Agreement between percentage pain reductions calculated from numeric rating scores of pain intensity and those reported by patients with acute or cancer pain

The use of percentage pain reduction is increasingly used to evaluate the effectiveness of pain treatments, but the degree of agreement between calculated percentage pain reduction (CPPR) as calculated from pre- and post-treatment levels of pain intensity and those reported directly by patients is unknown. Lack of agreement between these two measures could lead to errors in the determination of treatment effectiveness. We aimed to determine the agreement between CPPR and patient-reported percentage pain reduction (PRPPR). Patients with acute or cancer pain were asked to rate their pain intensity on a 0-10 verbal numerical rating scale (NRS) and to estimate the percent pain reduction from baseline pain after analgesic administration. They then received analgesics every 10 min until pain intensity declined to 4/10 or less. To evaluate agreement between CPPR and PRPPR, we computed the concordance correlation coefficient (CCC), which measures both accuracy and precision, and estimated the 95% limits of agreement for the differences between these two measures. 761 adult patients were enrolled. Female, healthy patients with acute pain of severe intensity and high levels of education predominated in the sample. The mean difference between CPPR and PRPPR was -2.6% (95% limits of agreement -12 to 17%). The CCC was 0.56 (accuracy was 0.9 and precision was 0.6). Although CPPR appeared to underestimate PRPPR in the higher range, this trend was not clinically important. The agreement between percentage pain reductions calculated from NRS scores and those estimated by patients did not vary according to gender or age. The good overall agreement between percentage pain reductions calculated from NRS scores and those estimated by patients suggests that these indices may be used interchangeably. The findings of this study extend existing patient-centered pain research and may be applied for the evaluation and comparison of pain treatments.     

Clinical tests for differentiating between patients with and without patellofemoral pain syndrome

Patellofemoral pain syndrome (PFPS) is a very common knee condition with various aetiologies. Because of the nebulous factors of the syndrome, physiotherapists often find it difficult to assess and treat these patients. The aim of this study was to identify the clinical assessment tool that can differentiate PFPS patients from patients with other lower limb conditions. Fifty-two patients from the National Health System (26 with PFPS and 26 with other lower limb conditions) took part in this study. They underwent a series of strength, flexibility, and stress tests. Their pain levels were also recorded. The results showed that among the various clinical tests, only the hip flexion component of the Thomas test was able to differentiate between the two groups. In addition, the stress test showed that the PFPS group could not recover their gluteal muscle strength in the same way the group with the other lower limb conditions did. The Lower Extremity Functional Scale was found to be more able to differentiate between the two groups than the Anterior Knee Pain Scale. This study has shown that it is difficult to find specific clinical tests to diagnose PFPS. More research is needed in this important area.     

Lumbopelvic manipulation in patients with patellofemoral pain syndrome

Abstract

Objectives: A recent clinical prediction rule (CPR) identified characteristics that may predict an immediate reduction in pain following lumbopelvic manipulation in patients with patellofemoral pain syndrome. The purpose of this single-arm cohort study was to replicate the proposed CPR in a different population and investigate changes in self-reported pain, hip range of motion, strength, and function immediately following lumbopelvic manipulation.

Methods: Forty-four subjects (63·6% female; mean age 27·4 years) met inclusion criteria. Hip internal rotation range of motion, lower extremity strength using a handheld dynamometer, and single/triple hop tests were assessed prior to and immediately following a spinal manipulation. A global rating of change questionnaire was administered after testing and telephonically at 1 week. Paired t-tests compared pre- and post-manipulation range of motion, strength, and hop test limb symmetry indices (α?=?0·05).

Results: Fifty-seven percent of subjects had a successful outcome measured by the numerical pain rating scale immediately following manipulation. Twenty-five of subjects experienced a successful outcome as measured by the global rating of change questionnaire at 1 week. No single individual or combination of predictor variables predicted a positive outcome immediately following the lumbopelvic manipulation (+likelihood ratio 0·7 with three of five predictor variables present). Statistically significant differences (P<0·05) were found in hip extension and abduction strength and hip internal rotation symmetry post-manipulation, but do not appear to be clinically meaningful.

