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Castagna C, Consorti G, Turinetto M, Lunghi C. Osteopathic Models Integration Radar Plot: A Proposed Framework for Osteopathic Diagnostic Clinical Reasoning. JOURNAL OF CHIROPRACTIC HUMANITIES 2021; 28:49-59. [PMID: 35002577 PMCID: PMC8720649 DOI: 10.1016/j.echu.2021.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The purpose of this article is to propose a tool to assist with clinical reasoning to select and integrate different osteopathic models and evidence-based actions into clinical practice. DISCUSSION The authors adopted the guidelines for writing a commentary as a reporting framework for the present article. The proposed Osteopathic Models Integration Radar Plot has potential for integration into clinical practice and the educational environment. This framework may enable clinicians to manage complex clinical phenomena, such as musculoskeletal disorders related to allostatic load. CONCLUSION This proposed framework may be helpful to communicate the outcome of osteopathic evaluations to other healthcare professionals. This proposed model will need to be tested to determine feasibility.
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Affiliation(s)
- Carmine Castagna
- Education Department of Osteopathy, Istituto Superiore di Osteopatia, Milan, Italy
| | - Giacomo Consorti
- Education Department of Osteopathy, Istituto Superiore di Osteopatia, Milan, Italy
- Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Matteo Turinetto
- Education Department of Osteopathy, Istituto Superiore di Osteopatia, Milan, Italy
| | - Christian Lunghi
- Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy
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Perspectives on tissue adaptation related to allostatic load: Scoping review and integrative hypothesis with a focus on osteopathic palpation. J Bodyw Mov Ther 2020; 24:212-220. [DOI: 10.1016/j.jbmt.2020.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 02/28/2020] [Accepted: 03/08/2020] [Indexed: 12/17/2022]
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Lunghi C, Baroni F. Cynefin Framework for Evidence-Informed Clinical Reasoning and Decision-Making. ACTA ACUST UNITED AC 2019; 119:312-321. [DOI: 10.7556/jaoa.2019.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Yoo JU, McIver TC, Hiratzka J, Carlson H, Carlson N, Radoslovich SS, Gernhart T, Boshears E, Kane MS. The presence of Waddell signs depends on age and gender, not diagnosis. Bone Joint J 2018; 100-B:219-225. [PMID: 29437065 DOI: 10.1302/0301-620x.100b2.bjj-2017-0684.r2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to determine if positive Waddell signs were related to patients’ demographics or to perception of their quality of life. Patients and Methods This prospective cross-sectional study included 479 adult patients with back pain from a university spine centre. Each completed SF-12 and Oswestry Disability Index (ODI) questionnaires and underwent standard spinal examinations to elicit Waddell signs. The relationship between Waddell signs and age, gender, ODI, Mental Component Score (MCS), and Physical Component Score (PCS) scores was determined. Results Of the 479 patients, 128 (27%) had at least one positive Waddell sign. There were significantly more women with two or more Waddell signs than men. The proportion of patients with at least one positive Waddell sign increased with age until 55 years, and then declined rapidly; none had a positive sign over the age of 75 years. Functional outcome scores were significantly worse in those with a single Waddell sign (p < 0.01). With one or more Waddell signs, patients’ PCS and ODI scores indicated a perception of severe disability; with three or more Waddell signs, patients’ MCS scores indicated severe disability. With five Waddell signs, ODI scores indicated that patients perceived themselves as crippled. Conclusion Positive Waddell signs, a potential indicator of central sensitization, indicated a likelihood of having functional limitations and an impaired quality of life, particularly in young women. Cite this article: Bone Joint J 2018;100-B:219–25.
