Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power. The value of physical performance tests for predicting therapy outcome in patients with subacute low back pain: a prospective cohort study Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Massed Practice versus Massed Practice with Stimulation: Effects on Upper Extremity Function and Cortical Plasticity in Individuals with Incomplete Cervical Spinal Cord Injury Corticospinal integrity and motor impairment predict outcomes after excitatory repetitive transcranial magnetic stimulation: a preliminary study. Psychophysiologic treatment for patients with medically unexplained symptoms: a randomized controlled trial. Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review Clinical Pressure Pain Threshold Testing in Neck Pain: Comparing Protocols, Responsiveness, and Association With Psychological Variables Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study Right secondary somatosensory cortex—a promising novel target for the treatment of drug-resistant neuropathic orofacial pain with repetitive transcranial magnetic stimulation Instrumented Test of Sensory Integration for Balance: A Validation Study Psychometric properties of a generic health measure in patients with neck pain Comparison between the reliability levels of manual palpation and pressure pain threshold in children who reported orofacial pain. Reliability of physical examination items used for classification of patients with low back pain. Sensory stimulation augments the effects of massed practice training in persons with tetraplegia. Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study Somatosensory symptoms and signs and conditioned pain modulation in chronic post-stroke shoulder pain.
BACKGROUND CONTEXT The " central ization phenomenon " ( CP ) is the progressive retreat of referred pain towards the spinal midline in response to repeated movement testing ( a McKenzie evaluation ) . A previous study suggested that it may have utility in the clinical diagnosis of discogenic pain and may assist patient selection for discography and specific treatments for disc pain . PURPOSE Estimation of the diagnostic predictive power of central ization and the influence of disability and patient distress on diagnostic performance , using provocation discography as a criterion st and ard for diagnosis , in chronic low back pain patients . STUDY DESIGN / SETTING This study was a prospect i ve , blinded , concurrent , reference st and ard-related validity design carried out in a private radiology clinic specializing in diagnosis of chronic spinal pain . PATIENT SAMPLE Consecutive patients with persistent low back pain were referred to the study clinic by orthopedists and other medical specialists for interventional radiological diagnostic procedures . Patients were typically disabled and displayed high levels of psychosocial distress . The sample included patients with previous lumbar surgery , and most had unsuccessful conservative therapies previously . OUTCOME MEASURES DIAGNOSIS results of provocation discography . INDEX TEST The CP . Psychometric evaluation : Rol and -Morris , Zung , Modified Somatic Perception question naires , Distress Risk Assessment Method , and 100-mm visual analog scales for pain intensity . METHODS Patients received a single physical therapy examination , followed by lumbar provocation discography .  Sensitivity , specificity , and likelihood ratios of the CP were estimated in the group as a whole and in subgroups defined by psychometric measures . RESULTS A total of 107 patients received the clinical examination and discography at two or more levels and post-discography computed tomography .  Thirty-eight could not tolerate a full physical examination and were excluded from the main analysis . Disability and pain intensity ratings were high , and distress was common . Sensitivity , specificity , and positive likelihood ratios for central ization observed during repeated movement testing for pain distribution and intensity changes were 40 % , 94 % , and 6.9 respectively . In the presence of severe disability , sensitivity , specificity , and positive likelihood ratios were 46 % , 80 % , 3.2 and for distress , 45 % , 89 % , 4.1 . In the subgroups with moderate , minimal , or no disability , sensitivity and specificity were 37 % , 100 % and for no or minimal distress 35 % , 100 % . CONCLUSIONS Central ization is highly specific to positive discography but specificity is reduced in the presence of severe disability or psychosocial distress Considering the enormous costs of intensive multidisciplinary treatment , predictive tests for therapy outcome are needed to evaluate patients ’ performance potential and increase cost effectiveness . Somatic parameters are commonly used to evaluate health status and serve as an additional means of forecasting the prognosis , yet little is known of their validity . In this study , we investigated the prognostic value of somatic parameters regarding the outcome of multidisciplinary treatment in patients with subacute low back pain . The study was design ed as a prospect i ve cohort study of 162 patients .  