Pain and physical functioning in neuropathic pain: a systematic review of psychometric properties of various outcome measures

INTRODUCTION: A range of outcome measures across various domains are used to evaluate change following an intervention in clinical trials on chronic neuropathic pain (NeP). However, to capture a real change in the variable of interest, the psychometric properties of a particular measure should demonstrate appropriate methodological quality. Various outcome measures in the domains of pain and physical functioning have been used in the literature for NeP, for which individual properties (eg, reliability/validity) have been reported. To date, there is no definitive synthesis of evidence on the psychometric properties of those outcome measures; thus, the aim of this systematic review was to evaluate the methodological quality [COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines] of studies that evaluated psychometric properties of pain and physical functioning outcome measures used for NeP. METHODS: Specific MeSH/keywords related to 3 areas (pain and/or physical functioning, psychometric properties, and NeP) were used to retrieve relevant studies (English language) in key electronic databases (MEDLINE (Ovid), CINAHL (EBSCO), Scopus, AMED, and Web of Science) from database inception-July 2012. Articles retrieval/screening and quality analysis (COSMIN) were carried out by 2 independent reviewers. RESULTS: Twenty-four pain and thirty-seven physical functioning outcome measures were identified, varying in methodological quality from poor-excellent. CONCLUSION: Although a variety of pain and physical functioning outcome measures have been reported in the literature, few have demonstrate methodologically strong psychometric properties. Thus, future research is required to further investigate the psychometric properties of existing pain and physical functioning outcome measures used for clinical and research purposes

Effectiveness of a treadmill-based aerobic exercise intervention on pain, daily functioning, and quality of life in women with primary dysmenorrhea: a randomized controlled trial

Objective: To evaluate the effectiveness of a treadmill-based aerobic exercise intervention on pain and associated symptoms of primary dysmenorrhea. Methods: Seventy women with primary dysmenorrhea were included in the study. The experimental group underwent supervised aerobic training for 4 weeks followed by unsupervised home exercise for the next 6 months. The control group continued usual care. The primary outcome was pain. Secondary outcomes included quality of life (QoL), daily functioning, and sleep. Results: After the 4-week training, compared to the control group exercise significantly improved primary outcomes pain quality (mean difference (MD) -1.9, 95% CI 3.8 to -0.04, p < 0.05), and intensity (MD -4.7, 95% CI -9.3 to -0.09, p < 0.05), but not present pain. Significant effects were also reported for pain interference (MD -1.7, 95% CI -3.4 to -0.02, p < 0.05) at 4 weeks; the other outcomes did not significantly differ between groups at this time. During the follow-up period of 7-months, the effect on pain improved to 22 mm (95% CI 18 to 25). Significant benefits of exercise were maintained up to 7-months for present pain, QoL and daily functioning. Conclusion: Exercise has significant effects on primary dysmenorrhea-related pain, QoL and function

Balance assessment in Multiple Sclerosis and cerebellar ataxia: rationale, protocol and demographic data

A core set of standardized balance measures are required for use in rehabilitation among people with multiple sclerosis (MS) and cerebellar ataxia. An earlier systematic review and Delphi survey identified the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), Posture and Gait sub-component of the International Co-operative Ataxia Rating Scale (PG of ICARS) and the gait, sitting and stance sub-components of the Scale for the Assessment and Rating of Ataxia (SARA Bal) as suitable balance measures. This study aims to estimate the reliability, validity and interpretability of these measures. This study will recruit 60 participants with multiple sclerosis with secondary cerebellar involvement across four centres in New Zealand and the United States of America. Participants will be assessed and videotaped performing the BBS, TUG, SARA Bal and PG of ICARS by trained physiotherapists. Barthel Index, Expanded Disability Status Scale (EDSS), Disease duration, ICARS and SARA will also be assessed to determine validity. A second assessment to determine reliability will be conducted by assessors watching the video-recording. Data collection is in progress, 44 samples have been collected and the demographic data are presented. The findings of this study will recommend a core set of reliable, valid and interpretable measures that are suitable for clinical practice and research for the assessment of balance among adults with MS and cerebellar ataxia. Minimal Clinically Important Difference (MCID) and cut-off scores to predict the use of assistive walking device will be established

Validating the Cambridge Protocol: Reliability of Hip Muscle Strength Measurements Using a Motorized Dynamometer and Electromyography

