Do Patients Undergoing Physical Testing Report Pain Intensity Reliably?

White, Stephen G.; McNair, Peter; Laslett, Mark; Hing, Wayne

doi:10.1002/acr.22530

Cited by 4 publications

(6 citation statements)

References 28 publications

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“…Consequently, the knee bend score was omitted and thus the second version of the DAP now consists of a single pain score. Simultaneously we clarified the construct assessed with the DAP to be ‘pain during activity’ instead of ‘the interaction between pain and function.’ The level of reliability is similar to that of pain ratings subsequent to other performance tests in patients with hip pain [ 5 ] and knee OA [ 6 ]. However, the validity, responsiveness, or interpretability of combined performance tests and pain ratings have not been evaluated.…”

Section: Introductionsupporting

confidence: 58%

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Dynamic weight-bearing assessment of pain in knee osteoarthritis: construct validity, responsiveness, and interpretability in a research setting

Klokker

Christensen

Wæhrens

et al. 2016

Health Qual Life Outcomes

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BackgroundThe Osteoarthritis Research Society International (OARSI) has suggested to asses pain after specific activities consistently in clinical trials on knee OA. The Dynamic weight-bearing Assessment of Pain (DAP) assesses pain during activity (30 s of performing repeated deep knee-bends from a standing position). The purpose of this study is to evaluate the construct validity, responsiveness, and interpretability of the DAP for knee osteoarthritis (OA).MethodsOne-hundred participants with knee OA were tested twice each with the DAP, the Knee injury and Osteoarthritis Outcome Score (KOOS), six-minute-walk-test (6MWT), and 6-min-walk-test with subsequent pain rating (6MWTpain), and once with a transition questionnaire (TRANS-Q) for the patient-reported change in pain after 12 weeks of exercise. Construct validity (baseline-scores) and responsiveness (change-scores) were estimated by Spearman Correlation Coefficients. We hypothesized that no correlations would be excellent (<0.7) (divergent validity), except for the 6MWTpain (convergent validity). The TRANS-Q was used for interpreting the DAP change-scores in terms of responsiveness and Minimal Important Change (MIC).ResultsDivergent validity with the KOOS subscales (r = −0.31 to–0.45) and the 6MWT (r = −0.25) was supported. Convergent validity with the 6MWTpain was not supported (r = 0.54). The DAP change-scores corresponded to patient-reported change in pain (TRANS-Q), while correlations with change-scores on the other instruments were <0.35. The MIC was 2.4 DAP points.ConclusionsThe DAP possesses divergent validity compared to other instruments for knee OA, supporting the potential for this new way of assessing pain directly during activity. Importantly, the DAP change-scores correspond to patient-reported changes in pain, showing responsiveness. A change of 2.4 or more can be interpreted as clinically relevant. The DAP is a promising alternative to using ‘pain on walking’ as a clinical trial inclusion criterion/outcome.

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Section: Introductionsupporting

confidence: 58%

“…Pain rating on a 0–10 NRS immediately after the 6MWT (6MWTpain) is not a standardized test. However, similar ratings of pain subsequent to a performance test have been applied in other studies [ 5 , 6 ]. The 6MWTpain was included to compare the DAP with this other assessment of pain during a performance test.…”

Section: Methodsmentioning

confidence: 99%

Dynamic weight-bearing assessment of pain in knee osteoarthritis: construct validity, responsiveness, and interpretability in a research setting

Klokker

Christensen

Wæhrens

et al. 2016

Health Qual Life Outcomes

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“…was recorded after each impairment test. A similar measure of pain during testing is found sufficiently reliable for tests of hip disorders [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index

Clausen

Witten

Holm

et al. 2017

BMC Musculoskelet Disord

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BackgroundPain and loss of function are cardinal symptoms associated with Subacromial impingement syndrome (SIS), while the presence and magnitude of deficits in strength and range of motion (ROM) are largely undescribed in non-athletic patients with SIS. Moreover, the relevance of impairments in strength and ROM to patient-reported shoulder function is not well described, even though testing of strength is recommended in clinical guidelines.The purpose of this study was, first, to investigate impairments in glenohumeral and scapulothoracic strength and in abduction and internal rotation ROM in patients with SIS. Secondly, to investigate the influence of these impairments on patient-reported shoulder function.MethodsCross-sectional study based on a consecutive cohort of 157 patients referred to specialist examination and diagnosed with shoulder impingement (SIS) using predefined validated diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during testing and for the last week. Impairments in strength (abduction, external-rotation, (protraction and horizontal-extension) and ROM (abduction and internal rotation) were investigated in patients with unilateral shoulder pain, using one-sample t-tests. SPADI total score (SPADI) and SPADI function score (SPADI-F), were chosen as dependent variables in multiple regressions to investigate the influence of impairments on patient-reported shoulder function. Independent variables of interest were; strength in abduction and external rotation, abduction ROM, pain-during-tests, pain-last-week and kinesiophobia.ResultsSignificant impairments were found for all impairment tests, but most pronounced for glenohumeral strength and abduction ROM (29–33% deficits), and less for scapulothoracic strength and internal rotation ROM (8–18% deficits). Pain variables influenced SPADI and SPADI-F score to a high degree (R2 = 23.4–31.6%, p < 0.001), while strength and ROM did not.ConclusionSubstantial strength and ROM impairments were found in patients with SIS. Only pain significantly influenced patient-reported function, while impairments did not. As SPADI score does not reflect the substantial strength and ROM impairments in external rotation and abduction observed in patients with SIS, supplemental assessment of these impairments seems important.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1667-1) contains supplementary material, which is available to authorized users.

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“…The NRS ranged from 0 to 10, with 0 representing no pain and 10 representing the worst pain possible. The NRS is a reliable method of scoring pain provoked by physical tests in patients with OA . Patients walked around a 25‐meter track while wearing their own shoes.…”

Section: Methodsmentioning

confidence: 99%

Association Between Knee Load and Pain: Within‐Patient, Between‐Knees, Case–Control Study in Patients With Knee Osteoarthritis

Birmingham

Marriott

Leitch

et al. 2019

Arthritis Care & Research

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Do Patients Undergoing Physical Testing Report Pain Intensity Reliably?

Cited by 4 publications

References 28 publications

Dynamic weight-bearing assessment of pain in knee osteoarthritis: construct validity, responsiveness, and interpretability in a research setting

Dynamic weight-bearing assessment of pain in knee osteoarthritis: construct validity, responsiveness, and interpretability in a research setting

Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index

Association Between Knee Load and Pain: Within‐Patient, Between‐Knees, Case–Control Study in Patients With Knee Osteoarthritis

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