The Prognosis of Disabling Musculoskeletal Pain and Predictors of Recovery in Children

Abstract

OBJECTIVE: To (1) describe the course of disabling musculoskeletal pain in children and adolescents in an 18-month follow-up, and (2) develop a prediction model to identify those most likely to recover. DESIGN: Prospective cohort study. METHODS: We recruited children and adolescents with disabling musculoskeletal pain from schools in Brazil. We collected information about sociodemographic characteristics and biopsychosocial variables. Recovery and recurrence were reported as frequencies and percentages over time. Prediction models were developed through logistic mixed models with candidate variables selected using a theoretical model. We measured the performance of the model and the internal validity. RESULTS: We included 694 children and adolescents with a mean age of 12.2 years (standard deviation, 2.7). Of those, 85.9% (95% confidence interval [CI]: 82.8, 88.6) recovered from disabling pain. From those who recovered, 31.7% (95% CI: 27.6, 36) suffered a recurrence. The prediction model identified cases of recovery from disabling musculoskeletal pain, with an area under the curve of 84.1% (95% CI: 79.8, 87.8), an accuracy of 0.55 (95% CI: 0.51, 0.58), and a sensitivity of 0.72 (95% CI: 0.67, 0.78). The model was assertive in 6 out of every 10 positive cases based on the positive predictive value. CONCLUSION: Up to 9 in every 10 children recovered from pain, and pain recurrence was common. The prediction model tested was adequate to identify children and adolescents who were more likely to recover from disabling musculoskeletal pain. J Orthop Sports Phys Ther 2026;56(6):359-369. Epub 27 March 2026. doi:10.2519/jospt.2026.13817.