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Table 2 Summary of study characteristics of the 22 included studies

From: Prevalence and incidence of musculoskeletal extremity complaints in children and adolescents. A systematic review

Author and year of publication Study Design Setting Age/
grade
Measurements (how did they ask?) Study Size Baseline response rate Follow up response rate Prevalence/incidence Type of complaints Main result (text) Bias
General population studies
 Abujam et al. 2014 Cross-sectional India School based 6–17 yrs Questionnaire filled in by children or parents if the child was less than 14 years 2059 ?   Lifetime prevalence Heel/
Ankle pain or swelling
N (%)
72 (3.5%)
High
 Adams et al. 2013 Cross-sectional US
Cohort - Kaiser Permanente Southern California
2–19 yrs ICD-9 codes 913,178    1 yrs. prevalence Lower extremity
Injuries or pain
Upper extremity:
Injuries or pain
5.8%
5.1%
Low
 Auvinen et al. 2009 Prospective cohort Finland
2-years
Birth Cohort
16–18 yrs Self-reported questionnaire 7344 7344/
9215 (80%)
2012/
2969
(68%)
6-month
prevalence
Shoulder pain
Elbow pain
Wrist pain
Knee pain
Ankle pain
Prevalence % (N) F: female, M: male
Age: 16 yrs. 18 yrs.
F: 52 (506) 63 (616)
M: 33 (253) 40 (307)
F: 2 (22) 4 (35)
M: 5 (37) 5 (37)
F: 16 (156) 23 (219)
M: 15 (114) 20 (150)
F: 18 (178) 21 (201)
M: 18 (141) 17 (129)
F: 16 (150) 19 (179)
M: 18 (142) 15 (116)
High
 Bishop et al. 2012 Prospective cohort England
Cohort -Avon Longitudinal Study of Parents and Children
5–13 yrs Questionnaire filled in by chief carer 9380 9380/
13,988 (67%)
6502/
13,988
(46%)
Often
prevalence
Total replied, n(%)
arms, n(%)
leg(s), n(%)
Total replied, n(%)
arms, n(%)
leg(s), n(%)
Total replied, n(%)
arms, n(%)
leg(s), n(%)
Age 5* Age 6*
9380 (100.0) 8599 (100.0)
13 + 227 = 240 (2.6) 14 + 299 = 313 (3.6)
1142 + 227 = 1369 (14.6) 1204 + 299 = 1503 (17.5)
Age 7* Age 8*
8325 (100.0) 7872 (100.0)
10 + 333 = 343 (4.1) 13 + 475 = 488 (6.2)
1226 + 333 = 1559 (18.7) 1188 + 475 = 1663 (21.1)
Age 11* Age 13*6996 (100.0) 6502 (100,0)
22 + 635 = 657 (9.4) 33 + 730 = 763 (11.7)
1386 + 635 = 2021 (28.9) 1342 + 730 = 2072 (31.9)
High
 Diepenmaat et al. 2006 Cross-sectional Holland
School based questionnaire
12–16 yrs Self-reported questionnaire 3485 3485/
4898
(71%)
  Monthly prevalence, pain lasting a day or longer Arm pain Male: 4.2%
Female: 3.6%
Low
 Ehrmann Feldman et al. 2002 Prospective cohort Canada High school based 7.-9. grade Self-reported questionnaire 810 810/
948 (85%)
502/
810
(62%)
6 months and 12 months Incidence Upper limb
Arm
Shoulder
6 monthsb 12 monthsb
19.9% 13.3%
9% 7%
8% 5%
Low
 El-Metwally et al. 2006 Cross-sectional Finland
