Diagnostic Prediction Using Discomfort Drawings with IBTM

In this paper, we explore the possibility to apply machine learning to make diagnostic predictions using discomfort drawings. A discomfort drawing is an intuitive way for patients to express discomfort and pain related symptoms. These drawings have proven to be an effective method to collect patient data and make diagnostic decisions in real-life practice. A dataset from real-world patient cases is collected for which medical experts provide diagnostic labels. Next, we use a factorized multimodal topic model, Inter-Battery Topic Model (IBTM), to train a system that can make diagnostic predictions given an unseen discomfort drawing. The number of output diagnostic labels is determined by using mean-shift clustering on the discomfort drawing. Experimental results show reasonable predictions of diagnostic labels given an unseen discomfort drawing. Additionally, we generate synthetic discomfort drawings with IBTM given a diagnostic label, which results in typical cases of symptoms. The positive result indicates a significant potential of machine learning to be used for parts of the pain diagnostic process and to be a decision support system for physicians and other health care personnel.Comment: Presented at 2016 Machine Learning and Healthcare Conference (MLHC 2016), Los Angeles, C

Assessment of nerve involvement in the lumbar spine: agreement between magnetic resonance imaging, physical examination and pain drawing findings

<p>Abstract</p> <p>Background</p> <p>Detection of nerve involvement originating in the spine is a primary concern in the assessment of spine symptoms. Magnetic resonance imaging (MRI) has become the diagnostic method of choice for this detection. However, the agreement between MRI and other diagnostic methods for detecting nerve involvement has not been fully evaluated. The aim of this diagnostic study was to evaluate the agreement between nerve involvement visible in MRI and findings of nerve involvement detected in a structured physical examination and a simplified pain drawing.</p> <p>Methods</p> <p>Sixty-one consecutive patients referred for MRI of the lumbar spine were - without knowledge of MRI findings - assessed for nerve involvement with a simplified pain drawing and a structured physical examination. Agreement between findings was calculated as overall agreement, the p value for McNemar's exact test, specificity, sensitivity, and positive and negative predictive values.</p> <p>Results</p> <p>MRI-visible nerve involvement was significantly less common than, and showed weak agreement with, physical examination and pain drawing findings of nerve involvement in corresponding body segments. In spine segment L4-5, where most findings of nerve involvement were detected, the mean sensitivity of MRI-visible nerve involvement to a positive neurological test in the physical examination ranged from 16-37%. The mean specificity of MRI-visible nerve involvement in the same segment ranged from 61-77%. Positive and negative predictive values of MRI-visible nerve involvement in segment L4-5 ranged from 22-78% and 28-56% respectively.</p> <p>Conclusion</p> <p>In patients with long-standing nerve root symptoms referred for lumbar MRI, MRI-visible nerve involvement significantly underestimates the presence of nerve involvement detected by a physical examination and a pain drawing. A structured physical examination and a simplified pain drawing may reveal that many patients with "MRI-invisible" lumbar symptoms need treatment aimed at nerve involvement. Factors other than present MRI-visible nerve involvement may be responsible for findings of nerve involvement in the physical examination and the pain drawing.</p

Review of methods used by chiropractors to determine the site for applying manipulation

Background: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods: Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results: A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions: A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.https://doi.org/10.1186/2045-709X-21-3

On the assessment of nerve involvement and of dysfunction in patients with spinal pain

