Digital Back Care for Children - Evaluating a Multidimensional Prevention Program for Primary School Children

Postural deviations are common in childhood (Batistão et al., 2016; Wilczyński et al., 2020; Yang et al., 2020) and continue to change significantly throughout various growth phases (Dolphens et al., 2012; Lafond et al., 2007). It is assumed that postural misalignments may place dysfunctional strain on the musculoskeletal system, potentially leading to chronic pain or functional impairments later in life (Sharma & Rawat, 2023). Although empirical findings on the direct relationship between posture and back pain remain inconclusive (Kamper et al., 2016), back pain is also recognized as a relevant health issue even in early developmental stages. It is highly prevalent across the population and is associated with considerable costs for healthcare systems (WIdO, 2023). These complaints are already present in childhood, with prevalence increasing with age (Greiner et al., 2018; Krause et al., 2019). Building on this background, the present thesis examines body posture and back pain in middle childhood, while also exploring the relevane of the diagnostic tool (Study 1) and their connections to other physical and psychological health dimensions during this important developmental period (Study 2 and 3). Study 1 focused on comparing two commonly used diagnostic tools for posture assessment in children: a visual orthopedic examination and a rasterstereographic scan conducted with the DIERS formetric system. While both methods identified a high prevalence of postural deviations in the third-grade sample, the technical scan detected significantly more abnormalities, particularly in spinal curvature. These discrepancies highlight methodological differences in detection thresholds and raise important Summary 7 questions regarding the cost-benefit ratio and accessibility of different tools in the context of postural assessment. Studies 2 and 3 examined children’s body posture in relation to additional physical and psychological factors. While Study 2 focused on identifying correlations between these variables, Study 3 employed a longitudinal design to explore potential causal relationships. Both studies were conducted as part of the project “BackFit – From the Very Beginning – For a Lifetime”. Study 2 focused on the associations between body posture, muscular fitness, psychological well-being, self-compassion, and physical self-concept, based on data collected during the pretesting of the intervention. The results revealed associations within the physical and within the psychological dimensions, but no significant connections were found between any physical and psychological variables. Study 3 evaluated the feasibility and effectiveness of a digital back-care program designed for children aged 7 to 11 years. The 12-week intervention combined physical exercises with educational content aimed at improving knowledge about the structure and function of the back, as well as postural awareness. Delivered through an interactive, web-based platform, the program targeted improvements in posture, muscular fitness, and psychological well-being, including self-compassion and physical self-concept. The active control group followed a parallel 12-week program delivered through the same platform, consisting of weekly educational videos on general health promotion topics without a specific focus on back health. While the program led to improvements in back-related knowledge and self-compassion, no significant effects were observed in the other assessed domains. Taken together, the three studies contribute to a more differentiated understanding of postural health in middle childhood and highlight the importance of better understanding psychophysical development and its trajectories during this critical period.