Skip to main content
Top
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Research article

Hip pain in children with cerebral palsy: a population-based registry study of risk factors

Authors: Alexander Marcström, Gunnar Hägglund, Ann I. Alriksson-Schmidt

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Login to get access

Abstract

Background

Hip pain is prevalent in children with cerebral palsy (CP). Hip displacement is a known risk factor for hip pain. However, many children do not have displaced hips but still have hip pain and the aetiologies are poorly understood. The aims of this study were to investigate: 1. the prevalence of hip pain related to age, gender, gross motor function, degree of hip displacement and 2. the associations between hip pain and age, gender, gross motor function, degree of hip displacement, ranges of hip and knee motion (ROM) and degree of spasticity in the muscles around the hip.

Methods

This was a cross-sectional retrospective register study based on data from the Swedish follow-up programme and national healthcare registry CPUP, which includes > 95% of children with CP in Sweden. The participants were born in 2000 or later and 4–16 years of age. Data from the latest examination were used. In Aim 1, the prevalence of hip pain was calculated using frequencies and crosstabs. Differences between groups were calculated using chi-square tests and independent samples t-tests. In Aim 2, associations between hip pain and the variables were analysed using logistic regression.

Results

The overall prevalence of hip pain was 7%. No significant gender difference was found. Hip pain prevalence increased with age, lower gross motor function and higher degree of hip displacement. The median migration percentage (MP) in painful hips was 26%, compared to 21% in hips where pain was not reported. In the multivariable analysis, significant associations with hip pain were found for MP > 30% and decreased ROM in abduction, flexion and inwards rotation of the hip (p < 0.05).

