Published online August 31, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. 673-681 (doi:10.1542/peds.2004-1758)
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Lower Limb Pain in a Preadolescent Population: Prognosis and Risk Factors for Chronicity—A Prospective 1- and 4-Year Follow-up Study

Ashraf El-Metwally, MD*,{ddagger}, Jouko J. Salminen, MD, PhD§, Anssi Auvinen, MD, PhD{ddagger},||, Hannu Kautiainen, BA* and Marja Mikkelsson, MD, PhD*

* Department of Physical and Rehabilitation Medicine, Rheumatism Foundation Hospital, Heinola, Finland
{ddagger} Tampere School of Public Health, University of Tampere, Tampere, Finland
§ Department of Physical and Rehabilitation Medicine, University Hospital of Turku, Turku, Finland
|| Pediatric Research Center, Tampere University Hospital, Tampere, Finland

Objective. To determine the short-term and long-term prognosis of preadolescent lower limb pain and to assess factors that contribute to pain persistence at 1-year follow-up and pain recurrence at 4-year follow-up.

Methods. A 1- and 4-year follow-up was conducted of a population-based 10- and 12-year old cohort of schoolchildren with lower limb pain at baseline

Results. Of the baseline students with lower limb pain, 32% reported pain persistence at 1-year follow-up and 31% reported pain recurrence at 4-year follow-up. Vigorous exercise was the only statistically significant predictor of lower limb pain persistence at 1-year follow-up (odds ratio [OR]: 2.43; 95% confidence interval [CI]: 1.16–5.05), whereas at 4-year follow-up (at adolescence), hypermobility was predictive of pain recurrence (OR: 2.93; 95% CI: 1.13–7.70). Traumatic lower extremity pain had a 50% lower risk for pain recurrence compared with nontraumatic pain (OR: 0.48; 95% CI: 0.19–0.92).

Conclusion. Trauma-induced lower extremity pain in preadolescents has a favorable long-term natural course. Children’s involvement in vigorous exercise predicts short-term outcome of lower limb pain, whereas hypermobile children have a worse long-term prognosis.

Key Words: musculoskeletal pain • pain • prognosis • lower limb • preadolescents

Abbreviations: CI, confidence interval • VO2max, maximal oxygen uptake • OR, odds ratio

Accepted Dec 23, 2004.


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