Tag Archives: Erepsonline

Clinical Practice, Exercise Therapy, Rehabilitation

Cervical Spine Proprioceptive Retraining

There is considerable evidence to support the importance of cervical afferent dysfunction in the development of dizziness, unsteadiness, visual disturbances, altered balance, and altered eye and head movement control following neck trauma, especially in those with persistent symptoms.(1) The evaluation of potential impairments (altered cervical joint position and movement sense, static and dynamic balance, and ocular mobility and coordination) should become an essential part of the routine assessment of those with traumatic neck pain, including those with concomitant injuries such as concussion and vestibular or visual pathology or deficits.(1)

Dizziness that occurs after concussion/mTBI presents with varied characteristics and several potential sources and mechanisms, including the inner ear, the brain, the cervical spine, and/or the integration of afferent input and tuning within the sensorimotor control system.(2) Vestibular rehabilitation therapy (VRT) has been used to treat persistent dizziness after concussion/mTBI, but recent attention has examined the possible role of the cervical spine in post-concussive dizziness.(2) Dizziness after concussion/mTBI has been shown to improve when manual therapy and specific sensorimotor control exercises for the cervical spine were added to standard care VRT.(2)

Hammerle et al (2) compared traditional VRT with cervical spine proprioceptive retraining (CSPR) in patients with recurring dizziness after concussion/mTBI who had at least 1 abnormal cervical spine proprioceptive test (e.g. cervical joint position error or smooth pursuit neck torsion test), regardless of the presence or absence of neck pain. Patients were excluded from the study if they had dizziness with a clear peripheral vestibular or central symptom origin (e.g. BPPV, consistent saccadic intrusions on smooth pursuits, gaze holding nystagmus, loss of gaze holding during VOR cancellation testing). The results demonstrated that patients who received CSPR were 30 times more likely to report improvement in dizziness symptoms compared with those who received VRT when abnormal CSP tests were present.(2) 

References:

1. Treleaven J. Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain. J Orthop Sports Phys Ther [Internet]. 2017;47(7):492–502. Available from: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=28622488&retmode=ref&cmd=prlinks

2. Hammerle M, Swan AA, Nelson JT, Treleaven JM. Retrospective Review: Effectiveness of Cervical Proprioception Retraining for Dizziness After Mild Traumatic Brain Injury in a Military Population With Abnormal Cervical Proprioception. J Manipulative Physiol Ther [Internet]. 2019;42(6):399–406. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0161475418300411

Clinical Practice, Outcome Measures

Patient-Reported Outcome Measures (PROMs): what to select clinically and how to reduce human scoring errors

Self-reported outcome instruments or patient-reported outcome measures (PROMs) are gaining popularity.(1) Recently, there has been interest in using PROMs to aid management of individual patients – this is mainly due to the importance of monitoring the subjective effectiveness of received treatments, required in the current healthcare system to assess treatment quality.(1,2)

In Australia, WorkSafe (3) expects that all healthcare professionals who provide services to injured workers for longer than 4-6 weeks will use standardised or customised outcome measures to assist in the clinical justification of their services. (read more here)

The outcome of objective tests (e.g. orthopaedic tests performed by a clinician) does not necessarily correspond with subjective feelings of patients, whereas PROMs provide feedback on patients’ view of their complaints.(1)

PROMs can be used in clinical practice in various ways: they can be used as one-time screening questionnaires; alternatively, they can be administered serially to monitor patients’ progress and facilitate identification of problems.(2)

Worksafe and The Transport Accident Commission (TAC) note the need to evaluate the appropriateness of PROMs based on the individual patient’s needs and the clinician’s own professional expertise.(3,4) Furthermore, the TAC (4) state “It is often best to use more than one measure.” As such, clinicians need to select multiple PROMs in an attempt to cover the various domains of a patients’ presenting complaint(s).

