Reliability of the French-Canadian adaptation of the Personality Assessment Inventory: Medical-legal implications.

The Personality Assessment Inventory (PAI) is a reliable multidimensional psychometric inventory that is increasingly being used in the medical-legal context. To date, 18 language adaptations of the PAI exist, yet only the Spanish, Greek and German language versions have been examined psychometrically. This study evaluated the psychometric properties of the French-Canadian version of the PAI by comparing mean scale and subscale scores between the French-Canadian and English language versions, and analyzing the internal consistency and mean item inter-correlations (MICs) of each version in a sample of 50 bilingual university students. Cronbach's alphas ranged from -.57 to .80 in the French-Canadian version and from -1.10 to .83 in the English version, with most scales being below .70, indicating inadequate internal consistency. In addition, most of the MICs were below .20, indicating a lack of item homogeneity. Caution is given to this adaptation of the PAI in the medical-legal context.

Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

PURPOSE: To develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD). METHODS: This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I-III NAD <6 months duration. RECOMMENDATION 1: Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III. RECOMMENDATION 2: Clinicians should assess prognostic factors for delayed recovery from NAD. RECOMMENDATION 3: Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I-III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care. RECOMMENDATION 4: For NAD grades I-II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat. RECOMMENDATION 5: For NAD grades I-II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections. RECOMMENDATION 6: For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction. RECOMMENDATION 7: For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management. RECOMMENDATION 8: Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.

Noninvasive management of soft tissue disorders of the shoulder: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.

OBJECTIVES: Objective of this study is to develop an evidence-based guideline for the noninvasive management of soft tissue disorders of the shoulder (shoulder pain), excluding major pathology. METHODS: This guideline is based on high-quality evidence from seven systematic reviews. Multidisciplinary experts considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience is clinicians; target population is adults with shoulder pain. RESULTS: When managing patients with shoulder pain, clinicians should (a) rule out major structural or other pathologies as the cause of shoulder pain and reassure patients about the benign and self-limited nature of most soft tissue shoulder pain; (b) develop a care plan in partnership with the patient; (c) for shoulder pain of any duration, consider low-level laser therapy; multimodal care (heat/cold, joint mobilization, and range of motion exercise); cervicothoracic spine manipulation and mobilization for shoulder pain when associated pain or restricted movement of the cervicothoracic spine; or thoracic spine manipulation; (d) for shoulder pain >3-month duration, consider stretching and/or strengthening exercises; laser acupuncture; or general physician care (information, advice, and pharmacological pain management if necessary); (e) for shoulder pain with calcific tendinitis on imaging, consider shock-wave therapy; (f) for shoulder pain of any duration, do not offer ultrasound; taping; interferential current therapy; diacutaneous fibrolysis; soft tissue massage; or cervicothoracic spine manipulation and mobilization as an adjunct to exercise (i.e., range of motion, strengthening and stretching exercise) for pain between the neck and the elbow at rest or during movement of the arm; (g) for shoulder pain >3-month duration, do not offer shock-wave therapy; and (h) should reassess the patient's status at each visit for worsening of symptoms or new physical, mental, or psychological symptoms, or satisfactory recovery. CONCLUSIONS: Our evidence-based guideline provides recommendations for non-invasive management of shoulder pain. The impact of the guideline in clinical practice requires further evaluation. SIGNIFICANCE: Shoulder pain of any duration can be effectively treated with laser therapy, multimodal care (i.e., heat/cold, joint mobilization, range of motion exercise), or cervicothoracic manipulation and mobilization. Shoulder pain (>3 months) can be effectively treated with exercises, laser acupuncture, or general physician care (information, advice, and pharmacological pain management if necessary).

Medicolegal Expert Core Competencies and Professionalism.

Medicolegal expert opinions can be the source of long and senseless acrimonious debates when they lack the necessary qualities to be considered good evidence. In contrast, quality medicolegal expert reports contribute significantly to the proper and prompt resolution of personal injury claims in civil litigation. To this end, expert physiatrists must develop the medicolegal mindset necessary to survive and thrive in the civil litigation arena. Medicolegal core competencies needed for this endeavor are identified and addressed for what is a lifelong learning project.

Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration.

