats:p>All 36 adolescents with PFP from the HAPPi Kneecaps! study were invited to participate in semi-structured interviews. We used a descriptive qualitative methodology underpinned by a relativist framework to investigate adolescents’ perspectives on participating in the trial. Inductive thematic analysis was used to examine patterns regarding how each adolescent experienced the HAPPi Kneecaps! study within their social, cultural, and historical contexts.</jats:p>

              </jats:sec><jats:sec>

                <jats:title>Results</jats:title>

                <jats:p>14 out of 36 HAPPi Kneecaps! participants provided consent and participated in interviews (12 females; mean [SD] age 14.9 [2.4] years). Overall, most adolescents responded positively when discussing their experience, such as improvements in their knee pain and satisfaction with how the study was run. Major themes that were generated from the analysis and feedback were: (1) shoe inserts require little effort to use; (2) perceptions of the program were generally positive; (3) participation in the trial could be made easier; (4) warm weather matters; and (5) life happens.</jats:p>

              </jats:sec><jats:sec>

                <jats:title>Conclusion</jats:title>

                <jats:p>Adolescents with PFP who participated in the HAPPi Kneecaps! study found that shoe inserts were easy to wear. Most adolescents experienced an improvement in their symptoms and enhanced participation in sport and exercise. Adolescents with PFP prefer an option for warmer climates (e.g. flip flops or sandals), access to online logbooks, and clinicians who are easily accessible.</jats:p>

              </jats:sec><jats:sec>

                <jats:title>Trial registration</jats:title>

                <jats:p>Australian New Zealand Clinical Trials Registry (ANZCTR): <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377749&isReview=true">ACTRN12619000957190</jats:ext-link>. Date registered: 8/07/2019.</jats:p>

              </jats:sec>},

keywords = {Knee Pain, Orthopedics and Sports Medicine},

pubstate = {published},

tppubtype = {article}

}

Close

Abstract
Background
Patellofemoral pain (PFP) affects one-quarter of adolescents, yet there are few evidence-informed recommendations to treat PFP in this population. HAPPi Kneecaps! is a randomised, controlled, participant- and assessor-blind, parallel-group feasibility trial of shoe inserts for adolescents with PFP. The aim of this qualitative study was to explore adolescents’ perspectives of participating in HAPPi Kneecaps!.

Methods
All 36 adolescents with PFP from the HAPPi Kneecaps! study were invited to participate in semi-structured interviews. We used a descriptive qualitative methodology underpinned by a relativist framework to investigate adolescents’ perspectives on participating in the trial. Inductive thematic analysis was used to examine patterns regarding how each adolescent experienced the HAPPi Kneecaps! study within their social, cultural, and historical contexts.

Results
14 out of 36 HAPPi Kneecaps! participants provided consent and participated in interviews (12 females; mean [SD] age 14.9 [2.4] years). Overall, most adolescents responded positively when discussing their experience, such as improvements in their knee pain and satisfaction with how the study was run. Major themes that were generated from the analysis and feedback were: (1) shoe inserts require little effort to use; (2) perceptions of the program were generally positive; (3) participation in the trial could be made easier; (4) warm weather matters; and (5) life happens.

Conclusion
Adolescents with PFP who participated in the HAPPi Kneecaps! study found that shoe inserts were easy to wear. Most adolescents experienced an improvement in their symptoms and enhanced participation in sport and exercise. Adolescents with PFP prefer an option for warmer climates (e.g. flip flops or sandals), access to online logbooks, and clinicians who are easily accessible.

Trial registration
Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000957190. Date registered: 8/07/2019.

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Santos, Veronica Souza; Kamper, Steven J.; Camargo, Barbara Isabel Aparecida; Leite, Mariana Nascimento; Saragiotto, Bruno T.; Costa, Leonardo O. P.; Yamato, Tiê P.

Translation, cross-cultural adaptation, and measurement properties of the psychosomatic questionnaire for children and adolescents with musculoskeletal pain into Brazilian-Portuguese Journal Article

In: Brazilian Journal of Physical Therapy, vol. 26, no. 3, 2022, ISSN: 1413-3555.

Links | BibTeX | Tags: Orthopedics and Sports Medicine, Pain, Physical Therapy, Rehabilitation, Sports Therapy and Rehabilitation

O'Sullivan, Isobel C.; da Costa, Nathalia Cordeiro; Smith, Melinda M. Franettovich; Vicenzino, Bill; Crossley, Kay M.; Kamper, Steven J.; van Middelkoop, Marienke; Menz, Hylton B.; Tucker, Kylie; O'Leary, Karina T.; Collins, Natalie J.

