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Oh D, To D, Corso M, Murnaghan K, Yu H, Cancelliere C. Agreement and concurrent validity between telehealth and in-person diagnosis of musculoskeletal conditions: a systematic review. Chiropr Man Therap 2024; 32:21. [PMID: 38872176 DOI: 10.1186/s12998-024-00542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVES To assess the concurrent validity and inter-rater agreement of the diagnosis of musculoskeletal (MSK) conditions using synchronous telehealth compared to standard in-person clinical diagnosis. METHODS We searched five electronic databases for cross-sectional studies published in English in peer-reviewed journals from inception to 28 September 2023. We included studies of participants presenting to a healthcare provider with an undiagnosed MSK complaint. Eligible studies were critically appraised using the QUADAS-2 and QAREL criteria. Studies rated as overall low risk of bias were synthesized descriptively following best-evidence synthesis principles. RESULTS We retrieved 6835 records and 16 full-text articles. Nine studies and 321 patients were included. Participants had MSK conditions involving the shoulder, elbow, low back, knee, lower limb, ankle, and multiple conditions. Comparing telehealth versus in-person clinical assessments, inter-rater agreement ranged from 40.7% agreement for people with shoulder pain to 100% agreement for people with lower limb MSK disorders. Concurrent validity ranged from 36% agreement for people with elbow pain to 95.1% agreement for people with lower limb MSK conditions. DISCUSSION In cases when access to in-person care is constrained, our study implies that telehealth might be a feasible approach for the diagnosis of MSK conditions. These conclusions are based on small cross-sectional studies carried out by similar research teams with similar participant demographics. Additional research is required to improve the diagnostic precision of telehealth evaluations across a larger range of patient groups, MSK conditions, and diagnostic accuracy statistics.
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Affiliation(s)
- David Oh
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
| | - Daphne To
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Melissa Corso
- Faculty of Health Sciences, Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Kent Murnaghan
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Hainan Yu
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Carol Cancelliere
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
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Kapitza C, Luedtke K, Komenda M, Kiefhaber M, Schmid AB, Ballenberger N, Tampin B. Inter- and intra-rater-reliability of a clinical framework for spine-related neck-arm pain. Musculoskelet Sci Pract 2023; 67:102853. [PMID: 37657399 DOI: 10.1016/j.msksp.2023.102853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE A mechanism-based clinical framework for spine-related pain differentiates (i) somatic referred pain, ii) heightened nerve mechanosensitivity, iii) radicular pain, iv) radiculopathy and mixed-pain. This study aimed to determine the reliability of proposed framework. METHOD Fifty-one people with unilateral spine-related neck-arm pain were assessed and categorized by examiner-1. The classifications were compared to those made by two other examiners, based on written documentation of examiner-1. Cohens kappa was calculated between examiner-pairs; Fleiss Kappa among all examiners to assess agreement in classifying subgroups and entire framework. RESULT Inter-rater-reliability showed moderate to almost perfect reliability (somatic: no variation, mechanosensitivity: 0.96 (95% CI 0.87-1.0) to 1.0 (95% CI: 1.0-1.0), radicular pain: 0.46 (95% CI: 0.19-0.69) to 0.62 (95% CI: 0.42-0.81), radiculopathy: 0.65 (95% CI: 0.43-0.84) to 0.80 (95% CI: 0.63-0.96) mixed-pain: 0.54 (95% CI: 0.21-0.81) to 0.75 (95% CI: 0.48-0.94). There was almost perfect to moderate reliability among all examiners (somatic: no variation, mechanosensitivity: 0.97 (95% CI: 0.82-1.0), radicular pain: 0.56 (95% CI: 0.40-0.71), radiculopathy: 0.74 (95% CI: 0.58-0.90), mixed-pain: 0.63 (95% CI: 0.47-0.79), entire framework: 0.64 (95% CI: 0.57-0.71)). Intra-rater-reliability showed substantial to almost perfect reliability (somatic: no variation, mechanosensitivity: 0.96 (95% CI: 0.87-1.0), radicular pain: 0.76 (95% CI: 0.57-0.92), radiculopathy: 0.84 (95% CI: 0.67-0.96), mixed-pain: 0.83 (95% CI: 0.60-1.0), entire framework: 0.80 (95% CI: 0.61-0.92). CONCLUSION Moderate to almost perfect reliability in subgrouping people with spine-related neck-arm pain and substantial reliability for entire framework support this classification's reliability.
