Risk factors for the first episode of low back pain in children are infrequently validated across samples and conditions: a systematic review.

QUESTION What risk factors have been identified for the first episode of low back pain in children and adolescents? Have these risk factors been validated? DESIGN Systematic review of prospective studies designed to identify possible modifiable and non-modifiable risk factors for the onset of low back pain in children and adolescents. PARTICIPANTS School children aged up to 18 years without low back pain at enrolment. RESULTS Five studies were included in the review. The included studies varied considerably in methods used to gather data, definitions of low back pain, and recall periods for an episode of low back pain. Forty-seven possible risk factors had been assessed for association with a first episode of low back pain in children. Of these, 13 were significantly associated with a first episode of low back pain. No risk factor was found to be associated with future low back pain in children in more than one study. CONCLUSION Inconsistency in definitions of low back pain, pre-defined recall periods, and methods used to collect and analyse data limit conclusions that can be drawn about factors that identify children at risk of developing low back pain. As no risk factor has been validated in independent investigation, we have no certainty that any factor places children at risk of developing low back pain.