Adolescent perspectives on participating in a feasibility trial investigating shoe inserts for patellofemoral pain Journal Article

In: Journal of Foot and Ankle Research, vol. 15, no. 1, 2022, ISSN: 1757-1146.

Abstract | Links | BibTeX | Tags: Orthopedics and Sports Medicine

@article{O'Sullivan2022,

title = {Adolescent perspectives on participating in a feasibility trial investigating shoe inserts for patellofemoral pain},

author = {Isobel C. O'Sullivan and Nathalia Cordeiro da Costa and Melinda M. Franettovich Smith and Bill Vicenzino and Kay M. Crossley and Steven J. Kamper and Marienke van Middelkoop and Hylton B. Menz and Kylie Tucker and Karina T. O'Leary and Natalie J. Collins},

url = {https://painsmart-education.sydney.edu.au/wp-content/uploads/2024/03/Adolescent-Perspectives-on-Participating-in-a-Feasibility-Trial-Investigating-Shoe-Inserts-for-Patellofemoral-Pain-1.pdf, PDF},

doi = {10.1186/s13047-022-00537-4},

issn = {1757-1146},

year  = {2022},

date = {2022-01-00},

urldate = {2022-01-00},

journal = {Journal of Foot and Ankle Research},

volume = {15},

number = {1},

publisher = {Wiley},

abstract = {<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Patellofemoral pain (PFP) affects one‐quarter of adolescents, yet there are few evidence‐informed recommendations to treat PFP in this population. HAPPi Kneecaps! is a randomised, controlled, participant‐ and assessor‐blind, parallel‐group feasibility trial of shoe inserts for adolescents with PFP. The aim of this qualitative study was to explore adolescents' perspectives of participating in HAPPi Kneecaps!.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>All 36 adolescents with PFP from the HAPPi Kneecaps! study were invited to participate in semi‐structured interviews. We used a descriptive qualitative methodology underpinned by a relativist framework to investigate adolescents' perspectives on participating in the trial. Inductive thematic analysis was used to examine patterns regarding how each adolescent experienced the HAPPi Kneecaps! study within their social, cultural, and historical contexts.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>14 out of 36 HAPPi Kneecaps! participants provided consent and participated in interviews (12 females; mean [SD] age 14.9 [2.4] years). Overall, most adolescents responded positively when discussing their experience, such as improvements in their knee pain and satisfaction with how the study was run. Major themes that were generated from the analysis and feedback were: (1) shoe inserts require little effort to use; (2) perceptions of the program were generally positive; (3) participation in the trial could be made easier; (4) warm weather matters; and (5) life happens.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Adolescents with PFP who participated in the HAPPi Kneecaps! study found that shoe inserts were easy to wear. Most adolescents experienced an improvement in their symptoms and enhanced participation in sport and exercise. Adolescents with PFP prefer an option for warmer climates (e.g. flip flops or sandals), access to online logbooks, and clinicians who are easily accessible.</jats:p></jats:sec><jats:sec><jats:title>Trial registration</jats:title><jats:p>Australian New Zealand Clinical Trials Registry (ANZCTR): <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377749&isReview=true">ACTRN12619000957190</jats:ext-link>. Date registered: 8/07/2019.</jats:p></jats:sec>},

keywords = {Orthopedics and Sports Medicine},

pubstate = {published},

tppubtype = {article}

}

Close

AbstractBackgroundPatellofemoral pain (PFP) affects one‐quarter of adolescents, yet there are few evidence‐informed recommendations to treat PFP in this population. HAPPi Kneecaps! is a randomised, controlled, participant‐ and assessor‐blind, parallel‐group feasibility trial of shoe inserts for adolescents with PFP. The aim of this qualitative study was to explore adolescents' perspectives of participating in HAPPi Kneecaps!.MethodsAll 36 adolescents with PFP from the HAPPi Kneecaps! study were invited to participate in semi‐structured interviews. We used a descriptive qualitative methodology underpinned by a relativist framework to investigate adolescents' perspectives on participating in the trial. Inductive thematic analysis was used to examine patterns regarding how each adolescent experienced the HAPPi Kneecaps! study within their social, cultural, and historical contexts.Results14 out of 36 HAPPi Kneecaps! participants provided consent and participated in interviews (12 females; mean [SD] age 14.9 [2.4] years). Overall, most adolescents responded positively when discussing their experience, such as improvements in their knee pain and satisfaction with how the study was run. Major themes that were generated from the analysis and feedback were: (1) shoe inserts require little effort to use; (2) perceptions of the program were generally positive; (3) participation in the trial could be made easier; (4) warm weather matters; and (5) life happens.ConclusionAdolescents with PFP who participated in the HAPPi Kneecaps! study found that shoe inserts were easy to wear. Most adolescents experienced an improvement in their symptoms and enhanced participation in sport and exercise. Adolescents with PFP prefer an option for warmer climates (e.g. flip flops or sandals), access to online logbooks, and clinicians who are easily accessible.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000957190. Date registered: 8/07/2019.

