Due to the high prevalence of LBP in children , adolescents  and adults , as well as disability and costs attributed to LBP , it is important to invest time, effort and economic resources on preventing LBP. In this context, much research is still needed to establish the potential of school-based postural education program on incident LBP.
The present results suggest that a postural education programme applied to children should be face-to-face. The present clinical trial was designed to be a face-to-face intervention, but due to the COVID-19 pandemic, modifications had to be made and the intervention was carried out remotely. The results obtained show that there are no differences in the intervention group between the pre-test and the post-test, and no differences between the intervention group and the control group. In fact, the present intervention, carried out at a distance, has not succeeded in improving the postural habits of the 10-12-year-old school population. A telephone-based intervention aimed at modifying lifestyle habits have found similar difficulties, and have not succeeded in changing habits .
Our results are not consistent with other investments in children and adolescents to prevent LBP through improving knowledge about back care [22–24]. These interventions were carried out face-to-face in schools, and combined interventions on theoretical knowledge and practical interventions, where physical exercise was performed [22, 25].
As mentioned above, the present intervention has consisted, due to the pandemic situation, in a telematic intervention. On the one hand, it is important to highlight the novelty of the intervention, since to the best of our knowledge, no telematic interventions to promote habit changes in schools have been carried out so far. On the other hand, it is necessary to highlight the difficulty of the intervention to produce improvements in the postural habits of the children, as no significant results were obtained after the intervention, nor when comparing the intervention arms.
Otherwise, there are face-to-face interventions that have not obtained improvements in children's postural habits , nor in adult population , so more research is needed to clarify which aspects are key to guarantee the success of interventions to prevent and reduce LBP in children and adolescents. According to the literature, it seems that the most beneficial actions for the prevention of LBP are interventions that combine theoretical knowledge with practical interventions on postural hygiene and physical fitness [22, 24, 27]. In this line, the present intervention has complied with these guidelines, going further and involving tutors teachers, physical education teachers, and families, so that the whole environment of the child was involved in the change of habits. Another cause that may explain the lack of results in habit change interventions related to LBP may be the lack of theoretical knowledge offered to the participants . In this sense, the information offered in this intervention was broad and diverse in topics, to address the prevention of LBP from multiple perspectives: scientific evidence of LBP, human anatomy and physiology, LBP risk factors, healthy physical exercise, ergonomics, postural hygiene, among others. In addition, future research needs to be adapted to the new post-pandemic reality, where telematic interventions have gained a lot of strength, and it will be necessary to determine their viability in child and adolescent populations.
Limitations and strengths
This study has several limitations. The use of self-reported postural behaviour can be a limitation. Future studies should consider the possibility to improve the precision of the measure. Another limitation could be the inexistence of follow-up, that will provide information about how long the effects of an intervention can be retained by the children. A marked strength of this study was the use of a large sample of girls and boys in school age, from 10 different schools, combining schools from different geographical areas, which increases the representativeness of the sample. Furthermore, questionnaires used in this study were previously tested for correct understanding of the children, validity and reliability in a sample of similar characteristics.