M.N. Leite1, P.V. Silva2, S.J. Kamper3, N.E. O'Connell4, Z.A. Michaleff3, C.M. Williams2, T.P. Yamato1
1Universidade Cidade de São Paulo, Masters and Doctoral Programs in Physical Therapy, São Paulo, Brazil, 2University of Newcastle, School of Medicine and Public Health, Callaghan, Australia, 3The University of Sydney, Institute for Musculoskeletal Health, Sydney, Australia, 4Brunel University London, Health Economics Research Group, Uxbridge, United Kingdom
Background: Chronic pain is responsible for major socioeconomic burden. The worldwide prevalence of chronic pain in children and adolescents is around 20%, and musculoskeletal conditions represent a large proportion. Chronic musculoskeletal pain in children is clinically managed with physical activity and education about physical activity. However, the quality of evidence related to physical activity interventions is often low.
Purpose: To evaluate the effectiveness of physical activity or education about physical activity, or both, compared to active medical care, waiting list, or usual care in children and adolescents with chronic musculoskeletal pain.
Methods: We included randomised controlled trials or crossover-controlled trials in this systematic review. The primary outcomes were pain intensity, disability, and adverse events. The secondary outcomes were depression, anxiety, fear of avoidance, quality of life, physical activity level and caregiver distress. Electronic searches were performed at CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PEDro and LILACS databases, and other two trials registers and reference lists. Risk of bias for each study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. The overall quality of the evidence for each outcome will be assessed using the GRADE approach.
Results: The search retrieved 851 studies and a total of 11 studies fulfilled the inclusion criteria. The trials were conducted in seven countries: Australia, Brazil, Canada, Egypt, The Netherlands, Turkey, and Sweden. The 11 trials enrolled a total of 563 participants. The study sample sizes ranged from 30 to 93 participants (median (IQR) = 58.0 (39.5-64.0)). The mean age of the participants was 11.33 (SD=2.30). Nine trials included participants with juvenile idiopathic arthritis, one trial included participants with fibromyalgia, and one trial included participants with juvenile idiopathic arthritis or other musculoskeletal disorders. The mean duration of the follow-up intervention was 4 months, the mean duration of the intervention programs was 46 minutes, and the mean frequency of the intervention programs was three times per week. Among 80% of the trials were unclear about the risk of bias. There is low-quality evidence that there is no significant difference between the physical activity group and active medical care group for reducing levels of pain at long-term (MD -12.73, 95% CI -32.48 to 7.03). In the disability meta-analysis, there is low-quality evidence that there is no significant difference between the physical activity group and the active medical care group (MD -0.23, 95% CI -0.62 to 0.16). And there is low-quality evidence for the quality of life that there is no significant difference between the physical activity group and active medical care group (MD 11.66, 95% CI -9.17 to 32.49). None of the trials reported adverse events.
Conclusion(s): Chronic musculoskeletal pain negatively impacts the lives of children and adolescents. However, until the moment there is a low-quality of evidence about what are the best treatments approaches for this population.
Implications: This Cochrane Review showed that there is a need for high-quality evidence about chronic musculoskeletal management to inform clinicians, patients, parents and carers, and policymakers about this condition.
Funding, acknowledgements: This Cochrane review is part of a PhD study funded by the Sao Paulo Research Foundation – FAPESP.
Keywords: musculoskeletal pain, children, adolescent
Topic: Paediatrics
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: It is a systematic review
All authors, affiliations and abstracts have been published as submitted.