OBJECTIVES: To develop an evidence-based guideline for the non-pharmacological management of persistent headaches associated with neck pain (i.e., tension-type or cervicogenic). METHODS: This guideline is based on systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain. RESULTS: When managing patients with headaches associated with neck pain, clinicians should (a) rule out major structural or other pathologies, or migraine as the cause of headaches; (b) classify headaches associated with neck pain as tension-type headache or cervicogenic headache once other sources of headache pathology has been ruled out; (c) provide care in partnership with the patient and involve the patient in care planning and decision making; (d) provide care in addition to structured patient education; (e) consider low-load endurance craniocervical and cervicoscapular exercises for tension-type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; (f) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise and postural correction) or clinical massage for chronic tension-type headaches; (g) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension-type headaches; (h) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization and exercises; and (i) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated. CONCLUSIONS: Our evidence-based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation. SIGNIFICANCE: Neck pain and headaches are very common comorbidities in the population. Tension-type and cervicogenic headaches can be treated effectively with specific exercises. Manual therapy can be considered as an adjunct therapy to exercise to treat patients with cervicogenic headaches. The management of tension-type and cervicogenic headaches should be patient-centred.

Certification standards of professionals coordinating life care plans for individuals who have acquired brain injury.

This article will discuss the history and evolution of what is now known as a life care plan. The objectives will be to understand that a life care plan is a tool of case management. A life care plan is based on a proper medical, psychological, case management, and/or rehabilitation foundation. The development of a life care plan requires following generally accepted and peer-reviewed methodology and standards of practice. Life care planning is a trans-disciplinary specialty practice. A life care plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research that provides an organized, concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or have chronic health care needs. The reader will also learn there are Standards of Practice for life care planning that have been a long-standing guide for the practitioner and its core components will be discussed. There are qualifications of professionals who perform the specialty practice of life care planning which will be reviewed, and in conclusion there are special considerations for individuals coordinating life care plans with individuals who have sustained an acquired brain injury will also be discussed.

Medicolegal causal analysis.

This article reviews basic tort law concepts, which medical evaluators should be familiar with when working in the medicolegal environment. To facilitate medicolegal causal analysis, the concept of the health claim statement or argument is proposed. We describe medicolegal causal analysis model, which should assist the medical evaluator's determination of the relationship between an alleged accident and personal injury. This practical model minimizes bias and ensures that inferences are supported by factual medical evidence.

Published research and physiatric opinion in life care planning.

This article outlines the use of medical literature to support a physiatrist's expert opinion in the development of a life care plan and proposes a basic ethical code of conduct in performing medicolegal work.

Interventions in chronic pain management. 1. Pain concepts, assessment, and medicolegal issues.

UNLABELLED: This self-directed learning module highlights the concepts of pain and suffering, and chronic pain management from basic science and medicolegal perspectives. It is part of the study guide on chronic pain management in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on explaining the concepts of pain and suffering as an expert witness, the causes and mechanisms of pain, and qualifying as an expert witness. The article also discusses chronic pain management OVERALL ARTICLE OBJECTIVE: To summarize the concepts of pain and suffering in a medicolegal context.

Interventions in chronic pain management. 2. New frontiers: invasive nonsurgical interventions.

UNLABELLED: Invasive nonsurgical techniques have a central role in the management of patients suffering from acute and chronic pain. This article surveys common percutaneous pain procedures: trigger point injections, intra-articular injections, spinal injections, nerve blocks, radiofrequency lesioning (thermocoagulation and pulsed-mode), epidural adhesiolysis and decompressive neuroplasty, neural mapping, intradiskal and intra-annular procedures, neuromodulation, continuous intrathecal analgesia, and deep brain stimulation. Physiatrists must understand the guiding principles behind these procedures before practicing interventional pain management. OVERALL ARTICLE OBJECTIVE: To review invasive, nonsurgical pain management procedures.

Interventions in chronic pain management. 5. Disease-specific issues in chronic pain.

UNLABELLED: This self-directed learning module highlights the importance of applying principles described earlier in the Study Guide to specific diseases encountered by practitioners managing chronic pain in order to administer appropriate treatment. This chapter focuses on several challenging and increasingly common maladies and attempts to delineate rationales for holistic, comprehensive care. OVERALL ARTICLE OBJECTIVE: To explore diagnostic concepts and therapeutic strategies in fibromyalgia syndrome, central pain, multiple sclerosis, complex regional pain syndrome, and postherpetic neuralgia.