Prevalence and determinants of hip pain in non-ambulatory cerebral palsy children: a retrospective cohort study.
Journal
European journal of physical and rehabilitation medicine
ISSN: 1973-9095
Titre abrégé: Eur J Phys Rehabil Med
Pays: Italy
ID NLM: 101465662
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
pubmed:
13
12
2022
medline:
7
3
2023
entrez:
12
12
2022
Statut:
ppublish
Résumé
Hip pain is common in cerebral palsy children, particularly at Gross-Motor Function Classification System level IV-V. It is associated to hip displacement and relates to the migration percentage. Recent literature suggested early reconstructive bone surgery, as the best approach to prevent hip luxation, then hip pain. Still, high rates of hip pain are reported. To investigate prevalence and determinants of hip pain in an Italian cerebral palsy sample. Single-center retrospective cohort study. Inpatient and outpatient. Patients with spastic or dyskinetic cerebral palsy, Gross-Motor Function Classification System level IV or V, age 0-18. A chart review was implemented to report hip pain, as a dichotomous variable (pain/no pain), age, sex, cerebral palsy subtype, Gross-Motor Function level, lumbar scoliosis, migration percentage, previous orthopedic surgery, or botulinum injections, oral or intrathecal baclofen, drug-resistant epilepsy, assistive devices for standing or walking. Descriptive statistics and a multivariate logistic stepwise regression were performed. A total of 504 subjects were included: 302 level V, 209 females, 432 spastics. The mean length of follow-up was 6 years. The overall prevalence of hip pain was 8.9% (6.3% were at level V) and of hip dislocation was 19% (15.9% were at level V). Just 39% of dislocated hips were painful. Children at spastic subtype and level V were predominantly affected. Botulinum and soft tissue surgery related to lower rates of hip pain, without statistical significance. Age (OR 1.19, 95%CI 1.14-1.25, P value 0.000), sex (OR 1.72, 95%CI 1.18-2.52, P value 0.005), migration percentage (OR 1.02, 95%CI 1.02-1.03, P value 0.000) and lumbar scoliosis (OR 1.32, 95%CI 0.86-2.01, P value 0.200) resulted significant independent determinants of hip pain. Hip pain relates with the migration percentage, but not all dislocated hips become painful. Hip pain may be transient and requires a targeted and individualized approach. Children at spastic subtype and level V were predominantly affected. Age and sex are confirmed as determinants. Specific validated measures are to be implemented to assess hip pain. Considering severe non-ambulatory cerebral palsy patients, pain and quality of life should be considered as outcomes, in the management of hip luxation.
Sections du résumé
BACKGROUND
BACKGROUND
Hip pain is common in cerebral palsy children, particularly at Gross-Motor Function Classification System level IV-V. It is associated to hip displacement and relates to the migration percentage. Recent literature suggested early reconstructive bone surgery, as the best approach to prevent hip luxation, then hip pain. Still, high rates of hip pain are reported.
AIM
OBJECTIVE
To investigate prevalence and determinants of hip pain in an Italian cerebral palsy sample.
DESIGN
METHODS
Single-center retrospective cohort study.
SETTING
METHODS
Inpatient and outpatient.
POPULATION
METHODS
Patients with spastic or dyskinetic cerebral palsy, Gross-Motor Function Classification System level IV or V, age 0-18.
METHODS
METHODS
A chart review was implemented to report hip pain, as a dichotomous variable (pain/no pain), age, sex, cerebral palsy subtype, Gross-Motor Function level, lumbar scoliosis, migration percentage, previous orthopedic surgery, or botulinum injections, oral or intrathecal baclofen, drug-resistant epilepsy, assistive devices for standing or walking. Descriptive statistics and a multivariate logistic stepwise regression were performed.
RESULTS
RESULTS
A total of 504 subjects were included: 302 level V, 209 females, 432 spastics. The mean length of follow-up was 6 years. The overall prevalence of hip pain was 8.9% (6.3% were at level V) and of hip dislocation was 19% (15.9% were at level V). Just 39% of dislocated hips were painful. Children at spastic subtype and level V were predominantly affected. Botulinum and soft tissue surgery related to lower rates of hip pain, without statistical significance. Age (OR 1.19, 95%CI 1.14-1.25, P value 0.000), sex (OR 1.72, 95%CI 1.18-2.52, P value 0.005), migration percentage (OR 1.02, 95%CI 1.02-1.03, P value 0.000) and lumbar scoliosis (OR 1.32, 95%CI 0.86-2.01, P value 0.200) resulted significant independent determinants of hip pain.
