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Helen Slater - One of the best experts on this subject based on the ideXlab platform.
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Field testing of the revised neuropathic Pain grading system in a cohort of patients with neck and Upper Limb Pain.
Scandinavian journal of pain, 2019Co-Authors: Brigitte Tampin, Rachel Elizabeth Broe, Lee Lee Seow, Shushana Gijohn George, Jiajie Tan, Rajiv Menon, Angela Jacques, Helen SlaterAbstract:Background and aims In 2008, the International Association for the Study of Pain Special Interest Group on Neuropathic Pain (NeuPSIG) proposed a clinical grading system to help identify patients with neuropathic Pain (NeP). We previously applied this classification system, along with two NeP screening tools, the PainDETECT (PD-Q) and Leeds Assessment of Neuropathic Symptoms and Signs Pain scale (LANSS), to identify NeP in patients with neck/Upper Limb Pain. Both screening tools failed to identify a large proportion of patients with clinically classified NeP, however a limitation of our study was the use of a single clinician performing the NeP classification. In 2016, the NeuPSIG grading system was updated with the aim of improving its clinical utility. We were interested in field testing of the revised grading system, in particular in the application of the grading system and the agreement of interpretation of clinical findings. The primary aim of the current study was to explore the application of the NeuPSIG revised grading system based on patient records and to establish the inter-rater agreement of detecting NeP. A secondary aim was to investigate the level of agreement in detecting NeP between the revised NeuPSIG grading system and the LANSS and PD-Q. Methods In this retrospective study, two expert clinicians (Specialist Pain Medicine Physician and Advanced Scope Physiotherapist) independently reviewed 152 patient case notes and classified them according to the revised grading system. The consensus of the expert clinicians' clinical classification was used as "gold standard" to determine the diagnostic accuracy of the two NeP screening tools. Results The two clinicians agreed in classifying 117 out of 152 patients (ICC 0.794, 95% CI 0.716-850; κ 0.62, 95% CI 0.50-0.73), yielding a 77% agreement. Compared to the clinicians' consensus, both LANSS and PD-Q demonstrated limited diagnostic accuracy in detecting NeP (LANSS sensitivity 24%, specificity 97%; PD-Q sensitivity 53%, specificity 67%). Conclusions The application of the revised NeP grading system was feasible in our retrospective analysis of patients with neck/Upper Limb Pain. High inter-rater percentage agreement was demonstrated. The hierarchical order of classification may lead to false negative classification. We propose that in the absence of sensory changes or diagnostic tests in patients with neck/Upper Limb Pain, classification of NeP may be further improved using a cluster of clinical findings that confirm a relevant nerve lesion/disease, such as reflex and motor changes. The diagnostic accuracy of LANSS and PD-Q in identifying NeP in patients with neck/Upper Limb Pain remains limited. Clinical judgment remains crucial to diagnosing NeP in the clinical practice. Implications Our observations suggest that in view of the heterogeneity in patients with neck/Upper Limb Pain, a considerable amount of expertise is required to interpret the revised grading system. While the application was feasible in our clinical setting, it is unclear if this will be feasible to apply in primary health care settings where early recognition and timely intervention is often most needed. The use of LANSS and PD-Q in the identification of NeP in patients with neck/Upper Limb Pain remains questionable.
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identification of neuropathic Pain in patients with neck Upper Limb Pain application of a grading system and screening tools
Pain, 2013Co-Authors: Brigitte Tampin, Helen Slater, Noelle Kathryn Briffa, Roger GouckeAbstract:The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain has proposed a grading system for the presence of neuropathic Pain (NeP) using the following categories: no NeP, possible, probable, or definite NeP. To further evaluate this system, we investigated patients with neck/Upper Limb Pain with a suspected nerve lesion, to explore: (i) the clinical application of this grading system; (ii) the suitability of 2 NeP questionnaires (Leeds Assessment of Neuropathic Symptoms and Signs Pain scale [LANSS] and the PainDETECT questionnaire [PD-Q]) in identifying NeP in this patient cohort; and (iii) the level of agreement in identifying NeP between the NeuPSIG classification system and 2 NeP questionnaires. Patients (n = 152; age 52 ± 12 years; 53% male) completed the PD-Q and LANSS questionnaire and underwent a comprehensive clinical examination. The NeuPSIG grading system proved feasible for application in this patient cohort, although it required considerable time and expertise. Both questionnaires failed to identify a large number of patients with clinically classified definite NeP (LANSS sensitivity 22%, specificity 88%; PD-Q sensitivity 64%, specificity 62%). These lowered sensitivity scores contrast with those from the original PD-Q and LANSS validation studies and may reflect differences in the clinical characteristics of the study populations. The diagnostic accuracy of LANSS and PD-Q for the identification of NeP in patients with neck/Upper Limb Pain appears limited.