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Affiliation(s)
- C Kapitza
- Hochschule Osnabrueck, University of Applied Sciences, Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Osnabrueck, Germany; Universität zu Lübeck, Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Luebeck, Germany.
| | - K Luedtke
- Universität zu Lübeck, Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Luebeck, Germany
| | - M Komenda
- Hochschule Osnabrueck, University of Applied Sciences, Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Osnabrueck, Germany
| | - M Kiefhaber
- Praxis für Physiotherapie Kiefhaber, Bad Dürkheim, Germany
| | - A B Schmid
- Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - N Ballenberger
- Hochschule Osnabrueck, University of Applied Sciences, Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Osnabrueck, Germany
| | - B Tampin
- Hochschule Osnabrueck, University of Applied Sciences, Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Osnabrueck, Germany; Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Plener J, da Silva-Oolup S, To D, Csiernik B, Hofkirchner C, Cox J, Chow N, Hogg-Johnson S, Ammendolia C. Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review. Spine (Phila Pa 1976) 2023; 48:E132-E157. [PMID: 36730764 DOI: 10.1097/brs.0000000000004537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/13/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The aim of this study was to evaluate the inclusion and exclusion criteria for participants in randomized control trials (RCTs) assessing conservative management for cervical radiculopathy (CR), to determine if any consensus exists within the literature. SUMMARY OF BACKGROUND DATA A 2012 systematic review identified a lack of uniformity for the eligibility criteria of participants in RCTs evaluating conservative interventions for CR. Since then, a large number of RCTs have been published, signaling the need for an updated evaluation of this topic. MATERIALS AND METHODS We electronically searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022, to identify RCTs assessing conservative management of CR. Information extracted was analyzed to determine the level of homogeneity and/or heterogeneity of the inclusion and exclusion criteria across studies. RESULTS Seventy-six RCTs met our inclusion criteria with 68 distinct trials identified. The inclusion of arm pain with or without another symptom ( i.e. numbness, paresthesia, or weakness) was required in 69.12% of trials, 50% of trials required participants to exhibit neck symptoms, and 73.53% of studies required some form of clinical examination findings, but inconsistencies existed for the number and type of tests used. Furthermore, 41.18% of trials included imaging, with 33.82% of trials requiring magnetic resonance imaging findings. The most common exclusion criteria included were the presence of red flags and cervical myelopathy in 66.18% and 58.82% of trials, respectively. CONCLUSIONS Overall, there is still a lack of uniformity for the inclusion/exclusion criteria of trials assessing the conservative management of CR, with some improvements noted compared with the 2012 review. Based on the current literature assessing the diagnostic utility of clinical symptoms and confirmatory tests, we proposed inclusion criteria for trials assessing conservative interventions. Future research should aim to develop standardized classification criteria to improve consistency among studies.
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Affiliation(s)
- Joshua Plener
- Division of Graduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sophia da Silva-Oolup
- Division of Graduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Daphne To
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Ben Csiernik
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | | | - Jocelyn Cox
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Ngai Chow
- Private Practice, Toronto, ON, Canada
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Disability and Rehabilitation Research, Oshawa, ON, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Carlo Ammendolia
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Mourad F, Giudice A, Maritati G, Maselli F, Kranenburg R, Taylor A, Kerry R, Hutting N. A guide to identify cervical autonomic dysfunctions (and associated conditions) in patients with musculoskeletal disorders in physical therapy practice. Braz J Phys Ther 2023; 27:100495. [PMID: 37075598 DOI: 10.1016/j.bjpt.2023.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 09/24/2022] [Accepted: 03/06/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Differential diagnosis is a hot topic in physical therapy, especially for those working in a direct access setting dealing with neck pain and its associated disorders. All international guidelines agree in recommending to first rule out non-musculoskeletal pathologies as the cause of signs and symptoms in the patient. Although the autonomic nervous system (ANS) has a crucial role and is also involved in pain conditions, coverage of it in neuroscience textbooks and educational programmes is limited and most healthcare professionals are unfamiliar with it. Although autonomic conditions are benign in nature, they are clinically of great importance as they may be a 'red flag' warning of an injury along the sympathetic pathway. Therefore, sound knowledge of the ANS system is essential for clinicians. OBJECTIVE To develop physical therapists' knowledge of and confidence in understanding cervical ANS function and dysfunction, thus enhancing clinical reasoning skills and the pattern recognition process, and performing and interpreting objective examinations. METHODS This master class provides an introductory guide and essential knowledge to facilitate clinicians to understand cervical autonomic dysfunctions and their clinical evaluation. The optimal referral method is also handled. CONCLUSIONS Gaining knowledge and understanding of the ANS, its function, its dysfunction, and the related clinical manifestations is likely to lead to a decision-making process driven by 'science and conscience'. This will empower physical therapists to be aware of subtle clues that may be offered by patients during the interview and history intake leading to the appropriate physical examination and triage.
