Reporting the Location and Extent of Pain in Adolescents: A Test-Retest Reliability Study.

BACKGROUND: A pain drawing is a self-administered assessment that requires the patient to shade in on a body chart the areas in which he or she experiences pain, regardless of the intensity. Pain drawings have already been validated in several adult populations. OBJECTIVES: The aim of this study is to establish adolescents' test-retest reliability in reporting the extent and location of their pain using a paper-based pain drawing. STUDY DESIGN: A one-day test-retest reliability study was set up. SETTING: The study took place in 2 separate locations-a pediatric hospital and a private physiotherapy practice in Ticino, in the southern part of Switzerland. This reliability study was approved by the local ethics committee of Ticino (2021-00492 CE 3832). METHODS: Adolescents with musculoskeletal pain (aged 11-16 years) were included. All participants were asked to shade the areas in which they experienced pain over the previous week. After the administration of a questionnaire and the acquisition of further personal data, the pain drawing was administered again. The pain drawings were then scanned and analyzed using a digital platform, which allowed the extraction of pain extent and location values. The test-retest reliability was evaluated on these data. The intraclass correlation coefficient and Bland-Altman analysis were used to assess the reliability of the reporting of the pain extent, whereas the Jaccard similarity coefficient was used to calculate the reliability of the reporting of the pain location. RESULTS: The reporting of the pain extent was observed to have excellent test-retest reliability: ICC2,1: 0.959 (95% CI: 0.925-0.978). The Bland-Altman analysis showed a mean difference close to 0: -0.010% (limits of agreements -0.962 to 0.942). The reliability of the reporting of pain location was also supported by the Jaccard index mean score of 0.82 (± 0.19). LIMITATIONS: Reliability of reporting may vary depending on the nature of the pain, its duration, or the type of disorder and body areas involved. CONCLUSIONS: Adolescents complaining musculoskeletal pain showed reliability in reporting pain extent and location using pain drawings.

Changes in Multiple Aspects of Pain Outcomes After Rehabilitation: Analysis of Pain Data in a Randomized Controlled Trial Evaluating the Effects of Adding Sensorimotor Training to Manual Therapy and Exercise for Chronic Neck Pain.

OBJECTIVES: To examine changes in pain outcomes to fully evaluate the effect of adding sensorimotor training to manual therapy and exercise in patients with chronic neck pain and sensorimotor deficits. Concordance was examined between pain distribution and pain intensity and patient-reported outcomes. METHODS: Participants (n=152) were randomly allocated into 4 intervention groups: One group received local neck treatment (NT) comprising manual therapy and exercise and the other 3 groups received additional sensorimotor training (either joint position sense/oculomotor exercises, balance exercises or both). Treatment was delivered twice a week for 6 weeks. Pain and patient-reported outcomes were measured at baseline, posttreatment, and 3-, 6- and 12-month follow-ups. RESULTS: There were greater changes in pain location, extent, and intensity at 6- and 12-month follow-ups in the sensorimotor training groups compared with the NT group ( P <0.05). A greater number of patients in the sensorimotor training groups gained ≥50% reduction in pain extent and intensity relative to the NT group at 6 and 12 months ( P <0.05). Clinical improvement in pain extent was concordant with pain intensity (adjusted kappa=056 to 0.66, %agreement=78.3 to 82.9, P <0.001) and disability (adjusted kappa=0.47 to 0.58, % agreement=73.7 to 79.0, P <0.01) at 3-, 6- and 12-month follow-ups, but not with function and well-being. The concordance tended to decline with time. DISCUSSION: Multiple aspects of the pain experience improved in the longer term by adding sensorimotor training to NT for patients with neck pain and sensorimotor deficits. The concordance between pain and patient-reported outcomes was not always evident and varied over time, suggesting the need for multidimensional assessments of pain.

Factors associated with increased risk of playing-related disorders among classical music students within the Risk of Music Students (RISMUS) longitudinal study.

Playing-related musculoskeletal disorders (PRMDs) are common among musicians but longitudinal data on risk factors are limited. The aim of the study was to longitudinally identify the factors associated with increased risk of PRMD onset among music students enrolled in different pan-European music institutions. A further goal was to assess the occurrence of PRMDs during a 12-month period. A total of 442 students without PRMDs from 56 European music universities completed a web-based questionnaire on lifestyle and practice habits, health history, physical activity, psychological distress, perfectionism, and fatigue. PRMD onset was assessed prospectively at 6 and 12 months. Logistic regression analysis showed that changes in physical activity level (6-month AOR = 2.343, 12-month AOR = 2.346), increased levels of fatigue (6-month AOR = 1.084, 12-month AOR = 1.081) and socially-prescribed perfectionism (6-month AOR = 1.102) were significantly associated with PRMD onset, which had occurred in 49% of participants during 12 months. Musculoskeletal complaints reported at baseline (6-month AOR = 0.145, 12-month AOR = 0.441) and changes to BMI (12-month AOR = 0.663) limited the onset of PRMDs. The study's novel longitudinal findings were appraised critically within the contexts of potential factors for PRMD onset and evidence-based preventive strategies to minimise the impact of PRMDs.