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Table 2 Description of intervention content and change strategies

From: Effectiveness of a theory-based back care intervention on spine-related behavior among pupils: a school-based randomised controlled trial (T-Bak study)

  Content Change strategies
Session 1.
(Improvement of beliefs)
Benefits of healthy back behavior and back pain prevention. When having a backache, sitting, swimming, running, participating in physical education, cycling and lifting heavy objects are dangerous. - Group discussion
- Role playing
- Recording pupils’ thoughts and experiences about back pain
Session 2.
(Improvement of knowledge)
A review of the anatomy of the spine focused on the three natural curves in the spine and the importance of maintaining an ‘S’ curve versus a ‘C’ curve during daily activity. Instruction of proper posture during sitting, standing, lifting a load, carrying a load, transferring a load; packing a backpack and correctly carrying a backpack. - Lecture
- Brainstorm, Q & A
- Slides show
- Posters
- Pamphlets
Session 3,4.
(Improvement of skills)
Mastery learning and practical demonstration of the back care essential skills included: - Direct experience
- Vicarious experience
1- Backpack wearing techniques: - Demonstration,
re- demonstration
• Using 2 straps.
• Firming both straps to keep the pack above the waist.  
• Balancing the load so the heaviest books are closer to the back.
• Not carrying more than 10% of the body weight.
2- Maintain a neutral spine:
• Keeping the ‘S’ curve.
• Avoiding the ‘C’ curve for good posture.
3- Lifting techniques:
• Keeping feet apart.
• Bending the knees and not waist.
• Keeping the load close to the body.
• Keeping the back straight.
• Pushing up with the legs.
4- Carrying techniques:
• Keeping the load close.
• Bending the knees to set the load down.
5- Balancing the load:
• Using 2 smaller bags instead of 1 large bag.
• Carrying items in both hands.
6- Picking up a load from a Table:
• Pivoting or moving the feet, not twisting.
• Keeping the load close.
7- Proper sitting posture:
• Sitting up straight. Avoiding slouching forward.
• Keeping both feet on the floor.
• Rolling side to side to feel the ‘sit bones’.
8- Proper standing posture:
• Standing up straight like a stack of bricks.
• Lining up the ear – shoulder – hip – knee – ankle.
• Pulling in the belly button to tuck the hips in correctly.
• Rolling the shoulders back.
Session 5,6.
(Improvement of self-efficacy)
1- Achieving back strengthening and flexibility exercises. - Mastery experience
- Goal setting
2- Attaining a natural curvature of the spine:
• Keeping the ‘S’ curve.
• Avoiding the ‘C’ curve for good posture.
- Social modeling
- Improving physical and emotional states
3- Minimal loading of the book bag. - Verbal persuasion
4- Paying attention to ergonomically postures during sitting, standing, lifting a load, carrying a load, transferring a load, and carrying a backpack.