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Identification of neuropathic Pain in patients with neck/Upper Limb Pain: application of a grading system and screening tools.
Pain, 2013Co-Authors: Brigitte Tampin, Noelle Kathryn Briffa, Roger Goucke, Helen SlaterAbstract:The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain has proposed a grading system for the presence of neuropathic Pain (NeP) using the following categories: no NeP, possible, probable, or definite NeP. To further evaluate this system, we investigated patients with neck/Upper Limb Pain with a suspected nerve lesion, to explore: (i) the clinical application of this grading system; (ii) the suitability of 2 NeP questionnaires (Leeds Assessment of Neuropathic Symptoms and Signs Pain scale [LANSS] and the PainDETECT questionnaire [PD-Q]) in identifying NeP in this patient cohort; and (iii) the level of agreement in identifying NeP between the NeuPSIG classification system and 2 NeP questionnaires. Patients (n = 152; age 52 ± 12 years; 53% male) completed the PD-Q and LANSS questionnaire and underwent a comprehensive clinical examination. The NeuPSIG grading system proved feasible for application in this patient cohort, although it required considerable time and expertise. Both questionnaires failed to identify a large number of patients with clinically classified definite NeP (LANSS sensitivity 22%, specificity 88%; PD-Q sensitivity 64%, specificity 62%). These lowered sensitivity scores contrast with those from the original PD-Q and LANSS validation studies and may reflect differences in the clinical characteristics of the study populations. The diagnostic accuracy of LANSS and PD-Q for the identification of NeP in patients with neck/Upper Limb Pain appears limited.
Nele Devoogdt - One of the best experts on this subject based on the ideXlab platform.
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Effectiveness of Botulinum Toxin A for Persistent Upper Limb Pain After Breast Cancer Treatment: A Double-Blinded Randomized Controlled Trial
Archives of physical medicine and rehabilitation, 2018Co-Authors: An De Groef, Marijke Van Kampen, Inge Geraerts, Nele Devoogdt, Patrick Neven, Ines Nevelsteen, Ann Smeets, Lore Dams, Elien Van Der Gucht, Philippe DebeerAbstract:Abstract Objective To investigate the effect of a single botulinum toxin A (BTX-A) infiltration in the pectoralis major muscle in addition to a standard physical therapy program for treatment of persistent Upper Limb Pain in breast cancer survivors. Design Double-blinded (patient and assessor) randomized controlled trial. Setting A university hospital. Participants Breast cancer patients (N=50) with Pain. Intervention The intervention group received a single BTX-A infiltration. The control group received a placebo (saline) infiltration. Within 1 week after the infiltration, all patients attended an individual physical therapy program (12 sessions) during the first 3 months and a home exercise program up to 6 months after infiltration. Main Outcome Measures The primary outcome was change in Pain intensity at the Upper Limb (visual analog scale, 0–100) after 3 months. Secondary outcomes were prevalence rate of Pain, pressure hypersensitivity, Pain quality, shoulder function, and quality of life. Measures were taken before the intervention and at 1, 3, and 6 months' follow-up. Results No significant difference in change in Pain intensity after 3 months was found (mean difference in change, 3/100; 95% confidence interval [CI], −13 to 19). From baseline up to 6 months, a significantly different change in Upper Limb Pain intensity was found between groups in favor of the intervention group (mean difference in change, 16/100; 95% CI, 1–31). Conclusions A single BTX-A infiltration in combination with an individual physical therapy program significantly decreased Pain intensity at the Upper Limb in breast cancer survivors up to 6 months. However, the effect size was not clinically relevant, and no other beneficial effects were found.