2-years
Birth Cohort
9–11 yrs Self-reported questionnaire 1756 1756/
1823 (96%)
  Weekly prevalence, within the last 3 months Prevalence N(%)
Lower limb pain
Ankle-foot pain
Knee pain
Thigh pain
Leg pain
Hip pain
Traumatic Non-traumatic Both groups
105 (6.0) 216 (12.3) 321 (18.3)
32 (1.8) 154 (8.8) 186 (10.6)
37 (2.1) 181 (10.3) 218 (12.4)
15 (0.9) 166 (9.5) 181 (10.3)
30 (1.7) 89 (5.1) 119 (6.8)
13 (0.7) 47 (2.7) 60 (3.4)
Low
 Hoftun et al. 2011 Cross-sectional Norway
Health Study
13–18 yrs Self-reported questionnaire 7373 7373/
7913 (93%)
  Weekly prevalence, within the last 3 months Upper extremity
Lower extremity
13–15 yrs. (n % 95% CI): 16–18 yrs. (n % 95% CI):
163 4.0 (3.4–4.6) 129 3.9 (3.3–4.6)
522 12.8 (11.8–13.8) 282 8.6 (7.6–9.6)
Low
 Hulsegge et al. 2011 Cross-sectional Holland
Cohort of pregnant women - Prevention and Incidence of Asthma and Mite Allergy
11 yrs Questionnaire answered by
parents and child
2638 2638/
3963 = (67%)
  1-year prevalence Upper extremity
Lower extremity
4,8% (Boys: 3.1%, girls: 6.3%)
10,9% (Boys: 10.4%, Girls: 11.2%)
Medium
J espersen et al. 2014 Prospective Denmark
School based cohort -
Childhood Health, Activity and Motor Performance School Study
6–12 yrs Repeated text messages and
ICD-10 diagnosis given by clinicians
1259 90% for sports
schools
71% for normal schools
  Weekly mean incidence
Weekly mean prevalence
Upper extremity
Lower extremity
Upper extremity
Lower extremity
Injury: 0.2 (± 4.0)
Overuse injury: 0.04 (± 2.0)
Traumatic injury: 0.1 (± 3.5)
Injury: 1.0 (± 9.7)
Overuse injury: 0.7 (± 8.2)
Traumatic injury: 0.3 (± 5.2)
Injury: 0.5 (± 7.2)
Overuse injury: 0.2 (± 4.9)
Traumatic injury: 0.3 (± 5.8)
Injury: 4.1 (± 19.9)
Overuse injury: 3.2 (± 17.7)
Traumatic injury: 1.1 (± 10.4)
Low
 Jespersen et al. 2015 Prospective Denmark
School based cohort -
Childhood Health, Activity and Motor Performance School Study
6–12 yrs Repeated text messages and
ICD-10 diagnosis given by clinicians
1259 90% for sportsschools
71% for normal schools
  Incidence Rate Shoulder/
Upper Arm
Elbow/under Arm
Hand/wrist
Finger
Hip/Groin
Thigh
Knee
Lower leg
Achilles
Heel
Ankle
Foot
Overuse Traumatic0.03 (0.02–0.05) 0.03 (0.02–0.04)
0.01 (0.00–0.02) 0.02 (0.01–0.03)0.01 (0.00–0.01) 0.08 (0.06–0.10)0.00 (0.00–0.01) 0.05 (0.03–0.07)0.05 (0.04–0.07) 0.01 (0.00–0.01)0.04 (0.03–0.06) 0.03 (0.02–0.04)0.31 (0.27–0.35) 0.09 (0.07–0.11)0.05 (0.03–0.06) 0.01 (0.00–0.02)
0.06 (0.04–0.08) 0.000.36 (0.31–0.4) 0.000.01 (0.00–0.01) 0.18 (0.15–0.21)0.09 (0.07–0.11) 0.07 (0.05–0.09)
Low
 Krul et al. 2009 Cross-sectional Holland -Second Dutch National Survey in generel practice 2–17 yrs Interview aboutself-reported musculoskeletal symptoms. In children younger than 12 years interview was carried out with a parent. 2459 2459/
