Pain in adults with cerebral palsy: A systematic review and meta-analysis of individual participant data - 04/06/20

Doi : 10.1016/j.rehab.2019.12.011

Wilma M.A. van der Slot ^a,^⁎ , Joyce L. Benner ^b, Laura Brunton ^c, Joyce M. Engel ^d, Philippe Gallien ^e, Sander R. Hilberink ^f, Grethe Månum ^g, Prue Morgan ^h, Arve Opheim ^i,^j, Inmaculada Riquelme ^k, Elisabet Rodby-Bousquet ^l, Tülay Tarsuslu Şimşek ^m, Deborah E. Thorpe ⁿ, Rita J.G. van den Berg-Emons ^b, Laura K. Vogtle ^o, Grigorios Papageorgiou ^p, Marij E. Roebroeck ^b
^a Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
^b Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, The Netherlands
^c School of Physical Therapy, Western University, London, Ontario, Canada
^d Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, Wi, USA
^e Breizh Paralysie Cérébrale Health Network, Pôle MPR Saint-Hélier, Rennes, France
^f Department of Rehabilitation Medicine, Erasmus University Medical Center and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
^g Department of Research, Sunnaas Rehabilitation Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
^h Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
ⁱ Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
^j Department of Research and Development, Habilitation & Health, Region Västra Götaland and Department of Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Gothenburg, Sweden
^k Department of Nursing and Physiotherapy, University Institute of Health Sciences, University of the Balearic Islands, Palma de Mallorca, Mallorca, Spain
^l Center for Clinical Research, Uppsala University, Region Västmanland, Västerås and Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
^m School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
ⁿ Division of Physical Therapy, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
^o Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
^p Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 04 June 2020
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

There is little focus on adults with cerebral palsy (CP) in research and health care and insufficient knowledge on how to identify and manage pain in this population.

Objectives

This systematic review and meta-analysis aimed to determine whether pain prevalence in adults with CP is high and to explore variations in pain prevalence of subgroups, pain locations, pain severity and pain interference.

Methods

Potential datasets were identified by experts in the field and literature searches in Embase, MEDLINE, and Cochrane, from January 2000 to October 2016. Included studies had a representative sample of ≥25 adults with CP and ≥1 pain outcomes. Methodological quality assessment, pain prevalence estimates and logistic regression models for subgroup effects on pain prevalence were conducted.

Results

In total, 17 eligible studies were identified from 4584 publications. A meta-analysis was performed with individual participant data from 15 studies totalling 1243 participants (mean [SD] age 34.3 [12.6] years). Overall mean pain prevalence was 70% (95% CI 62–78). Women were more likely to have pain than men (P<0.001). The odds of pain was increased in adults with gross motor function level II (odds ratio [OR] 1.92, 95% CI 1.22–3.12) and IV (OR 1.77, 95% CI 1.03–4.29). Participants with pain reported pain predominantly in the legs (76%, 95% CI 66–84), and mean pain severity was 3.7/10 (95% CI 2.7–4.7) and pain interference 3.5/10 (95% CI 2.5–4.5).

Conclusions

This meta-analysis provides the first reliable pain prevalence estimate in a large international sample of adults with CP. The high prevalence of pain, 70%, suggests that adults with CP should be routinely screened for pain and treated accordingly. The range of measurement instruments used by the included studies emphasizes using common outcome measures specific to pain internationally.

Le texte complet de cet article est disponible en PDF.

Keywords : Pain, Cerebral palsy, Adults, Review, Meta-analysis