Adjunctive psychological approaches in randomized controlled trials of exercise interventions for pediatric chronic musculoskeletal diseases – A scoping review

Abstract

Objective

To map existing research on adjunctive psychological approaches in exercise-based randomized controlled trials (RCTs) involving children with chronic musculoskeletal diseases (CMD).

Data Sources

We conducted a scoping review, following Joanna Briggs Institute methodology and a prospectively registered protocol. Medline, Embase, PsycInfo, CINAHL, Cochrane CENTRAL and Scopus databases were searched in February 2024 and September 2025.

Methods

RCTs involving children with CMD, exploring therapeutic exercises with psychological approaches, were included. Four independent reviewers screened the studies; data were extracted by one reviewer and verified by another using standardized previously piloted forms. Covidence was used for all review steps. PRISMA extension for Scoping Reviews recommendations was followed for synthesis and reporting.

Results

Of 6793 screened studies, 21 were assessed for full-text eligibility, and five RCTs (223 children, 80% female, mean age 14.2 years) were included from two countries (USA [n = 4], Sweden). Conditions included chronic musculoskeletal pain (n = 2), complex regional pain syndrome, patellofemoral pain syndrome, and juvenile fibromyalgia. Outcomes focused on pain, psychological, and clinical findings. Psychological approaches (motivational interviewing, behavior modification, pain psychoeducation) were delivered by psychologists and physiotherapists. Exercise interventions included neuromuscular exercises (n = 3), usual physiotherapy (n = 1), and tailored physiotherapy (n = 1).

Conclusions

Managing children with CMD is complex requiring multidisciplinary care, with psychological approaches potentially enhancing exercise-based rehabilitation. Although this integration appears promising, progress is limited by the lack of standardized protocols, scarce long-term evidence, and barriers such as accessibility, caregiver engagement, and therapist training.