The results suggest that PPT is adequately reliable and that 3 measurements should be taken to maximize measurement properties. The variance explained by the psychological variables was small but significant for 3 constructs related to catastrophizing, depression, and fear of movement. Clinical implications for application and interpretation of PPT are discussed.
Estimation of prognosis after acute trauma is an important concern for clinicians and rehabilitation funders. It has recently been estimated that approximately 50% of people with acute whiplash-associated disorder (WAD) will experience persistent disability, representing a significant direct and indirect cost on the individual and the community.2 The optimal clinical approach to treat acute T T STUDY DESIGN: Longitudinal cohort study.
T T OBJECTIVES:To determine whether pressure pain threshold (PPT), tested at 2 standardized sites, could provide additional prognostic ability to predict short-term outcomes in people with acute whiplash, after controlling for age, sex, and baseline pain intensity.
T T BACKGROUND:PPT may be a valuable assessment and prognostic indicator for people with whiplash-associated disorder. The extent to which PPT can predict short-term disability scores has yet to be explored in people with acute (of less than 30 days in duration) whiplash-associated disorder in a clinical setting.
T T METHODS:Eligible patients were recruited from community-based physiotherapy clinics in Canada. Baseline measurements included PPT, as well as pain intensity, age, and sex. Neck-related disability was collected with the Neck Disability Index 1 to 3 months after PPT testing. Multiple linear regression models were constructed to evaluate the unique contribution of PPT in the prediction of follow-up disability scores.
T T RESULTS:A total of 45 subjects provided complete data. A regression model that included sex, baseline pain intensity, and PPT at the distal tibialis anterior site was the most parsimonious model for predicting short-term Neck Disability Index scores 1 to 3 months after PPT testing, explaining 38.6% of the variance in outcome. None of the other variables significantly improved the predictive power of the model.
T T CONCLUSION:Sex, pain intensity, and PPT measured at a site distal to the injury were the most parsimonious set of predictors of short-term neckrelated disability score, and represented promising additions to assessment of traumatic neck pain. Neither age nor PPT at the local site was able to explain significant variance beyond those 3 predictors. Limitations to interpretation are addressed.
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T t STUDY DESIGN: Observational cohort.
T t BACKGROUND:Outcomes for acute musculoskeletal injuries are currently suboptimal, with an estimated 10% to 50% of injured individuals reporting persistent problems. An early risk-targeted intervention may hold value for improving outcomes.
T t OBJECTIVES:To describe the development and preliminary concurrent and longitudinal validation of the Traumatic Injuries Distress Scale (TIDS), a new tool intended to provide the magnitude and nature of risk for persistent problems following acute musculoskeletal injuries.
T t METHODS:Two hundred participants recruited from emergency medicine departments and rehabilitation clinics completed the TIDS and a battery of other self-reported questionnaires. A subcohort (n = 76) was followed at 1 week and at 12 weeks after the inciting event. Exploratory factor analysis and concurrent and longitudinal correlations were used to evaluate the ability of the TIDS to predict acute presentation and 12-week outcomes.
T t RESULTS:Exploratory factor analysis revealed 3 factors explaining 62.8% of total scale variance. Concurrent and longitudinal associations with established clinical measures supported the nature of each subscale. Scores on the TIDS at baseline were significantly associated with variability in disability, pain intensity, satisfaction, anxiety, and depression at 12 weeks postinjury, with adequate accuracy to endorse its use as part of a broader screening protocol. Limitations to interpretation are discussed.
T t CONCLUSION:We present the initial psychometric properties of a new measure of acute posttraumatic distress following musculoskeletal injury. The subscales may be useful as stratification variables in subsequent investigations of clinical interventions.
Evaluation of KT strategies is critical. This study revealed high awareness and moderate use of the ATT. Future work should consider the impact of toolkits on patient outcomes. Implications for Rehabilitation A toolkit is a novel knowledge translation (KT) strategy designed to provide accessibleevidence-informed resources to facilitate best practice by clinicians. The evaluation of the Achilles tendinopathy toolkit (ATT) revealed favourable findingsregarding the impact of this KT strategy on the knowledge and attitudes of British Columbia(BC) PTs and the possibility of a positive impact on best practice in clinical care. This research suggests toolkits are a feasible and meaningful KT strategy to provide clinicianswith valuable synthesized resources that have the potential to benefit patient outcomes.
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