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Affiliation(s)
- Firas Mourad
- Department of Physical Therapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg; Luxembourg Health & Sport Sciences Research Institute A.s.b.l., Differdange, Luxembourg
| | - Andrea Giudice
- Department of Physical Therapy, Poliambulatorio Physio Power, Brescia, Italy
| | - Giorgio Maritati
- Department of Physical Therapy, Poliambulatorio Physio Power, Brescia, Italy
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy
| | - Rik Kranenburg
- Healthy Ageing, Allied Health Care and Nursing Research Group, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Alan Taylor
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, UK
| | - Roger Kerry
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, UK
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands.
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Peolsson A, Löfgren H, Dedering Å, Kristedal M, Öberg B, Zsigmond P, Wibault J. Neurological outcomes after surgery and postoperative rehabilitation for cervical radiculopathy due to disc disease: a 2-year-follow-up of a randomized clinical trial. Sci Rep 2023; 13:3830. [PMID: 36882483 PMCID: PMC9992477 DOI: 10.1038/s41598-023-31005-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Reports on neurological outcomes in patients with cervical radiculopathy (CR) undergoing surgery and postoperative rehabilitation are important to inform prognosis. This 2-year-follow-up of a randomized clinical trial aimed to compare secondary neurological outcomes between structured postoperative rehabilitation and a standard approach after surgery for CR. A secondary aim was to increase knowledge about recovery of neurological impairments in relation to patient-reported neck disability. Neurological outcomes included assessment of sensibility, motor function, arm reflexes and the Spurling test. A total of 153 and 135 participants (> 70% response rate) completed the clinical examination. Between-group differences, changes over time, and associations between persistent neurological impairments and the Neck Disability Index were investigated. No between-group differences were reported (p > 0.07), and neurological impairments in sensibility, motor function, and a positive Spurling test decreased over time in both groups (p < 0.04). Persistent impairments in sensibility and reflex arm were most frequent at follow-up, whereas, a persistent positive Spurling test, and impairments in motor function were associated with higher NDI score. Neurological outcomes improved over time in patients undergoing surgery for CR with no between-group differences., However, persistent neurological impairments were common, and associated with poorer outcome for patient-reported neck disability.Clinical registration: clinicaltrial.gov NCT01547611, 08/03/2012, Title: Outcome of physiotherapy after surgery for cervical disc disease: a prospective multi-centre trial.
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Affiliation(s)
- Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Occupational and Environmental Medicine Center, Linköping University, Linköping, Sweden
| | - Håkan Löfgren
- Neuro-Orthopedic Center, Jönköping, Region Jönköping County, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Åsa Dedering
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Kristedal
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Peter Zsigmond
- Department of Neurosurgery, Linköping University Hospital, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Johanna Wibault
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden. .,Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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Sorondo D, Delpierre C, Côté P, Lemeunier N. Do chiropractic interns use clinical practice guidelines when managing patients with neck pain in France? A feasibility study. Chiropr Man Therap 2022; 30:43. [PMID: 36209083 PMCID: PMC9548113 DOI: 10.1186/s12998-022-00453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In France, we lack knowledge about factors influencing chiropractors' use of French guideline for managing neck pain and associated disorders (NAD). In particular, we know little about how chiropractic interns use clinical practice guidelines during their training. OBJECTIVES We aimed to determine the feasibility of conducting a cross-sectional study of chiropractic interns to determine their utilization and conformity with clinical practice guidelines when managing patients with NAD in France. METHOD We developed a web-based questionnaire which included 3 sections: (1) clinical vignettes; (2) determinants of practice and (3) socio-demographic and current practice information. The study was conducted in two phases. The first phase included 2 groups: chiropractors and students (interns). Ten chiropractors reviewed and made recommendations on content (especially clinical vignettes), readability, and flow of the survey. Fifteen interns were invited to pretest the proposed recruitment strategy and determine time needed to survey completion, assess completeness of data collection, and evaluate its readability and flow in students. Due to the low participation of students during the first phase, 20 additional interns were invited to participate and pilot the revised recruitment strategy during the second phase. A group of 20 interns were invited to participate and pilot the revised recruitment strategy during the second phase. Qualitative feedbacks about the recruitment strategy, the content of the questionnaire and the survey process were collected by phone to improve all these steps if necessary. RESULTS We collected data from November 2020 to February 2021. In phase 1, 70% of chiropractors (7/10) reviewed the survey and one intern responded (7% participation rate). A revised recruitment strategy was designed and 70% of interns agreed to participate in phase 2. Time to complete the questionnaire was on average 48 m:22 s. Interns evaluated survey content as relevant, comprehensive, covering the range of 4 grades of NAD, and adapted to an intern sample. Five main modifications were recommended by (1) Adjusting survey support; (2) Enhancing communication strategy; (3) Considering interns' comments about the length of the questionnaire; (4) Modifying 2 determinants not adapted to a French context; (5) Adding a proposal when determinants deal with multidisciplinary management. CONCLUSION Conducting a web-based cross-sectional study of chiropractic interns to assess their utilization and conformity to clinical practice guideline is feasible.
