RECENT RESEARCH period ( 12 weeks ) but not at 12 months , with changes at 12 weeks reaching clinically meaningful thresholds for the Neck Cases . Findings suggest the need for continuation of exercise to maintain benefits in the longer term .
Bittencourt JV , de Melo Magalhães Amaral AC , Rodrigues PV . et al .
Diagnostic accuracy of the clinical indicators to identify central sensitization pain in patients with musculoskeletal pain . Arch Physiother . 2021 , 11 , Article no . 2 . https :// doi . org / 10.1186 / s40945-020-00095-7
Background : The identification of central sensitization ( CS ) is an important aspect in the management of patients with chronic musculoskeletal pain . Several methods have been developed , including clinical indicators and psychophysical measures . However , whether clinical indicators coincide with the psychophysical test of CSrelated sign and symptoms is still unknown . Therefore , the present study aimed to analyze the diagnostic accuracy of the clinical indicators in identifying CS-related sign and symptoms in patients with musculoskeletal pain .
Methods : One-hundred consecutive patients with musculoskeletal pain were included . Clinical indicators ( index method ) based on a combination of patient self-report pain characteristics and physical examination were used to identify the phenotype of patients with musculoskeletal pain and the predominance of the CS-related sign and symptoms . Conditioned pain modulation ( CPM ) was assessed by the Cold Pressor Test ( reference standard ), which is a psychophysical test used to detect impairment of CPM . Measurements of the diagnostic accuracy were performed .
Results : Twenty-seven patients presented predominance of CS-related sign and symptoms in the assessment of the clinical indicators , and 20 had impairment of CPM . Clinical indicators showed high accuracy ( 75.0 %; 95 % confidence interval = 65.3 to 83.1 ), high specificity ( 80.0 %; 95 % confidence interval = 69.6 to 88.1 ), high negative predictive value ( 87.7 %; 95 % confidence interval = 81.2 to 92.1 ), and a relevant positive likelihood ratio ( 2.8 , 95 % confidence interval = 1.5 to 5.0 ) when compared to the Cold Pressor Test .
Conclusion : Clinical indicators demonstrated a valuable tool for detecting the impaired CPM , which is a remarkable feature of the CS-related sign and symptoms . Clinicians are encouraged to use the clinical indicators in the management of patients with musculoskeletal pain .
Bek M , Mikas C , Merrild B . et al .
Less than half of patients in secondary care adheres to clinical guidelines for subacromial pain syndrome and have acceptable symptoms after treatment : A Danish nationwide cohort study of 3306 patients . Musculoskeletal Science and Practice . 2021 , 52 , 102322 . https :// doi . org / 10.1016 / j . msksp . 2021.102322
Background : Evidence-based guidelines recommend exercise-therapy as first line treatment for subacromial pain syndrome , but no previous study has mapped the content of care for subacromial pain syndrome and knowledge about adherence to clinical guidelines are lacking . We aim to describe the content and outcome of current care and investigate the relationship between content and outcome of care .
Methods : We invited all patients diagnosed with subacromial pain syndrome at any Danish hospital to participate in this nationwide retrospective population-based cohortstudy . Patient-reported information on content of care was collected using a validated questionnaire . Outcome of care was assessed using global impression of change ( GIC ) and patient acceptable symptom state ( PASS ). Invitations were sent 14 weeks after diagnosis .
Results : In total , 3306 eligible patients participated . At follow-up , 45 % had completed the recommended 12 weeks of exercise-therapy . From the total cohort , 12 % underwent surgery without completing 12 weeks of exercisetherapy . For patients undergoing nonoperative care , 43 % reached PASS while 61 % were improved since diagnosis at the hospital . Completing 12 weeks with exercise-therapy did not increase the odds of improvement ( OR 1.05 , 95 % CI : 0.88 – 1.24 ), but having conducted strengthening exercises did ( OR 1.65 , 95 % CI : 1.25 – 2.19 ).
Conclusion : More than half of patients diagnosed with subacromial pain syndrome in specialist care settings do not adhere to recommendations regarding duration of exercise-therapy , but this is not related to symptom improvement . Conversely , conducting strengthening exercises relates to higher chance of symptom improvement . This challenges current clinical guidelines , indicating that a time-based cut-point may not be relevant while specific types of exercises are .
Sung Y- H .
Upper cervical spine dysfunction and dizziness . J Exerc Rehabil . 2020 , 16 ( 5 ): 385-391 . DOI : https :// doi . org / 10.12965 / jer . 2040612.306
Although various causes of dizziness have been identified , many patients suffer from dizziness of unknown etiology and continue to visit hospitals to resolve their symptoms . Problems that occur in the ligaments or muscles of the upper cervical spine can cause confusion in proprioception . These changes can convey misinformation to the vestibular nucleus , resulting in abnormal reactions that can lead to cervicogenic dizziness ( CGD ). Though CGD remains controversial , it should be considered while diagnosing patients with dizziness . Understanding CGD can help create treatment strategies for them . This article suggested a relationship between the structure and function of the upper cervical spine and dizziness , and presented evaluations and treatments for the same .
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