Listed below are PROMs  grouped according to their primary focus (3,4). As a  general guideline, clinicians should select one PROM from each primary focus group, for each region (e.g. a patient presents with neck pain – the clinician would select one PROM for pain, another PROM for neck disability / function etc)

  1. Pain
    • e.g. Quadruple Numerical Rating Scale (QNRS)
  2. Disability / Function
    • e.g. Upper Extremity Functional Index (UEFI), Shoulder Pain and Disability Index (SPADI), Lower Extremity Functional Scale (LEFS)
, Neck Disability Index (NDI)
, Whiplash Disability Questionnaire (WDI), Quebec Back Pain Disability Scale (QBPDS)
  3. Risk Identification / Predicting response to treatment (‘Yellow Flags’)
  4. General Health Status (Quality of Life)
    • Short-Form 12 Health Survey (SF-12), RAND 36-Item Health Survey (SF-36)

Importantly, it has been shown that clinicians have incorrectly scored PROMs at a level that is of concern, and problematic!(5) A study by Matthey et al (5) suggest that clinicians adopt using scoring templates and a double adding-up procedure to reduce scoring errors… one of the great things about Erepsonline, is that you can save time and remove the human error when scoring outcome measures.

Easily administer, score and interpret outcome measures through Erepsonline – which may be used to assist your clinical practice. You must evaluate the appropriateness of the outcome measures based on the individual’s needs and your own professional expertise.

 

References

  1. Vuurberg G, Kluit L, van Dijk CN. The Cumberland Ankle Instability Tool (CAIT) in the Dutch population with and without complaints of ankle instability. Knee Surgery Sports Traumatol Arthrosc. 2018;26:882-891
  2. Snyder CF, Aaronson NK. Use of patient-reported outcomes in clinical practice. The Lancet. 2009;374(9687):369–70.
  3. WorkSafe. (n.d.). Outcome Measures. Retrieved from: http://www.worksafe.vic.gov.au/health-professionals/treating-injured-workers/outcome-measures
  4. TAC (Transport Accident Commission). Standard Outcome Measures. Retrieved from: http://www.tac.vic.gov.au/providers/working-with-tac-clients/clinical-resources/outcome-measures
  5. Matthey S, Lee C, Črnčec R, Trapolini T. Errors in scoring the Edinburgh Postnatal Depression scale. Arch Womens Ment Health. 2013 Apr;16(2):117-22.
Clinical Practice, Outcome Measures

The Central Sensitization Inventory (CSI)

Central Sensitization (CS) has been proposed as a common neurophysiological phenomenon to explain related syndromes for which no specific organic cause can be found.(1) The term Central Sensitivity Syndrome (CSS) is a newly proposed category for a group of inter-related disorders for which CS is a common etiology, including:(1,2)

  • Fibromyalgia
  • Myofascial Pain Syndrome
  • Chronic Fatigue Syndrome
  • Temporomandibular Joint Disorder
  • Irritable Bowel Syndrome
  • Migraine/Tension Type Headaches
  • Restless Leg Syndrome
  • Multiple Chemical Sensitivity

The Central Sensitization Inventory (CSI) was developed by Mayer et al (1) in 2012 to assess the overlapping health-related symptom dimensions of CS/CSSs. It was originally designed as a screening instrument to help identify when a patient’s presenting symptoms may indicate the presence of a CSS diagnosis, so that potentially unnecessary diagnostic and treatment procedures can be avoided, and biopsychosocial treatment planning can be initiated.

The CSI has been found to have a high degree of test-retest reliability and internal consistency.(1) A 2017 systematic review looking at the measurement properties of the CSI concluded “…the tool generates reliable and valid data that quantifies the severity of several symptoms of CS.”(3)

A 2015 study found that patients with high CSI scores (>40) before knee replacement reported more severe postsurgical pain intensity, required higher dosage of postsurgical analgesics, and were at higher risk of persistent pain 3 months later.(5) Use of the CSI, with the 40-point cut-off score, has also been recommended to help classify chronic pain patients with CS, and to help differentiate them from patients with neuropathic and nocioceptive pain.(6,7)

Total scores on the CSI range from 0-100, with the following severity ranges recommended:

  • Subclinical = 0 to 29;
  • Mild = 30 to 39;
  • Moderate = 40 to 49;
  • Severe = 50 to 59;
  • Extreme = 60 to 100.

A 2017 study provided “support for these CSI severity levels as a guideline for healthcare providers and researchers in interpreting CSI scores and evaluating treatment responsiveness.”(4)

In summary, the CSI is appropriate for clinical purposes with higher CSI scores, indicating a higher probability of CS. Additionally, a CSI score of >40-points is clinically significant, providing both good sensitivity and specificity for the presence of CSS.