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Affiliation(s)
- Delphine Sorondo
- CERPOP UMR1295, Université Toulouse III, Inserm, Equipe EQUITY, Toulouse, France. .,Institut Franco-Européen de Chiropraxie, Toulouse, France.
| | | | - Pierre Côté
- grid.266904.f0000 0000 8591 5963Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada ,grid.266904.f0000 0000 8591 5963Institute for Disability and Rehabilitation Research at, Ontario Tech University, Oshawa, ON Canada
| | - Nadège Lemeunier
- Institut Franco-Européen de Chiropraxie, Toulouse, France ,grid.266904.f0000 0000 8591 5963Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada
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Redebrandt HN, Brandt C, Hawran S, Bendix T. Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study. Health Sci Rep 2022; 5:e589. [PMID: 35434382 PMCID: PMC8995534 DOI: 10.1002/hsr2.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Methods Results Conclusions
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Affiliation(s)
- Henrietta N. Redebrandt
- Department of Neurosurgery Skåne University Hospital Lund Sweden
- Department of Clinical Sciences, Division of Neurosurgery, Rausing Laboratory Lund University Lund Sweden
| | - Christian Brandt
- Department of Neurosurgery Skåne University Hospital Lund Sweden
| | - Said Hawran
- Center for Rheumatology and Spine Diseases, Rigshospitalet Copenhagen University Hospital Glostrup Denmark
| | - Tom Bendix
- Center for Rheumatology and Spine Diseases, Rigshospitalet Copenhagen University Hospital Glostrup Denmark
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F M, N L, S M, V P, P C. Characteristics, expectations, experiences of care, and satisfaction of patients receiving chiropractic care in a French University Hospital in Toulouse (France) over one year: a case study. BMC Musculoskelet Disord 2022; 23:229. [PMID: 35264131 PMCID: PMC8906111 DOI: 10.1186/s12891-022-05147-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In October 2017, a partnership was established between the University Hospital of Toulouse and the French Chiropractic College, "Institut Franco-Européen de Chiropraxie" (IFEC). Before 2017, chiropractors did not practice in hospitals in France. Chiropractic students and chiropractors are now integrated in an interdisciplinary medical team at University Hospital. Our study aimed to describe the characteristics of patients who received chiropractic care at the University Hospital of Toulouse, their expectations, experiences of care, and satisfaction. METHOD A prospective case study was conducted. Patients referred for chiropractic care in the French University Hospital of Toulouse from January to December 2020 were eligible to participate. Participants provided the following data: demographics, previous chiropractic care treatments, pain location, intensity (NRS) and duration, disability (NDI, ODI), health-related quality of life (SF-12) and depressive symptomatology (PHQ-9). We conducted semi-structured interviews to explore their expectations, barriers and facilitators impacting their experience of care, and satisfaction. RESULTS Seventeen participants were recruited and seven were interviewed. All participants had chronic pain with a median pain intensity of 05/10 (IQR 04-06) on the NRS scale. Nine of 17 participants presented with multiple pain locations. Thirteen of seventeen participants presented with low back pain and eight with neck pain. The median SF-12 health-related quality of life score was 50/100 (IQR 28.5-60.5) for physical health, and 52/100 (IQR 43-62) for mental health. The PHQ-9 median score of depressive symptomatology was 7.7/27 (IQR 2.0-12.5). Overall, participants were satisfied with their care and the collaboration between chiropractors and physicians. Participants expected a caring communication with the chiropractic team. Their experience was facilitated by their trust in their physician. Patients perceived the turnover of chiropractic students as a barrier to their satisfaction. CONCLUSION Our participants presented with chronic musculoskeletal pain and depressive symptoms. Our study identified facilitators and barriers for patient expectation and satisfaction with chiropractic care in a hospital setting. This study provides the first data describing the collaboration between chiropractors and physicians in France in the management of musculoskeletal disorders. These findings will inform the quality improvement of our partnership, student's training and the development of future hospital-based collaborations integrating chiropractic care in a multidisciplinary team in France.