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The effectiveness of botulinum toxin A for persistent Pain at the pectoral region after breast cancer treatment: Randomized controlled trial
Annals of Physical and Rehabilitation Medicine, 2018Co-Authors: A. De Groef, Nele Devoogdt, Lore Dams, Elien Van Der Gucht, K. Peers, Philippe DebeerAbstract:Introduction/Background Upper Limb Pain after breast cancer treatment is a common and difficult to treat problem. The aim of the present study was to investigate the effect of a single botulinum toxin A infiltration in the pectoralis major muscle in addition to a standard physical therapy program for treatment of persistent Upper Limb Pain in breast cancer survivors. Material and method Fifty breast cancer patients with Pain participated in a double-blinded randomized controlled trial. The intervention group received a single botulinum toxin A (BTX-A) infiltration. The control group received a placebo (saline) infiltration. Within one week after the infiltration, all patients attended an individual physical therapy program (12 sessions) during the first 3 months and a home exercise program up to 6 months after infiltration. The primary outcome was change in Pain intensity at the Upper Limb (Visual Analogue Scale [VAS] [0–100]) after 3 months. Secondary outcomes were prevalence rate of Pain, pressure hypersensitivity, Pain quality, shoulder function and quality of life. Measures were taken before the intervention and at 1, 3 and 6 months follow-up. Results No significant difference in change in Pain intensity after 3 months was found (mean difference in change of 3/100; 95% CI: −13 to 19). From baseline up to 6 months, a significantly different change in Upper Limb Pain intensity was found between groups in favor of the intervention group (mean difference in change of 16/100; 95% CI: 1 to 31). Conclusion A single botulinum toxin A infiltration in combination with an individual physical therapy program has been found to significantly decrease Pain intensity at the Upper Limb in breast cancer survivors up to 6 months. However, the effect size was not clinically relevant and no other beneficial effects were found.
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Identification of Myofascial Trigger Points in Breast Cancer Survivors with Upper Limb Pain: Interrater Reliability.
Pain medicine (Malden Mass.), 2017Co-Authors: An De Groef, Marijke Van Kampen, Evi Dieltjens, Sophie De Geyter, Lore Vos, Tessa De Vrieze, Inge Geraerts, Nele DevoogdtAbstract:Objective Despite the increasing awareness of the contribution of myofascial dysfunctions to Upper Limb Pain in breast cancer survivors, reliability of the identification of myofascial trigger points (MTPs) in this population has not yet been investigated. Therefore, the aim of the present study was to investigate the interrater reliability of the identification of MTPs by palpation at the Upper Limb region in breast cancer survivors with Upper Limb Pain. Design Interrater reliability study. Setting University Hospitals Leuven, Belgium. Subjects Thirty breast cancer survivors with Pain at the Upper Limb region. Methods Nine muscles (Upper trapezius, levator scapulae, infraspinatus, supraspinatus, teres major and minor, subscapularis, pectoralis major, and scalene muscles) at the operated side were examined. The weighted kappa (WK) coefficient and Absolute Agreement with 95% confidence intervals were calculated. Results Moderate agreement was found for all examined Upper Limb muscles (WK = 0.41-0.60), except for the trapezius muscle, for which the agreement was almost perfect (WK = 0.83), and the supraspinatus muscle (WK = 0.23), for which the agreement was only fair. Conclusions For most muscles, moderate interrater reliability for the identification of MTPs by palpation in breast cancer survivors with Upper Limb Pain was found. Therefore, we concluded that the identification of MTPs by palpation may add to the diagnosis of the myofascial Pain syndrome in breast cancer survivors.
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Myofascial techniques have no additional beneficial effects to a standard physical therapy programme for Upper Limb Pain after breast cancer surgery: a randomized controlled trial.
Clinical rehabilitation, 2017Co-Authors: An De Groef, Marijke Van Kampen, Sophie De Geyter, Lore Vos, Tessa De Vrieze, Inge Geraerts, Nele Vervloesem, Marie-rose Christiaens, Patrick Neven, Nele DevoogdtAbstract:Objective:To investigate the effects of myofascial techniques, in addition to a standard physical therapy programme for Upper Limb Pain shortly after breast cancer surgery.Design:Double-blinded (pa...