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O’Sullivan, Isobel C.; Crossley, Kay M.; Kamper, Steven J.; van Middelkoop, Marienke; Vicenzino, Bill; Smith, Melinda M. Franettovich; Menz, Hylton B.; Smith, Anne J.; Tucker, Kylie; O’Leary, Karina T.; Costa, Nathalia; Collins, Natalie J.

HAPPi Kneecaps! A double-blind, randomised, parallel group superiority trial investigating the effects of sHoe inserts for adolescents with patellofemoral PaIn: phase II feasibility study Journal Article

In: J Foot Ankle Res, vol. 14, no. 1, 2021, ISSN: 1757-1146.

Abstract | Links | BibTeX | Tags: Knee Pain, Orthopedics and Sports Medicine

@article{O’Sullivan2021,

title = {HAPPi Kneecaps! A double-blind, randomised, parallel group superiority trial investigating the effects of sHoe inserts for adolescents with patellofemoral PaIn: phase II feasibility study},

author = {Isobel C. O’Sullivan and Kay M. Crossley and Steven J. Kamper and Marienke van Middelkoop and Bill Vicenzino and Melinda M. Franettovich Smith and Hylton B. Menz and Anne J. Smith and Kylie Tucker and Karina T. O’Leary and Nathalia Costa and Natalie J. Collins},

url = {https://painsmart-education.sydney.edu.au/wp-content/uploads/2024/03/HAPPi-Kneecaps_A-double-blind-randomised_Phase-II-feasibility-study.pdf, PDF},

doi = {10.1186/s13047-021-00498-0},

issn = {1757-1146},

year  = {2021},

date = {2021-12-00},

urldate = {2021-12-00},

journal = {J Foot Ankle Res},

volume = {14},

number = {1},

publisher = {Wiley},

abstract = {<jats:title>Abstract</jats:title><jats:sec>

                <jats:title>Background</jats:title>

                <jats:p>Patellofemoral pain (PFP) affects one-third of adolescents and can persist into adulthood, negatively impacting health and quality of life. Foot orthoses are a recommended treatment for adults with PFP, but have not been evaluated in adolescents. The primary objective was to determine the feasibility of conducting a full-scale randomised controlled trial (RCT) evaluating effects of contoured, prefabricated foot orthoses on knee pain severity and patient-perceived global change, compared to flat insoles. The secondary objective was to describe outcomes on a range of patient-reported outcome measures.</jats:p>

              </jats:sec><jats:sec>

                <jats:title>Methods</jats:title>

                <jats:p>We recruited adolescents aged 12–18 years with PFP of ≥2 months duration into a double-blind, randomised, parallel-group feasibility trial. Participants were randomised to receive prefabricated contoured foot orthoses or flat shoe insoles, and followed for 3 months. Participants and outcome assessors were blinded to group allocation. Primary outcomes were feasibility of a full-scale RCT (number of eligible/enrolled volunteers; recruitment rate; adherence with the intervention and logbook completion; adverse effects; success of blinding; drop-out rate), and credibility and expectancy of interventions. Secondary outcomes were patient-reported measures of pain, symptoms, function, quality of life, global rating of change, patient acceptable symptom state, and use of co-interventions.</jats:p>

              </jats:sec><jats:sec>

                <jats:title>Results</jats:title>

                <jats:p>36 out of 279 (12.9%) volunteers (27 female, mean (SD) age 15 (2) years, body mass 60 (13) kg) were eligible and enrolled, at a recruitment rate of 1.2 participants/week. 17 participants were randomised to receive foot orthoses, and 19 to flat insoles. 15 participants returned logbooks; 7/15 (47%) adhered to the intervention. No serious adverse events were reported. 28% (10/36, 4 pandemic-related) of participants dropped out before 3 months. Blinding was successful. Both groups found the inserts to be credible.</jats:p>

