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Hebert A, MacDermid J, Harris J, Packham T. How should we define and assess painful sensitivity in the hand? An international e-Delphi study. J Hand Ther 2023:S0894-1130(23)00116-3. [PMID: 37777441 DOI: 10.1016/j.jht.2023.08.012] [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: 01/28/2023] [Revised: 06/24/2023] [Accepted: 08/15/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Painful sensitivity in the hand is commonly seen with neuropathic pain, interfering with daily activities including rehabilitation. However, there are currently several terms used to describe the problem and a lack of guidance on what assessments should be used. PURPOSE To gather expert opinion a) identifying current and common terminology used in hand therapy, b) developing a consensus definition of hypersensitivity, and c) developing consensus guidance on how to best assess allodynia. STUDY DESIGN International e-Delphi survey study. METHODS We conducted an e-Delphi consensus study drawing on international experts in hand rehabilitation. We planned up to four rounds of consensus-seeking, defining consensus as 75% or more of participants agreeing with a definition or recommendation. Experts were identified from 21 countries, with the nomination of other experts encouraged for 'snowball sampling'. The first round included clinical vignettes describing 'painful sensitivity of the hand' and asked participants to describe how they would assess each case. Definitions for hypersensitivity, tactile hyperesthesia, and allodynia were also requested. RESULTS We invited 68 participants: 44 more were added through nominations. Sixty-three agreed to participate and were sent the round one survey; 54 participants from 19 countries completed this survey and were invited to participate in all subsequent rounds. No two definitions of hypersensitivity were the same, while 87% of the definitions for allodynia and 78% for tactile hyperesthesia were concordant with a published taxonomy. Over 700 assessment items were proposed in round one: ultimately 38 items representing eight distinct constructs reached a consensus for assessing allodynia. CONCLUSIONS Therapists definitions were consistent with an existing taxonomy for allodynia. Although hypersensitivity conceptualizations varied regarding the qualities of stimulus and response, a working definition was reached. Recommended assessments were relatively consistent internationally, holistic, and reflected a potential link between allodynia and central sensitization.
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Affiliation(s)
- Andrea Hebert
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada
| | - Joy MacDermid
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada; School of Physiotherapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada.
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Turgeman Dahan N, Vatine JJ, Weissman-Fogel I, Karpin H, Shmuely S, Bar-Shalita T. Quantitative Dynamic Allodynograph-A Standardized Measure for Testing Dynamic Mechanical Allodynia in Chronic Limb Pain. SENSORS (BASEL, SWITZERLAND) 2023; 23:7949. [PMID: 37766006 PMCID: PMC10535773 DOI: 10.3390/s23187949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Dynamic mechanical allodynia (DMA) is both a symptom and a central sensitization sign, yet no standardized method for quantifying the DMA area has been reported. This study aimed to establish psychometric properties for Quantitative Dynamic Allodynography (QDA), a newly developed protocol measuring the DMA area as a percentage of the body surface. METHODS Seventy-eight patients aged 18-65 diagnosed with chronic complex regional pain syndrome (CRPS) participated in this study. Test-retest reliability was conducted twice, one week apart (N = 20), and inter-rater (N = 3) reliability was conducted on 10 participants. Disease severity (CRPS Severity Score, CSS), pain intensity (VAS), and quality of life (SF-36) measures were utilized to test construct validity. RESULTS High inter-rater reliability (intraclass correlation coefficient (ICC) = 0.96, p < 0.001) and test-retest reliability (r = 0.98, p < 0.001) were found. Furthermore, the QDA score was found to be correlated with the CSS (r = 0.47, p < 0.001), VAS (r = 0.37, p < 0.001), and the SF-36 physical health total (r = -0.47, p < 0.001) scores. CONCLUSION The QDA is the first developed reliable and valid protocol for measuring DMA in a clinical setting and may be used as a diagnostic and prognostic measure in clinics and in research, advancing the pain precision medicine approach.
