Background/Objectives: The identification of health risk factors in children should rely not only on body mass index but also on modifiable lifestyle behaviors. Early screening for physical inactivity, poor nutrition, inadequate sleep, and chronic stress is crucial for effective preventive healthcare. The aim of this project was to develop the OWL screening tool, a protocol for the holistic assessment of key lifestyle risk factors in children aged 6–12. Methods/Rationale: The OWL tool was developed by integrating evidence-based recommendations from major health societies (WHO, EFSA, the National Sleep Foundation, and the Pediatric Endocrine Society), incorporating psychological principles, and adapting validated components from existing pediatric screening instruments. Its design prioritizes flexibility for use across various age groups and settings. The development process resulted in the 20-item OWL questionnaire, structured into four lifestyle domains: nutrition, physical activity, sleep, and stress management. Each item is a closed-ended question requiring a dichotomous (yes/no) response. One point is awarded for each health-promoting behavior endorsed, yielding a total possible score of 20. The tool is suitable for self-report by older children, parent-report for younger children, or clinician-administered review. Conclusions: By integrating sleep and stress management with traditional lifestyle factors, the OWL screening tool offers a highly relevant approach to pediatric preventive care. The findings presented here should be interpreted as a proof-of-concept, and the tool is not yet ready for clinical implementation without further rigorous evaluation.

Background/Objectives: Persistent spinal pain syndrome type 2 (PSPS-T2) is treated with two mechanistically distinct interventional families: epidural adhesiolysis (EA), directed at structural epidural pathology, and neuromodulation (NM), directed at modulation of nociceptive signaling. Epidural fibrosis is a biologically plausible candidate for treatment stratification, but whether it independently modifies treatment response remains unproven. This study reviewed the available evidence to determine both the comparative findings and the limitations imposed by the current evidence architecture. Methods: A PROSPERO-registered systematic review and frequentist random-effects network meta-analysis were performed. Studies were classified at the study level, rather than the individual-patient level, as fibrosis-positive (structurally confirmed) or unselected (without confirmed fibrosis). Treatment effects were synthesized separately within each stratum, and an exploratory study-level meta-regression evaluated fibrosis status as a potential moderator. Results: The final dataset comprised 87 studies including 33,504 patients: 40 fibrosis-positive studies (n = 4180) and 47 fibrosis-unselected studies (n = 29,324). Treatment family and fibrosis status were almost completely confounded. EA was evaluated almost exclusively in fibrosis-positive cohorts, whereas NM was evaluated almost exclusively in fibrosis-unselected studies. Although pooled improvements in pain (−0.97 vs. −0.63) and disability (−11.01 vs. −8.46) were greater in fibrosis-positive studies, these differences cannot be attributed independently to fibrosis. Residual heterogeneity remained substantial (I² 71–92%). Peripheral nerve field stimulation and EA protocols incorporating steroid, hyaluronidase, and hypertonic saline achieved the highest probability score for pain relief. All probability scores for the treatments should be interpreted as exploratory. Conclusions: Discordance between EA and NM in PSPS-T2 stems from structurally different populations, precluding pooled comparative classifications or claims that fibrosis modifies treatment effect. While fibrosis remains a promising candidate stratifier, proving it requires prospective trials that stratify randomization to EA versus NM following standardized fibrosis assessment.