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Affiliation(s)
- J. U. Yoo
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - T. C. McIver
- St. Cloud Orthopaedics, Spine Centre, 1901
Connecticut
Avenue South, Sartell, Minnesota
56388, USA
| | - J. Hiratzka
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - H. Carlson
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - N. Carlson
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - S. S. Radoslovich
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - T. Gernhart
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - E. Boshears
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - M. S. Kane
- Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA
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Lue YJ, Chang JJ, Wu YY, Lin RF, Lu YM. The psychometric properties of the cervical nonorganic signs in patients with neck pain: an assessment of pain expression. Disabil Rehabil 2017; 40:751-756. [PMID: 28054833 DOI: 10.1080/09638288.2016.1274339] [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: 10/20/2022]
Abstract
PURPOSE Neck pain is a common cause of disability. This study investigated the psychometric properties of the cervical nonorganic signs (CNOS), a tool for assessing abnormal illness behaviors in patients with neck pain. METHODS The CNOS was administered on patients with neck pain. Reliability and validity analyses were used to evaluate the psychometric properties. Exploratory factor analysis was used to investigate the dimensionality. Correlations with the Short Form-36 were used to investigate the convergent validity. RESULTS The results supported the reliability (inter-rater reliability intra-class correlation: 0.920), validity (correlated with body pain (|ρ|=0.31) and vitality (|ρ| =0.30), and two-factor dimensionality (χ2= 5.904, p= 0.66; χ2/df = 0.738; RMSEA< 0.001; CFI = 1.000; TLI = 1.024; SRMR = 0.047) of the scale. The two factors were pain (severe pain) and vitality (poor vitality) expressed by the patients. CONCLUSION The CNOS is a reliable and valid instrument for assessing pain and vitality problems. It helps patients to express severe pain and lack of vitality. The rehabilitation discipline could use the scale to understand pain expression and to design proper rehabilitation programs. Implications for Rehabilitation The cervical nonorganic signs has two domains (pain and vitality). The scale is reliable and valid for patients with neck pain. Patients with high scores on the pain domain have severe body pain that may interfere with normal social activities. Clinicians should understand their suffering and try to help them to alleviate the pain.
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Affiliation(s)
- Yi-Jing Lue
- a Department of Physical Therapy, College of Health Sciences , Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Jyh-Jong Chang
- b Department of Occupational Therapy, College of Health Science , Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Yuh-Yih Wu
- c Department of Special Education , National Kaohsiung Normal University , Kaohsiung, Taiwan
| | - Rong-Fong Lin
- d Graduate Institute of Behavioral Sciences, College of Health Science , Kaohsiung Medical University , Kaohsiung , Taiwan.,e Shinlioho Physical Therapy Clinic , Pingtung , Taiwan
| | - Yen-Mou Lu
- f Department of Orthopaedics, School of Medicine, College of Medicine , Kaohsiung Medical University , Kaohsiung , Taiwan.,g Department of Orthopaedics , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan
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van Hooff ML, van Loon J, van Limbeek J, de Kleuver M. The Nijmegen decision tool for chronic low back pain. Development of a clinical decision tool for secondary or tertiary spine care specialists. PLoS One 2014; 9:e104226. [PMID: 25133645 PMCID: PMC4136789 DOI: 10.1371/journal.pone.0104226] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/09/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In Western Europe, low back pain has the greatest burden of all diseases. When back pain persists, different medical specialists are involved and a lack of consensus exists among these specialists for medical decision-making in Chronic Low Back Pain (CLBP). OBJECTIVE To develop a decision tool for secondary or tertiary spine care specialists to decide which patients with CLBP should be seen by a spine surgeon or by other non-surgical medical specialists. METHODS A Delphi study was performed to identify indicators predicting the outcome of interventions. In the preparatory stage evidence from international guidelines and literature were summarized. Eligible studies were reviews and longitudinal studies. Inclusion criteria: surgical or non-surgical interventions and persistence of complaints, CLBP-patients aged 18-65 years, reported baseline measures of predictive indicators, and one or more reported outcomes had to assess functional status, quality of life, pain intensity, employment status or a composite score. Subsequently, a three-round Delphi procedure, to reach consensus on candidate indicators, was performed among a multidisciplinary panel of 29 CLBP-professionals (>five years CLBP-experience). The pre-set threshold for general agreement was ≥70%. The final indicator set was used to develop a clinical decision tool. RESULTS A draft list with 53 candidate indicators (38 with conclusive evidence and 15 with inconclusive evidence) was included for the Delphi study. Consensus was reached to include 47 indicators. A first version of the decision tool was developed, consisting of a web-based screening questionnaire and a provisional decision algorithm. CONCLUSIONS This is the first clinical decision tool based on current scientific evidence and formal multidisciplinary consensus that helps referring the patient for consultation to a spine surgeon or a non-surgical spine care specialist. We expect that this tool considerably helps in clinical decision-making spine care, thereby improving efficient use of scarce sources and the outcomes of spinal interventions.
