Article

The Ten Test for Sensation

School of Rehabilitation Science, McMaster University, Canada.
Journal of physiotherapy (Impact Factor: 2.89). 06/2013; 59(2):132. DOI: 10.1016/S1836-9553(13)70171-1
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    ABSTRACT: Background/aim: Knowledge Translation (KT) in health service can be conceptualized as evidence based knowledge transfer to clinical practice. KT puts evidence-informed innovations into practice and evaluates the effectiveness innovations. The use of quantitative sensory testing (QST) is rare in clinics despite its scientific evidence and potential benefit for patient care. Appropriate KT plan can reduce the gap between scientific evidence and clinical practice. This KT project aimed to develop and conduct beta testing of two KT tools (created knowledge) with the target population (clinicians) who treat musculoskeletal pain disorders. Methods: This paper explores how evidence-informed innovations (knowledge creation) may work in action process model of KT. The whole process may be defined as “knowledge-to-action” process, and it is a dynamic interaction between researchers, clinicians and stakeholders. We used Ovid database (e.g. MEDLINE, EMBASE, AMED, PsycINFO) for literature review and KT tool production ((knowledge creation). This KT project evaluated two KT tools (manual and video) by administering the survey with 12 clinicians. Results: Overall rating of the KT tools (manual and video) = 5.75 out of 6. All responses from 12 clinicians were affirmative answer and minimum 75% inquires strongly agreed on all components/topics. Clinicians supported implementation of the two QST techniques for the clinical setting and their feedback assisted in the strategy for implementation. Conclusions: Evaluation of KT through the wide lens of the “knowledge-to-action” process creates awareness of the value of clinicians and research based evidence. It justifies opportunities and pathways of KT for QST in clinic. The study with a KT model reflected clinical perspective of knowledge has a potential role in successful KT intervention. The future directed models may allow clinicians and stakeholders to analyze complex situation in health service, and it may help to identify target KT strategies to solve the practical problem for implementing two reliable, feasible and economic QST in clinical practice.
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    ABSTRACT: Study Design Cross-sectional discriminative analysis. Objective To determine whether current perception threshold (CPT) can differentiate between categories of patients with mechanical neck disorders (MNDs). Background Neck pain is the third most common musculoskeletal disorder, affecting a third of all adults each year. It can present as neck pain without musculoskeletal signs; neck pain with musculoskeletal signs but no neurological signs; neck pain with neurological signs. CPT testing can assess altered sensory perception that may reflect neurological changes. Methods Patients with MNDs (n=106) were classified into 3 groups based on a standardized musculoskeletal examination process performed by an experienced physiotherapist blinded to CPT scores. The 3 groups were defined as: MND-I, neck pain without musculoskeletal signs (n=60); MND-II, neck pain with musculoskeletal signs (n=29); MND-III, neck pain with neurological signs (n=17). A rapid protocol of CPT testing was performed at 3 frequencies (5, 250, 2000 Hz), using 3 dermatomal locations on the hand. A 1-way ANOVA with post hoc comparison and effect sizes were calculated to compare the mean CPT score between the groups. A binary logistic regression model was used to predict probability of higher CPT in MND-III and used to create a receiver operating characteristic (ROC) curve. Results Mean CPT differed significantly across the 3 MND groups (MND-I, 9.7; MND-II, 10.6; and MND-III, 11.8; P < .001, η(2) = .6). Post hoc comparisons indicated differences between MND-I and MND-II (P = .05) and between MND-II and MND-III (P = .01), that were large effect sizes (MND I versus II, d = 1 and MND II versus III, d = 2.2). CPT testing was able to distinguish between MND II and III when a threshold value of greater than 11 was used to indicate MND-III. The predicted probability of abnormal CPT in MND-III had an estimated 73% sensitivity and 81% specificity; the odds ratio was 11.5 (P =.001) for the differentiation capacity of CPT between MND-II and III with a cut-off of 11. The area under the ROC curve (AUC) was .84 (95% CI =.72 to .96, P < .001). Conclusions CPT testing has moderate discriminatory accuracy, specificity, and sensitivity for classification of MND categories into neck pain with or without neurological signs. J Orthop Sports Phys Ther, Epub 10 May 2014. doi:10.2519/jospt.2014.5691.
    05/2014; 44(7). DOI:10.2519/jospt.2014.5691
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    ABSTRACT: The study was conducted to estimate the extent to which pressure pain sensitivity (PPS) and patient factors predict pain-related disability in patients with neck pain (NP), and to determine if PPS differs by gender. Forty-four participants with a moderate level of chronic NP were recruited for this cross sectional study. All participants were asked to complete self-reported assessments of pain, disability and comorbidity and then underwent PPS testing at 4-selected body locations.Pearsos r w was computed to explore relationships between the PPS measures and the self-reported assessments. Regression models were built to identify predictors of pain and disability. An independent sample t-test was done to identify gender-related differences in PPS, pain-disability and comorbidity. In this study, greater PPS (threshold and tolerance) was significantly correlated to lower pain-disability (r = -.30 to -.53, p≤0.05). Age was not correlated with pain or disability but comorbidity was (r= 0.42-.43, p≤0.01). PPS at the 4-selected body locations was able to explain neck disability (R 2 =25-28%). Comorbidity was the strongest predictor of neck disability (R 2 =30%) and pain (R 2 =25%). Significant mean differences for gender were found in PPS, disability and comorbidity, but not in pain intensity or rating. This study suggests that PPS may play a role in outcome measures of pain and disability but between-subject comparisons should consider gender and comorbidity issues.
    The Open Orthopaedics Journal 06/2014; 8(1). DOI:10.2174/1874325001408010302

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