Conclusion

Hip displacement was associated with hip pain. However, hip displacement was not present in the majority of painful hips. In addition to hip displacement, decreased ROM was also associated with hip pain.
Appendix
Available only for authorised users
Literature
1.
go back to reference Colver A, Fairhurst C, Pharoah POD. Cerebral palsy. Lancet. 2014;383(9924):1240–9.CrossRef Colver A, Fairhurst C, Pharoah POD. Cerebral palsy. Lancet. 2014;383(9924):1240–9.CrossRef
2.
go back to reference Simeonsson RJ, McMillen JS, Huntington GS. Secondary conditions in children with disabilities: spina bifida as a case example. Ment Retard Dev Disabil Res Rev. 2002;8(3):198–205.CrossRef Simeonsson RJ, McMillen JS, Huntington GS. Secondary conditions in children with disabilities: spina bifida as a case example. Ment Retard Dev Disabil Res Rev. 2002;8(3):198–205.CrossRef
3.
go back to reference Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics. 2012;130(5):e1285–312.CrossRef Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics. 2012;130(5):e1285–312.CrossRef
4.
go back to reference Dickinson HO, Parkinson KN, Ravens-Sieberer U, Schirripa G, Thyen U, Arnaud C, et al. Self-reported quality of life of 8–12-year-old children with cerebral palsy: a cross-sectional European study. Lancet. 2007;369(9580):2171–8.CrossRef Dickinson HO, Parkinson KN, Ravens-Sieberer U, Schirripa G, Thyen U, Arnaud C, et al. Self-reported quality of life of 8–12-year-old children with cerebral palsy: a cross-sectional European study. Lancet. 2007;369(9580):2171–8.CrossRef
5.
go back to reference Fauconnier J, Dickinson HO, Beckung E, Marcelli M, McManus V, Michelsen SI, et al. Participation in life situations of 8-12 year old children with cerebral palsy: cross sectional European study. BMJ. 2009;338:b1458.CrossRef Fauconnier J, Dickinson HO, Beckung E, Marcelli M, McManus V, Michelsen SI, et al. Participation in life situations of 8-12 year old children with cerebral palsy: cross sectional European study. BMJ. 2009;338:b1458.CrossRef
6.
go back to reference Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised gross motor function classification system. Dev Med Child Neurol. 2008;50(10):744–50.CrossRef Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised gross motor function classification system. Dev Med Child Neurol. 2008;50(10):744–50.CrossRef
7.
go back to reference Kennes J, Rosenbaum P, Hanna SE, Walter S, Russell D, Raina P, et al. Health status of school-aged children with cerebral palsy: information from a population-based sample. Dev Med Child Neurol. 2002;44(4):240–7.CrossRef Kennes J, Rosenbaum P, Hanna SE, Walter S, Russell D, Raina P, et al. Health status of school-aged children with cerebral palsy: information from a population-based sample. Dev Med Child Neurol. 2002;44(4):240–7.CrossRef
8.
go back to reference Houlihan CM, O'Donnell M, Conaway M, Stevenson RD. Bodily pain and health-related quality of life in children with cerebral palsy. Dev Med Child Neurol. 2004;46(5):305–10.CrossRef Houlihan CM, O'Donnell M, Conaway M, Stevenson RD. Bodily pain and health-related quality of life in children with cerebral palsy. Dev Med Child Neurol. 2004;46(5):305–10.CrossRef
9.
go back to reference Parkinson KN, Dickinson HO, Arnaud C, Lyons A, Colver A. Pain in young people aged 13 to 17 years with cerebral palsy: cross-sectional, multicentre European study. Arch Dis Child. 2013;98(6):434–40.CrossRef Parkinson KN, Dickinson HO, Arnaud C, Lyons A, Colver A. Pain in young people aged 13 to 17 years with cerebral palsy: cross-sectional, multicentre European study. Arch Dis Child. 2013;98(6):434–40.CrossRef
10.
go back to reference Alriksson-Schmidt A, Hagglund G. Pain in children and adolescents with cerebral palsy: a population-based registry study. Acta Paediatr. 2016;105(6):665–70.CrossRef Alriksson-Schmidt A, Hagglund G. Pain in children and adolescents with cerebral palsy: a population-based registry study. Acta Paediatr. 2016;105(6):665–70.CrossRef
11.
go back to reference Brun Sundblad GM, Saartok T, Engström LM. Prevalence and co-occurrence of self-rated pain and perceived health in school-children: age and gender differences. Eur J Pain. 2007;11(2):171–80.CrossRef Brun Sundblad GM, Saartok T, Engström LM. Prevalence and co-occurrence of self-rated pain and perceived health in school-children: age and gender differences. Eur J Pain. 2007;11(2):171–80.CrossRef
12.
go back to reference Sandström K, Alinder J, Öberg B. Descriptions of functioning and health and relations to a gross motor classification in adults with cerebral palsy. Disabil Rehabil. 2004;26(17):1023–31.CrossRef Sandström K, Alinder J, Öberg B. Descriptions of functioning and health and relations to a gross motor classification in adults with cerebral palsy. Disabil Rehabil. 2004;26(17):1023–31.CrossRef
13.
go back to reference Penner M, Xie WY, Binepal N, Switzer L, Fehlings D. Characteristics of pain in children and youth with cerebral palsy. Pediatrics. 2013;132(2):e407–13.CrossRef Penner M, Xie WY, Binepal N, Switzer L, Fehlings D. Characteristics of pain in children and youth with cerebral palsy. Pediatrics. 2013;132(2):e407–13.CrossRef
14.
go back to reference Ramstad K, Terjesen T. Hip pain is more frequent in severe hip displacement: a population-based study of 77 children with cerebral palsy. J Pediatr Orthop B. 2016;25(3):217–21.CrossRef Ramstad K, Terjesen T. Hip pain is more frequent in severe hip displacement: a population-based study of 77 children with cerebral palsy. J Pediatr Orthop B. 2016;25(3):217–21.CrossRef
15.
go back to reference Hermanson M, Hägglund G, Riad J, Rodby-Bousquet E, Wagner P. Prediction of hip displacement in children with cerebral palsy: development of the CPUP hip score. Bone Joint J. 2015;97-B(10):1441–4.CrossRef Hermanson M, Hägglund G, Riad J, Rodby-Bousquet E, Wagner P. Prediction of hip displacement in children with cerebral palsy: development of the CPUP hip score. Bone Joint J. 2015;97-B(10):1441–4.CrossRef
16.