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Abstract PD4-04: Effectiveness of myofascial techniques in addition to a standard physical therapy program as postoperative intervention for Upper Limb Pain in breast cancer patients: A randomized controlled trial
Poster Discussion Abstracts, 2017Co-Authors: A. De Groef, Inge Geraerts, Nele Vervloesem, Marie-rose Christiaens, Patrick Neven, M. Van Kampen, S De Geyter, Nele DevoogdtAbstract:Background: In addition to fatigue, Pain is the most frequent and persistent symptom following cancer and cancer treatment. Despite the effectiveness of several postoperative physical therapy modalities, many patients after breast cancer still have Pain at the Upper Limb region at short and long term. Several authors already recommended the use of myofascial therapy. Therefore, the aim of this study was to investigate short and long term effects of myofascial therapy, in addition to a standard physical therapy program, as postoperative intervention for Upper Limb Pain after breast cancer surgery. Methods: Randomized controlled trial with assessor and patient blinding and intention-to-treat analysis. One hundred forty-seven consecutive patients with breast cancer and unilateral axillary surgery were included. All participants received a standard physical therapy program starting immediately after surgery during 4 months. The intervention group received additionally 8 sessions of myofascial therapy on weekly basis from 2 up to 4 months after surgery. The control group received 8 sessions of a placebo intervention in addition to the same standard physical therapy program. Primary outcomes were prevalence rate of Pain (i.e. Pain at the operated Upper Limb region during the past week), maximal Pain intensity at this region (Visual Analogue Scale (VAS) (0-100)), pressure hypersensitivity (pressure Pain thresholds (kg/cm2) (PPT)) and Pain quality (McGill Pain Questionnaire). All measurements were performed at 2 (=baseline), 4, 9 and 12 months post-surgery. Analysis of covariance (ANCOVA) were performed to correct for differences at baseline (i.e. 2 months after surgery). Additionally, effect size is given by means of relative risk reduction (RRR) and mean differences and their 95% confidence interval. Results: Both groups were comparable at baseline. At 4, 9 and 12 months post-surgery, prevalence rates of Pain were comparable between the intervention and control group (40%, 53%, 49% versus 41%, 47%, 51%, p=1.000, p=0.508 and p=0.868 and RRR of 3.2% (-0.44 - 0.35), -13% (-0.57 - 0.18) and 2.7% (-0.35 - 0.30), respectively). Pain intensity was comparable between the intervention group and control group as well. PPT of the Upper Trapezius muscle was significantly higher in the intervention group at 4 months (4.86 (2.43) versus 3.69 (2.04) kg/cm2, p=0.012; mean difference -1.2 (-1.9 – 0.4) kg/cm2). PPT of the Supraspinatus muscle was significantly higher in the intervention group at 4 months (4.54 (2.1) versus 3.8 (1.85) kg/cm2, p=0.021; mean difference -0.7 (-1.4 – 0.1) kg/cm2) and at 9 months (3.92 (1.7) versus 3.39 (1.61) kg/cm2, p=0.040; mean difference -0.5 (-1.1 – 0.0) kg/cm2). No significant differences in Pain quality were found between groups. Conclusion: Myofascial therapy, in addition to a standard physical therapy program, has beneficial effect as postoperative intervention for pressure hypersensitivity of Upper Limb muscles after breast cancer surgery. No beneficial effect on Pain prevalence rate, Pain intensity and Pain quality was found. Citation Format: De Groef A, Van Kampen M, Vervloesem N, De Geyter S, Christiaens M-R, Neven P, Geraerts I, Devoogdt N. Effectiveness of myofascial techniques in addition to a standard physical therapy program as postoperative intervention for Upper Limb Pain in breast cancer patients: A randomized controlled trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD4-04.
Auwal Ali Mohammed - One of the best experts on this subject based on the ideXlab platform.
