Bone and joint complications and reduced mobility are associated with pain in children with cerebral palsy

Aim To investigate the relationships between pain in the lower extremities and back, and spasticity, bone/joint complications and mobility. Methods Retrospective population-based registry study. Participants (N = 3256) with cerebral palsy (CP), 2.5-16 years of age, participating in the Swedish Cerebral Palsy Follow-up Program were included. Spasticity was measured using scissoring and the Modified Ashworth Scale. Bone/joint complications consisted of hip displacement, range of motion, windswept posture and scoliosis. Mobility was measured using the Functional Mobility Scale (5-, 50- and 500-metres), wheelchair use (outdoors) and the ability to stand/get up from sitting/use stairs, respectively. Pain was measured as presence of pain in hips, knees, feet and back. Data were analysed using structural equation modelling. Results Bone/joint complications had the strongest direct pathway with pain in the lower extremities (standardised regression coefficient = 0.48), followed by reduced mobility (standardised regression coefficient = -0.24). The pathways between spasticity and pain, and age and pain were not significant. The R-2 of the model was 0.15. Conclusion Bone/joint complications and reduced mobility were associated with pain in the lower extremities when controlling for sex. Considering the R-2 of the model, other factors not included in the model are also associated with pain in the lower extremities in children with CP.