Achtergrond: Pijn is een lastig te meten, subjectief fenomeen. Pijn wordt vaak gemeten met subjectieve self-reported vragenlijsten. Een andere manier om pijn vast te leggen is het objectief meten van de pijndrempel (Pressure Pain Threshold, PPT) door middel van het uitoefenen van mechanische druk met behulp van een drukalgometer. De pijndrempel is het punt waarop een persoon voor het eerst pijn opmerkt. Het is een bruikbare en betrouwbare manier om op een objectieve wijze de PPT in kaart te brengen. Referentiewaarden van pijndrempels en de invloed van diverse variabelen hierop zijn nog vrij onbekend. Ook is nog onduidelijk of er binnen een individu verschillen kunnen zijn tussen de gevoeligheid voor pijn aan de dominante en niet-dominante zijde van het lichaam. Vraagstelling: Wat is de mate van variatie in de hoogte van pijndrempelwaarden op diverse locaties op het lichaam, gemeten met een drukalgometer, aan de dominante zijde ten opzichte van de niet-dominante zijde bij pijnvrije ouderen van 40 tot 85 jaar?” Methode: Bij gezonde deelnemers (zonder pijn) in de leeftijd van 40 tot 85 jaar werden pijndrempels gemeten op drie locaties rond de knie, twee locaties op de arm en één op het voorhoofd. Metingen werden op elke locatie drie keer verricht, met een tussenpose van 30 seconden. Dit werd gedaan aan de dominante en niet-dominante zijde van het lichaam. Op elke locatie werd de gemiddelde pijndrempel van drie metingen berekend. Door middel van een ongepaarde t-toets werd per locatie de gemiddelde pijndrempel aan de dominante zijde vergeleken met de niet-dominante zijde. Resultaten: De steekproef bestond uit 53 deelnemers, waarvan 23 mannen (gemiddelde leeftijd 64,3 jaar ±13,3) en 30 vrouwen (gemiddelde leeftijd 55,5 jaar ±9,4), waarvan vijf linkshandige deelnemers en één linksbenige deelnemer. Gemiddelde pijndrempels waren op alle zes locaties aan de dominante zijde niet significant hoger dan aan de niet-dominante zijde (p<0,05). Conclusie: Er zijn geen significante verschillen in de hoogte van de pijndrempels aan de op dominante zijde ten opzichte van de niet-dominante zijde bij pijnvrije ouderen van 40 tot 85 jaar. Dit maakt het gebruik van pijndrempels eenvoudiger wanneer dit wordt toegepast in een klinische setting. Implicatie voor de fysiotherapie: Pijndrempelmetingen kunnen in de praktijk gebruikt worden om pijn objectief te meten. Hierbij hoeft er geen rekening gehouden te worden met de dominante of niet-dominante zijde van de arm en het been.
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Purpose: The etiology of pain in osteoarthritis (OA) is complex andmultifactorial. A growing number of studies suggest that modificationof pain-transmission in the peripheral and central nervous system,leading to sensitization, plays a role in OA pain. Sensitization seems tobe associated with neuropathic pain-like symptoms and assessment ofthese symptoms can help to identify patients who could benefit fromadditional treatment options. Several questionnaires are available todistinguish neuropathic from nociceptive pain symptoms. The modifiedpainDETECT questionnaire (mPDQ) is a self-reported questionnairedeveloped to discriminate between nociceptive- and possible/likelyneuropathic pain in knee OA patients. Recently the mPDQ was translatedinto Dutch and adjusted to also fit hip OA patients. The aim of thisstudy was to assess the validity of the mPDQ-NL in patients with hip orknee OA.Methods: Primary hip and knee OA patients were recruited from threeDutch hospitals. Based on previous research, confirmatory factor analysisfor two principal components was performed to assess structuralvalidity. Construct validity (both convergent and divergent) wasassessed using hypothesis testing. Predefined hypotheses were formulatedconcerning the correlation between the mPDQ-NL and theSelf-reported Leeds Assessment of Neuropathic Symptoms and Signs (SLANSS),subscales of the Knee injury and Osteoarthritis Outcome score/Hip disability and Osteoarthritis Outcome Score (KOOS/HOOS), VisualAnalogue Scale for pain (VAS pain), and subscales of the RAND-36health survey (RAND-36). According to the COSMIN criteria, constructvalidity of a questionnaire is sufficient if 75% of predefined hypothesesare met. Additionally, convergent validity was assessed with blunt PainPressure Thresholds (PPTs) in a subsample of participants. A reducedPPT is a somatosensory abnormality that is considered an indication ofsensitization in OA. Therefore it was expected that reduction of PPTswas associated with higher mPDQ scores.Results: 168 participants were included. PPT measurements wereperformed in a sample of 46 participants. Factor analysis confirmed twoprincipal components. The items that loaded on the first componentcould be described as “evoked neuropathic sensations”, the items thatloaded on the second component as “spontaneous neuropathic sensations”.However there were two items that substantially loaded on bothcomponents. The item regarding pain pattern did not load on anycomponent. Considering construct analysis, 80% of the predefinedhypotheses concerning the correlation between mPDQ and self-reportedquestionnaires were met. Considering the correlation with PPTmeasurements, 50% of the predefined hypotheses were met.Conclusions: The mPDQ-NL seems to adequately reflect neuropathicpain-like symptoms experienced by hip and knee OA patients. Concerningstructural validity, two determinative components seem to bepresent, in line with previous research. However, one particular itemregarding pain pattern might not reflect the construct of neuropathicpain-like symptoms in hip or knee OA. Therefore, when using the mPDQin hip or knee OA patients, it might be considered to skip this particularitem. Construct validity can be considered sufficient, with over 75% ofthe predefined hypotheses regarding correlation between the mPDQNLand other questionnaires were met. However, only 50% of the hypotheses concerning PPT measurements were met, probably due toheterogeneity and limited sample size of this subgroup. To ourknowledge, this study is the first to assess the structural validity of themPDQ knee and hip by using factor analysis and to assess constructvalidity using elaborate hypothesis testing as proposed by the COSMINguidelines.