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A Novel Approach to Upper Limb Task Specific Training in Children with Hemiparesis
International Journal of Physical Medicine & Rehabilitation, 2014Co-Authors: Auwal Abdullahi, Auwal Ali MohammedAbstract:Introduction: Studies of task specific training in children traditionally make children to perform tasks for some periods of time. However, this method may not show clearly how much task was practiced. Recently, alternative way of measuring amount of task practice has been proposed. This method uses the number of task repetition. Task repetition up to 300 times per day was possible in adults. Feasibility of this amount of task practice is however not clear in children. Aim: The aim of this study was to find out the feasibility of 300 task repetitions spread over 3 sessions per day, and that whether the intervention can cause Upper Limb Pain. Method: Seventeen children with hemiparesis were included in the study. They were made to practice 5 tasks, each 20 times per session, 3 times a day for 4 weeks. PMAL and TAUT were used to measure motor function at baseline and 2 and 4 weeks post-intervention. The data was analyzed using repeated measures ANOVA. Result: The result of the study showed a significant effect of task specific training from baseline to 2 and 4 weeks post-intervention on TAUT (AOP, QOU & AOU) and PMAL (AOU & QOU), and no evidence on increased Upper Limb Pain on VAS from baseline. Interpretation: The result indicates the feasibility and effectiveness of 300 repetitions of task practice spread over 3 sessions per day in children with hemiparesis.
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A Novel Approach to Upper Limb Task Specific Training in Children with
2014Co-Authors: Auwal Ali MohammedAbstract:Introduction: Studies of task specific training in children traditionally make children to perform tasks for some periods of time. However, this method may not show clearly how much task was practiced. Recently, alternative way of measuring amount of task practice has been proposed. This method uses the number of task repetition. Task repetition up to 300 times per day was possible in adults. Feasibility of this amount of task practice is however not clear in children. Aim: The aim of this study was to find out the feasibility of 300 task repetitions spread over 3 sessions per day, and that whether the intervention can cause Upper Limb Pain. Method: Seventeen children with hemiparesis were included in the study. They were made to practice 5 tasks, each 20 times per session, 3 times a day for 4 weeks. PMAL and TAUT were used to measure motor function at baseline and 2 and 4 weeks post-intervention. The data was analyzed using repeated measures ANOVA. Result: The result of the study showed a significant effect of task specific training from baseline to 2 and 4 weeks post-intervention on TAUT (AOP, QOU & AOU) and PMAL (AOU & QOU), and no evidence on increased Upper Limb Pain on VAS from baseline. Interpretation: The result indicates the feasibility and effectiveness of 300 repetitions of task practice spread over 3 sessions per day in children with hemiparesis.
Brigitte Tampin - One of the best experts on this subject based on the ideXlab platform.
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Field testing of the revised neuropathic Pain grading system in a cohort of patients with neck and Upper Limb Pain.
Scandinavian journal of pain, 2019Co-Authors: Brigitte Tampin, Rachel Elizabeth Broe, Lee Lee Seow, Shushana Gijohn George, Jiajie Tan, Rajiv Menon, Angela Jacques, Helen SlaterAbstract:Background and aims In 2008, the International Association for the Study of Pain Special Interest Group on Neuropathic Pain (NeuPSIG) proposed a clinical grading system to help identify patients with neuropathic Pain (NeP). We previously applied this classification system, along with two NeP screening tools, the PainDETECT (PD-Q) and Leeds Assessment of Neuropathic Symptoms and Signs Pain scale (LANSS), to identify NeP in patients with neck/Upper Limb Pain. Both screening tools failed to identify a large proportion of patients with clinically classified NeP, however a limitation of our study was the use of a single clinician performing the NeP classification. In 2016, the NeuPSIG grading system was updated with the aim of improving its clinical utility. We were interested in field testing of the revised grading system, in particular in the application of the grading system and the agreement of interpretation of clinical findings. The primary aim of the current study was to explore the application of the NeuPSIG revised grading system based on patient records and to establish the inter-rater agreement of detecting NeP. A secondary aim was to investigate the level of agreement in detecting NeP between the revised NeuPSIG grading system and the LANSS and PD-Q. Methods In this retrospective study, two expert clinicians (Specialist Pain Medicine Physician and Advanced Scope Physiotherapist) independently reviewed 152 patient case notes and classified them according to the revised grading system. The consensus of the expert clinicians' clinical classification was used as "gold standard" to determine the diagnostic accuracy of the two NeP screening tools. Results The two clinicians agreed in classifying 117 out of 152 patients (ICC 0.794, 95% CI 0.716-850; κ 0.62, 95% CI 0.50-0.73), yielding a 77% agreement. Compared to the clinicians' consensus, both LANSS and PD-Q demonstrated limited diagnostic accuracy in detecting NeP (LANSS sensitivity 24%, specificity 97%; PD-Q sensitivity 53%, specificity 67%). Conclusions The application of the revised NeP grading system was feasible in our retrospective analysis of patients with neck/Upper Limb Pain. High inter-rater percentage agreement was demonstrated. The hierarchical order of classification may lead to false negative classification. We propose that in the absence of sensory changes or diagnostic tests in patients with neck/Upper Limb Pain, classification of NeP may be further improved using a cluster of clinical findings that confirm a relevant nerve lesion/disease, such as reflex and motor changes. The diagnostic accuracy of LANSS and PD-Q in identifying NeP in patients with neck/Upper Limb Pain remains limited. Clinical judgment remains crucial to diagnosing NeP in the clinical practice. Implications Our observations suggest that in view of the heterogeneity in patients with neck/Upper Limb Pain, a considerable amount of expertise is required to interpret the revised grading system. While the application was feasible in our clinical setting, it is unclear if this will be feasible to apply in primary health care settings where early recognition and timely intervention is often most needed. The use of LANSS and PD-Q in the identification of NeP in patients with neck/Upper Limb Pain remains questionable.