CONCLUSIONS
CONCLUSIONS
Hip pain relates with the migration percentage, but not all dislocated hips become painful. Hip pain may be transient and requires a targeted and individualized approach. Children at spastic subtype and level V were predominantly affected. Age and sex are confirmed as determinants. Specific validated measures are to be implemented to assess hip pain.
CLINICAL REHABILITATION IMPACT
CONCLUSIONS
Considering severe non-ambulatory cerebral palsy patients, pain and quality of life should be considered as outcomes, in the management of hip luxation.
Identifiants
pubmed: 36507793
pii: S1973-9087.22.07725-5
doi: 10.23736/S1973-9087.22.07725-5
pmc: PMC10035438
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
32-41Références
Ital J Pediatr. 2021 May 12;47(1):110
pubmed: 33980280
Acta Paediatr. 2016 Jun;105(6):665-70
pubmed: 26880375
Arch Dis Child. 2013 Jun;98(6):434-40
pubmed: 23606716
Dev Med Child Neurol. 2022 Apr;64(4):447-452
pubmed: 34726259
Acta Paediatr. 2010 Mar;99(3):446-51
pubmed: 20003101
J Child Orthop. 2022 Jun;16(3):227-232
pubmed: 35800654
Dev Med Child Neurol. 2016 Dec;58(12):1273-1280
pubmed: 27312016
Bone Joint J. 2014 Nov;96-B(11):1546-52
pubmed: 25371472
Dev Med Child Neurol. 2012 Oct;54(10):951-7
pubmed: 22881288
Ann Phys Rehabil Med. 2017 Nov;60(6):371-375
pubmed: 28690031
Dev Med Child Neurol. 2017 Jul;59(7):743-749
pubmed: 28432692
Acta Orthop. 2017 Apr;88(2):205-210
pubmed: 27892753
Dev Neurorehabil. 2014 Dec;17(6):420-5
pubmed: 25057804
Dev Med Child Neurol. 2019 Mar;61(3):305-314
pubmed: 30508221
Pediatrics. 2013 Aug;132(2):e407-13
pubmed: 23858420
Dev Med Child Neurol. 2019 Aug;61(8):929-936
pubmed: 30508224
J Pediatr Rehabil Med. 2011;4(3):197-203
pubmed: 22207096
Dev Med Child Neurol. 2000 Dec;42(12):816-24
pubmed: 11132255
BMC Musculoskelet Disord. 2019 Feb 8;20(1):62
pubmed: 30736784
Dev Med Child Neurol. 2016 Apr;58(4):395-401
pubmed: 26510627
Acta Orthop Scand Suppl. 1980;184:1-100
pubmed: 6930145
J Am Acad Orthop Surg. 2020 May 1;28(9):363-375
pubmed: 31663909
Disabil Rehabil. 2019 Nov;41(22):2622-2629
pubmed: 29888977
Acta Orthop. 2019 Oct;90(5):495-500
pubmed: 31210072
J Bone Joint Surg Br. 2010 Mar;92(3):436-41
pubmed: 20190318
J Pediatr Orthop. 2019 Aug;39(7):e536-e541
pubmed: 30589680
Int J Rehabil Res. 2022 Dec 1;45(4):319-328
pubmed: 36059222
Curr Probl Pediatr Adolesc Health Care. 2012 May;42(5):113-9
pubmed: 22483081
Curr Neurol Neurosci Rep. 2020 Feb 21;20(2):3
pubmed: 32086598
Toxicon. 2021 Aug;199:60-67
pubmed: 34081932
Dev Med Child Neurol. 2017 Aug;59(8):858-863
pubmed: 28509356
Dev Med Child Neurol. 2019 Mar;61(3):315-321
pubmed: 30378122
J Child Orthop. 2019 Dec 01;13(6):582-592
pubmed: 31908675
Dev Med Child Neurol. 2021 May;63(5):601-607
pubmed: 33393085
Dev Med Child Neurol. 2009 Sep;51(9):705-10
pubmed: 19459910
Dev Med Child Neurol. 2011 Nov;53(11):1013-8
pubmed: 22014321
Pediatrics. 2011 Mar;127(3):529-38
pubmed: 21339266