Prognostic factors for pain and functional disability in children and adolescents with persisting pain: a systematic review and meta-analysis

Background and objective: The aim of this study was to investigate prognostic factors for pain and functional disability in children and/or adolescents with persisting pain. Databases and data treatment: To be included, studies had to be published, peer-reviewed prospective cohort studies of children and/or adolescents with persisting pain at baseline, that reported at least one baseline prognostic factor and its relationship with pain or functional disability at least 1 month after baseline. Two reviewers independently assessed study eligibility, completed data extraction and undertook quality assessment. Meta-analyses were performed when a prognostic factor was reported in two or more studies. Results: Of 10,992 studies identified from electronic database searches, 18 were included, investigating 62 potential prognostic factors. In clinical settings, insufficient data were available for meta-analysis. Some positive associations with pain and/or disability were reported by single studies for older age, baseline pain intensity and baseline functional disability across multiple combinations of follow-up times and outcomes. In community settings, meta-analyses of two studies found that prognostic factors for the ongoing presence of pain at medium-term (1-year) follow-up were older age (OR 1.25; 95% CI = 1.05–1.47), weekly day tiredness (OR 1.69; 95% CI = 1.14–2.51), weekly abdominal pain (OR 1.44; 95% CI = 1.03–2.02) and waking during the night (OR 1.49; 95% CI = 1.05–2.13). No studies in community settings reported on prognostic factors for functional disability. Conclusions: Prognostic factors having significant associations with future pain and disability were identified; however, as few were investigated in more than one comparable study, the results need to be interpreted with caution. Significance: Prognostic factors from across the biopsychosocial spectrum are important to consider in paediatric pain clinical practice. However, most prognostic factors that experts have previously agreed upon have not been assessed in prospective cohort studies to date. The findings may help with prioritising data to collect during clinical assessments of children presenting with pain, in the context of pain and functional disability outcomes.