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Background: The modified painDETECT questionnaire (PDQ) is a self-reported questionnaire to discriminatebetween nociceptive and neuropathic-like pain in patients with knee/hip osteoarthritis (OA). This studyaims to assess the structural and construct validity of this questionnaire.Methods: Confirmatory factor analysis and hypothesis-testing was used. For 168 patients, predefinedhypotheses were formulated on the correlation between the modified painDETECT and several otherquestionnaires, and in a subsample of 46 with pain pressure thresholds (PPTs).Results: Two principal components were confirmed. The pain pattern item did not load on any component.Eighty per cent of the hypotheses on the correlation between modified PDQ and the questionnaireswere met, as were 50% concerning PPTs measurements.Conclusions: This study is the first to assess structural and construct validity of the modified PDQ knee/hip by using factor analysis and hypothesis-testing. This questionnaire seems to reflect neuropathic-like pain symptoms experienced by hip/knee OA-patients with adequate validity. The item on pain patternmight not reflect the construct. More than 75% of the predefined hypotheses regarding the modified PDQ and the other questionnaires were met. Only 50% of the hypotheses on PPTs measurements were met, probably due to heterogeneity and limited size of this subsample.
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Previous research has shown clinical effectiveness of dermal substitution; however, in burn wounds, only limited effect has been shown. A problem in burn wounds is the reduced take of the autograft, when the substitute and graft are applied in one procedure. Recently, application of topical negative pressure (TNP) was shown to improve graft take. The aim of this study was to investigate if application of a dermal substitute in combination with TNP improves scar quality after burns. In a four-armed multicenter randomized controlled trial, a split-skin graft with or without a dermal substitute and with or without TNP was compared in patients with deep dermal or full-thickness burns requiring skin transplantation. Graft take and rate of wound epithelialization were evaluated. Three and 12 months postoperatively, scar parameters were measured. The results of 86 patients showed that graft take and epithelialization did not reveal significant differences. Significantly fewer wounds in the TNP group showed postoperative contamination, compared to other groups. Highest elasticity was measured in scars treated with the substitute and TNP, which was significantly better compared to scars treated with the substitute alone. Concluding, this randomized controlled trial shows the effectiveness of dermal substitution combined with TNP in burns, based on extensive wound and scar measurements.
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BACKGROUND: Pain assessment is a necessary step in pain management in older people in palliative care. In older people, pain assessment can be challenging due to underreporting and atypical pain manifestations by other distressing symptoms. Anxiety, fatigue, loss of appetite, nausea, insomnia, dyspnoea, and bowel problems correlate with pain in palliative care patients. Insight into these symptoms as predictors may help to identify the underlying presence of pain. This study aimed to develop and test a prediction model for pain in community-dwelling frail older people in palliative care. METHODS: In this cross-sectional observational study, community-care nurses from multiple organizations across the Netherlands included eligible patients (life expectancy
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Objective: To systematically describe changes in pain and functioning in patients with osteoarthritis (OA) awaiting total joint replacement (TJR), and to assess determinants of this change. Methods: MEDLINE®, EMBASE, CINAHL® and Cochrane Database were searched through June 2008. The reference lists of eligible publications were reviewed. Studies that monitored pain and functioning in patients with hip or knee OA during the waiting list for TJR were analyzed. Data were collected with a pre-specified collection tool. Methodological quality was assessed and a best-evidence analysis was performed to summarize results. Results: Fifteen studies, of which two were of high quality, were included and involved 788 hip and 858 knee patients (mean age 59-72 and main wait 42-399 days). There was strong evidence that pain (in hip and knee OA) and self-reported functioning (in hip OA) do not deteriorate during a
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