              </jats:sec><jats:sec>

                <jats:title>Conclusions</jats:title>

                <jats:p>Based on a priori criteria for feasibility, findings suggest that a full-scale RCT comparing contoured foot orthoses to flat insoles in adolescents with PFP would not be feasible using the current protocol. Prior to conducting a full-scale RCT, feasibility issues should be addressed, with protocol modifications to facilitate participant retention, logbook completion and shoe insert wear.</jats:p>

              </jats:sec><jats:sec>

                <jats:title>Trial registration</jats:title>

                <jats:p>Australian New Zealand Clinical Trials Registry (ANZCTR): <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377749">ACTRN12619000957190</jats:ext-link>. Date registered: 8/07/2019.</jats:p>

              </jats:sec>},

keywords = {Knee Pain, Orthopedics and Sports Medicine},

pubstate = {published},

tppubtype = {article}

}

Close

Abstract
Background
Patellofemoral pain (PFP) affects one-third of adolescents and can persist into adulthood, negatively impacting health and quality of life. Foot orthoses are a recommended treatment for adults with PFP, but have not been evaluated in adolescents. The primary objective was to determine the feasibility of conducting a full-scale randomised controlled trial (RCT) evaluating effects of contoured, prefabricated foot orthoses on knee pain severity and patient-perceived global change, compared to flat insoles. The secondary objective was to describe outcomes on a range of patient-reported outcome measures.

Methods
We recruited adolescents aged 12–18 years with PFP of ≥2 months duration into a double-blind, randomised, parallel-group feasibility trial. Participants were randomised to receive prefabricated contoured foot orthoses or flat shoe insoles, and followed for 3 months. Participants and outcome assessors were blinded to group allocation. Primary outcomes were feasibility of a full-scale RCT (number of eligible/enrolled volunteers; recruitment rate; adherence with the intervention and logbook completion; adverse effects; success of blinding; drop-out rate), and credibility and expectancy of interventions. Secondary outcomes were patient-reported measures of pain, symptoms, function, quality of life, global rating of change, patient acceptable symptom state, and use of co-interventions.

Results
36 out of 279 (12.9%) volunteers (27 female, mean (SD) age 15 (2) years, body mass 60 (13) kg) were eligible and enrolled, at a recruitment rate of 1.2 participants/week. 17 participants were randomised to receive foot orthoses, and 19 to flat insoles. 15 participants returned logbooks; 7/15 (47%) adhered to the intervention. No serious adverse events were reported. 28% (10/36, 4 pandemic-related) of participants dropped out before 3 months. Blinding was successful. Both groups found the inserts to be credible.

Conclusions
Based on a priori criteria for feasibility, findings suggest that a full-scale RCT comparing contoured foot orthoses to flat insoles in adolescents with PFP would not be feasible using the current protocol. Prior to conducting a full-scale RCT, feasibility issues should be addressed, with protocol modifications to facilitate participant retention, logbook completion and shoe insert wear.

Trial registration
Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000957190. Date registered: 8/07/2019.

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Swain, Michael; Kamper, Steven J; Maher, Christopher G; Broderick, Carolyn; McKay, Damien; Henschke, Nicholas

Relationship between growth, maturation and musculoskeletal conditions in adolescents: a systematic review Journal Article

In: Br J Sports Med, vol. 52, no. 19, pp. 1246–1252, 2018, ISSN: 1473-0480.

Abstract | Links | BibTeX | Tags: General Medicine, Msk (Pain), Orthopedics and Sports Medicine, Physical Therapy, Sports Therapy and Rehabilitation

@article{Swain2018,

title = {Relationship between growth, maturation and musculoskeletal conditions in adolescents: a systematic review},

author = {Michael Swain and Steven J Kamper and Christopher G Maher and Carolyn Broderick and Damien McKay and Nicholas Henschke},

url = {https://painsmart-education.sydney.edu.au/wp-content/uploads/2024/03/Relationship-between-growth-maturation-and-musculoskeletal-conditions-in-adolescents-a-systematic-review.pdf, PDF},

