RESUMO
OBJECTIVE: To assess the degree of resilience in patients with complex regional pain syndrome (CRPS) 1, to explore the relationship between resilience and patient-related outcome measurements and to describe a pattern of clinical manifestations associated with low resilience. METHODS: This study presents a cross-sectional analysis of baseline information collected from patients enrolled in a single center study between February 2019 and June 2021. Participants were recruited from the outpatient clinic of the Department of Physical Medicine & Rheumatology of the Balgrist University Hospital, Zurich, Switzerland. We used linear regression analysis to explore association of resilience with patient reported outcomes at baseline. Furthermore, we explored the impact of significant variables on the low degree resilience using logistic regression analysis. RESULTS: Seventy-one patients (females 90.1%, mean age 51.2 ± 12.9 years) were enrolled. There was no association between CRPS severity and the level of resilience. Quality of Life was positively correlated with resilience, as was pain self-efficacy. Pain catastrophizing was inversely correlated with the level of resilience. We observed a significant inverse association between anxiety, depression and fatigue and the level of resilience. The proportion of patients with a low resilience increased with higher level of anxiety, depression and fatigue on the PROMIS-29, without reaching statistical significance. CONCLUSION: Resilience seems to be an independent factor in CRPS 1 and is associated with relevant parameters of the condition. Therefore, caretakers may screen the current resilience status of CRPS 1 patients to offer a supplementary treatment approach. Whether specific resilience training modifies CRPS 1 course, requires further investigations.
Assuntos
Síndromes da Dor Regional Complexa , Distrofia Simpática Reflexa , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Estudos Transversais , Qualidade de Vida , Medição da Dor , Estudos de Coortes , FadigaRESUMO
OBJECTIVES: Existing research has established the importance of appearance concerns for individuals with cancer and identified appearance as an important factor in dying with dignity. No research, however, has explored in depth the role of appearance in the experiences of individuals who have incurable cancer. This research aims to explore patients' experiences and perspectives in relation to the role of appearance issues in adults with incurable cancer. METHODS: Semi-structured interviews were conducted with 24 adults with incurable cancer (20 women, 4 men; mean age 54.5, SD 11.32). RESULTS: Thematic analysis generated three themes: 'Identity: Embodying Cancer', 'Communication: Wearing your illness' and 'Support: Holistic Care'. Appearance was felt to be an important element of identity, which was often dominated by cancer, leading to feelings of separation from the participant's previous self. Appearance changes also influenced the way in which individuals communicated with their external world, forcing discussion of their diagnosis, and increasing focus on their cancer, with participants having to manage the emotional impact of this on loved ones, as well as the impact on their legacy. Finally, participants highlighted the positive impact of appearance-related support in their well-being and identified peer connections and refocusing on the self as key elements of such support. CONCLUSIONS: Appearance changes play an important role in the experiences of individuals with incurable cancer with regards to both identity and communication and challenged participants' ability to maintain normalcy. Further psychosocial support relating to appearance concerns was considered necessary to promote dignity and provide truly holistic patient care.
Assuntos
Neoplasias , Aparência Física , Masculino , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Cuidados Paliativos/psicologia , Emoções , Comunicação , Neoplasias/psicologia , Pesquisa QualitativaRESUMO
There have been some modest recent advancements in the research of Complex Regional Pain Syndrome, yet the amount and quality of the work in this complicated multifactorial disease remains low (with some notable exceptions; e.g., the recent work on the dorsal root ganglion stimulation). The semi-systematic (though in some cases narrative) approach to review is necessary so that we might treat our patients while waiting for "better research." This semi-systematic review was conducted by experts in the field, (deliberately) some of whom are promising young researchers supplemented by the experience of "elder statesman" researchers, who all mention the system they have used to examine the literature. What we found is generally low- to medium-quality research with small numbers of subjects; however, there are some recent exceptions to this. The primary reason for this paucity of research is the fact that this is a rare disease, and it is very difficult to acquire a sufficient sample size for statistical significance using traditional statistical approaches. Several larger trials have failed, probably due to using the broad general diagnostic criteria (the "Budapest" criteria) in a multifactorial/multi-mechanism disease. Responsive subsets can often be identified in these larger trials, but not sufficient to achieve statistically significant results in the general diagnostic grouping. This being the case the authors have necessarily included data from less compelling protocols, including trials such as case series and even in some instances case reports/empirical information. In the humanitarian spirit of treating our often desperate patients with this rare syndrome, without great evidence, we must take what data we can find (as in this work) and tailor a treatment regime for each patient.