2719 (90%)
  2 weeks prevalence Upper extremity
All ages
2–11 y
12–17 y
Lower extremity
All ages
2–11 y
12–17 y
Hip and knee
All ages
2–11 y
12–17 y
Ankle and foot
All ages
2–11 y
12–17 y
% (n)
1.2 (26)
0.4 (5)
2.7 (21)
6.9 (147)
4.1 (57)
12.4 (90)
3.5 (75)
1.8 (25)
6.5 (50)
3.4 (72)
2.4 (32)
5.5 (40)
Low
 Mikkelssona et al. 1997 Cross-sectional Finland -School based cohort 3.-5. grade Self-reported questionnaire 1756 1756/
2141
(82%)
1628/
1756
(92%)
Weekly prevalence Relative frequency (%) with 95% CI Upper extremity
Lower extremity
Boys: 7 (6–9)b
Girls: 5.5 (4–7)b
Boys: 19 (16–22)b
Girls: 18 (15–20)b
Low
 Molgaard et al. 2011 Single-blind case control (case-cohort) Denmark
High School based
16–18 yrs Self-reported questionnaire 299 227/
299 (76%)
  Monthly-prevalence Non-traumatic knee pain 57/227 = (25%) Medium
 Rathleff et al. 2013 Cross-sectional Denmark –
Cohort -
Adolescent Pain in Aalborg 2011,
12–19 yrs Self-reported questionnaire 4007 2953/
4007 (73%)
  Point prevalence Knee
Shoulder
Foot
Shin
Hip/groin
Forearm/hand
Thigh
Elbow
Any frequency:
32.3 (30.6–34.0)
13.3 (12.1–14.5)
11.5 (10.4–12.7)
6.2 (5.4–7.1)
5.9 (5.0–6.7)
4.4 (3.7–5.1)
2.7 (2.2–3.2)
2.6 (2.1–3.2)
Low
 Shrier et al. 2001 Prospective cohort Canada
High School based
12–18 yrs Self-reported questionnaire 810 810/948 (85%) 502/810 (62%) Incidence
6 months
12 months
(once a week the last 6 months)
Lower extremity
Foot/ankle
Knee
Leg
Hip
6 monthsb 12 monthsb
% %
21 16
14 8
13 11
11 6
7 4
Low
 Smedbraten et al. 1998 Cross-sectional Norway
School based
10–15 yrs Self-reported questionnaire 569 569/661
(86%)
  Prevalence
Usually pain
Shoulder
Elbow
Hand
Hip
Knee
Ankle
Foot
Boys (n = 282) Girls (n = 287)
% %
6 14
4 4
5 7
5 7
32 29
7 12
8 11
High
 Slowinska et al. 2015 Cross-sectional Poland
School based
6–7 yrs Questionnaire filled in by parents 1509 1509/
2748 (55%)
  Prevalence
often
Knee
Hands
Often
11%
3%
High
 Verhagen et al. 2009 Prospective cohort Holland
school based
(iplay study)
10–12 yrs Injuries during physical activity
monitored by teachers
996/
(996 + 95) (91%)
   Incidence Rate Shoulder
Upper arm/elbow
Lower arm/wrist/hand
Upper leg/hip
Knee
Lower leg/ankle
Foot
0.03 × 0.48 = 0.01c
0.03 × 0.48 = 0.01c
0.22 × 0.48 = 0.11c
0.06 × 0.48 = 0.03c
0.11 × 0.48 = 0.05c
0.25 × 0.48 = 0.12c
0.15 × 0.48 = 0.07c
High
Clinical population studies
 Bot et al. 2005 Cross-sectional Holland Second Dutch National Servey of generel practice 0–19 yrs ICPC codes 375,899(all ages)    Incidence per 1000 person years L08 Shoulder complaint
L09 Arm complaint
L10 Elbow complaint
L11 wrist complaint