Discussion: The previously identified CPR was not able to be replicated and no clinically meaningful changes in range of motion, strength, or function were apparent. Future research should focus on a comprehensive impairment-based treatment approach in patients with patellofemoral pain syndrome.     

Lumbopelvic manipulation in patients with patellofemoral pain syndrome

Objectives:

A recent clinical prediction rule (CPR) identified characteristics that may predict an immediate reduction in pain following lumbopelvic manipulation in patients with patellofemoral pain syndrome. The purpose of this single-arm cohort study was to replicate the proposed CPR in a different population and investigate changes in self-reported pain, hip range of motion, strength, and function immediately following lumbopelvic manipulation.

Methods:

Forty-four subjects (63·6% female; mean age 27·4 years) met inclusion criteria. Hip internal rotation range of motion, lower extremity strength using a handheld dynamometer, and single/triple hop tests were assessed prior to and immediately following a spinal manipulation. A global rating of change questionnaire was administered after testing and telephonically at 1 week. Paired t-tests compared pre- and post-manipulation range of motion, strength, and hop test limb symmetry indices (α = 0·05).

Results:

Fifty-seven percent of subjects had a successful outcome measured by the numerical pain rating scale immediately following manipulation. Twenty-five of subjects experienced a successful outcome as measured by the global rating of change questionnaire at 1 week. No single individual or combination of predictor variables predicted a positive outcome immediately following the lumbopelvic manipulation (+likelihood ratio 0·7 with three of five predictor variables present). Statistically significant differences (P<0·05) were found in hip extension and abduction strength and hip internal rotation symmetry post-manipulation, but do not appear to be clinically meaningful.

Discussion:

The previously identified CPR was not able to be replicated and no clinically meaningful changes in range of motion, strength, or function were apparent. Future research should focus on a comprehensive impairment-based treatment approach in patients with patellofemoral pain syndrome.     

Pain assessment in invasive diagnostic procedures. Comparison of an eleven-point numerical rating scale and a six-point verbal rating scale for pain measurement in bone marrow puncture

BACKGROUND AND OBJECTIVE: Pain measurement during diagnostic procedures is an accepted prerequisite for appropriate therapy. In this study, the agreement between rankings of pain intensity on a numerical and a verbal rating scale was analyzed. METHODS: Patients attending a haematological outpatient clinic who underwent bone marrow puncture were requested to assess pain intensity perceived during the procedure on a elen-point numerical and a six-point verbal rating scale. RESULTS: Analysis of patients' pain ratings in 263 bone marrow punctures showed a very good correlation between numerical and verbal rating scale (Spearman correlation coefficient 0,86). By means of a transfer instruction categories of the verbal rating scale were assigned to figures of the numerical rating scale (0 - no pain, 1 or 2 - mild p., 3, 4 or 5 moderate p., 6 or 7 severe p., 8, 9 or 10 - very severe and worst possible pain). The resulting transfer table showed a good agreement with a weighted kappa of 0.72 (95% confidence interval: 0.66-0.79). CONCLUSION: Both scales can be employed efficiently for pain assessment during diagnostic procedures. Verbal categories can be assigned to numerical values and vice versa numerical values to verbal categories. However, in view of the inter-individual variations it appears appropriate to re-assure pain perception with each patient in order to avoid over- or undertreatment.     

Relationship between intensity and relief in patients with acute severe pain

OBJECTIVE: To test whether a single-category improvement on a Likert pain relief scale equals the minimum clinically significant difference of 1.3 units in pain intensity reduction on a 10-unit numerical rating scale (NRS). METHODS: Prospective cohort of adults with acute severe pain receiving standardized analgesia. Patients rated pain intensity via NRS before receiving morphine and 30 minutes later. Patients described pain relief as "none," "a little," "moderate," "a lot," or "complete." The primary outcome was the difference in NRS scores between each contiguous pair of pain relief categories over 30 minutes. RESULTS: One hundred thirty-one patients, age range 21 to 65 years, median baseline NRS pain score 10 (interquartile range, 9-10). Patients whose relief was "complete," "a lot," "moderate," "mild," and "none" had the following NRS unit reductions in pain, respectively: 9, 5.7, 3.9, 2.1, and -0.1. The difference between each pair of relief categories was 3.3, 1.8, 1.8, and 2.2 units. CONCLUSION: Each single-category improvement on a pain relief scale exceeds the minimum clinically significant difference in pain intensity as measured on an NRS.     

