Evidence and gap maps (EGMs) can be used to identify gaps within specific research areas and help guide future research agendas and directions. Currently, there are no EGMs within the broad domain of chronic musculoskeletal (MSK) pain in adults. The aim of this study was to create a contemporary EGM of interventions and outcomes used for research investigating chronic MSK pain. This EGM was based on systematic reviews of interventions published in scientific journals within the past 20 years. Embase, PubMed, the Cochrane Library, and PsycINFO were used to retrieve studies for inclusion. The quality of the included reviews was assessed using AMSTAR-II. Interventions were categorised as either physical, psychological, pharmacological, education/advice, interdisciplinary, or others. Outcomes were categorised using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations. Of 4299 systematic reviews, 457 were included. Of these, 50% were rated critically low quality, 25% low quality, 10% moderate quality, and 15% rated high quality. Physical interventions (eg, exercise therapy) and education were the most common interventions reported in 80% and 20% of the studies, respectively. Pain (97%) and physical functioning (87%) were the most reported outcomes in the systematic reviews. Few systematic reviews used interdisciplinary interventions (3%) and economic-related outcomes (2%). This contemporary EGM revealed a low proportion of high-quality evidence within chronic MSK pain. This EGM clearly outlines the lack of high-quality research and the need for increased focus on interventions encompassing the entire biopsychosocial perspective.

INTRODUCTION Perceived diagnostic uncertainty can leave adolescents confused about their condition and impede their ability to understand ″what′s wrong with me″. Our aim is to develop credible explanations (trustworthy and understandable explanation of the condition) for adolescents suffering from chronic non-traumatic knee pain. METHODS This multiple-method study integrated findings from a systematic literature search of qualitative studies, an Argumentative Delphi with international experts (n=16) and think-aloud sessions with adolescents (n=7). Experts provided feedback with arguments on how to communicate credible explanations to meet adolescents′ needs. We analyzed feedback using thematic analysis before tailoring explanations to end-users. RESULTS We screened 3.239 titles/abstracts and included 16 papers which explored diagnostic uncertainty from adolescents′ and parents′ perspectives. Five themes emerged: (1) Understanding causes and contributors to the pain experience, (2) Feeling stigmatized for having an invisible condition, (3) Having a name for pain, (4) Controllability of pain, and (5) Worried about something being missed. The Argumentative Delphi revealed the following themes: (1) Multidimensional perspective, (2) Tailored to adolescents, (3) Validation and reassurance, and (4) Careful wording. Merging findings from the systematic search and the Delphi revealed three essential domains to address in credible explanations: ″What is non-traumatic knee pain and what does it mean?″, ″What is causing my knee pain?″ and ″How do I manage my knee pain?″. CONCLUSIONS Six credible explanations for the six most common diagnoses of chronic non-traumatic knee pain were developed. We identified three domains to consider when tailoring credible explanations to adolescents experiencing non-traumatic knee pain.

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IntroductionWe aimed to describe Quality of life (QoL) among adolescents with Patellofemoral Pain (PFP) and Osgood-Schlatter Disease (OSD) according to the QoL subscale of The Knee injury and Osteoarthritis Outcome Score (KOOS) and the EuroQol 5-dimensions (EQ-5D) and to investigate the characteristics associated with QoL.MethodsThis individual participant analysis included data from three clinical trials on adolescents diagnosed with PFP or OSD. We relabeled individual data and constructed a single dataset.ResultsWe included 323 adolescents with PFP or OSD. Total score of KOOS-QoL was 51±18 and total index score for the EQ5D was 0.67±0.21. KOOS-QoL subscale showed that 59% reported being aware of their knee problems daily or constantly, 37% reported severe to extreme lack of confidence in their knees, 27% reported severe to extreme difficulty with their knees, and 20% reported severely or totally modifying their lifestyle to avoid potentially damaging activities to their knee. EQ-5D showed that 77% experienced problems with everyday activities, 47% reported mobility problems, 17% felt worried, sad, or unhappy, and 7% reported problems looking after themselves. Older participants (age 17-19) reported worse QoL than younger participants. None of the other characteristics were associated with QoL.ConclusionsA high proportion of adolescents with chronic non-traumatic knee pain experience low QoL. More than half were aware of their knee problems at least daily, one in three reported a severe lack of confidence in their knee, and one in six felt worried, sad, or unhappy. QoL was lowest among older adolescents.Highlights-One in every three adolescents with PFP or OSD reported a severe lack of confidence in their knee.-Many adolescents reported being sad or worried, and modified their usual activities due to their knee pain.-Clinicians may extend the scope and include pain management strategies to address psychological perspectives when managing adolescents diagnosed with PFP or OSD.-Modifiable targets such as adolescents understanding of pain may be a beneficial management strategy to consider in rehabilitation for PFP or OSD.