RESUMO
Background: The Identification Pain questionnaire (IDPQ) is one of the recommended tools by the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain for neuropathic pain screening. This study aimed to translate, cross-culturally adapt, and validate the Persian version of the IDPQ. Methods: First, the IDPQ was translated based on the recommended guidelines. Afterward, the internal consistency (Cronbach's alpha coefficient), test-retest reliability (intraclass correlation coefficient), construct validity (compared to the Douleur Neuropathique 4 [DN4] questionnaire), and discriminant validity (Receiver operating curve analysis) of the IDPQ-P were evaluated. A total of 90 patients with neuropathic (n=50) and nociceptive pain (n=40) were enrolled in the study. In the next 72 h after the initial assessment, 30 patients (15 with neuropathic and 15 with nociceptive pain) completed the IDPQ-P. Results: No modifications were needed in the process of translation and cultural adaptation. Cronbach's alpha coefficient was obtained at 0.47 for all patients, indicating poor internal consistency. The intraclass correlation coefficient was estimated at 0.97, showing excellent test-retest reliability. A high correlation was found between the DN4 questionnaire and IDPQ-P (0.74), showing acceptable construct validity. The area under the curve was 0.94 (95% CI: 0.88-0.99) and 0.92 (95% CI: 0.85-0.99) when the physician's diagnosis and the DN4 cut-off value were used as the reference standard, respectively. The optimal cut-off value of ≥ 2 demonstrated the highest sensitivity (98%) and specificity (79%). Conclusion: The IDPQ-P can be used in the clinical setting as an accurate and quick screening tool to diagnose patients with neuropathic pain. Sufficient test-retest reliability, construct validity, discriminant validity, and high diagnostic accuracy were found for the IDPQ-P.
RESUMO
Background: Previous studies have shown that outcomes following a place and active hold (PAH) are better than a passive flexion protocol after a two-strand core-suture repair of flexor tendons injuries in zone II. This study aims to determine the outcomes of a PAH protocol of flexor tendon rehabilitation following a four-strand core-suture plus an epitendinous suture repair of the flexor digitorum profundus (FDP) combined with a simple horizontal loop repair of the flexor digitorum superficialis (FDS). Methods: This is a prospective study of patients with complete injury to both flexor tendons in zone II. All tendons were repaired with a simple horizontal loop for FDS and four-strand core-suture plus epitendinous suture for FDP. The PAH protocol was used postoperatively for 6 weeks. The outcome was evaluated using flexion contracture and total active motion (TAM), interpreted using Strickland criteria and categorised as excellent, good, fair and poor at 6 weeks and 3 months. The linear regression model was used to determine predictors of outcomes. Results: The study included 32 patients with flexor tendon injury in 46 fingers. No repairs ruptured, and 24 (52%) digits achieved good or excellent motion 6 weeks after surgery using the Strickland criteria. According to the Strickland criteria, 41 (89%) digits ranked as excellent and good with no poor result at a 3-month follow-up. Four patients had 5-10° of flexion contracture. Age was the predictor of TAM at 6 weeks and accounted for 13% of its variation. Improvement of TAM from 6 weeks to 3 months was related to age and flexion contracture at 6 weeks. Conclusions: The PAH protocol can be considered a safe technique for flexor rehabilitation after four-strand core-suture repair of FDP in zone II. Level of Evidence: Level IV (Therapeutic).