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Affiliation(s)
- Mallard F
- Division of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada. .,Institut Franco-Européen de Chiropraxie, Toulouse, France.
| | - Lemeunier N
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France
| | - Mior S
- Division of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Pecourneau V
- Institut Franco-Européen de Chiropraxie, Toulouse, France
| | - Côté P
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
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Affiliation(s)
- Arianne P Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia.
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10
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Lawson GE, Nolet PS, Little AR, Bhattacharyya A, Wang V, Lawson CA, Ko GD. Medial Branch Blocks for Diagnosis of Facet Joint Pain Etiology and Use in Chronic Pain Litigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217932. [PMID: 33137975 PMCID: PMC7662497 DOI: 10.3390/ijerph17217932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022]
Abstract
A commonly disputed medicolegal issue is the documentation of the location, degree, and anatomical source of an injured plaintiff’s ongoing pain, particularly when the painful region is in or near the spine, and when the symptoms have arisen as result of a relatively low speed traffic crash. The purpose of our paper is to provide health and legal practitioners with strategies to identify the source of cervical pain and to aid triers of fact (decision makers) in reaching better informed conclusions. We review the medical evidence for the applications and reliability of cervical medial branch nerve blocks as an indication of painful spinal facets. We also present legal precedents for the legal admissibility of the results of such diagnostic testing as evidence of chronic spine pain after a traffic crash. Part of the reason for the dispute is the subjective nature of pain, and the fact that medical documentation of pain complaints relies primarily on the history given by the patient. A condition that can be documented objectively is chronic cervical spine facet joint pain, as demonstrated by medial branch block (injection). The diagnostic accuracy of medial branch blocks has been extensively described in the scientific medical literature, and evidence of facet blocks to objectively document chronic post-traumatic neck pain has been accepted as scientifically reliable in courts and tribunals in the USA, Canada and the United Kingdom. We conclude that there is convincing scientific medical evidence that the results of cervical facet blocks provide reliable objective evidence of chronic post-traumatic spine pain, suitable for presentation to an adjudicative decision maker.
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Affiliation(s)
- Gordon E. Lawson
- Canadian Memorial Chiropractic College, Toronto, ON M2H 3J1, Canada; (G.E.L.); (V.W.)
| | - Paul S. Nolet
- Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
| | | | - Anit Bhattacharyya
- Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2 W1, Canada;
| | - Vivian Wang
- Canadian Memorial Chiropractic College, Toronto, ON M2H 3J1, Canada; (G.E.L.); (V.W.)
| | - C. Adam Lawson
- Shibley Righton LLP, Toronto, ON M5H 3E5, Canada
- Correspondence: ; Tel.: +1-416-312-7986
| | - Gordon D. Ko
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
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11
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Diagnostic accuracy of patient interview items and clinical tests for cervical radiculopathy. Physiotherapy 2020; 111:74-82. [PMID: 33309074 DOI: 10.1016/j.physio.2020.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of patient interview items and clinical tests to diagnose cervical radiculopathy. DESIGN A prospective diagnostic accuracy study. PARTICIPANTS Consecutive patients (N=134) with a suspicion of cervical radiculopathy were included. A medical specialist made the diagnosis of cervical radiculopathy based on the patient's clinical presentation and corresponding Magnetic Resonance Imaging findings. Participants completed a list of patient interview items and the clinical tests were performed by a physiotherapist. MAIN OUTCOME MEASURES Diagnostic accuracy was determined in terms of sensitivity, specificity, and positive (+LR) and negative likelihood ratios (-LR). Sensitivity and specificity values ≥0.80 were considered high. We considered +LR≥5 and -LR≤0.20 moderate, and +LR≥10 and -LR≤0.10 high. RESULTS The history items 'arm pain worse than neck pain', 'provocation of symptoms when ironing', 'reduction of symptoms by walking with your hand in your pocket', the Spurling test and the presence of reduced reflexes showed high specificity and are therefore useful to increase the probability of cervical radiculopathy when positive. The presence of 'paraesthesia' and 'paraesthesia and/or numbness' showed high sensitivity, indicating that the absence of these patient interview items decreases the probability of cervical radiculopathy. Although most of these items had potentially relevant likelihood ratios, none showed moderate or high likelihood ratios. CONCLUSIONS Several patient interview items, the Spurling test and reduced reflexes are useful to assist in the diagnosis of cervical radiculopathy. Because there is no gold standard for cervical radiculopathy, caution is required to not over-interpret diagnostic accuracy values.
