Validation of a pain mechanism classification system (PMCS) in physical therapy practice

Abstract

The objective of this study was to validate the clinical application of a pain mechanism classification system (PMCS) in clinical practice. We analyzed data abstracted from the medical records of patients who were treated in the outpatient clinics of a large urban rehabilitation hospital in Chicago. We hypothesized that there would be good agreement between the PMCS determined by trained therapists and the PMCS category assigned based on a computer-generated statistical model using patients' signs and symptoms. Using cluster analysis, when we assumed five groups, 97% of patients could be classified. Sensitivity and specificity results with 95% confidence intervals were calculated for the categories using the physical therapist assigned categories (PMCS) as the criterion standard. Sensitivity for four of the five categories (inflammatory, ischemia, peripheral neurogenic, and other ranged from 72.0 to 83.1%). For the central mechanism, sensitivity was much lower at 15%. Specificity for the five categories ranged from 72.4% (ischemia) to 98.8% (central). This study provides empirical support for recent findings in the literature that the peripheral components of a PMCS can be implemented consistently in an outpatient pain clinical practice.

Quantitative Sensory Testing Discriminates Central Sensitization Inventory Scores in Participants with Chronic Musculoskeletal Pain: An Exploratory Study

“…Several pain mechanism classification schemes have been proposed to improve upon the management of various musculoskeletal conditions 5–7 . Acceptable reliability and validity have been reported for classification schemes that divide patients with musculoskeletal pain into nociceptive, peripheral neuropathic, or central sensitization (CS) categories 5,6,8 . Although identification of CS in humans is not currently possible, use of the term CS to refer to a pain mechanism classification category has been proposed 6 .…”

Validity of the Yellow Flag Risk Form in People Treated for Low Back Pain with Mechanical Diagnosis and Therapy and the Pain Mechanism Classification System

“…In a similar way, the YFRF was used in our study to identify participants who presented with psychosocial risk factors as well as categorize these participants into subcategories. The face validity of the YFRF is supported through its use at the Rehabilitation Institute of Chicago where the tool was administered to over 18,000 participants and was integral to a validation study of the PMCS [4]. In that study, physical therapists had good agreement with cluster analysis for categories of inflammatory pain, ischemic pain, peripheral pain and other.…”

“…Tools assessing psychosocial risk can identify these factors and the condition may be further sub classified using the Pain Mechanism Classification System (PMCS). This method of sub classification showed preliminary evidence for effectively guiding treatment [4]. In the Kolski et al study [4], physical therapists trained in the PMCS were able to accurately classify participants into inflammatory, ischemic, peripheral neurogenic, central, and other categories when compared to classifications generated by a statistical model with cluster analysis based on patient signs and symptoms.…”

“…In the Kolski et al study [4], physical therapists trained in the PMCS were able to accurately classify participants into inflammatory, ischemic, peripheral neurogenic, central, and other categories when compared to classifications generated by a statistical model with cluster analysis based on patient signs and symptoms. The Yellow Flag Risk Form (YFRF) is a tool used in the PMCS to sub classify participants into intervention driven subgroups by categorizing participants based on the individual's psychological construct [4].…”