Dor lombar incapacitante em crianças e adolescentes

Abstract

Low back pain (LBP) is among the top ten causes of disability in children and adolescents, however, outcomes related to disabling LBP are still poorly explored in this population. The study aimed to investigate disabling LBP in children and adolescents in northeastern Brazil. Two products were developed. Product 1 consisted of a systematic review that aimed to identify Patient‐Reported Outcome Measures (PROMs) that assess disability in children and adolescents with LBP, analyze adherence to the International Classification of Functioning, Disability and Health (ICF), and characterize the measurement properties of these PROMs. We identified eight PROMs in the 23 included studies. There was concentration of concepts in the domain activities, followed by the domains of body structure and function and environmental factors, however there were no concepts linked to the domain of personal factors. Only two PROMs were tested in this population among those included. Most of the PROMs included (75%) that propose to assess disability in children and adolescents with LBP have concepts linked to the ICF domains, with the exception of the personal factors domain, however there is a limitation regarding the validation of the PROMs for the pediatric population. Product 2, a cross-sectional study, included 777 children and adolescents from public schools in Fortaleza-Ceará. Guardians authorized the participation of children and adolescents and answered questionnaires. The dependent variable was disabling LBP and independent variables: pain intensity; number of painful sites; psychosomatic symptoms; backpack weight perception; agreement on pain reports; frequency of the sports activities; time of use of electronic devices and sleep disorders. Descriptive and comparative analysis and logistic regressions were performed to analyze the association between disabling LBP and the previously variables. When comparing participants with and without disabling LBP, we noticed worse measures for pain intensity (<0.001), number of painful sites (<0.001), psychosomatic symptoms (<0.001), sleep disorders (0.003), backpack perceived as too heavy more often (0.004) and their guardians agreed less about pain reporting (<0.001) in those with disabling LBP. The biophysical variables greater pain intensity (OR = 1.32[95%CI 1.14-1.53], p<0.001), greater number of painful sites (OR = 2.50[95%CI 1.58-3.95], p<0.001) increased the chance of occurrence of disabling LBP and the social variable agreement on pain reports (OR = 0.11[CI 95% 0.05-0.24], p<0.001) reduced the chance of occurrence of disabling LBP, there was no association of the other variables. Clinicians and researchers when choosing a PROM that meets the proposed objectives in the assessment of disability related to LBP should be aware of the domains covered and not covered by the PROM according to the ICF and as well as the validity of the PROM for the population for a child- and adolescent-centered assessment. In the same way, these professionals, parents, educators of this public must understand the disabling LBP in children and adolescents to help them manage this complaint.