Assuntos
Síndromes da Dor Regional Complexa , Distrofia Simpática Reflexa , Idoso , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/terapia , Gânglios Espinais , HumanosRESUMO
OBJECTIVE: Painful diabetic neuropathy (PDN) is a painful complication of diabetes. This study aimed to explore: (1) strategies used by participants to manage impacts of PDN and (2) their perspectives on whether strategies from pain management programmes (PMPs) had applicability for PDN. DESIGN: Participants were recruited through local National Health Service (NHS) diabetes and PDN clinics, and nationally from a diabetes support charity. One-to-one interviews were conducted. The transcribed data were analysed using inductive thematic analysis. RESULTS: Twenty-three people were interviewed who had PDN symptoms for mean 10 years. Four themes emerged from the data: seeking help and advice, pragmatic approach to management, perspectives on physical activity and perspectives on psychological coping strategies. CONCLUSION: Some participants were open to the strategies advised by PMP strategies. There were also strong opinions that no exercise or psychological approach could help with diabetes-related pain. It is possible PMPs as currently delivered need to be adapted to maximise engagement from people with PDN. Research is required to understand the healthcare priorities of people with PDN and whether these priorities can be mapped to existing management strategies.
RESUMO
BACKGROUND: Effective treatment of longstanding Complex Regional Pain Syndrome (CRPS) is a challenge, as causal mechanisms remain elusive. People with CRPS frequently report distorted subjective perceptions of their affected limb. Evidence of pain reduction when the affected limb is visually altered in size suggests that visual illusions used to target central processing could restore coherence of this disrupted limb representation. We hypothesized that using virtual reality that alters hand image to match the patient's desired hand appearance would improve body perception disturbance and pain. Also, repeated exposure would maintain any therapeutic effect. METHODS: A blinded randomized controlled trial of 45 participants with refractory upper-limb CRPS and body perception disturbance (BPD) viewed a digital image of their affected hand for 1 min. The image was digitally altered according to the patient's description of how they desired their hand to look in the experimental group and unaltered in the control group. BPD and pain were measured pre- and post-intervention. A subgroup was followed up 2 weeks after a course of repeated interventions. RESULTS: BPD (mean-6, ±SD 7.9, p = 0.036, effect size [ES] = 0.6) and pain intensity (mean-0.43, ±SD 1.3, p = 0.047, ES = 0.5) reduced in 23 participants after single exposure compared to controls (n = 22). At follow-up, the subgroup (experimental n = 21; control n = 18) showed sustained pain reduction only (p = 0.037, ±SD 1.9, ES = 0.7), with an overall 1.2 decrease on an 11-point scale. CONCLUSIONS: Visually changing the CRPS hand to a desired appearance modulates BPD and pain suggesting therapeutic potential for those with refractory CRPS. Further research to optimize this therapeutic effect is required. SIGNIFICANCE: Visual bodily illusions that change the shape and appearance of the painful CRPS hand to that desired by the patient result in a rapid amelioration of pain and body perception disturbance in people with longstanding CRPS. These findings highlight the future potential of this drug-free approach in the treatment of refractory CRPS.