Somatic parameters were assessed with three physical performance tests ( Villiger test , Oesch test , Biering – Sørensen test ) before treatment ( T0 ) , after 3 weeks ’ inpatient therapy ( T1 ) and at 6-month follow-up ( T2 ) . Psychometric characteristics of subjective pain perception ( VAS ) , a pain disability index ( PDI ) and a physical capability index ( FFbH-R ) were recorded . Correlation coefficients between the physical performance test scores and psychometric characteristics were calculated . To predict therapy outcome , discriminant analyses were performed . A control group ( n = 30 ) was evaluated at similar time points without receiving any therapy . Our results demonstrate good discrimination between patients and controls by means of the investigated performance tests and exhibit a significant negative correlation with the psychometric data . Lower outcome values at study entry correlated with higher pain intensity and disability after multidisciplinary treatment . However , the statistical magnitude of correlation was relatively low and further discriminant analysis did not reveal any predictive value . Consequently the physical performance tests do not have a prognostic value regarding therapy outcome BACKGROUND CONTEXT A range of morphologic and psychosocial variables has been suggested as risk factors for serious low back pain ( LBP ) illness . Although the relative contributions of structural and psychosocial variables are intensely debated , the validity of differing hypotheses has proven difficult to test because the incidence of serious disabling LBP illness is low in healthy subjects . These factors dictate the requirement for large sample sizes , extensive structural imaging and extended longitudinal study . Previous studies included either small cohorts with intensive imaging testing or large population studies that do not establish a detailed morphologic baseline . PURPOSE To establish , using a strict patient sample design , the relative contribution of structural and psychosocial determinants of serious LBP illness among subjects with no previous LBP disability or clinical LBP illness . STUDY DESIGN / SETTING A prospect i ve , longitudinal study of subjects with high risk factors for serious LBP as determined by structural and psychosocial characteristics . PATIENT SAMPLE One hundred subjects with known mild persistent low back pain and a 2:1 ratio of chronic ( non-lumbar ) pain syndrome were recruited from a study population with a predisposition to disc degenerative disease , to undergo baseline examination , testing and 5-year follow-up . OUTCOME MEASURES Observations were made at 6-month intervals over 4 to 6 years ( mean , 5.3 ) for the after primary outcomes measures : episodes of serious back pain ( visual analogue scale [ VAS ] > or = 6 ) , episodes of occupational disability less than 1 week , episodes of occupational disability for 1 week , remission episodes of all back pain symptoms at least 6 months and medical visits primarily for LBP evaluation and treatment . METHODS Lumbar magnetic resonance imaging ( MRI ) , lumbar provocative discography ( in psychometrically normal subjects ) , physical examinations , medical and work histories and psychometric testing were performed at baseline . Imaging and psychometric testing were grade d by blinded examiners . A scripted interview was conducted every 6 months during follow-up by independent research assistants who also were blinded to patient baseline data . The interview covered interval medical , occupational and accident or injury histories . RESULTS Psychosocial variables strongly predicted both long- and short-term disability events , duration and health-care visits for LBP problems ( p<0.0001 - 0.004 ) . The likelihood of a sustained remission from the baseline persistent ( sub clinical ) LBP appeared to be linked to occupation factors ( leaving a heavy labor occupation ; p=0.0001 ) , neurophysiologic variables ( chronic nonlumbar pain ; p=0.0002 ) and psychometric profiles at baseline ( DRAM and FABQ-PA ; p=0.003 - 0.002 ) . Of the structural findings measured only moderate or severe Modic changes of the vertebral end plate were weakly associated with an adverse outcome . A positive provocative discogram at baseline did not predict any future adverse event . CONCLUSION The development of serious LBP disability in a cohort of subjects with both structural and psychosocial risk factors was strongly predicted by baseline psychosocial variables . Structural variables on both MRI and discography testing at baseline had only weak association with back pain episodes and no association with disability or future medical care To determine the effect of massed practice ( MP ) versus massed practice combined with somatosensory stimulation ( MP+SS ) on cortical plasticity and function in persons with incomplete tetraplegia . Methods . Ten subjects were assigned to either MP or MP+SS . Median nerve stimulation ( 500 ms train , 10 Hz , 1 ms pulse duration ) was delivered at the intensity eliciting a motor threshold response . Training sessions were 5 d/week for 3 weeks at 2 h/session . Outcome measures included 1 ) motor-evoked potentials ( MEPs ) elicited via transcranial magnetic stimulation ( TMS ) , motor threshold ( MT ) and MEP amplitude at 1.2 MT ; 2 ) maximal pinch grip force ; 3 ) Wolf Motor Function Test ( WMFT ) and Jebsen H and Function Test . Results . The MP+SS group demonstrated