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García-Pérez-Juana D, Fernández-de-Las-Peñas C, Arias-Buría JL, Cleland JA, Plaza-Manzano G, Ortega-Santiago R. Changes in Cervicocephalic Kinesthetic Sensibility, Widespread Pressure Pain Sensitivity, and Neck Pain After Cervical Thrust Manipulation in Patients With Chronic Mechanical Neck Pain: A Randomized Clinical Trial. J Manipulative Physiol Ther 2019; 41:551-560. [PMID: 30442354 DOI: 10.1016/j.jmpt.2018.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/14/2018] [Accepted: 02/12/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of the current randomized clinical trial was to examine the effects of cervical thrust manipulation or sham manipulation on cervicocephalic kinaesthetic sense, pain, pain-related disability, and pressure pain sensitivity in patients with mechanical neck pain. METHODS Fifty-four individuals with neck pain were randomly assigned to receive either a cervical manipulation (right or left) or a sham manipulation. Immediate outcomes included cervical kinesthetic sense as assessed by joint position sense error (JPSE) and pressure pain thresholds (PPTs). At 1 week, neck pain intensity (numerical pain rate scale) and neck pain-related disability (Neck Disability Index [NDI]) outcomes were also collected. RESULTS The mixed-model analysis of covariance revealed a significant group × time interaction in favor of the cervical thrust manipulation group for the JPSE on rotation and extension. There was also a significant interaction for changes in PPTs at C5 to C6 and tibialis anterior. At the 1-week follow-up, a significant interaction existed for neck-related disability but not for neck pain at rest, worst pain, or lowest pain experienced the preceding week. CONCLUSIONS Our results suggest that cervical spine thrust manipulation improves JPSE, PPT and NDI in participants with chronic mechanical neck pain. Furthermore, changes in JPSE and NDI were large and surpass published minimal detectable changes for these outcome measures. In addition, the effect sizes of PPTs were medium; however, only C5 to C6 zygapophyseal joint exceeded the minimal detectable change. In contrast, cervical thrust manipulation did not improve neck pain intensity at 1 week after the intervention.
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Affiliation(s)
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, New Hampshire
| | - Gustavo Plaza-Manzano
- Department of Rehabilitation and Physical Medicine, Medical Hydrology, Complutense University of Madrid, Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
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Lemeunier N, Suri-Chilana M, Welsh P, Shearer HM, Nordin M, Wong JJ, Torres P, Oolup-da Silva S, D’Silva C, Jeoun EB, Stern P, Yu H, Murnaghan K, Sutton D, Côté P. Reliability and validity of clinical tests to assess the function of the cervical spine in adults with neck pain and its associated disorders: part 5. A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) collaboration. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1626906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nadège Lemeunier
- Department of Research, Institut Franco-Européen de Chiropraxie (IFEC), Toulouse, France
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Canada
| | - Minisha Suri-Chilana
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Patrick Welsh
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Heather M. Shearer
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Margareta Nordin
- Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Centre (OIOC), New York, NY, USA
| | - Jessica J. Wong
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Paola Torres
- Rehabilitation Centre, San Cristobal Clinic, Santiago, Chile
| | - Sophia Oolup-da Silva
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Chelsea D’Silva
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Eun Been Jeoun
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Paula Stern
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Kent Murnaghan
- Librarian, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Deborah Sutton
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College, Toronto, Canada
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14
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Lemeunier N, da Silva-Oolup S, Olesen K, Shearer H, Carroll LJ, Brady O, Côté E, Stern P, Tuff T, Suri-Chilana M, Torres P, Wong JJ, Sutton D, Murnaghan K, Côté P. Reliability and validity of self-reported questionnaires to measure pain and disability in adults with neck pain and its associated disorders: part 3-a systematic review from the CADRE Collaboration. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1156-1179. [PMID: 30879185 DOI: 10.1007/s00586-019-05949-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/10/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the reliability and validity of self-reported questionnaires to measure pain and disability in adults with grades I-IV neck pain and its associated disorders (NAD). METHODS We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and systematically searched databases from 2005 to 2017. Independent reviewers screened and critically appraised studies using standardized tools. Evidence from low-risk-of-bias studies was synthesized according to best evidence synthesis principles. Validity studies were ranked according to the Sackett and Haynes classification. RESULTS We screened 2823 articles, and 26 were eligible for critical appraisal; 18 were low risk of bias. Preliminary evidence suggests that the Neck Disability Index (original and short versions), Whiplash Disability Questionnaire, Neck Pain Driving Index, and ProFitMap-Neck may be valid and reliable to measure disability in patients with NAD. We found preliminary evidence for the validity and reliability of pain measurements including the Body Pain Diagram, Visual Analogue Scale, the Numeric Rating Scale and the Pain-DETECT Questionnaire. CONCLUSION The evidence supporting the validity and reliability of instruments used to measure pain and disability is preliminary. Further validity studies are needed to confirm the clinical utility of self-reported questionnaires to assess pain and disability in patients with NAD. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- N Lemeunier
- Institut Franco-Européen de Chiropraxie (IFEC), 72 chemin de la Flambère, 31300, Toulouse, France.