Background: Muscle weakness is common after injury in athletes and in the presence of hip pathology. It will cause abnormal hip biomechanics and can predict future injury. However, objective measurement of hip muscle strength is difficult to perform accurately and reliably. Therefore, it is challenging to determine when an athlete has returned to preinjury levels of strength. In addition, there is currently no standardized method of obtaining measurements, which prevents the data being compared or shared between research centers. Purpose: The purpose of this study is to comprehensively assess the inter- and intraobserver reliability of our standardized muscle strength measurement protocol. Study Design: Descriptive laboratory study. Level of Evidence: Level 3, inception cohort study. Methods: A total of 16 healthy male volunteers (age = 28.3 ± 7.9 years) were recruited. Those with a previous history of hip injuries or disorders were excluded. These volunteers underwent strength testing according to the Cambridge Protocol on 4 separate occasions, performed by 2 independent assessors. Maximal voluntary contractions, fatigue torque fluctuations, and electromyography measurements were recorded. Intra- and interobserver reliability was assessed using intraclass correlation coefficient (ICC). Results: Good-to-excellent correlation was seen for both intra- and interobserver reliability across almost all hip movements for maximal contractions: ICC ranged 0.78 to 0.93 and 0.78 to 0.96, respectively. The standard error of the mean for all hip movements was also extremely low at 2% to 3%. Conclusion: The Cambridge Protocol is a highly reliable method for objective measurement of hip muscle strength. We recommend future studies use this protocol, or the principles underpinning it, to enable data sharing and comparison across different studies. Clinical Relevance: This is a description and analysis of hip muscle strength measurement. If widely used, it will allow for accurate and objective strength assessment and closer monitoring of hip injuries and pathology

Social media for physiotherapy clinics: considerations in creating a Facebook page

Social media websites play a prominent role in modern society, and the most popular of these websites is Facebook. Increasingly, physiotherapy clinics have begun to utilize Facebook in order to create pages to publicize their services. There are many factors to consider in the planning, implementing, and maintenance of Facebook pages for physiotherapy clinics, including ethical and privacy issues. The primary purpose of creating a page must be clearly defined, with dedicated clinicians given adequate time to manage the page. This technical article discusses these factors and summarizes the experiences at the University of Otago, New Zealand, in creating a Facebook page for the physiotherapy clinic and provides suggestions for physiotherapy clinicians in operating a Facebook page

Rigour in quantitative research

This article which forms part of the research series addresses scientific rigour in quantitative research. It explores the basis and use of quantitative research and the nature of scientific rigour. It examines how the reader may determine whether quantitative research results are accurate, the questions that should be asked to determine accuracy and the checklists that may be used in this process. Quantitative research has advantages in nursing, since it can provide numerical data to help answer questions encountered in everyday practice

Physiological rationales of physical therapy interventions in the management of primary dysmenorrhea: a critical review

Background: The mechanisms underlying the physical therapy interventions for obtaining relief from primary dysmenorrhea (PD) symptoms are not fully understood. Objective: To provide an overview of the physiological rationales from randomized controlled trials (RCTs) on how physical therapy interventions in the management of PD might work. Methods: Databases CINAHL, PEDro, Embase, Web of Science, Ovid Medline, and AMED were searched from database inception to October 2014 using related terms for dysmenorrhea and physical therapy interventions. Trials were independently selected and data extracted by two reviewers. Results: The search yielded 287 citations; 26 RCTs met the inclusion criteria and were included for review. Among the 26 included trials, eight trials on acupressure, seven on acupuncture, and five on TENS, two on spinal manipulation, one on low-level light therapy (LLLT), one on heat, one on far-infrared ray, and one on yoga were identified. The predominant physiological rationales identified in the RCTs are endogenous opioid mechanisms (n = 12), gate-control theory (n = 8), and traditional Chinese medicine (TCM) theory (n = 6). A few trials reported up to four different rationales. Conclusions: The analgesic effect of acupuncture is primarily through the release of endogenous opioids and hormones. In addition, practitioners of TCM believe that acupuncture alleviates pain of PD by regulating the prostaglandin levels. Acupressure, heat, high frequency transcutaneous electrical nerve stimulation (TENS), and yoga are proposed to work by segmental inhibition of pain pathway

The effect of dry needling for myofascial trigger points in the neck and shoulders: A systematic review and meta-analysis

Background and purpose: The aim of this systematic review with meta-analysis is to determine the effect of dry needling in the treatment of MTrPs. Methods: Searches were performed using the electronic databases AMED, EBM reviews, Embase, and Ovid MEDLINE (all from database inception-February 2012). Study selection: Randomized controlled trials (RCTs) were included if they compared dry needling with another form of treatment or placebo and included pain intensity as an outcome. Data extraction: Two blinded reviewers independently screened the articles, scored their methodological quality and extracted data. Quality assessment: Physiotherapy Evidence Database (PEDro) quality scale and the Cochrane risk of bias tool were used. Results: Four RCTs compared dry needling to lidocaine and one RCT compared dry needling to placebo. Meta-analyses of dry needling revealed no significant difference between dry needling and lidocaine immediately after treatment standardized mean difference (SMD) 0.41 (95%CI −0.15 to 0.97), at one month (SMD −1.46; 95% CI −2.04 to 4.96) and three to six months (SMD −0.28; 95% CI −0.63 to 0.07). Discussion: Although not significant in the meta-analyses, there were interesting patterns favoring lidocaine immediately after treatment and dry needling at three to six months