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identification of neuropathic Pain in patients with neck Upper Limb Pain application of a grading system and screening tools
Pain, 2013Co-Authors: Brigitte Tampin, Helen Slater, Noelle Kathryn Briffa, Roger GouckeAbstract:The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain has proposed a grading system for the presence of neuropathic Pain (NeP) using the following categories: no NeP, possible, probable, or definite NeP. To further evaluate this system, we investigated patients with neck/Upper Limb Pain with a suspected nerve lesion, to explore: (i) the clinical application of this grading system; (ii) the suitability of 2 NeP questionnaires (Leeds Assessment of Neuropathic Symptoms and Signs Pain scale [LANSS] and the PainDETECT questionnaire [PD-Q]) in identifying NeP in this patient cohort; and (iii) the level of agreement in identifying NeP between the NeuPSIG classification system and 2 NeP questionnaires. Patients (n = 152; age 52 ± 12 years; 53% male) completed the PD-Q and LANSS questionnaire and underwent a comprehensive clinical examination. The NeuPSIG grading system proved feasible for application in this patient cohort, although it required considerable time and expertise. Both questionnaires failed to identify a large number of patients with clinically classified definite NeP (LANSS sensitivity 22%, specificity 88%; PD-Q sensitivity 64%, specificity 62%). These lowered sensitivity scores contrast with those from the original PD-Q and LANSS validation studies and may reflect differences in the clinical characteristics of the study populations. The diagnostic accuracy of LANSS and PD-Q for the identification of NeP in patients with neck/Upper Limb Pain appears limited.
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Identification of neuropathic Pain in patients with neck/Upper Limb Pain: application of a grading system and screening tools.
Pain, 2013Co-Authors: Brigitte Tampin, Noelle Kathryn Briffa, Roger Goucke, Helen SlaterAbstract:The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain has proposed a grading system for the presence of neuropathic Pain (NeP) using the following categories: no NeP, possible, probable, or definite NeP. To further evaluate this system, we investigated patients with neck/Upper Limb Pain with a suspected nerve lesion, to explore: (i) the clinical application of this grading system; (ii) the suitability of 2 NeP questionnaires (Leeds Assessment of Neuropathic Symptoms and Signs Pain scale [LANSS] and the PainDETECT questionnaire [PD-Q]) in identifying NeP in this patient cohort; and (iii) the level of agreement in identifying NeP between the NeuPSIG classification system and 2 NeP questionnaires. Patients (n = 152; age 52 ± 12 years; 53% male) completed the PD-Q and LANSS questionnaire and underwent a comprehensive clinical examination. The NeuPSIG grading system proved feasible for application in this patient cohort, although it required considerable time and expertise. Both questionnaires failed to identify a large number of patients with clinically classified definite NeP (LANSS sensitivity 22%, specificity 88%; PD-Q sensitivity 64%, specificity 62%). These lowered sensitivity scores contrast with those from the original PD-Q and LANSS validation studies and may reflect differences in the clinical characteristics of the study populations. The diagnostic accuracy of LANSS and PD-Q for the identification of NeP in patients with neck/Upper Limb Pain appears limited.
An De Groef - One of the best experts on this subject based on the ideXlab platform.