抑郁与下腰痛手术疗效的关系

目的 探讨抑郁与下腰痛患者进行腰椎椎板减压椎体间融合术疗效的相关性.方法 120例行腰椎椎板减压椎体间融合术的下腰痛患者术前根据抑郁自评量表(SDS)抑郁评分分组:正常组92例、抑郁组28例.术前和术后6个月采用Oswestry功能障碍评分(ODI)和疼痛视觉类比评分(VAS)进行功能、疼痛评价,比较两组间临床疗效差异.结果 抑郁组术前的ODI评分、腰痛VAS评分、下肢腿痛VAS评分与正常组比较,差异均无统计学意义(t分别=1.66、0.87、0.43,P均＞0.05);抑郁组术后6个月的ODI评分、腰痛VAS评分、下肢腿痛VAS评分的改善率与正常组比较,差异均有统计学意义(t分别:4.76、6.48、7.10,P均＜0.05).结论 抑郁与下腰痛手术疗效具有相关性,建议术前进行抑郁评估.     

不同人群使用NRS评分评估患儿术后疼痛的相关性分析

目的 比较护士、家长,患儿三者使用数字疼痛评分法(NRS)对儿童术后疼痛评估的准确度,并评估其相关性.方法 选择年龄5～12岁,拟行手术治疗的患儿为研究对象.在患儿手术后进入麻醉恢复室(PACU)时,由患儿、家长及护士分别对术后疼痛情况进行评估,患儿、家长、护士互相之前均不了解他方的评估结果.然后,在患儿离开PACU返回病房之前,再进行1次同样的评估.结果 回收有效数据31份,手术类型包括腹部手术、泌尿外科手术、矫形手术、腔镜手术等.患儿转入PACU及转出PACU时,家长评估与患儿自身评估之间的组内相关系数(ICC)分别为0.948(95％CI,0.897～0.975)和0.938(95％CI,0.877-0.970);护士评估与患儿自身评估之间的组内相关系数为0.961(95％CI,0.922～0.981),0.972(95％CI,0.944～0.986);家长评估与护士评估的组内相关系数则为0.924(95％CI,0.850～0.963),0.921(95％CI,0.844～0.961).结论 数字疼痛评分法(NRS)的年龄适用范围较为宽广,患儿、家长和护士使用NRS对患儿术后疼痛进行评估时,具有良好的相关性.     

视觉模拟量表和语言评价量表用于术后疼痛评估的比较

目的探讨是否可以使用简单的语言评价量表代替视觉模拟量表进行手术后疼痛的评估。方法将美国麻醉医师协会(ASA)Ⅰ -Ⅲ级的120例患者依其受教育程度的高低分2组 :初中及初中以下文化程度组(Ⅰ组 ,n=45) ,高中及高中以上文化程度组 (Ⅱ组 ,n=75)。患者于术后进行视觉模拟量表(VAS)和语言评价量表(VRS)的填写。麻醉医生对如何进行量表的填写向患者进行解释 ,并记录以下数据 :每位患者VAS和VRS的数值 ,填写VAS和VRS量表前向患者解释的次数 (Nvas和Nvrs)。结果Ⅰ组和Ⅱ组的VAS和VRS评分均有显著相关性 (P<0.01) ,其相关系数分别为0.936和0.901。在Ⅰ组中Nvas较Nvrs高 (P<0.05) ,同时Nvas在Ⅰ组中较Ⅱ组中高 (P<0.05) ,但在Ⅱ组中Nvas和Nvrs无显著差异(P>0.05)。结论在对患者进行术后疼痛评定时VRS和VAS具有良好的相关性 ,而VRS更适用于文化程度低及抽象概念理解有困难的患者 ,如老人     

