A review of the measurement properties of disability measures used in children and adolescents with musculoskeletal pain: a clinimetric review.

BACKGROUND

Musculoskeletal pain is common in children and adolescents and is associated with disability. Although multiple Patient-Reported Outcome Measures (PROMs) are used to assess disability, no previous review has evaluated both risk of bias and certainty of the evidence. This study aimed to appraise and summarise the evidence on PROMs for disability in children with musculoskeletal pain.

METHODS

We conducted a systematic review following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). We included studies of measurement properties of disability PROMs in children aged 3-19 years with musculoskeletal pain. Evaluation was conducted in three steps: (1) risk of bias; (2) quality criteria for each measurement property; and (3) certainty of evidence using a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We also reported overall recommendations (strong, weak, inconclusive).

RESULTS

We included 24 studies of 20 PROMs. Measurement properties ranged from very low certainty of evidence of insufficient to high certainty evidence of sufficient measurement properties. The Functional Disability Inventory (FDI) had a weak recommendation in favour of use, while the Oswestry Disability Index (ODI) and Patient-Reported Outcomes Measurement Information System (PROMIS) had weak recommendations against use.

CONCLUSION

There are 20 PROMs available to measure disability in children and adolescents with musculoskeletal pain. Overall, measurement properties showed considerable variability, with most instruments supported by low or very low certainty of evidence. Consequently, there is insufficient evidence to recommend most PROMs for use. The FDI appears to be the most promising instrument.