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Effectiveness of Botulinum Toxin A for Persistent Upper Limb Pain After Breast Cancer Treatment: A Double-Blinded Randomized Controlled Trial
Archives of physical medicine and rehabilitation, 2018Co-Authors: An De Groef, Marijke Van Kampen, Inge Geraerts, Nele Devoogdt, Patrick Neven, Ines Nevelsteen, Ann Smeets, Lore Dams, Elien Van Der Gucht, Philippe DebeerAbstract:Abstract Objective To investigate the effect of a single botulinum toxin A (BTX-A) infiltration in the pectoralis major muscle in addition to a standard physical therapy program for treatment of persistent Upper Limb Pain in breast cancer survivors. Design Double-blinded (patient and assessor) randomized controlled trial. Setting A university hospital. Participants Breast cancer patients (N=50) with Pain. Intervention The intervention group received a single BTX-A infiltration. The control group received a placebo (saline) infiltration. Within 1 week after the infiltration, all patients attended an individual physical therapy program (12 sessions) during the first 3 months and a home exercise program up to 6 months after infiltration. Main Outcome Measures The primary outcome was change in Pain intensity at the Upper Limb (visual analog scale, 0–100) after 3 months. Secondary outcomes were prevalence rate of Pain, pressure hypersensitivity, Pain quality, shoulder function, and quality of life. Measures were taken before the intervention and at 1, 3, and 6 months' follow-up. Results No significant difference in change in Pain intensity after 3 months was found (mean difference in change, 3/100; 95% confidence interval [CI], −13 to 19). From baseline up to 6 months, a significantly different change in Upper Limb Pain intensity was found between groups in favor of the intervention group (mean difference in change, 16/100; 95% CI, 1–31). Conclusions A single BTX-A infiltration in combination with an individual physical therapy program significantly decreased Pain intensity at the Upper Limb in breast cancer survivors up to 6 months. However, the effect size was not clinically relevant, and no other beneficial effects were found.
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Identification of Myofascial Trigger Points in Breast Cancer Survivors with Upper Limb Pain: Interrater Reliability.
Pain medicine (Malden Mass.), 2017Co-Authors: An De Groef, Marijke Van Kampen, Evi Dieltjens, Sophie De Geyter, Lore Vos, Tessa De Vrieze, Inge Geraerts, Nele DevoogdtAbstract:Objective Despite the increasing awareness of the contribution of myofascial dysfunctions to Upper Limb Pain in breast cancer survivors, reliability of the identification of myofascial trigger points (MTPs) in this population has not yet been investigated. Therefore, the aim of the present study was to investigate the interrater reliability of the identification of MTPs by palpation at the Upper Limb region in breast cancer survivors with Upper Limb Pain. Design Interrater reliability study. Setting University Hospitals Leuven, Belgium. Subjects Thirty breast cancer survivors with Pain at the Upper Limb region. Methods Nine muscles (Upper trapezius, levator scapulae, infraspinatus, supraspinatus, teres major and minor, subscapularis, pectoralis major, and scalene muscles) at the operated side were examined. The weighted kappa (WK) coefficient and Absolute Agreement with 95% confidence intervals were calculated. Results Moderate agreement was found for all examined Upper Limb muscles (WK = 0.41-0.60), except for the trapezius muscle, for which the agreement was almost perfect (WK = 0.83), and the supraspinatus muscle (WK = 0.23), for which the agreement was only fair. Conclusions For most muscles, moderate interrater reliability for the identification of MTPs by palpation in breast cancer survivors with Upper Limb Pain was found. Therefore, we concluded that the identification of MTPs by palpation may add to the diagnosis of the myofascial Pain syndrome in breast cancer survivors.
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Myofascial techniques have no additional beneficial effects to a standard physical therapy programme for Upper Limb Pain after breast cancer surgery: a randomized controlled trial.
Clinical rehabilitation, 2017Co-Authors: An De Groef, Marijke Van Kampen, Sophie De Geyter, Lore Vos, Tessa De Vrieze, Inge Geraerts, Nele Vervloesem, Marie-rose Christiaens, Patrick Neven, Nele DevoogdtAbstract:Objective:To investigate the effects of myofascial techniques, in addition to a standard physical therapy programme for Upper Limb Pain shortly after breast cancer surgery.Design:Double-blinded (pa...