颈肩腰腿痛患者慢性炎症反应与干预措施的相关性

目的:观察炎症反应在颈肩腰腿痛治疗中的作用和使用抗生素治疗的必要性。方法:2001-08/2002-08和2003-08/2004-10解放军总医院康复医学科收治的152例颈肩痛或腰腿痛患者入院时化验血象,62例有白细胞>1万和中性白细胞比例>70%,或白细胞<1万,但中性白细胞比例>70%。比较患者的平均住院时间及抗生素使用效果。结果:入院时血象升高的患者,平均住院时间少于血象正常的患者,使用抗生素未能缩短住院时间。结论:急性期颈肩腰腿痛患者炎症反应有利于患者康复,抗生素使用是不必要的。     

A comparison between whole-body vibration and conventional training on pain and performance in athletes with patellofemoral pain

IntroductionPatellofemoral pain (PFP) is the most common cause of anterior knee pain in athletes, which affects their performance especially during single leg activities. The aim of this study was to compare the effects of whole-body vibration training (WBVT) and conventional training (CT) on pain and performance in athletes with PFP.Methods30 athletes with unilateral PFP were randomly assigned to the WBVT (6 women, 9 men) or CT (7 women, 8 men) group. All participants received training for 4 weeks in 12 sessions. The outcomes of pain and performance were measured at three points in time: baseline, immediately after training and 2 weeks after training. Pain was assessed with the Numeric Pain Rating Scale (NPRS). Performance was measured with the leg-press test and the Kujala Patellofemoral Score (KPS).ResultsIn both groups, pain intensity decreased significantly (p < 0.001) and the KPS and number of leg presses increased significantly (p < 0.001) with time. There was no significant difference between groups for changes in the pain score (p = 0.896), KPS (p = 0.463) or leg press (p = 0.796) results.ConclusionWhole-body vibration training had the same effect as exercise therapy on pain reduction and on improvements in performance in athletes with PFP.     

Improvements in kinematics,muscle activity and pain during functional tasks in females with patellofemoral pain following a single patterned electrical stimulation treatment

BackgroundIndividuals with patellofemoral pain present with altered hip muscle activation, faulty movement patterns, and pain during functional tasks. Examining new treatment options to address these impairments may better treat those with patellofemoral pain. The purpose of this study was to determine if patterned electrical stimulation to the lower extremity affects muscle activity, movement patterns, and pain following a single treatment.MethodsFifteen females with patellofemoral pain were randomized to receive a single 15-minute treatment of either a patterned electrical neuromuscular stimulation or a sham. Peak kinematics of the knee, hip, and trunk, electromyography and pain were examined pre and post-intervention during a single leg squat and lateral step-down task. Group means and pre/post reduced kinematic values were also plotted during the entire task with 90% confidence intervals to identify differences in movement strategies.FindingsNo baseline differences were found in peak kinematics between groups. No pre to post-intervention differences in peak knee, hip and trunk kinematics were found, however differences were seen when the quality of movement across the entire tasks was assessed. The electrical stimulation group had improved knee flexion and hip abduction during the lateral step-down. A significant improvement in gluteus medius activation following patterned electrical neuromuscular stimulation occurred during the step-down (P = 0.039). Significant pain improvements were also seen in both the single leg squat (P = 0.025) and lateral step-down (P = 0.006).InterpretationA single treatment of patterned electrical neuromuscular stimulation improved muscle activation, lower extremity kinematics during functional tasks, and pain.     

Outcomes of a weight-bearing rehabilitation program for patients diagnosed with patellofemoral pain syndrome

