Using quantitative sensory testing to predict attrition in an interdisciplinary pain management program: a pilot study.

Aim: To determine the extent to which quantitative sensory testing (QST) predicted attrition in an interdisciplinary pain program (IPP). Patients & methods: Participants (n = 53) enrolled in an IPP completed pretreatment assessments of QST and the PROMIS-29 quality of life survey. Results & conclusion: Compared with completers, non-completers (24.5%) reported significantly higher pain intensity (7.1, 95% CI [5.8, 8.4] versus 5.4, 95% CI [4.8, 6.1]) and cold hyperalgesia (14.6°C, 95% CI [8.8, 20.4] versus 7.5°C, 95% CI [4.8, 6.1]), with both variables also predicting attrition. This finding highlights a potentially novel and clinically significant use of QST. Higher overall pain intensity and the presence of remote cold hyperalgesia may identify patients at risk for dropping out of an IPP.

The purpose of this research study was to determine the extent to which quantitative sensory testing (QST) predicted which patients enrolled in an interdisciplinary pain program (IPP) would drop out. Fifty-three patients with chronic pain enrolled in an IPP were assessed before treatment with mechanical and thermal QST at a painful and a non-painful site, as well as with the PROMIS-29 quality of life survey. Pretreatment findings were compared between non-completers (i.e., attended five or fewer sessions for any component of the IPP) and completers. Resulting significant predictors were included in a logistic regression to predict attrition. Compared with those who completed the program, non-completers (24.5%) reported significantly higher pain intensity and oversensitivity to cold at a non-painful site pretreatment, with both variables also predicting completion of the IPP. In summary, these preliminary findings suggest that higher overall pain intensity and the presence of cold oversensitivity (at baseline) may identify patients at risk for dropping out of an IPP.

Test-Retest Reliability and Minimal Detectable Change of the Instrumented Modified Clinical Test of Sensory Interaction on Balance in Healthy, Older Adults.

BACKGROUND AND PURPOSE: Test-retest reliability has not been previously reported for the instrumented modified Clinical Test of Sensory Interaction on Balance (i-mCTSIB) utilizing the Neurocom Very Simple Rehab (VSR) Sport force plate. The VSR Sport is a portable, relatively inexpensive force plate system utilized to assess postural stability in various populations. Therefore, the purpose of this study is to determine the test-retest reliability, standard error of measurement (SEM), and minimal detectable change (MDC) of the i-mCTSIB when assessed using the VSR Sport in a sample of healthy, older adults. METHODS: This was a methodological study with 20 healthy, older adults between the ages of 65 and 85 years. Participants were tested twice in a single session on the i-mCTSIB utilizing the VSR Sport force plate. The mean sway velocity (°/s) measurements for the 2 trials were compared for each test condition to compute intraclass correlation coefficients (ICCs) for each measurement. Standard error of measurements and minimal detectable change at the 90% confidence level (MDC90) were also calculated. RESULTS AND DISCUSSION: The test-retest reliability for each of the test conditions ranged from 0.762 to 0.909, which can be broadly interpreted as good-to-excellent reliability. The ICC(2,k) value of 0.898 for the composite score can also be interpreted as excellent reliability. Our results revealed small SEM for all test conditions (SEM = 0.060-0.101) except for the foam surface, eyes closed condition, with an SEM of 0.481. The MDC90 results for all testing conditions ranged from 0.140 to 0.285 except for the foam surface, eyes closed condition, which had an MDC90 = 1.12. CONCLUSIONS: The i-mCTSIB measurements utilizing the VSR Sport demonstrated good-to-excellent test-retest reliability. The clinical relevance of this study is that it demonstrates that the VSR Sport is a feasible alternative to other more expensive computerized systems used for the assessment of postural sway. MDC90 scores allow interpretation of change in i-mCTSIB scores following intervention. Practice effects may have contributed to the larger MDC90 for sway scores in the foam surface, eyes closed condition.

THE DIAGNOSTIC ACCURACY OF THE LEVER SIGN FOR DETECTING ANTERIOR CRUCIATE LIGAMENT INJURY.

BACKGROUND: An alternative physical examination procedure for evaluating the integrity of the anterior cruciate ligament (ACL) has been proposed in the literature but has not been validated in a broad population of patients with a symptomatic complaint of knee pain for its diagnostic value. PURPOSE: To investigate the diagnostic accuracy of the Lever Sign to detect ACL tears and compare the results to Lachman testing in both supine and prone positions. STUDY DESIGN: Prospective, blinded, diagnostic accuracy study. METHODS: Sixty-two consecutive patients with a complaint of knee pain were independently evaluated for the status of the ACL's integrity with the Lever Sign and the Lachman test in a prone and supine by a blinded examiner before any other diagnostic assessments were completed. RESULTS: Twenty-four of the 60 patients included in the analysis had a torn ACL resulting in a prevalence of 40%. The sensitivity of the Lever Sign, prone, and supine Lachman tests were 38, 83, and 67 % respectively and the specificity was 72, 89, and 97% resulting in positive likelihood ratios of 1.4, 7.5, and 24 and negative likelihood ratios of 0.86, 0.19, and 0.34 respectively. The positive predictive values were 47, 83, and 94% and the negative predictive values were 63, 89, and 81% respectively. The diagnostic odds ratios were 1.6, 40, and 70 with a number needed to diagnose of 10.3, 1.4, and 1.6 respectively. CONCLUSIONS: The results of this study suggest that Lever Sign, in isolation, does not accurately detect the status of the ACL. During the clinical examination, the Lever Sign should be used as an adjunct to the gold standard assessment technique of anterior tibial translation assessment as employed in the Lachman tests in either prone or supine position. LEVEL OF EVIDENCE: 2.