significant improvements ( P < 0.05 ) in pinch grip strength ( 190 % ) , WMFT scores ( 52 % ) , and Jebsen test scores ( 33 % ) , whereas the MP group demonstrated significant improvement ( P < 0.05 ) only in Jebsen test scores ( 11 % ) . No significant changes were detected in cortical excitability in the MP+SS or MP group . Conclusions . The findings of this preliminary study suggest that MP+SS results in greater increases in pinch strength and timed functional test scores than MP . Optimal stimulation paradigms and training methods are needed to further test this strategy OBJECTIVE To identify the effective predictors for therapeutic outcomes based on intermittent theta-burst stimulation ( iTBS ) . DESIGN A sham-controlled , double-blind parallel study design . SETTING A tertiary hospital . PARTICIPANTS People with stroke ( N=72 ) who presented with unilateral hemiplegia . INTERVENTIONS Ten consecutive sessions of real or sham iTBS were implemented with the aim of enhancing h and function . Patients were categorized into 4 groups according to the presence ( MEP+ ) or absence ( MEP- ) of motor-evoked potentials ( MEPs ) and grip strength according to the Medical Research Council ( MRC ) scale . MAIN OUTCOME MEASURES Cortical excitability , Wolf Motor Function Test ( WMFT ) , finger-tapping task ( FT ) , and simple reaction time were performed before and after the sessions . RESULTS MEPs and the MRC scale were predictive of iTBS therapeutic outcomes . Group A ( MEP+ , MRC>1 ) exhibited the greatest WMFT change ( 7.6±2.3 , P<.001 ) , followed by group B ( MEP- , MRC>1 ; 5.2±2.2 score change ) and group C ( MEP- , MRC=0 ; 2.3±1.5 score change ) . These improvements were correlated significantly with baseline motor function and ipsilesional maximum MEP amplitude . CONCLUSIONS The effectiveness of iTBS modulation for poststroke motor enhancement depends on baseline h and grip strength and the presence of MEPs . Our findings indicate that establishing neurostimulation strategies based on the proposed electrophysiological and clinical criteria can allow iTBS to be executed with substantial precision . Effective neuromodulatory strategies can be formulated by using electrophysiological features and clinical presentation information as guidelines BACKGROUND Patients presenting with medically unexplained physical symptoms ( MUPS ) typically present with significant distress and marked impairment in functioning and pose a unique challenge to health care providers . The purpose of this study was to examine the efficacy of a psychophysiological treatment ( PT ) for MUPS . METHODS Thirty-eight participants meeting criteria for subthreshold somatization disorder ( abridged somatization ) were r and omly assigned to one of two conditions : ( 1 ) st and ard medical care augmented by a psychiatric consultation intervention ( wait-list ) or ( 2 ) a 10-session , manualized , individually-administered PT added to the psychiatric consultation intervention . Assessment s were conducted at baseline , at midpoint ( after four sessions ) , and after completing the last session . The primary outcome measure was the severity scale of the Clinical Global Impression Scale anchored for Somatic Symptoms ( CGI-SD ) . Secondary outcome measures were responder status as determined by clinical ratings , self-report measures of mental and physical functioning . RESULTS At the end of the trial , the severity ( and frequency ) of physical symptoms improved significantly more ( p<0.05 ) in the intervention group . The average improvement in the CGI-SD was 0.80 points greater in the intervention group than in the wait-list group . PT was also associated with greater improvements in self-reported functioning and depressive symptomatology . The effect sizes at the final assessment point indicate that this intervention had a robust effect on complex somatic symptom presentations . CONCLUSION For patients with high levels of MUPS ( abridged somatization ) , PT produces significant improvements in symptoms and functional status Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted Background Quantitative sensory testing , including  pressure pain threshold ( PPT ) , is seeing increased use in clinical practice . In order to facilitate clinical utility , knowledge of the properties of the tool and interpretation of results are required . Objectives This observational study used a clinical sample of people with mechanical neck pain to determine : ( 1 ) the influence of number of testing repetitions on measurement properties , ( 2 ) reliability and minimum clinical ly important difference , and ( 3 ) associations between PPT and key psychological constructs . Design This study was observational with both cross-sectional and prospect i ve elements . Methods Experienced clinicians measured  PPT  in patients with mechanical neck pain following a st and ardized protocol . Subcohorts also provided repeated measures and completed scales of key psychological constructs . Results The total sample was 206 participants , but not all participants provided data for all analyses . Interrater and 1-week test-retest reliability were excellent ( intraclass correlation coefficients [2,1]=.75–.95 ) . Potentially important differences in reliability and PPT scores were found when using only 1 or 