L12 Hand/finger complaint
L92 Shoulder syndrome
Age group (years)
Sex 0–9 (95% CI) 10–19 (95% CI)
M: 0.6 (0.3–0.9) M: 4.0 (3.2–4.9)
F: 0.7 (0.4–1.1) F: 4.8 (3.9–5.7)
M: 2.0 (1.4–2.6) M:2.3 (1.7–3.0)
F:2.3 (1.7–2.9) F: 2.8 (2.1–3.5)
M: 1.3 (0.9–1.8) M: 2.3 (1.7–3.0)
F: 1.7 (1.2–2.3) F: 1.9 (1.3–2.4)
M: 1.8 (1.3–2.4) M: 6.3 (5.3–7.4)
F: 2.1 (1.5–2.7) F: 7.9 (6.8–9.1)
M: 5.0 (4.1–5.9) M: 8.7 (7.5–9.8)
F: 3.9 (3.1–4.7) F: 9.1 (7.8–10.3)
M: 0.1 (0.0–0.3) M: 1.4 (0.9–1.9)
F: 0.0 ((0.0–0.1) F: 1.9 (1.3–2.4)
Low
 Henschke et al. 2014 Cross-sectional Australia
national study in general practice –
Bettering the Evaluation and Care of Health
5–17 yrs ICPC-2 codes 65,279 encounters    Management rate per 100 encounters (encs.) Lower Limb
Upper Limb
Lower Limb
Upper Limb
Lower Limb
Upper Limb
Age: 5–9
Boys Girls
Number 118121
Rate/100 encs. 1.72 1.85
(95% CI) (1.39–2.06) (1.51–2.19)
Number 89 90
Rate/100 encs. 1.30 1.38
(95% CI) (1.02–1.58) (1.09–1.66)
Age: 10–14
Boys Girls
Number 311254
Rate/100 encs 5.33 4.40
(95% CI) (4.72–5.95) (3.85–4.96)
Number 257188
Rate/100 encs 4.41 3.26
(95% CI) (3.85–4.97) (2.76–3.76)
Age: 15–17
Boys Girls
Number 169134
Rate/100 encs 4.55 2.26
(95% CI) (3.84–5.26) (1.87–2.65)
Number 169 82
Rate/100 encs. 4.55 1.38
(95% CI) (3.83–5.27) (1.08–1.69)
Low
 van der Waal et al. 2006 Cross-sectional Holland
Second Dutch National Servey of generel practice
0–19 yrs ICPC codes 375,899(all ages)    Incidence per 1000 person years L13 Hip complaints
L14 Leg/thigh complaints
L15 Knee complaints
L16 Ankle complaints
L17 Foot/toe complaints
L77 sprain of ankle/ft
L78 sprain/strain of knees
Acute meniscus/ligament knee
L97 Chronic int knee derangement
Age group (years)
0–9 (95% CI) 10–19 (95% CI)
M: 4.0 (3.2–4.8) M: 2.1 (1.5–2.7)
F: 4.9 (3.9–5.8) F: 2.2 (1.6–2.8)
M: 4.1 (3.3–4.9) M: 5.1 (4.2–6.0)
F: 4.2 (3.4–5.1) F: 4.3 (3.4–5.1)
M: 3.6 (2.8–4.3) M: 17.0 (15.3–18.6)
F: 2.7 (2.1–3-4) F: 16.7 (15.0–18.3)
M: 2.4 (1.8–3.0) M: 5.3 (4.4–6.2)
F: 1.9 (1.3–2.5) F: 5.0 (4.1–5.9)
M: 9.2 (8.0–10.4) M: 16.2 (14.6–17.8)
F: 8.5 (7.2–9.7) F: 14.3 (12.7–15.8)
M: 3.6 (2.8–4.3) M: 15.4 (13.8–17.0)
F: 3.8 (3.0–4.6) F: 16.4 (14.7–18.0)
M: 0.9 (0.54–1.33) F: 6.0 (5.0–7.0)
F: 0.4 (0.1–0.7) F: 3.7 (2.9–4.5)
M: 0.1 (−0.03–0.2) F: 1.2 (0.8–1.7)
F: 0 F: 0.8 (0.5–1.2)
M: 0.4 (0.1–0.6) F: 4.3 (3.4–5.1)
F: 0.6 (0.3–0.9) F: 7.0 (5.9–8.1)
Low
  1. ICD-10: International Classification of Diseases – 10
  2. ICPC: International Classification of Primary Care
  3. a Only baseline were reported
  4. b percentages taken from Fig. 1 in the original article
  5. c percentage taken from Fig. 1 in the original article times the total incidence rate per 1000 exposure hours (0.48)