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Some studies suggest a high economic burden among children and adolescents with musculoskeletal pain. However, there is no summary in the literature to understand the scenario of the economic burden of musculoskeletal pain in this population. This study aimed to synthesize the economic burden of musculoskeletal pain in children and adolescents. We conducted electronic searches on MEDLINE, EMBASE, CINAHL, EconLit, NHS-EED, and HTA databases from inception to July/2022. We included cost-of-illness studies that estimated healthcare, patient/family, lost productivity, and/or societal costs in children and adolescents (up to 24 years old) with musculoskeletal pain. The primary outcome was cost, and the results were grouped by the same cost categories (i.e., healthcare, patient/family, lost productivity, societal), conditions, time horizon, and cost range for musculoskeletal pain. All costs were inflated to the same reference year (2021) and converted to American Dollars ($). The risk of bias the included studies was assessed using a checklist based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. We included 45 cost-of-illness studies (n=665,623). Thirty-eight studies (84.4%) were conducted in high-income countries, six (13.3%) in upper-middle-income countries, and one (2.2%) in lower-middle-income countries. Regarding the risk of bias assessment, 75.5% (n=34 studies) clearly presented the unit costs, and 69% (n=31 studies) presented the expenditure data transparently. In contrast, more than half of the studies did not include productivity costs or sensitivity analysis. The annual healthcare costs ranged from $143 to $41,379 per child/adolescent (n=22 studies). The annual patient/family costs ranged from $287 to $27,972 per child/adolescent (n=9 studies). The annual lost productivity costs ranged from $124 to $4,671 per child/adolescent (n=7 studies). The annual societal costs ranged from $1,095 to $69,351 per child/adolescent (n=9 studies). Children and adolescents with juvenile idiopathic arthritis and musculoskeletal pain had higher annual incremental healthcare costs than children and adolescents without these conditions (mean difference: $3,800, 95% confidence interval [CI]: 50 to 7,550; mean difference: $740, 95% CI: 470 to 1,010, respectively). The annual economic burden of musculoskeletal pain per child and adolescent ranged from $124 to $69,351. This systematic review summarizes the evidence of the economic burden of musculoskeletal pain in children and adolescents. The results of this study showed that the musculoskeletal pain in children and adolescents seems to represent an important part of the economic burden in children's health. However, our estimates span a large range for all cost categories, making it difficult to interpret the economic burden in this population. [ABSTRACT FROM AUTHOR]

The EQ-5D-Y-3L and the EQ-5D-Y-5L are friendly-child versions of the EQ-5D instruments that measure health-related quality of life in children and adolescents (kids) aged 8-15 years old. However, both instruments' measurement properties have not yet been tested in Brazilian kids yet. This study aimed to test the EQ-5D-Y-3L and EQ-5D-Y-5L measurement properties in Brazilian kids with disabling musculoskeletal pain. This is a measurement proprieties study with two periods of measures was conducted in 181 Brazilian kids with disabling musculoskeletal pain (i.e., who reported pain in the back, neck, arm, or legs that lead to school absenteeism and/or interference with normal and/or recreational activities) from public and private schools in Sao Paulo state. Kids answered the self-reported versions of the EQ-5D-Y-3L and the EQ-5D-Y-5L. We tested test-retest reliability using the Kappa coefficient for the descriptive system and intraclass correlation coefficients (ICC) for EQ-VAS. We tested construct validity (classified as sufficient if at least 75% of the results were in accordance with our pre-specified hypothesis) using the Pediatric Quality of Life Inventory questionnaire version 4.0 (PedsQL) and the Child Health Utility 9D (CHU9D). We also tested the ceiling and floor effects of the instruments using the dimensions' descriptive system and health profile and the feasibility by the missing responses. Most kids with musculoskeletal pain were female (61%) with a mean age of 12 years old (standard deviation: 3). In the descriptive system, reliability ranged from 0.32 to 0.47 for the EQ-5D-Y-3L and 0.20 to 0.49 for the EQ-5D-Y-5L. There was substantial reliability for the EQ-VAS (ICC: 0.80; 95% CI: 0.71, 0.86). Construct validity was sufficient for the EQ-5D-Y-3L and the EQ-5D-Y-5L compared to the PedsQL, sufficient for the EQ-5D-Y-5L and insufficient for the EQ-5D-Y-3L compared to the CHU9D (89%, 100%, 81%, and 47% in accordance with the hypothesis, respectively). There was as lower ceiling effect of the EQ-5D-Y-5L compared to the EQ-5D-Y-3L for all the dimensions of the descriptive system, except for the 'having pain or discomfort', while the health profile (11111) was 18.2% for the EQ-5D-Y-3L and 16% for the EQ-5D-Y-5L. The missing response rate ranged from 1.3% for the EQ-5D-Y-3L and 4% for the EQ-5D-Y-5L. The descriptive system of the EQ-5D-Y-3L and the EQ-5D-Y-5L presented inadequate reliability and the EQ-VAS presented substantial reliability, but both instruments presented sufficient construct validity, except the EQ-5D-Y-3L compared to the CHU9D. Furthermore, the EQ-5D-Y-5L had lower ceiling effects compared to the EQ-5D-Y-3L and both instruments had good feasibility. This study tested the measurement properties of the EQ-5D-Y-3L and the EQ-5D-Y-5L in Brazilian kids with disabling musculoskeletal pain. The results of this study could help clinicians to measure health-related quality of life in the youth population. Furthermore, the EQ-5D-Y-3L may facilitate the calculation of the quality-adjusted life of years in economic evaluations conducted in Brazil in the future. [ABSTRACT FROM AUTHOR]

Background: The stratified model of care has been an effective approach for the treatment of low back pain. However, the treatment of patients with low risk of psychosocial-factor involvement is unclear. The addition of the therapeutic alliance to a minimal intervention may be an option for the treatment of low back pain. This paper reports on the rationale, design and protocol for a randomized controlled trial with blind assessor to assess the effectiveness of the addition of therapeutic alliance with minimal intervention on pain and disability in patients with chronic, nonspecific low back pain.Methods: Two hundred and twenty-two patients with chronic, nonspecific low back pain and low risk of involvement of psychosocial factors will be assessed and randomly allocated into three groups (n = 74 patients per group). The Positive Therapeutic Alliance group will receive counseling and guidance with an emphasis on therapeutic alliance and empathy. The Usual Treatment group will receive the same information and counseling with limited interaction with the therapist. The Control group will not receive any intervention. The treatment will be composed by two intervention sessions with a 1-week interval. A blinded assessor will collect the following outcomes at baseline, 1 month, 6 months and 12 months after randomization: pain intensity (Pain Numerical Rating Scale), specific disability (Patient-specific Functional Scale), general disability (Oswestry Disability Index), global perceived effect (Global Perceived Effect Scale), empathy (Consultation and Relational Empathy Measure), credibility and expectations related to treatment. The analysis will be performed using linear mixed models.Discussion: This will be the first study to understand the effect of combining enhanced therapeutic alliance to a treatment based on counseling, information and advice (minimal intervention). The addition of the therapeutic alliance to minimal intervention may improve the treatment of chronic, nonspecific low back pain.Trial Registration: ClinicalTrials.gov, NCT 02497625. Registered on 10 July 2015. [ABSTRACT FROM AUTHOR]