Assuntos
Síndromes da Dor Regional Complexa , Ilusões , Mãos , Humanos , Dor , Extremidade SuperiorRESUMO
Individuals with pain report higher sensory disturbances during sensorimotor conflicts compared to pain-free individuals. In the pain field, it is frequently assumed that disturbances arise from a discordance between sensory and efference copies (defined as sensory-motor conflict), while in the sensorimotor control field they are considered to result from the incongruence between sensory modalities (defined as sensory-sensory conflict). The general aim of this study was to disentangle the relative contribution of motor efferences and sensory afferences to the increased sensitivity to sensorimotor conflicts in individual with fibromyalgia (nâ¯=â¯20) compared to controls (nâ¯=â¯20). We assessed sensory and motor disturbances during sensory-sensory and sensory-motor conflicts using a robotized exoskeleton interfaced with a 2D virtual environment. There was a significant interaction between the group and the type of conflict (pâ¯=â¯0.03). Moreover, the increase in conflict sensitivity from sensory-sensory to sensory-motor conflicts in fibromyalgia was related to conflict-induced motor disturbances (râ¯=â¯0.57; pâ¯<â¯0.01), but did not result from a poorer proprioception (râ¯=â¯0.12; pâ¯=â¯0.61). Therefore, it appears that higher conflict sensitivity in fibromyalgia is mainly explained by a sensory-motor conflict rather by a sensory-sensory conflict. We suggest this arises due to a deficit in updating predicted sensory feedback rather than in selecting appropriate motor commands.
Assuntos
Fibromialgia , Retroalimentação Sensorial , Humanos , Dor , PropriocepçãoRESUMO
Complex regional pain syndrome (CRPS) and fibromyalgia are chronic pain conditions of unexplained origins. In addition to symptoms in the diagnostic criteria, patients can report changes to vision and other sensations or bodily functions. It is unclear whether these are greater than would be expected due to normal ageing, living with chronic pain generally, or common comorbidities of chronic pain such as depression or anxiety. We administered an on-line survey evaluating the frequencies and types of self-reported somatic symptoms, bodily changes, and sensory sensitivity in respondents with CRPS (n = 390), fibromyalgia (n = 425), and both CRPS and fibromyalgia ("CRPS+fibromyalgia"; n = 88) compared to respondents with other chronic pain conditions (n = 331) and pain-free controls (n = 441). The survey assessed somatic symptoms (Patient Health Questionnaire-15), bodily changes, pain/discomfort/distress triggers, and pain intensifiers. We conducted analysis of covariance's with age, sex, Patient Health Questionnaire-9 (measuring depression), Generalized Anxiety Disorder-7, pain duration in years, hours of pain per day, and number of pain-related medical diagnoses as covariates. After controlling for covariates, respondents with CRPS and/or fibromyalgia reported more somatic symptoms, changes in movement and biological responses, pain/discomfort/distress triggers, and pain intensifiers than pain(-free) control groups. Fibromyalgia specifically related to changes in vision and hearing, urinary/intestinal function, and drinking and eating. Complex regional pain syndrome related to changes in hair, skin, and nails; and infection and healing. The CRPS+fibromyalgia group presented with features of both disorders with minimal additional stressors or symptoms over and above these. Our findings suggest that CRPS and fibromyalgia share underlying pathophysiologies, although specific mechanisms might be different.
Assuntos
Síndromes da Dor Regional Complexa , Fibromialgia , Comorbidade , Síndromes da Dor Regional Complexa/complicações , Síndromes da Dor Regional Complexa/epidemiologia , Fibromialgia/complicações , Fibromialgia/epidemiologia , Humanos , Dor , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This qualitative evidence synthesis aimed to identify, review and synthesise qualitative research describing the experience of persistent pain in adult cancer survivors. METHODS: A systematic literature search was conducted between December 2007 and June 2019. Data synthesis followed Thomas and Harden's (2008) method of thematic synthesis. RESULTS: Four studies were identified, together incorporating findings from 52 female breast cancer survivors. Six themes were generated as follows: (a) interwoven relationship between experience of cancer and persistent pain, (b) lack of preparedness and support for persistent pain, (c) physical impact of persistent pain, (d) employing coping strategies, (e) emotional experience of persistent pain and (f) conceptualisation of persistent pain. CONCLUSIONS: Persistent pain is intrinsically interwoven with women's experiences of cancer. Persistent pain was unexpected, and women did not feel supported. Women need more information about persistent pain after cancer treatment and support with self-management of pain. Ways to best support cancer survivors with persistent pain need exploration and a review of currently available services is required. More research is needed to understand the experiences of men and other cancer groups.