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada.
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
| | - S da Silva-Oolup
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - K Olesen
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - H Shearer
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - L J Carroll
- School of Public Health, University of Alberta, 4075 Research Transition Facility, 8308 - 114 St., Edmonton, AB, T6G 2E1, Canada
| | - O Brady
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher Ave, Tampa, FL, USA
| | - E Côté
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College St., Toronto, ON, M5T 3A9, Canada
| | - P Stern
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - T Tuff
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - M Suri-Chilana
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - P Torres
- Rehabilitation Centre, San Cristobal Clinic, Santiago Spine Group, Santiago, Chile
| | - J J Wong
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - D Sutton
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - K Murnaghan
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - P Côté
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
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15
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Lemeunier N, Jeoun EB, Suri M, Tuff T, Shearer H, Mior S, Wong JJ, da Silva-Oolup S, Torres P, D'Silva C, Stern P, Yu H, Millan M, Sutton D, Murnaghan K, Cȏté P. Reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with neck pain and its associated disorders: Part 4. A systematic review from the cervical assessment and diagnosis research evaluation (CADRE) collaboration. Musculoskelet Sci Pract 2018; 38:128-147. [PMID: 30455032 DOI: 10.1016/j.msksp.2018.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with grades I-IV neck pain and associated disorders (NAD). METHODS We systematically searched electronic databases to update the systematic review of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Eligible reliability and validity studies were critically appraised using modified versions of the QAREL and QUADAS-2 instruments, respectively. Evidence from low risk of bias studies were synthesized following best evidence synthesis principles. RESULTS We screened 14302 articles, critically appraised 46 studies, and found 32 low risk of bias articles (14 reliability and 18 validity studies). We found preliminary evidence of: 1) reliability of visual inspection, aided with devices (CROM and digital caliper) to assess head posture; 2) reliability and validity of soft tissue palpation to locate tender/trigger points in muscles; 3) reliability and validity of joint motion palpation to assess stiffness and pain provocation in combination; and 4) range of motion tests using visual estimation (in cervical extension only) or devices (digital caliper, goniometer, inclinometer) to assess cervical mobility. CONCLUSIONS We found little evidence to support the reliability and validity of clinical tests to assess head posture, pain location and cervical mobility in adults with NAD grades I-III. More advanced validity studies are needed to inform the clinical utility of tests used to evaluate patients with NAD.
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Affiliation(s)
- N Lemeunier
- Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère, 31300, Toulouse, France; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada.
| | - E B Jeoun
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - M Suri
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - T Tuff
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - H Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - S Mior
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - J J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - S da Silva-Oolup
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - P Torres
- Rehabilitation Centre, San Cristobal Clinic, Santiago Spine Group, Santiago, Chile
| | - C D'Silva
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, L1H 7K4, Canada
| | - P Stern
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - H Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada
| | - M Millan
- Cabinet d'expertise médicale, Castres, France
| | - D Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada
| | - K Murnaghan
- Librarian, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - P Cȏté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, L1H 7K4, Canada
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Landén Ludvigsson M, Peterson G, Peolsson A. Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash - Analyses of a randomized clinical trial. Sci Rep 2018; 8:12409. [PMID: 30120313 PMCID: PMC6098137 DOI: 10.1038/s41598-018-30556-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/02/2018] [Indexed: 12/02/2022] Open
Abstract
Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA. Pain/bothersomeness frequency, six measures of arm pain/paraesthesia (VAS scales), and four clinical neurological tests were evaluated after 3 months. The NSE group reported the lowest frequency and lowest levels of arm pain, the highest proportion of participants with at least 50% pain reduction and the highest proportion of normal arm muscle force. The NSEB group reported increased normal tendon reflexes. No improvements were recorded for the PPA group. Neck-specific exercise may improve arm pain and decrease signs of neurological deficits, but the addition of a behavioural approach does not seem to be of additional benefit.