doi = {10.1136/bjsports-2017-098418},

issn = {1473-0480},

year  = {2018},

date = {2018-10-00},

urldate = {2018-10-00},

journal = {Br J Sports Med},

volume = {52},

number = {19},

pages = {1246--1252},

publisher = {BMJ},

abstract = {<jats:sec><jats:title>Objective</jats:title><jats:p>To determine whether there is a relationship between physical growth and development, as determined by markers of biological maturation, and musculoskeletal conditions in adolescents.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Systematic review.</jats:p></jats:sec><jats:sec><jats:title>Data sources</jats:title><jats:p>Electronic databases (PubMed, EMBASE and the Cumulative Index to Nursing and Allied Health Literature) were searched up to 6 September 2017.</jats:p></jats:sec><jats:sec><jats:title>Eligibility criteria for selecting studies</jats:title><jats:p>Studies that evaluated the association between biological maturation or growth and musculoskeletal conditions in adolescents (chronological age 10–19 years).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>From 20 361 titles identified by the searches, 511 full-text articles were retrieved and assessed for eligibility; 56 studies, all at high risk of bias, evaluating the relationship between maturation and/or growth and musculoskeletal conditions were included. A total of 208 estimates of association were identified across the included studies, which generally indicated no association or an unclear association between maturation, growth and musculoskeletal conditions.</jats:p></jats:sec><jats:sec><jats:title>Summary/Conclusions</jats:title><jats:p>While the relationship between maturation, growth and musculoskeletal conditions remains plausible, the available evidence is not supportive. The current body of knowledge is at high risk of bias, which impedes our ability to establish whether biological maturity and growth are independent risk factors for musculoskeletal conditions.</jats:p></jats:sec>},

keywords = {General Medicine, Msk (Pain), Orthopedics and Sports Medicine, Physical Therapy, Sports Therapy and Rehabilitation},

pubstate = {published},

tppubtype = {article}

}

Close

Yamato, Tiê Parma; Maher, Chris G; Traeger, Adrian C; Wiliams, Christopher M; Kamper, Steve J

Do schoolbags cause back pain in children and adolescents? A systematic review Journal Article

In: Br J Sports Med, vol. 52, no. 19, pp. 1241–1245, 2018, ISSN: 1473-0480.

Abstract | Links | BibTeX | Tags: Back Pain, General Medicine, Orthopedics and Sports Medicine, Physical Therapy, Sports Therapy and Rehabilitation

@article{Yamato2018,

title = {Do schoolbags cause back pain in children and adolescents? A systematic review},

author = {Tiê Parma Yamato and Chris G Maher and Adrian C Traeger and Christopher M Wiliams and Steve J Kamper},

url = {https://painsmart-education.sydney.edu.au/wp-content/uploads/2024/03/Do-schoolbags-cause-back-pain-in-children-and-adolescents-A-systematic-review.pdf, PDF},

doi = {10.1136/bjsports-2017-098927},

issn = {1473-0480},

year  = {2018},

date = {2018-10-00},

urldate = {2018-10-00},

journal = {Br J Sports Med},

volume = {52},

number = {19},

pages = {1241--1245},

publisher = {BMJ},

abstract = {<jats:sec><jats:title>Objective</jats:title><jats:p>To investigate whether characteristics of schoolbag use are risk factors for back pain in children and adolescents.</jats:p></jats:sec><jats:sec><jats:title>Data sources</jats:title><jats:p>Electronic searches of MEDLINE, EMBASE and CINAHL databases up to April 2016.</jats:p></jats:sec><jats:sec><jats:title>Eligibility criteria for selecting studies</jats:title><jats:p>Prospective cohort studies, cross-sectional and randomised controlled trials conducted with children or adolescents. The primary outcome was an episode of back pain and the secondary outcomes were an episode of care seeking and school absence due to back pain. We weighted evidence from longitudinal studies above that from cross-sectional. The risk of bias of the longitudinal studies was assessed by a modified version of the Quality in Prognosis Studies tool.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included 69 studies (n=72 627), of which five were prospective longitudinal and 64 cross-sectional or retrospective. We found evidence from five prospective studies that schoolbag characteristics such as weight, design and carriage method do not increase the risk of developing back pain in children and adolescents. The included studies were at moderate to high risk of bias. Evidence from cross-sectional studies aligned with that from longitudinal studies (ie, there was no consistent pattern of association between schoolbag use or type and back pain). We were unable to pool results due to different variables and inconsistent results.</jats:p></jats:sec><jats:sec><jats:title>Summary/conclusion</jats:title><jats:p>There is no convincing evidence that aspects of schoolbag use increase the risk of back pain in children and adolescents.</jats:p></jats:sec>},

keywords = {Back Pain, General Medicine, Orthopedics and Sports Medicine, Physical Therapy, Sports Therapy and Rehabilitation},

pubstate = {published},

tppubtype = {article}

}