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Affiliation(s)
| | - Jan van Loon
- Sint Maartenskliniek, Department of Orthopedics, Nijmegen, The Netherlands
| | | | - Marinus de Kleuver
- Sint Maartenskliniek, Department of Orthopedics, Nijmegen, The Netherlands
- VU University Medical Center, Department of Orthopedics, Amsterdam, The Netherlands
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Abstract
Pain is a common complaint among clients seeking physical therapy services, yet interpretation of associated sensory changes can be difficult for the clinician. Musculoskeletal injury typically results in nociceptive pain due to noxious stimuli of the damaged muscle or joint tissues. However, with progression from acute to chronic stages, altered nociceptive processing can give rise to an array of sensory findings. Specifically, patients with chronic joint injury may present with signs and symptoms typically associated with neuropathic injury, due to changes in nociceptive processing. Clinical presentation may include expansion of hyperalgesia into adjacent and remote areas, allodynia, dysesthesias, and perceptual deficits. Quantitative sensory testing (QST) may provide an objective method of examining sensation and, thereby, of recognizing potential changes in the nociceptive pathways. The purpose of this paper is to provide an overview of altered nociceptive processing and somatosensory changes that may occur following a musculoskeletal injury without associated neural injury. Recommendations are made on clinical uses of quantitative sensory testing in orthopaedic physical therapy practice, and supporting clinical and laboratory evidence are presented. Examples related to joint injury are discussed, specifically, osteoarthritis of the knee and low back pain. Quantitative sensory testing may be a useful clinical tool to aid clinical decision making and for determination of prognosis.
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Carleton RN, Abrams MP, Kachur SS, Asmundson GJG. Waddell's symptoms as correlates of vulnerabilities associated with fear-anxiety-avoidance models of pain: pain-related anxiety, catastrophic thinking, perceived disability, and treatment outcome. JOURNAL OF OCCUPATIONAL REHABILITATION 2009; 19:364-374. [PMID: 19636514 DOI: 10.1007/s10926-009-9191-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 06/29/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Fear-anxiety-avoidance models of chronic pain emphasize psychological constructs as key vulnerabilities for the development and maintenance of disabling chronic pain. Complementarily, Waddell described physical signs and symptoms thought inconsistent with anatomic and pathologic disease patterns that might function as indications of pain-related psychological distress. Research has not supported using Waddell's signs due to low inter-rater reliability and limited associations with psychological distress; however, these findings are equivocal. Similarly, theorists have suggested that endorsement of Waddell's symptoms may indicate psychological distress; however, the precedent research has not included the psychological constructs described in fear-anxiety-avoidance models as vulnerability factors for the development and maintenance of chronic pain. METHODS Participants for the current study were patients (n = 68; 35% women) with chronic low back pain involved in a multi-disciplinary work-hardening program provided by a third-party insurer. Patients endorsing more than two of Waddell's symptoms were compared with those who did not on demographic variables as well as established self-report psychological measures, measures of perceived disability, functional capacity, and treatment outcome. RESULTS Patients endorsing more than two of Waddell's symptoms reported higher levels of depressive symptoms, pain-related anxiety, fear, catastrophizing, and pain intensity. Unexpectedly, there were no significant differences in functional capacity. Similar differences were found between those who did and did not return to work. CONCLUSIONS While Waddell's symptoms must still be interpreted judiciously, they may provide much needed cross-disciplinary utility as indicators that more detailed psychological assessment is warranted. Comprehensive implications and directions for future research are discussed.
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Affiliation(s)
- R N Carleton
- Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, SK S4S 0A2, Canada.
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Carleton RN, Kachur SS, Abrams MP, Asmundson GJG. Waddell's symptoms as indicators of psychological distress, perceived disability, and treatment outcome. JOURNAL OF OCCUPATIONAL REHABILITATION 2009; 19:41-48. [PMID: 19205852 DOI: 10.1007/s10926-009-9165-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 01/22/2009] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Waddell's signs and symptoms have been described as patient presentations not within usual anatomic patterns of injury pathology. Waddell's signs were thought to indicate psychological distress and were termed "non-organic findings"; similarly, Waddell's symptoms were described as inappropriate and attributable to psychological features. Endorsement of more than two of Waddell's symptoms is thought to be associated with psychological distress, disability, and poor treatment outcomes; however, this has not been empirically assessed. METHODS The current study used a sample of patients (n = 108; 30% women) involved in a multi-disciplinary work hardening program provided by a third-party insurer. Patients who endorsed more than two of Waddell's symptoms were compared with those who did not on demographic variables as well as self-report measures of psychological distress, disability, and treatment outcome. RESULTS Patients who endorsed more than two of Waddell's symptoms reported higher levels of psychological distress, perceived disability, pain intensity, and pain durations. Moreover, consistent with previous research on Waddell's symptoms, patients endorsing more than two symptoms were also less likely to return to work. CONCLUSIONS Waddell's symptoms were associated with increased perceived disability and pervasive pain interference. Patients who endorsed more than two symptoms were significantly less likely to return to work than those who endorsed zero, one, or two symptoms. Patients who endorsed more than two symptoms may indeed be affected by factors beyond tissue pathology that nonetheless warrant clinical attention. Waddell's symptoms appear to have promise as a quick indicator of treatment complexity and outcome.
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Affiliation(s)
- R N Carleton
- Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, SK, S4S 0A2, Canada.
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