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Affiliation(s)
- Maria Landén Ludvigsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden.
- Rehab Väst, County Council of Östergötland, Department of Rehabilitation and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
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17
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Responsiveness and minimal important change of the NeckPix© in subjects with chronic neck pain undergoing rehabilitation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1324-1331. [PMID: 29052814 DOI: 10.1007/s00586-017-5343-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/27/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The NeckPix© is a simple and rapid means of measuring the beliefs of subjects with chronic neck pain concerning pain-related fears of a specific set of activities of daily living. The original version showed satisfactory psychometric properties. This observational study is aimed at evaluating its responsiveness and minimal important changes (MICs) in subjects with chronic neck pain. METHODS At the beginning, at the end of an 8-week rehabilitation programme as well as at the one-year follow-up, 153 subjects completed the NeckPix©. After the programme and at follow-up, subjects and physiotherapists also completed the global perceived effect (GPE) scale, which was divided to produce a dichotomous outcome. Responsiveness was calculated by distribution [effect size (ES); standardised response mean (SRM)] and anchor-based methods [receiver-operating characteristics (ROC) curves; correlations between change scores of the NeckPix© and GPEs]. ROC curves were also used to compute MICs. RESULTS The ES ranged from 0.95 to 1.26 and the SRM from 0.84 to 0.98 at post-treatment and follow-up based on subjects' and physiotherapists' perspective. The ROC analyses revealed AUCs of 0.89 and 0.97 at post-treatment and follow-up, respectively; MICs (sensitivity; specificity) were of 6 (0.82; 0.88) and 8 (0.80; 0.92) at post-treatment and of 8 (0.95; 0.90 based on subjects and 0.95; 0.92 based on physiotherapists perspective) at follow-up. The correlations between change scores of the NeckPix© and GPEs ranged from -0.69 to -0.82. CONCLUSIONS The NeckPix© was sensitive in detecting clinical changes in subjects with chronic neck pain undergoing rehabilitation. We recommend taking the MICs provided into account when assessing subjects' improvement or planning studies in this clinical context.
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Lemeunier N, da Silva-Oolup S, Chow N, Southerst D, Carroll L, Wong JJ, Shearer H, Mastragostino P, Cox J, Côté E, Murnaghan K, Sutton D, Côté P. Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1-A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2225-2241. [PMID: 28608175 DOI: 10.1007/s00586-017-5153-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/24/2017] [Accepted: 05/20/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. METHODS We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders. We also searched the literature to identify studies on the reliability and validity of Doppler velocimetry for the evaluation of cervical arteries. Two independent reviewers screened and critically appraised studies. We conducted a best evidence synthesis of low risk of bias studies and ranked the phases of investigations using the classification proposed by Sackett and Haynes. RESULTS We screened 9022 articles and critically appraised 8 studies; all 8 studies had low risk of bias (three reliability and five validity Phase II-III studies). Preliminary evidence suggests that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joints. The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling's and the upper limb neurodynamic tests. No evidence was found for doppler velocimetry. CONCLUSIONS Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension-rotation test, neurological examination, Spurling's and the upper limb neurodynamic tests.
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Affiliation(s)
- Nadège Lemeunier
- Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère, 31300, Toulouse, France. .,UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada.
| | - S da Silva-Oolup
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - N Chow
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada.,Michael G. DeGroote Institute for Pain Research and Care, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - D Southerst
- Occupational and Industrial Orthopaedic Centre, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 63 Downing Street, New York, NY, 10014, USA
| | - L Carroll
- School of Public Health, University of Alberta, 116 St and 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - J J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
| | - H Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada.,Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - P Mastragostino
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - J Cox
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - E Côté
- Faculty of Medicine, University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada
| | - K Murnaghan
- Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, Canada
| | - D Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada
| | - P Côté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, L1H 7K4, Canada.,Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St. N., Oshawa, ON, Canada
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