Nerve involvement originating in the spine can cause pain and/or organ dysfunction. Reliable and valid assessment of nerve involvement is a prime diagnostic task as it may require other than symptomatic treatment. The aim of this thesis was to analyse the reliability of, and association between, some diagnostic methods and classifications used in the assessment of patients with spinal pain. In particular the reliability of, and association between, methods used to detect nerve involvement originating in the spine. Material. Articles I and II are based on study A where 100 consecutive primary health care patients with neck- and/or shoulder discomfort were assessed by 2 independent examiners using a simplified pain drawing, patient history and a physical exam with 66 clinical tests focused on neurology. Article III is based on study B on 50 consecutive outpatients with low back pain (LBP), assessed by 2 independent examiners using patient history and a physical exam with 30 clinical tests. Article IV is based on study C on 61 consecutive patients referred to magnetic resonance imaging (MRI) of the lumbar spine where we used the simplified pain drawing, patient history and a physical exam focused on neurology to detect nerve involvement originating in the spine. Results. In study A inter-examiner reliability was less than acceptable for many tests. Only a bimanual sensibility test with spurs reached K > 0.6 indicating good reliability and no bias. With known history, prevalence of positive findings increased but not reliability. Four out of five patients had, in the region of discomfort, 2 or more clinical test findings indicating nerve involvement originating in the spine. Interexaminer reliability based on a first impression assessment of the pain drawing reached 88% overall agreement and a sensitivity of 90 % to the final assessment. Two thirds of the patients added symptoms to the pain drawing during history session. In study B excellent inter-examiner reliability (K > 0.8) was found for using Kirkaldy-Willis Classification of LBP. Radiological findings had no impact. Good inter-examiner reliability was found for straight leg raise, movement range and sensibility testing with spurs. In study C we found that MRI visible nerve involvement significantly underestimated the high percentage of nerve involvement detected in the physical exam and in the pain drawing. Conclusions. Nerve involvement can be detected reliably, simply and quickly with a bimanual sensibility test with spurs and a pain drawing. MRI visible nerve involvement in the lumbar spine underestimates presence of nerve involvement detected in a physical exam and a pain drawing. Nerve involvement in both the cervical and lumbar spine may be a greatly underestimated cause of pain and/or organ dysfunction. This may explain part of today s poor treatment outcome of spinal pain and should encourage further studies on diagnostics and treatment of nerve involvement originating in the spine

Diagnostic Prediction Using Discomfort Drawings

In this paper, we explore the possibility to apply machine learning to make diagnostic predictions using discomfort drawings. A discomfort drawing is an intuitive way for patients to express discomfort and pain related symptoms. These drawings have proven to be an effective method to collect patient data and make diagnostic decisions in real-life practice. A dataset from real-world patient cases is collected for which medical experts provide diagnostic labels. Next, we extend a factorized multimodal topic model, Inter-Battery Topic Model (IBTM), to train a system that can make diagnostic predictions given an unseen discomfort drawing. Experimental results show reasonable predictions of diagnostic labels given an unseen discomfort drawing. The positive result indicates a significant potential of machine learning to be used for parts of the pain diagnostic process and to be a decision support system for physicians and other health care personnel.Comment: NIPS 2016 Workshop on Machine Learning for Healt

Photobiomodulation, as additional treatment to traditional dressing of hard-to-heal venous leg ulcers, in frail elderly with municipality home healthcare

The main objectives of the study were to explore whether laser Photobiomodulation (PBM) in addition to traditional dressing of hard-to-heal venous leg ulcer, reduced healing time of the ulcer and if the duration of the ulcer before PBM impacted the treatment time with PBM to healing. The intervention group was frail, elderly patients with home healthcare in the municipality of Skellefteå, registered in the Swedish quality registry RiksSar for ulcer treatment with hard-to-heal venous leg ulcer. The control group with equivalent physical conditions was obtained from the same quality registry. Definition of hard-to-heal ulcer was six weeks duration or more. The PBM was performed two times per week with laser type infrared GaAs, 904nm, 60mW, and 700Hz, targeting lymphatic area and ulcer area. Laser type red visible, GaAllnp, 635nm, 75mW and 250Hz, targeting ulcer area. The intervention group treated with PBM in addition to traditional dressing healed significantly faster than the control group with a mean of 123 days (p = 0.0001). Duration of the ulcer before PBM did not impact the healing time. To conclude, the findings indicate that using PBM in addition to dressing may have multiple benefits on hard-to-heal venous leg ulcer, saving valuable time and resources for patients, healthcare providers, and institutions.Validerad;2022;Nivå 2;2022-09-26 (joosat);2022-10-04: Dubblettpost PID: 1700859 har raderats. (sofila)</p