Measures of central sensitization and their measurement properties in musculoskeletal trauma: A systematic review

Background and Objective: Chronic pain following musculoskeletal trauma is common, which may partially be attributed to the early presence of central sensitization (CS). Multiple measures are suggested to assess clinical features of CS, yet no systematic review has evaluated the measurement properties of these measures in a musculoskeletal trauma population. Databases and Data Treatment: This systematic review, which followed a published and PROSPERO registered protocol (CRD42018091531), aimed to establish the scope of CS measures used within a musculoskeletal trauma population and evaluate their measurement properties. Searches were conducted in two stages by two independent reviewers. The Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) checklist was used to evaluate risk of bias and overall quality was assessed using the modified Grading of Recommendations Assessment, Development and Evaluation. Results: From 86 studies, 30 different CS outcome measures were identified. Nine studies evaluated measurement properties of nine outcome measures; eight evaluated reliability and one evaluated construct validity. Measures included seven quantitative sensory testing methods (pressure, cold and electrical pain thresholds; warm, cold and vibration detection thresholds; vibration perception thresholds), pain drawings and a pinwheel. Risk of bias was assessed as doubtful/inadequate for all but one study, overall quality of evidence was low/very low for all measures. Reliability of measures ranged from poor to excellent. Conclusions: Many measures are used to evaluate CS but with limited established measurement properties in musculoskeletal trauma. High quality research to establish measurement properties of CS outcome measures is required

How does Low Back Pain Influence Muscle Activity during a Cyclical Dynamic Lifting Task?

Title How does LBP Influence Muscle Activity during a Cyclical Dynamic Lifting Task? Authors Andy Sanderson, Corrado Cescon, Nicola R. Heneghan, Alison Rushton, Marco Barbero, Pauline Kuithan, Deborah Falla Purpose Chronic non-specific low back pain (cLBP) is a leading cause of disability, limiting activity in 540 million people globally. High-density electromyography (HDEMG) has been used to investigate changes in back muscle activity in people with cLBP. Previous studies have utilised static or mono-planar tasks or focussed on small areas of the erector spinae (ES). This study uses innovative HDEMG and kinematic analysis to investigate the effect of cLBP on muscle activity and movement during a multi-planar lifting task. Methods Sixteen people with cLBP (8 male, age: 26.9±10.8 years) and sixteen age and gender-matched controls (7 male, age: 31.7±14.0 years) completed the study. HDEMG signals from the ES were detected with four 64-channel semi-disposable 13x5 electrode grids (2 grids bilaterally) covering the lumbar and thoraco-lumbar ES. Kinematic surface markers were placed over the back, enabling 3D motion capture. HDEMG and kinematic data were recorded continuously during a dynamic task involving the cyclical lifting of a 5kg box between 6 shelves for 10 cycles (~7 minutes). The shelves were arranged around the participant, at knee and sternal height, with one pair of shelves anterior and two pairs lateral. To the beat of a metronome, the participant moved the box between shelves, returning to a central shelf each time (10 movements). HDEMG amplitude data were normalised to the first cycle for each movement to a shelf, and factorial ANOVA’s used to compare subsequent cycles to the first. Results Kinematic analysis revealed no significant differences between groups in the movement pattern used to complete the lifting task (P>0.05 for all relevant outcomes). Despite similar movements, significant differences in muscle activity, were seen between groups. The cLBP group showed systematically higher amplitude, indicating higher levels of muscle activity, in 6/10 shelf movements (P0.05). Conclusion As the data were normalised and amplitude is a measure of muscle activity, these results indicate that for a majority of movements, the activity in the ES for the LBP group did not show as great a reduction over the task as that of the control group. These data therefore support an altered motor control strategy in participants with cLBP. While no differences were found in the movement strategy, likely due to the standardisation of the task, cLBP participants showed lower reductions in activity, indicating that already fatigued or dysfunctional muscles remained in use throughout the task

“Snap Anatomy”: the development of a game to engage audiences in Anatomy.

Postgraduate medical training in anatomy is frequently sought by prevocational doctors to assist in entry to competitive specialty training programmes. A strong foundation in anatomical science is critical for safe clinical practice and a requirement for entry into the Surgical Education and Training (SET) programme in Australia. Postgraduate anatomy programmes provide a unique opportunity to review, consolidate and enhance anatomical knowledge. In addition, these programmes should be structured to facilitate the development of research and critical thinking skills with the aim of improving an individual’s ability to both recall information and apply it effectively in a clinical setting. This theoretical work examines the role of anatomical variation as a key aspect of anatomical literacy for postgraduate surgical anatomy education. It draws together some of the latest research to put forward a theoretical framework of best practice in teaching and learning strategies to help students find clinical relevance in their anatomy learning. There is evidence from the educational literature of strategies that guide students towards deep learning approaches, assisting in the developing positive attitudes to learning and an enhanced ability to apply knowledge within appropriate clinical contexts. This is analysed and applied to current postgraduate anatomy course structures currently available and educationally endorsed by the Royal Australasian College of Surgeons (RACS). The retention and application of anatomical knowledge, and the relevance of anatomical variation, plays a pivotal role in both clinical specialty training and clinical best practice. It is therefore essential that we tailor postgraduate teaching methods to meet the needs of both students’ and the training colleges,and that reflect modern approaches to learning, teaching and assessment of anatomy. No ethical approval for this study was required