Clinical course and prognosis of musculoskeletal pain in patients referred for physiotherapy: does pain site matter?

Background: Danish patients with musculoskeletal disorders are commonly referred for primary care physiotherapy treatment but little is known about their general health status, pain diagnoses, clinical course and prognosis. The objectives of this study were to 1) describe the clinical course of patients with musculoskeletal disorders referred to physiotherapy, 2) identify predictors associated with a satisfactory outcome, and 3) determine the influence of the primary pain site diagnosis relative to those predictors. Methods: This was a prospective cohort study of patients (n = 2,706) newly referred because of musculoskeletal pain to 30 physiotherapy practices from January 2012 to May 2012. Data were collected via a web-based questionnaire 1–2 days prior to the first physiotherapy consultation and at 6 weeks, 3 and 6 months, from clinical records (including primary musculoskeletal symptom diagnosis based on the ICPC-2 classification system), and from national registry data. The main outcome was the Patient Acceptable Symptom State. Potential predictors were analysed using backwards step-wise selection during longitudinal Generalised Estimating Equation regression modelling. To assess the influence of pain site on these associations, primary pain site diagnosis was added to the model. Results: Of the patients included, 66% were female and the mean age was 48 (SD 15). The percentage of patients reporting their symptoms as acceptable was 32% at 6 weeks, 43% at 3 months and 52% at 6 months. A higher probability of satisfactory outcome was associated with place of residence, being retired, no compensation claim, less frequent pain, shorter duration of pain, lower levels of disability and fear avoidance, better mental health and being a non-smoker. Primary pain site diagnosis had little influence on these associations, and was not predictive of a satisfactory outcome. Conclusion: Only half of the patients rated their symptoms as acceptable at 6 months. Although satisfactory outcome was difficult to predict at an individual patient level, there were a number of prognostic factors that were associated with this outcome. These factors should be considered when developing generic prediction tools to assess the probability of satisfactory outcome in musculoskeletal physiotherapy patients, because the site of pain did not affect that prognostic association

Effect of varying compression on the efficiency of a Fairbanks-Morse horizontal gas engine

http://www.archive.org/details/effectofvaryingc00bergThesis (B.S.)--Armour Institute of Technology, 1910 B.S. in Mechanical Engineering, 191

Documentation of postoperative pain by nurses in surgical wards

Summary Purpose: To describe nursing documentation of pain assessment and management in the first 72 h postoperatively in surgical wards. Methods: A retrospective approach was used to collect data on nurses' documentation from patients' records. A total sample size of 322 records at six hospitals in Jordan were audited using three audit instruments; Pain and Anxiety Audit Tool, the North American Nursing Diagnosis Association (NANDA) form for characteristics of acute pain, and comprehensiveness assessment tool. Results: There was no evidence of pain assessment documentation on the first day of surgery in 113 (35%) of patient's records. Pain location was the most recorded information for pain assessment in 197 (61%) notes, and only 14 (4.3%) nurses used a pain scale. More than 53% of the records lacked information about medication for pain management. There was a significant difference (p < 0.05) in all the categories of pain documentation between the first day and the subsequent days. Nurses documented patients' self-report of pain [297 (92.3%)], and patients ' crying [200 (62.1%)]. More than 80% (273) of the records were ranked below the minimum score for a satisfactory documentation. Conclusion: The results indicate the need to improve postoperative pain assessment and documentation, and the establishment of acute pain service