Easily administer, score and interpret outcome measures – including the CSI – through Erepsonline. For more information on selecting and viewing outcome measures, see the Erepsonline Video Tutorials, or check out the Quick Start Guide

 

References:

  1. Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ, et al. The development and psychometric validation of the central sensitization inventory. Pain Pract. 2012 Apr;12(4):276–85.
  2. PRIDE; c2017 [cited 2017 September 13]. Available from: https://www.pridedallas.com/questionnaires/
  3. Scerbo T, Colasurdo J, Dunn S, Unger J, Nijs J, Cook C. Measurement Properties of the Central Sensitization Inventory: A Systematic Review. Pain Pract. 2017 Aug 29.
  4. Neblett R, Hartzell MM, Mayer TG, Cohen H, Gatchel RJ. Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory. Pain Pract. 3rd ed. 2017 Feb 1;17(2):166–75.
  5. Kim SH, Yoon KB, Yoon DM, Yoo JH, Ahn KR. Influence of centrally mediated symptoms on postoperative pain in osteoarthritis patients undergoing total knee arthro- plasty: a prospective observational evaluation. Pain Pract. 2015;15:E46–E53.
  6. Nijs J, Torres-Cueco R, van Wilgen CP, et al. Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain. Pain Physician. 2014;17:447–457.
  7. Nijs J, Apeldoorn A, Hallegraeff H, et al. Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain Physician. 2015;18:E333–E346.
Clinical Practice, Outcome Measures, Psychosocial Factors

Short Form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-10)

Evidence suggests that clinicians are limited in their ability to identify psychosocial factors in patients presenting with musculoskeletal (MSK) pain.(1,2) As such, it is important to use screening tools to improve clinical recognition and the contribution of psychosocial factors in MSK pain disorders.(3-5)

The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) has had several studies demonstrate its clinical utility in the identification of psychosocial factors.(6-8) However, calls were made to reduce the 21-item ÖMPSQ to a shorter form. A shorter version of the ÖMPSQ would improve practicality and reduce the burden on patients, clinicians and researchers.

The ÖMPSQ short version (ÖMPSQ-10) has recently been shown to be valid in identifying potential risk of pain-related disability and long-term work absence.(9) The ÖMPSQ-10 includes 10 items selected from the full version.(9)  These items are scored 0-10, where 0 refers to absence of impairment and 10 to severe impairment.

The total score will range between 1 and 100, with a score >50 correlating with greater long-term sick leave and poorer outcomes (high risk patient).(9)

In conclusion, the ÖMSPQ-10 is appropriate for clinical and research purposes, since it is nearly as accurate as the longer version.(9) It can also be used to monitor patient progress (e.g. administer the ÖMSPQ-10 monthly or every 3-months to monitor changes over time).

Easily administer, score and interpret outcome measures – including the ÖMSPQ-10- through Erepsonline. For more information on selecting and viewing outcome measures, see the Erepsonline Video Tutorials, or check out the Quick Start Quide

 

References:

  1. Bishop A, Foster NE. Do physical therapists in the United kingdom recognize psychosocial factors in patients with acute low back pain? Spine 2005;30:1316-22.[PMID: 15928559]
  2. Hill JC, Vohora K, Dunn KM, et al. Comparing the STarT back screening tool’s subgroup allocation of individual patients with that of independent clinical experts. Clin J Pain2010;26:783-7. [PMID: 20842014]
  3. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based mamagement of acute musculoskeletal pain. Brisbane: Australian Government: National Health and Medical Research Council, 2003. [pdf]
  4. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of internal medicine 2007;147:478-91. [PMID: 17909209]
  5. van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006;15 Suppl 2:S169-91. [PMID: 16550447]
  6. Gabel CP, Burkett B, Neller A, Yelland M. Can long term impairment in General Practitioner Whiplash patients be predicted using screening and Patient Report Outcomes? Int J Rehabil Res 2008; 31(1): 79-80.
  7. Gabel CP, Melloh M, Yelland M, Burkett B, Roiko A. Predictive Ability of a Modified Örebro Musculoskeletal Pain Questionnaire in an Acute Low Back Pain Working Population. Eur Spine J 2011; 20(3): 449-57.
  8. Gabel CP, Burkett B, Yelland M, Melloh M, Osborne J. The Örebro Musculoskeletal Screening Questionnaire: validation of a modified primary care musculoskeletal screening tool in an acute work injured population. Man Ther 2012;17(6):554-65
  9. Linton, S. J., Nicholas, M., & MacDonald, S. (2011). Development of a short form of the Orebro Musculoskeletal Pain Screening Questionnaire. Spine, 36(22), 1891-1895.[PMID: 21192286]