ABSTRACT
On behalf of the German chapter of the International Association for the Study of Pain (IASP) recommendations for German pain treatment services have been developed for the first time. The criteria were based on the IASP recommendations but adapted to the specific German situation. According to the structure and process criteria four different levels of pain treatment services can be distinguished. The aim of the recommendations is to serve as a guide for future development and implementation of pain therapy and quality assurance.
Subject(s)
Chronic Pain/therapy , Pain Clinics/classification , Ambulatory Care/organization & administration , Back Pain/therapy , Chronic Pain/classification , Germany , Headache Disorders/therapy , Health Plan Implementation/organization & administration , Health Services Needs and Demand/organization & administration , Health Services Research/organization & administration , Humans , Pain Clinics/organization & administration , Quality Assurance, Health Care/organization & administration , Societies, MedicalABSTRACT
BACKGROUND: Complex forms of musculoskeletal dysfunction are thought to be risk factors for the development of chronic pain syndromes of the locomotor system. Unfortunately there are insufficient data on the reliability and validity of clinical tests for musculoskeletal dysfunctions. METHOD: The intrarater and interrater reliability of clinical tests for hypermobility and for the stabilisation system were examined in a multicentre trial. A total of 68 patients in 6 centres were functionally examined by 2 examiners once (intrarater reliability) and by 1 examiner twice (interrater reliability). RESULTS: The tests for hypermobility showed good to very good reliability. The results for the stabilisation system were more variable whereby 23 tests showed a kappa-coefficient greater than 0.5 and 15 tests good to very good reliability. DISCUSSION: All tests for hypermobility and 23 tests for the stabilisation system are suitable for further evaluation. The broad range in test reliability might be explained by the differences in examiner skills demanded by each test. Therefore, dependent on their validity, some tests will be useful in specialized centres while others might be used in primary care.
Subject(s)
Ataxia/diagnosis , Back Pain/etiology , Joint Instability/diagnosis , Movement Disorders/diagnosis , Postural Balance , Adult , Aged , Ataxia/complications , Biometry , Female , Humans , Joint Instability/complications , Male , Middle Aged , Movement Disorders/complications , Observer Variation , Pain Measurement/statistics & numerical data , Predictive Value of Tests , Prospective Studies , Young AdultABSTRACT
Magnetic resonance imaging (MRI) was performed on seven patients with aseptic osteonecrosis (n = 4) and osteochondritis dissecans (OCD; n = 3) of the elbow. Precontrast MRI was superior to plain radiographs, which did not show any abnormality in three cases of osteonecrosis. On gadopentetate-dimeglumine-enhanced T1-weighted images, which were obtained in three patients with osteonecrosis and three patients with OCD, all cases of osteonecrosis demonstrated homogeneous enhancement of the lesions. All cases of OCD were diagnosed on plain radiographs. On MRI one showed significant enhancement of the loose body. In another case an incompletely enhancing loose body was surrounded by a diffusely enhancing region. In the third patient only a small marginal enhancement of the defect was observed. Our results suggest that MRI can improve the accuracy in diagnosis of aseptic osteonecrosis of the elbow. The use of gadopentetate dimeglumine allows the viability of the lesions or the loose bodies to be demonstrated and reparative tissue to be detected.
