Prevention of neural hypersensitivity after acute upper limb burns: Development and pilot of a cortical training protocol

The effect of mirror therapy on joint movement, pain and functionality in acute upper limb burns

OBJECTIVE

Mirror therapy is aimed at developing a normal proprioceptive perception for the area with pain or movement restriction by making use of the person's monitoring of the healthy side movements thanks to the mirror's reflective feature. The aim of this study is to investigate the effect of mirror therapy on joint range of motion, pain and functionality in acute upper extremity burn injuries.

METHODS

Demographic and burn-specific data of individuals with upper extremity burns were recorded. Individuals were divided into two groups. Standard treatment was applied to the first group, and mirror treatment in addition to the standard treatment was applied to the second group for 30 sessions, 5 days a week for 6 weeks. In the standard treatment program, passive, active-assisted and active ROM, strengthening, stretching, resistant and functional exercises were applied. In the mirror therapy group, active exercises were performed on the healthy side by covering the burn area in the mirror box. Before and after the treatment, joint range of motion(ROM) was evaluated with Universal Goniometer, pain intensity was evaluated with Visual Analog Scale and upper extremity functions were evaluated with QuickDASH.

RESULTS

A total of 32 (23 Male, 9 Female) individuals between the ages of 18-65 were included. The mean total burn surface area was 12.93 ± 9.80 in the standard treatment and 6.12 ± 2.96 in the mirror treatment. The groups were similar in terms of ROM change (p > 0.05). The pretest/posttest pain scores of both the standard therapy and mirror therapy groups were similar (p > 0.05). There was no statistically significant difference in terms of pretest and posttest QuickDASH scores according to the groups (p > 0.05). The difference between the pretest/posttest QuickDASH scores of both Standard treatment and Mirror treatment groups was statistically significant.

CONCLUSION

This study showed that the standard physiotherapy and rehabilitation program applied in the acute period in upper extremity burns and the mirror treatment applied in addition to this program provide similar improvements in joint range of motion and pain.

Reliability of the English version of the painDETECT questionnaire

BACKGROUND

The painDETECT questionnaire (PD-Q) has been used widely for the identification of neuropathic pain (NeP); however, the reliability of the English version of the PD-Q has never been investigated.

OBJECTIVE

This study aimed to determine the reliability of the PD-Q pre- (T0) and immediately post- (T1) clinical consultation and at one-week follow-up (T2).

METHODS

We recruited 157 patients attending a Neurosurgery Spinal Clinic and Pain Management Department. Minor changes to PD-Q instructions were made to facilitate patient understanding; however, no changes to individual items or scoring were made. Intraclass correlation coefficients (ICCs) were used to assess the reliability of PD-Q total scores between T0-T1 and T0-T2; weighted kappa (κ) was used to assess the agreement of PD-Q classifications (unlikely NeP, ambiguous, likely NeP) between all time-points. To ensure stability of clinical pain, patients scoring ≤2 or ≥6 on the Patient Global Impression Scale (PGIC) at T2 were excluded from the T0-T2 analysis.

RESULTS

Accounting for missing data and exclusions (change in PGIC score), data for 136 individuals (mean [SD] age: 56.8 [15.2]; 54% male) was available, of whom n = 129 were included in the T0-T1 and n = 69 in the T0-T2 comparisons. There was almost perfect agreement between the PD-Q total scores at T0-T1 time-points (ICC 0.911; 95% CI: 0.882-0.941) and substantial agreement at T0-T2 (ICC 0.792; 95% CI: 0.703-0.880). PD-Q classifications demonstrated substantial agreement for T0-T1 (weighted κ: 0.771; 95% CI: 0.683-0.858) and for T0-T2 (weighted κ: 0.691; 95% CI: 0.553-0.830). Missing data was accounted in 13% of our cohort and over 42% of our patients drew multiple pain areas on the PD-Q body chart.

CONCLUSION

The English version of the PD-Q is reliable as a screening tool for NeP. The validity of the questionnaire is still in question and has to be investigated in future studies.