Are chronic musculoskeletal pain and generalized joint hypermobility disabling contributors to physical functioning?

BACKGROUND: Chronic musculoskeletal pain (CMP), Generalized Joint Hypermobility (GJH) and pain-related fear have influence on physical functioning in adolescents. AIM: to evaluate differences in physical functioning between adolescents with CMp, GJH or the combination of both, and in addition evaluate the potential contribution of pain-related fear. DESIGN: The design of this study was observational and cross-sectional. SETTING: The adolescents with CMp were recruited by a physician in rehabilitation medicine and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands). The adolescents without CMp were recruited in the Southern area of the Netherlands and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands). pOpULATION: Four subgroups of adolescents were included; 21 adolescents with CMp without GJH, 9 adolescents with CMp and GJH, 51 adolescents without CMp without GJH, and 11 adolescents without CMp with GJH. METHODS: Outcome measures were muscle strength and endurance, motor performance, physical activity level, and pain-related fear. Hierarchical regression analyses were used to study differences in physical functioning and the contribution of pain-related fear in adolescents with/ without CMp as well as with/without GJH. RESULTS: Adolescents with CMp had decreased muscle strength (p=0.01), endurance (p=0.02), and lower motor performance (p<0.01) compared to adolescents without CMp. Higher levels of pain-related fear were related to decreased muscle strength (p=0.01), endurance (p<0.01), and motor performance (p<0.01). No differences in physical functioning and pain-related fear between hypermobile and non-hypermobile adolescents with CMp were found. CONCLUSIONS: Adolescents with CMp had decreased muscle strength and motor performance associated with increased levels of pain-related fear compared to adolescents without CMp. The association of being hypermobile with physical functioning is not more pronounced in adolescents with CMp. CLINICAL REHABILITATION IMpACT: No differences were found in physical functioning and pain-related fear between hypermobile adolescents with CMp compared to non-hypermobile adolescents with CMp. Future rehabilitation treatment in hypermobile adolescents with CMp should also focus on psychological components, such as pain-related fear.