OBJECTIVE: To determine the effects of a weight-bearing rehabilitation program on quadriceps and gluteus medius electromyographic activity, pain, and function in subjects diagnosed with patellofemoral pain syndrome (PFPS). DESIGN: Pretest and posttest 6-week intervention study. SETTING: Musculoskeletal research laboratory. PARTICIPANTS: Fourteen subjects diagnosed with PFPS and 14 healthy control subjects volunteered to participate in this study. No subjects withdrew from the study because of adverse effects. INTERVENTION: Subjects diagnosed with PFPS participated in a 6-week rehabilitation program. The rehabilitation program consisted of weight-bearing exercises that focused on strengthening the quadriceps and hip abductor musculature. MAIN OUTCOME MEASURES: Electromyographic onsets of the vastus medialis oblique (VMO) and vastus lateralis and onset and duration of the gluteus medius were collected during a stair-stepping task that was performed during the pretest and posttest. A visual analog scale (VAS) and Functional Index Questionnaire (FIQ) were administered at pretest and posttest and each week of the intervention. RESULTS: Vastus lateralis and VMO onset timing differences (vastus lateralis electromyographic onset minus VMO electromyographic onset) and VAS and FIQ scores significantly improved for patients diagnosed with PFPS. Vastus lateralis and VMO onset timing in the PFPS group were significantly different from those in the control group at baseline and were not significantly different from the control group after the intervention. We did not find differences in gluteus medius onsets or duration of activity. CONCLUSIONS: Subjects diagnosed with PFPS responded favorably and quickly to a therapeutic exercise program that incorporated quadriceps and hip musculature strengthening. The efficacy of the therapeutic exercise program used in this study should be further investigated in a larger subject population.     

Chinese translation and validation of the Kujala scale for patients with patellofemoral pain

Purpose: This study translated and validated the Kujala scale, a well-documented questionnaire for patients with patellofemoral pain, into Chinese version. Method: Chinese Kujala scale was translated from the original English version following the recommendations of the International Society for Pharmacoeconomics and Outcomes Research. Sixty four Chinese reading patients who are diagnosed of patellofemoral pain were recruited from multiple hospitals and physiotherapy clinics. Psychometric property was evaluated in terms of test-retest reliability and internal consistency. Convergent validity was examined by Spearman rank correlation coefficient tests by comparing its score with the validated Chinese version of WOMAC Osteoarthritis Index and SF-36. Results: Chinese Kujala scale demonstrated excellent reliability (ICC?=?0.968, p?<?0.001). Cronbach’s α of individual questions and its overall value were above 0.7. Strong correlation was found between the Chinese Kujala scale and the WOMAC Osteoarthritis Index (rho?=??0.708, p?<?0.001). Fairly weak correlations were also found between Chinese Kujala scale with the “physical” (rho?=?0.413–0.498, p?<?0.001) and “energy vitality” (rho?=?0.290, p?=?0.02) domains of SF-36. However, the relationship between the “bodily pain” was not significant (rho?=?0.136, p?=?0.284). Conclusion: The Chinese translated version of Kujala scale is a reliable and valid instrument for assessing the patellofemoral pain associated functional disturbances among the patient cohort.

Implications for Rehabilitation

• The Chinese translated version of Kujala scale is a reliable and valid instrument for assessing the functional disturbances associated with patellofemoral pain among the patient cohort.

• This instrument facilitates research among Chinese population and multinational studies.

     

Evidence for the use of a numerical rating scale to assess the intensity of pediatric pain

The aim of this work was to evaluate the psychometric properties of the Numerical Rating Scale-11 (NRS-11) when used to assess pediatric pain intensity. We performed two studies: 175 schoolchildren, aged 8–12, participated in Study 1 and 63 children undergoing surgery and aged 6–16, participated in Study 2. The NRS-11 showed (a) adequate convergent construct validity when correlated with the Faces Pain Scale – Revised (FPS-R; r₁ = 0.78, r₂ = 0.93); (b) adequate discriminant validity in relation to measures of pain-related affect (z₁ = 3.55, z₂ = 7.62) and disability (z₁ = 7.62, z₂ = 6.83); and (c) adequate criterion-related validity using measures of pain-related affect (r₁ = .58, r₂ = .66), disability (r₁ = 0.22, r₂ = .39), and quality of life (r₂ = ?.46). Schoolchildren were asked whether they preferred using the NRS-11 or the FPS-R when reporting the intensity of their pain. While both sexes and both the younger and older age groups preferred the FPS-R, this preference was more marked among girls and younger children.The NRS-11 has shown an acceptable level of validity for assessing pain intensity in both samples, however, additional research is needed in order to fully clarify the lower age limit in which the NRS-11 can be used.