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Comprehensive assessment and classification of upper and lower limb pain in athletes: a scoping review
  1. Ciarán Purcell1,2,
  2. Ciara Duignan1,2,
  3. Brona M Fullen1,
  4. Shiofra Ryan1,2,
  5. Tomas Ward3,
  6. Brian Caulfield1,2
  1. 1 School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
  2. 2 Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
  3. 3 Insight Centre for Data Analytics, School of Computing, Dublin City University, Dublin, Ireland
  1. Correspondence to Ciarán Purcell, Physiotherapy, University College Dublin, Dublin, Leinster, Ireland; ciaran.purcell.1{at}


Background Upper and lower limb (peripheral) pain is prevalent in athletes. Contemporary research prioritises multidimensional pain assessment and classification. This study aims to review comprehensive athlete pain assessment practices against the reference standard (International Olympic Committee, IOC Athlete Pain framework), identifying trends and highlighting gaps.

Methods and analysis Six databases were searched using a comprehensive search strategy. This review followed the Joanna Briggs Institute standardised methodology for scoping reviews and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Title and abstract, full-text screening and data charting were completed by two independent reviewers.

Inclusion criteria Original research, systematic reviews and clinical practice guidelines reporting assessment or classification of pain in athletes of any age with chronic or acute peripheral pain in English on human participants from database inception.

Results 470 studies with 175 different pain assessment tools were mapped against the IOC Athlete Pain Framework. Papers included tools from neurophysiological (470/100%), biomechanical (425/90%), affective (103/22%), cognitive (59/13%) and socioenvironmental (182/39%) domains. Pain classification was included in 108 studies (23%). 4 studies (0.85%) defined pain. Athletes with physical disability were included in 13 (3%) studies and no studies included athletes with intellectual disabilities. Socioeconomic factors were addressed in 29 (6%) studies.

Discussion Neurophysiological and biomechanical domains are frequently addressed. Affective, socioenvironmental and cognitive tools are under-represented. Potential tools for use by researchers and clinicians are highlighted. Defining and classifying pain and determining predominant pain mechanisms is needed in both research and clinical practice. More work on underrepresented populations is needed.

Conclusion This review informs researchers and clinicians working with athletes in pain how pain assessment and classification is currently conducted and highlights future priorities.

  • athletes
  • diagnosis
  • upper extremity
  • lower limb
  • sporting injuries

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  • Correction notice This article has been corrected since it published Online First. Data has been corrected in the abstract and results, due to rounding errors.

  • Contributors CP and BC conceived the original idea. CP, BC, CD, TW and BMF developed the original idea. CP, CD and SR completed title/abstract and full text review and data charting. CP completed analysis and composed the initial manuscript draft. BC, CD, SR, TW and BMF provided comments on and contributed towards the writing and editing of the final draft.

  • Funding This work was supported by the Chartered Physiotherapists in Sports and Exercise Medicine (CPSEM) branch of the Irish Society of Chartered Physiotherapists through the yearly spring research bursary. This work was supported by funding from Science Foundation Ireland under the grant for the Insight SFI Research Centre for Data Analytics (SFI/12/RC/2289_P2).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.