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European Journal of Physical and Rehabilitation Medicine 2021 October;57(5):747-57

DOI: 10.23736/S1973-9087.21.06455-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Are chronic musculoskeletal pain and generalized joint hypermobility disabling contributors to physical functioning?

Thijs VAN MEULENBROEK 1, 2 , Ivan P. HUIJNEN 1, 2, Raoul H. ENGELBERT 3, 4, 5, Jeanine A. VERBUNT 1, 2

1 Research School CAPHRI, Department of Rehabilitation Medicine, University of Maastricht, Maastricht, the Netherlands; 2 Adelante, Center of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; 3 Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, the Netherlands; 4 Department of Rehabilitation, Amsterdam University Medical Centers, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the Netherlands; 5 Department of Pediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands



BACKGROUND: Chronic musculoskeletal pain (CMP), Generalized Joint Hypermobility (GJH) and pain-related fear have influence on physical functioning in adolescents.
AIM: to evaluate differences in physical functioning between adolescents with CMP, GJH or the combination of both, and in addition evaluate the potential contribution of pain-related fear.
DESIGN: The design of this study was observational and cross-sectional.
SETTING: The adolescents with CMP were recruited by a physician in rehabilitation medicine and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands). The adolescents without CMP were recruited in the Southern area of the Netherlands and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands).
POPULATION: Four subgroups of adolescents were included; 21 adolescents with CMP without GJH, 9 adolescents with CMP and GJH, 51 adolescents without CMP without GJH, and 11 adolescents without CMP with GJH.
METHODS: Outcome measures were muscle strength and endurance, motor performance, physical activity level, and pain-related fear. Hierarchical regression analyses were used to study differences in physical functioning and the contribution of pain-related fear in adolescents with/without CMP as well as with/without GJH.
RESULTS: Adolescents with CMP had decreased muscle strength (P=0.01), endurance (P=0.02), and lower motor performance (P<0.01) compared to adolescents without CMP. Higher levels of pain-related fear were related to decreased muscle strength (P=0.01), endurance (P<0.01), and motor performance (P<0.01). No differences in physical functioning and pain-related fear between hypermobile and non-hypermobile adolescents with CMP were found.
CONCLUSIONS: Adolescents with CMP had decreased muscle strength and motor performance associated with increased levels of pain-related fear compared to adolescents without CMP. The association of being hypermobile with physical functioning is not more pronounced in adolescents with CMP.
CLINICAL REHABILITATION IMPACT: No differences were found in physical functioning and pain-related fear between hypermobile adolescents with CMP compared to non-hypermobile adolescents with CMP. Future rehabilitation treatment in hypermobile adolescents with CMP should also focus on psychological components, such as pain-related fear.


KEY WORDS: Activities of daily living; Chronic pain; Fear; Joint instability; Muscle strength

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