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Affiliation(s)
- Noy Turgeman Dahan
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 69978, Israel;
- Reuth Rehabilitation Hospital, Tel Aviv-Yafo 6772830, Israel; (H.K.); (S.S.)
| | | | - Irit Weissman-Fogel
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3103301, Israel;
| | - Hana Karpin
- Reuth Rehabilitation Hospital, Tel Aviv-Yafo 6772830, Israel; (H.K.); (S.S.)
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3103301, Israel;
| | - Sharon Shmuely
- Reuth Rehabilitation Hospital, Tel Aviv-Yafo 6772830, Israel; (H.K.); (S.S.)
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 69978, Israel;
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Llewellyn A, Buckle L, Grieve S, Birklein F, Brunner F, Goebel A, Harden RN, Bruehl S, Vaughan-Spickers N, Connett R, McCabe C. Delphi study to define core clinical outcomes for inclusion in a complex regional pain syndrome international research registry and data bank. Pain 2023; 164:543-554. [PMID: 36006075 DOI: 10.1097/j.pain.0000000000002729] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Complex regional pain syndrome (CRPS) clinical trials have historically captured a diverse range of outcomes. A minimum set of CRPS patient-reported outcomes has been agreed for inclusion in a future CRPS international clinical research registry and data bank. This study aimed to identify a complementary set of core clinical outcomes. Clinicians and researchers from the international CRPS community informed the content of a 2-round electronic Delphi study. Participation was invited from members of the International Association for the Study of Pain CRPS Special Interest Group and the International Research Consortium for CRPS. In round 1, participants rated the relevance of 59 clinical outcomes in relation to the question "What is the clinical presentation and course of CRPS, and what factors influence it?" (1 = not relevant and 9 = highly relevant). In round 2, participants rerated each outcome in the light of the round 1 median scores. The criterion for consensus was median score ≥7, agreed by 75% of respondents. The core study team considered the feasibility of data collection of each identified outcome in agreeing final selections. Sixty respondents completed both survey rounds, with responses broadly consistent across professions. Nine outcomes met the consensus criterion. Final outcomes recommended for inclusion in the core clinical set were record of medications, presence of posttraumatic stress disorder, extent of allodynia, and skin temperature difference between limbs. Study findings provide robust recommendations for core clinical outcome data fields in the future CPRS international clinical research registry. Alongside patient-reported outcomes, these data will enable a better understanding of CRPS.
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Affiliation(s)
- Alison Llewellyn
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
- Research and Education, Dorothy House Hospice, Winsley, Bradford-on-Avon, United Kingdom
| | - Lisa Buckle
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
- Research and Development Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Sharon Grieve
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
- Research and Development Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Frank Birklein
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Zurich, Switzerland
| | - Andreas Goebel
- Department of Pain Medicine, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - R Norman Harden
- Departments of PM&R and Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | | | - Candida McCabe
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
- Research and Education, Dorothy House Hospice, Winsley, Bradford-on-Avon, United Kingdom
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The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:91-105. [PMID: 36650605 DOI: 10.1097/ajp.0000000000001089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/22/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To summarize and critically appraise the body of evidence on conservative management of complex regional pain syndrome (CRPS), we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We conducted a literature search from inception to November 2021 in the following databases: Embase, Medline, CINAHL, Google Scholar, PEDRO, and Psychinfo. Two independent reviewers conducted risk of bias and quality assessment. Qualitative synthesis and meta-analysis were the methods for summarizing the findings of the RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the overall quality and certainty of the evidence on each treatment outcome. RESULT Through a database search, 751 records were found, and 33 RCTs were eligible for inclusion. Studies were published between 1995 and 2021. The overall risk of bias for 2 studies was low, 8 studies were unclear, and 23 studies were high.Low-quality evidence suggests that mirror therapy (as an addition to conventional stroke rehabilitation interventions) and graded motor imagery program (compared with routine rehabilitation interventions) may result in a large improvement in pain and disability up to 6-month follow-up in poststroke CRPS-1 patients. Low-quality evidence suggests that pain exposure therapy and aerobic exercises as an additive treatment to physical therapy interventions may result in a large improvement in pain up to a 6-month follow-up. The evidence is very uncertain about the effect of all other targeted interventions over conventional physical therapy or sham treatments on pain and disability. DISCUSSION There is an ongoing need for high-quality studies to inform conservative management choices in CRPS.