go back to reference Elkamil AI, Andersen GL, Hägglund G, Lamvik T, Skranes J, Vik T. Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway. BMC Musculoskelet Disord. 2011;12:284.CrossRef Elkamil AI, Andersen GL, Hägglund G, Lamvik T, Skranes J, Vik T. Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway. BMC Musculoskelet Disord. 2011;12:284.CrossRef
17.
go back to reference Hägglund G, Alriksson-Schmidt A, Lauge-Pedersen H, Rodby-Bousquet E, Wagner P, Westbom L. Prevention of dislocation of the hip in children with cerebral palsy: 20-year results of a population-based prevention programme. Bone Joint J. 2014;96-B(11):1546–52.CrossRef Hägglund G, Alriksson-Schmidt A, Lauge-Pedersen H, Rodby-Bousquet E, Wagner P, Westbom L. Prevention of dislocation of the hip in children with cerebral palsy: 20-year results of a population-based prevention programme. Bone Joint J. 2014;96-B(11):1546–52.CrossRef
18.
go back to reference Alriksson-Schmidt AI, Arner M, Westbom L, Krumlinde-Sundholm L, Nordmark E, Rodby-Bousquet E, et al. A combined surveillance program and quality register improves management of childhood disability. Disabil Rehabil. 2017;39(8):830–6.CrossRef Alriksson-Schmidt AI, Arner M, Westbom L, Krumlinde-Sundholm L, Nordmark E, Rodby-Bousquet E, et al. A combined surveillance program and quality register improves management of childhood disability. Disabil Rehabil. 2017;39(8):830–6.CrossRef
19.
go back to reference Wood E, Rosenbaum P. The gross motor function classification system for cerebral palsy: a study of reliability and stability over time. Dev Med Child Neurol. 2000;42(5):292–6.CrossRef Wood E, Rosenbaum P. The gross motor function classification system for cerebral palsy: a study of reliability and stability over time. Dev Med Child Neurol. 2000;42(5):292–6.CrossRef
20.
go back to reference Alriksson-Schmidt A, Nordmark E, Czuba T, Westbom L. Stability of the gross motor function classification system in children and adolescents with cerebral palsy: a retrospective cohort registry study. Dev Med Child Neurol. 2017;59(6):641–6.CrossRef Alriksson-Schmidt A, Nordmark E, Czuba T, Westbom L. Stability of the gross motor function classification system in children and adolescents with cerebral palsy: a retrospective cohort registry study. Dev Med Child Neurol. 2017;59(6):641–6.CrossRef
21.
go back to reference Palisano RJ, Cameron D, Rosenbaum PL, Walter SD, Russell D. Stability of the gross motor function classification system. Dev Med Child Neurol. 2006;48(6):424–8.CrossRef Palisano RJ, Cameron D, Rosenbaum PL, Walter SD, Russell D. Stability of the gross motor function classification system. Dev Med Child Neurol. 2006;48(6):424–8.CrossRef
22.
go back to reference Reimers J. The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthop Scand Suppl. 1980:184:1–100. Reimers J. The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthop Scand Suppl. 1980:184:1–100.
23.
go back to reference Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206–7.CrossRef Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206–7.CrossRef
24.
go back to reference Meseguer-Henarejos AB, Sanchez-Meca J, Lopez-Pina JA, Carles-Hernandez R. Inter- and intra-rater reliability of the modified Ashworth scale: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2017. Meseguer-Henarejos AB, Sanchez-Meca J, Lopez-Pina JA, Carles-Hernandez R. Inter- and intra-rater reliability of the modified Ashworth scale: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2017.
26.
go back to reference Ranstam J. Repeated measurements, bilateral observations and pseudoreplicates, why does it matter? Osteoarthr Cartil. 2012;20(6):473–5.CrossRef Ranstam J. Repeated measurements, bilateral observations and pseudoreplicates, why does it matter? Osteoarthr Cartil. 2012;20(6):473–5.CrossRef
27.
go back to reference IBM Corp. Released 2016. IBM SPSS Statistics for Macintosh, Version 24.0. Armonk, NY: IBM Corp. IBM Corp. Released 2016. IBM SPSS Statistics for Macintosh, Version 24.0. Armonk, NY: IBM Corp.
28.
go back to reference Westbom L, Rimstedt A, Nordmark E. Assessments of pain in children and adolescents with cerebral palsy: a retrospective population-based registry study. Dev Med Child Neurol. 2017;59(8):858–63.CrossRef Westbom L, Rimstedt A, Nordmark E. Assessments of pain in children and adolescents with cerebral palsy: a retrospective population-based registry study. Dev Med Child Neurol. 2017;59(8):858–63.CrossRef
29.
go back to reference Hodgkinson I, Jindrich ML, Duhaut P, Vadot JP, Metton G, Berard C. Hip pain in 234 non-ambulatory adolescents and young adults with cerebral palsy: a cross-sectional multicentre study. Dev Med Child Neurol. 2001;43(12):806–8.CrossRef Hodgkinson I, Jindrich ML, Duhaut P, Vadot JP, Metton G, Berard C. Hip pain in 234 non-ambulatory adolescents and young adults with cerebral palsy: a cross-sectional multicentre study. Dev Med Child Neurol. 2001;43(12):806–8.CrossRef
30.
go back to reference Hägglund G, Wagner P. Spasticity of the gastrosoleus muscle is related to the development of reduced passive dorsiflexion of the ankle in children with cerebral palsy: a registry analysis of 2,796 examinations in 355 children. Acta Orthop. 2011;82(6):744–8.CrossRef Hägglund G, Wagner P. Spasticity of the gastrosoleus muscle is related to the development of reduced passive dorsiflexion of the ankle in children with cerebral palsy: a registry analysis of 2,796 examinations in 355 children. Acta Orthop. 2011;82(6):744–8.CrossRef
31.
go back to reference Hadden KL, LeFort S, O'Brien M, Coyte PC, Guerriere DN. A comparison of observers' and self-report pain ratings for children with cerebral palsy. J Dev Behav Pediatr. 2015;36(1):14–23.CrossRef Hadden KL, LeFort S, O'Brien M, Coyte PC, Guerriere DN. A comparison of observers' and self-report pain ratings for children with cerebral palsy. J Dev Behav Pediatr. 2015;36(1):14–23.CrossRef
Metadata
Title
Hip pain in children with cerebral palsy: a population-based registry study of risk factors
Authors
Alexander Marcström
Gunnar Hägglund
Ann I. Alriksson-Schmidt
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2449-8

Other articles of this Issue 1/2019

BMC Musculoskeletal Disorders 1/2019 Go to the issue