Assuntos
Adaptação Psicológica , Neoplasias da Mama/fisiopatologia , Dor do Câncer/fisiopatologia , Sobreviventes de Câncer , Dor Crônica/fisiopatologia , Autogestão , Neoplasias da Mama/psicologia , Dor do Câncer/psicologia , Dor Crônica/psicologia , Feminino , Humanos , Pesquisa QualitativaRESUMO
BACKGROUND: Published guidelines promote best practice in complex regional pain syndrome (CRPS) treatment and management; however, these recommendations are not always applied in clinical practice. Understanding existing care internationally will help inform future patient and health professional service delivery, education initiatives and content of clinical guidelines. METHODS: An e-survey was conducted in order to gain an insight into routine CRPS clinical practice. Health professionals and academics, from the field of CRPS, were recruited from an international population. Quantitative and qualitative data were elicited. Data were mapped onto a framework to identify macro-regional factors. RESULTS: Of the 260 survey respondents, 96% (n = 241) provided clinical care for people with CRPS, with academics not involved in patient care also responding. Half of respondents expressed difficulty in recognizing the symptoms of CRPS but treatment aims corresponded with published guidelines. However, a lack of resources and fragmented care were reported as barriers to early intervention. Service constraints were most frequently reported by European respondents. Five themes emerged from the qualitative data: the benefit of interdisciplinary working; the importance of symptom management; need for early diagnosis and intervention; establishing a collaborative partnership with patients; the value of education for patients and health professionals. CONCLUSIONS: Our data suggest that more work is required to raise awareness of the Budapest CRPS diagnostic criteria so as to promote early diagnosis and intervention. Future work to optimize clinical effectiveness should consider enhancing interdisciplinary service delivery that encourages a collaborative patient/clinician partnership; includes excellent patient education; and addresses modifiable patient-related factors. SIGNIFICANCE: Health professionals expressed some level of difficulty recognizing the signs and symptoms of CRPS despite the majority of health professionals having had clinical experience exceeding 6 years in the field of CRPS. More work is required to raise awareness amongst clinicians of the Budapest CRPS diagnostic criteria so as to promote early diagnosis and intervention Health professionals' treatment aims reflected the current clinical guidelines however, a lack of resources and fragmented care were frequently cited as barriers to achieving these.
Assuntos
Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/terapia , Padrões de Prática Médica , Australásia , Comportamento Cooperativo , Diagnóstico Precoce , Intervenção Médica Precoce , Europa (Continente) , Humanos , Neurologia , América do Norte , Oceania , Ortopedia , Manejo da Dor , Equipe de Assistência ao Paciente , Medicina Física e Reabilitação , Relações Médico-Paciente , Guias de Prática Clínica como Assunto , Pesquisa Qualitativa , Reumatologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: The purpose of this study was to conduct classical psychometric evaluation and Rasch analysis on the Neuropathic Qualities subscale of the Short-Form McGill Pain Questionnaire-2 utilizing scores from persons with complex regional pain syndrome to consider reliability and person separation, validity (including unidimensionality), and responsiveness in this population. METHODS: Secondary analysis of longitudinal data from persons with acute complex regional pain syndrome was utilized for analysis of the psychometric properties and fit to the Rasch model of the Neuropathic Qualities subscale. We followed an iterative process of Rasch analysis to evaluate and address data fitting challenges. RESULTS: Repeated measures from 59 persons meeting the Budapest criteria were used for analysis. Both item-total correlations and unidimensionality analyses supported theoretical construct validity; all convergent construct validity hypotheses were also supported. Responsiveness was demonstrated comparing baseline and one-year data at d = 0.92, with a standardized response mean of 0.97. Data were able to fit the Rasch model, but all Neuropathic Qualities items had disordered thresholds that required rescoring. Additionally, local dependency and differential item function were addressed by "bundling," suggesting that no further item reduction would be possible. CONCLUSIONS: This study provided preliminary support for the validity and responsiveness of the Neuropathic Qualities subscale in persons with complex regional pain syndrome. Rasch analysis further endorses use of the Neuropathic Qualities subscale as a "stand-alone" measure for neuropathic features, but with substantial background data transformations. Replication with larger samples is recommended to increase confidence in these findings.
