Clinical indicators of ‘nociceptive’, ‘peripheral neuropathic’ and ‘central’ mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians

The reliability of clinical judgments and criteria associated with mechanisms-based classifications of pain in patients with low back pain disorders: a preliminary reliability study

“…13 Response options for each criterion included 'present', 'absent', or 'don't know'. Pain classification and completion of the CCC was performed independently by each clinician.…”

“…1 In the absence of any criterion or diagnostic gold standards it has been suggested that pain states characterized by a dominance of 'nociceptive', 'peripheral neuropathic' and 'central' mechanisms may be distinguishable from one another clinically, based on the pattern recognition of clusters of symptoms and signs particular to each category. 2,10 Employing a methodology considered suitable for classification system development, 11,12 an expert consensus-derived list of clinical criteria associated with such mechanistic classifications has recently been generated; 13 however, the reliability of clinical judgments and criteria associated with mechanismsbased classifications of pain has not been previously tested. Classification system validation is a multistep process, 14 and proof of reliability is considered a prerequisite of validity, 15 i.e.…”

“…a classification system cannot be considered valid until its reliability has first been demonstrated, where reliability refers to an assessment procedure with demonstrable reproducibility on repeated administrations of the procedure. 16 Accepting reliability as a prerequisite of validity, the purpose of this study was to assess the inter-and intraexaminer reliability of clinical judgments associated with: (i) mechanisms-based classifications of pain; and (ii) the identification and interpretation of individual symptoms and signs from a Delphi-derived expert consensus list of clinical criteria associated with mechanisms-based classifications of pain 13 in patients with low back (¡leg) pain disorders. …”

Mechanisms-based classifications of musculoskeletal pain: Part 2 of 3: Symptoms and signs of peripheral neuropathic pain in patients with low back (±leg) pain

“…A recent Delphi-type survey of pain consultants and musculoskeletal physiotherapists identified a consensus-derived list of nine symptoms and five signs suggestive of a dominance of PNP (see Figure 1) (Smart et al 2010). …”

Physiotherapy for shoulder impingement syndrome

“…All joints are manually assessed with passive, active, RANDOMIZED CONTROLLED TRIAL -STUDY PROTOCOL | 53 and combined angular movements, and with translatory tests according to the description of Kaltenborn [55], Evjenth and Hamberg [56] or Maitland [57]. Isometric resistance tests are used to judge shoulder strength and pain.…”