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Tactile stimulation programs in patients with hand dysesthesia after a peripheral nerve injury: A systematic review. J Hand Ther 2021; 34:3-17. [PMID: 32828612 DOI: 10.1016/j.jht.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/20/2020] [Accepted: 05/02/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a systematic review performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. INTRODUCTION Diverse approaches based on tactile stimulation are used in hand rehabilitation settings to treat touch-evoked dysesthesias. However, there is a lack of literature synthesis on the description and the effectiveness of the various approaches based on tactile stimulation that can be used for treating hand dysesthesia after nerve injury. PURPOSE OF THE STUDY The purpose of the study was to summarize the current evidence on tactile stimulation programs for managing touch-evoked hand dysesthesia due to nerve injury. METHODS The search was carried out on Medline, Embase, CINAHL, and the Cochrane Library databases. The selected studies had to present patients with touch-evoked dysesthesia after nerve injury who were treated with tactile stimulation approaches to reduce pain. The methodological quality of the included studies was assessed using the methodological index for nonrandomized studies scale, as well as the risk of bias. RESULTS Eleven studies met the inclusion criteria. These studies present tactile stimulation interventions that are heterogeneous relative to the target populations and the intervention itself (desensitization versus somatosensory rehabilitation method). Painful symptoms appear to diminish in patients with touch-evoked hand dysesthesia, regardless of the tactile stimulation program used. However, the included studies present significant risks of bias that limit the confidence in these results. DISCUSSION The evidence does not unequivocally support the beneficial effects of tactile stimulation to treat touch-evoked hand dysesthesia. CONCLUSION Future studies with more rigorous methodological designs, such as randomized controlled trials, are required to verify the potential benefits of these approaches.
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Packham TL, Spicher CJ, MacDermid JC, Quintal I, Buckley N. Evaluating a sensitive issue: reliability of a clinical evaluation for allodynia severity. Somatosens Mot Res 2019; 37:22-27. [PMID: 31858880 DOI: 10.1080/08990220.2019.1704242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose/Aim: Allodynia is a common feature of neuropathic pain with few validated clinical evaluation options. We identified a need to estimate the measurement properties of the standardised evaluation procedure for static mechanical allodynia severity popularised by the somatosensory rehabilitation of pain method, known as the rainbow pain scale. This study (www.clinicaltrials.gov. NCT02070367) undertook preliminary investigation of the inter-rater and test-retest reliability of the rainbow pain scale.Methods: Persons with pain in one upper extremity after Complex Regional Pain Syndrome, a peripheral nerve injury or a recent hand fracture were recruited for assessment of static mechanical allodynia threshold using calibrated monofilaments by two raters at baseline, and repeated assessment one week later.Results: Single measures estimates suggested inter-rater reliability was substantial for the rainbow pain scale [intra-class correlation coefficient = 0.78 (n = 31), p < 0.001]. Test-retest reliability was also excellent at with an intraclass correlation coefficient of 0.87 [n = 28, p < 0.001]. However, confidence intervals suggest the true values could be more moderate, with lower bounds of the 95% confidence interval at 0.60 and 0.74, respectively.Conclusions: This pilot study has generated preliminary support for the inter-rater and test-retest reliability of the rainbow pain scale. Future studies should seek to increase confidence in estimates of reliability, and estimate validity and responsiveness to change in persons with somatosensory disorders.
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Affiliation(s)
- Tara L Packham
- School of Rehabilitation Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, ON, Canada.,Regional Rehabilitation Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Claude J Spicher
- Translational Neurosciences Institute, Department of Neurosciences and Movement Sciences, Faculty of Sciences & Medicine, University of Fribourg, Fribourg, Switzerland
| | - Joy C MacDermid
- School of Rehabilitation Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Isabelle Quintal
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada
| | - Norman Buckley
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
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