Assuntos
Síndromes da Dor Regional Complexa/diagnóstico , Medição da Dor/instrumentação , Psicometria/instrumentação , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Inquéritos e Questionários , Adulto JovemRESUMO
Chronic pain is often accompanied by patient-reported distorted body perception and an altered kinesthesia (referring to the senses of limb position and limb movement), but the association between these deficits is unknown. The objectives of this study were to assess body perception and the senses of limb position and limb movement in complex regional pain syndrome (CRPS) and to test whether these variables are related to each other and to pain intensity. Thirteen patients with upper limb CRPS (mean pain intensity, 4.2 ± 2.4 out of 10) and 13 controls were recruited. Body perception was self-reported with a questionnaire, and the senses of limb position (task 1) and of limb movement (task 2) were assessed with a robotic system combined with a 2D virtual reality display. The results showed altered kinesthesia in the patients with CRPS compared with controls (all P < .05). Moreover, in the CRPS group, greater pain intensity was associated with lower performance on task 2 (râ¯=â¯-.60; P < .05). Although alterations in participants' sense of limb position and limb movement were associated with each other (râ¯=â¯-.70, P < .01), they were not related to the altered body perception (all P > .26). Therefore, the results suggest that kinesthesia and body perception should be considered and evaluated separately in patients with CRPS. PERSPECTIVE: Senses of limb position and movement rely on sensorimotor integration. Both are altered in complex regional pain syndrome. However, they are not related to the subjective perception of the painful limb, and thus they should be assessed separately in rehabilitation.
Assuntos
Dor Crônica/fisiopatologia , Síndromes da Dor Regional Complexa/fisiopatologia , Propriocepção/fisiologia , Extremidade Superior/fisiopatologia , Adulto , Feminino , Humanos , Cinestesia/fisiologia , Masculino , Pessoa de Meia-Idade , Realidade VirtualRESUMO
BACKGROUND: Sensorimotor conflicts are well known to induce sensory disturbances. However, explanations as to why patients with chronic pain are more sensitive to sensorimotor conflicts remain elusive. The main objectives of this study were (a) to assess and compare the sensory disturbances induced by sensorimotor conflict in complex regional pain syndrome (n = 38), fibromyalgia (n = 36), arthritis (n = 34) as well as in healthy volunteers (HV) (n = 32); (b) to assess whether these disturbances were related to the intensity and duration of pain, or to other clinical variables assessed using questionnaires (abnormalities in sensory perception, depression and anxiety); and (c) to categorize different subgroups of conflict-induced sensory disturbances. METHODS: One hundred and forty participants performed in phase or anti-phase movements with their arms while viewing a reflection of one arm in a mirror (and the other arm obscured). They were asked to report changes in sensory disturbances using a questionnaire. RESULTS: First, results showed that patients with complex regional pain syndrome and fibromyalgia were more prone to report sensory disturbances than arthritis patients and HV in response to conflicts (small effect size). Second, conflict-induced sensory disturbances were correlated with pain intensity (large effect size) and abnormalities in sensory perception (only in the CRPS group) but were not related to the duration of the disease or psychological factors. Finally, we identified two distinct subgroups of conflict-induced sensory disturbances. CONCLUSIONS: Our results suggest that pain lowers the threshold for the detection of sensorimotor conflicts, a phenomenon that could contribute to the maintenance of pain in clinical populations. SIGNIFICANCE: Individuals with complex regional pain syndrome and fibromyalgia were more sensitive to sensorimotor conflicts than arthritis patients and controls. Moreover, conflict-induced sensory disturbances were specific to higher pain intensity and higher sensory abnormalities in all groups, suggesting that pain lowers the threshold for the detection of sensorimotor conflicts.
Assuntos
Artrite/complicações , Síndromes da Dor Regional Complexa/complicações , Fibromialgia/complicações , Dor/etiologia , Sensação/fisiologia , Córtex Sensório-Motor/fisiopatologia , Adulto , Artrite/fisiopatologia , Estudos de Casos e Controles , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/fisiopatologia , Feminino , Fibromialgia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Dor/fisiopatologia , Dor/psicologia , Inquéritos e QuestionáriosRESUMO
Sensorimotor conflict induces both sensory and motor disturbances, but the specific factors playing a role in conflict-induced disturbances are still misunderstood. For example, we still do not know the role played by motor intention (vs. a purely visuo-proprioceptive conflict) or the influence of specific types of incongruent visual feedback. The objective of this study was threefold: 1- to compare the effect of passive and active movement during sensorimotor conflict on sensory disturbances measured with a questionnaire; 2- to compare the effect of three incongruent visual feedback conditions on sensory and motor (mediolateral drift and movement amplitude) disturbances; 3- to test whether conflict-induced sensory and motor disturbances were stable over time. 20 healthy participants realized active or passive cyclic upper limb movements while viewing either congruent or incongruent visual feedback about their movement using a robotized exoskeleton combined with 2D virtual reality interface. First, results showed that in condition of conflict, participants reported higher sensory disturbances during active movements compared to passive movements (p = 0.034), suggesting that the efference copy reinforces the conflict between vision and proprioception. Second, the three conditions of incongruence in the active condition induced similar sensory (all p>0.45) and motor disturbances (medio-lateral drift: all p>0.59 and amplitude: all p>0.25), suggesting that conflict induced motor disturbances could be related more to the observation of another movement rather than to a detection of conflict between motor intention and sensory feedback. Finally, both sensory and motor disturbances were stable over time (all ICCs between 0.76 and 0.87), demonstrating low variability within participants. Overall, our results suggest that the efference copy is more involved in sensory disturbances than in motor disturbances, suggesting that they might rely on independent processes.
Assuntos
Retroalimentação Sensorial , Movimento , Percepção Visual , Adulto , Conflito Psicológico , Exoesqueleto Energizado , Feminino , Humanos , Masculino , Propriocepção , Psicofísica , Extremidade Superior , Realidade VirtualRESUMO
Incongruence between our motor intention and the sensory feedback of the action (sensorimotor conflict) induces abnormalities in sensory perception in various chronic pain populations, and to a lesser extent in pain-free individuals. The aim of this study was to simultaneously investigate sensory and motor disturbances evoked by sensorimotor conflicts, as well as to assess how they are influenced by the presence of acute pain. It was hypothesized that both sensory and motor disturbances would be increased in presence of pain, which would suggest that pain makes body representations less robust. Thirty healthy participants realized cyclic asymmetric movements of flexion-extension with both upper limbs in a robotized system combined to a 2D virtual environment. The virtual environment provided a visual feedback (VF) about movements that was either congruent or incongruent, while the robotized system precisely measured motor performance (characterized by bilateral amplitude asymmetry and medio-lateral drift). Changes in sensory perception were assessed with a questionnaire after each trial. The effect of pain (induced with capsaicin) was compared to three control conditions (no somatosensory stimulation, tactile distraction and proprioceptive masking). Results showed that while both sensory and motor disturbances were induced by sensorimotor conflicts, only sensory disturbances were enhanced during pain condition comparatively to the three control conditions. This increase did not statistically differ across VF conditions (congruent or incongruent). Interestingly however, the types of sensations evoked by the conflict in the presence of pain (changes in intensity of pain or discomfort, changes in temperature or impression of a missing limb) were different than those evoked by the conflict alone (loss of control, peculiarity and the perception of having an extra limb). Finally, results showed no relationship between the amount of motor and sensory disturbances evoked in a given individual. Contrary to what was hypothesized, acute pain does not appear to make people more sensitive to the conflict itself, but rather impacts on the type and amount of sensory disturbances that they experienced in response to that conflict. Moreover, the results suggest that some sensorimotor integration processes remain intact in presence of acute pain, allowing us to maintain adaptive motor behavior.
RESUMO
Complex regional pain syndrome (CRPS) is a persistent pain condition that remains incompletely understood and challenging to treat. Historically, a wide range of different outcome measures have been used to capture the multidimensional nature of CRPS. This has been a significant limiting factor in the advancement of our understanding of the mechanisms and management of CRPS. In 2013, an international consortium of patients, clinicians, researchers, and industry representatives was established, to develop and agree on a minimum core set of standardised outcome measures for use in future CRPS clinical research, including but not limited to clinical trials within adult populations. The development of a core measurement set was informed through workshops and supplementary work, using an iterative consensus process. "What is the clinical presentation and course of CRPS, and what factors influence it?" was agreed as the most pertinent research question that our standardised set of patient-reported outcome measures should be selected to answer. The domains encompassing the key concepts necessary to answer the research question were agreed as follows: pain, disease severity, participation and physical function, emotional and psychological function, self-efficacy, catastrophizing, and patient's global impression of change. The final core measurement set included the optimum generic or condition-specific patient-reported questionnaire outcome measures, which captured the essence of each domain, and 1 clinician-reported outcome measure to capture the degree of severity of CRPS. The next step is to test the feasibility and acceptability of collecting outcome measure data using the core measurement set in the CRPS population internationally.
Assuntos
Ensaios Clínicos como Assunto/normas , Síndromes da Dor Regional Complexa/diagnóstico , Síndromes da Dor Regional Complexa/terapia , Avaliação de Resultados em Cuidados de Saúde/normas , Medição da Dor/normas , Medicina Baseada em Evidências/normas , Humanos , Internacionalidade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Diabetes is rising in prevalence; painful diabetic neuropathy (PDN) is one complication of diabetes. PDN is primarily managed with medication but analgesic failure is common and people remain in pain and distress. It is unclear whether pain management strategies are appropriate for PDN. OBJECTIVES: To establish the effectiveness of physical activity and psychological coping strategies for PDN. DESIGN: Systematic literature review. DATA SOURCES: Ten online databases. ELIGIBILITY CRITERIA (PARTICIPANTS AND INTERVENTIONS): Controlled trials reporting specific results for PDN, investigating, (a) physical activity or (b) psychological coping strategies and measuring pain as an outcome. The search was restricted to published research with no restriction on language or date of publication. STUDY APPRAISAL METHODS: Methodological quality and risk of bias assessed with Cochrane collaboration and NICE checklist for randomised controlled trials. RESULTS: Of 1306 titles identified, four studies met the inclusion criteria. Two trials investigated physical activity and two investigated psychological coping interventions. Studies showed pain measures improved or did not worsen compared to controls, but methodological quality was moderate and results need cautious interpretation. LIMITATIONS: The studies were of small sample size and used a diverse range of outcome measures. There is high risk of bias from lack of blinding and attrition at follow up. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: The research literature in this area is sparse and inconsistent, despite the pressing clinical challenge of PDN. Firm conclusions cannot be drawn from the studies included. Further high quality research is required to match treatment provision to patient requirements.
Assuntos
Adaptação Psicológica , Neuropatias Diabéticas/psicologia , Neuropatias Diabéticas/reabilitação , Exercício Físico , Manejo da Dor/métodos , Ensaios Clínicos como Assunto , Humanos , Medição da DorRESUMO
OBJECTIVE: Sustained abnormal postures (i.e., fixed dystonia) are the most frequently reported motor abnormalities in complex regional pain syndrome (CRPS), but these symptoms may also develop after peripheral trauma without CRPS. Currently, there is no valid and reliable measurement instrument available to measure the severity and distribution of these postures. The range of motion scale (ROMS) was therefore developed to assess the severity based on the possible active range of motion of all joints (arms, legs, trunk, and neck), and the present study evaluates its reliability and validity. METHODS: Inter- and intra-rater reliability of the ROMS was determined in 16 patients with abnormal sustained postures, who were videotaped following a standard video protocol in a university hospital. The recordings were rated by a panel of international experts. In addition, 30 patients were clinically tested with both the Burke-Fahn-Marsden (BFM) scale as well as the ROMS to assess construct validity. RESULTS: Inter-rater reliability for total ROMS scores showed an intra-class correlation coefficient (ICC) of 0.85. The majority of the scores for the separate joints (13 out of 18) demonstrated an almost perfect agreement with ICCs ranging from 0.81 to 0.94; of the other items, one showed fair, one moderate, and three substantial agreement. The ICCs for the intra-rater reliability ranged from moderate to almost perfect (0.68-0.98). Spearman's correlation coefficients between corresponding body areas as measured with the ROMS or BFM were all above 0.82. CONCLUSION: The ROMS is a reliable and valid instrument to evaluate the severity and distribution of sustained abnormal postures.