2 repeated measures compared with all 3 . The PPT over a distal location ( tibialis anterior muscle ) was not adequately responsive in this sample , but the local site ( upper trapezius muscle ) was responsive and may be useful as part of a protocol to evaluate clinical change . Sensitivity values ( range=0.08–0.50 ) and specificity values ( range=0.82–0.97 ) for a range of change scores are presented . Depression , catastrophizing , and kinesiophobia were able to explain small but statistically significant variance in local PPT ( 3.9%–5.9 % ) , but only catastrophizing and kinesiophobia explained significant variance in the distal PPT ( 3.6 % and 2.9 % , respectively ) . Limitations Limitations of the study include multiple raters , unknown recruitment rates , and unknown measurement properties at sites other than those tested here . Conclusions The results suggest that PPT is adequately reliable and that 3 measurements should be taken to maximize measurement properties . The variance explained by the psychological variables was small but significant for 3 constructs related to catastrophizing , depression , and fear of movement . Clinical implication s for application and interpretation of PPT are discussed Objectives . Studies have shown decreases in N30 somatosensory evoked potential ( SEP ) peak amplitudes following spinal manipulation ( SM ) of dysfunctional segments in sub clinical pain ( SCP ) population s. This study sought to verify these findings and to investigate underlying brain sources that may be responsible for such changes . Methods . Nineteen SCP volunteers attended two experimental sessions , SM and control in r and om order .  SEPs from 62-channel EEG cap were recorded following median nerve stimulation ( 1000 stimuli at 2.3 Hz ) before and after either intervention . Peak-to-peak amplitude and latency analysis was completed for different SEPs peak . Dipolar models of underlying brain sources were built by using the brain electrical source analysis . Two-way repeated measures ANOVA was used to assessed differences in N30 amplitudes , dipole locations , and dipole strengths . Results . SM decreased the N30 amplitude by 16.9 ± 31.3 % ( P = 0.02 ) , while no differences were seen following the control intervention ( P = 0.4 ) . Brain source modeling revealed a 4- source model but only the prefrontal source showed reduced activity by 20.2 ± 12.2 % ( P = 0.03 ) following SM . Conclusion . A single session of spinal manipulation of dysfunctional segments in sub clinical pain patients alters somatosensory processing at the cortical level , particularly within the prefrontal cortex Abstract High-frequency repetitive transcranial magnetic stimulation ( rTMS ) of the motor cortex has analgesic effect ; however , the efficacy of other cortical targets and the mode of action remain unclear . We examined the effects of rTMS in neuropathic orofacial pain , and compared 2 cortical targets against placebo . Furthermore , as dopaminergic mechanisms modulate pain responses , we assessed the influence of the functional DRD2 gene polymorphism ( 957C > T ) and the catechol-O-methyltransferase ( COMT ) Val158Met polymorphism on the analgesic effect of rTMS .  Sixteen patients with chronic drug-resistant neuropathic orofacial pain participated in this r and omized , placebo-controlled , crossover study . Navigated high-frequency rTMS was given to the sensorimotor ( S1/M1 ) and the right secondary somatosensory ( S2 ) cortices . All subjects were genotyped for the DRD2 957C > T and COMT Val158Met polymorphisms . Pain , mood , and quality of life were monitored throughout the study . The numerical rating scale pain scores were significantly lower after the S2 stimulation than after the S1/M1 ( P = 0.0071 ) or the sham ( P = 0.0187 ) stimulations . The Brief Pain Inventory scores were also lower 3 to 5 days after the S2 stimulation than those at pretreatment baseline ( P = 0.0127 for the intensity of pain and P = 0.0074 for the interference of pain ) or after the S1/M1 ( P = 0.001 and P = 0.0001 ) and sham ( P = 0.0491 and P = 0.0359 ) stimulations . No correlations were found between the genetic polymorphisms and the analgesic effect in the present small clinical sample . The right S2 cortex is a promising new target for the treatment of neuropathic orofacial pain with high-frequency rTMS Background and Purpose : Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment . Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative . This is the first study to compare the modified Clinical Test of Sensory Integration for Balance ( i-mCTSIB ) to the laboratory test of the Sensory Organization Test ( SOT ) with dynamic posturography in a group of participants with Parkinson 's disease ( PD ) and subtle balance limitations . The purpose of this study was to ( 1 ) determine the concurrent validity of the i-mCTSIB with the SOT ( 6 and 4 conditions ) and ( 2 ) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months . Methods : This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson 's Disease Rating Scale score of 32.7 ( 13.5 ) out of 108 . Results : The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated : composite scores r = −0.64 ( P ⩽ .001 ) , C1 r = −0.43 ( P = .03 ) , C3 r = −0.60 ( P ⩽ .01 ) , and C4 r = −0.54 ( P ⩽ .001 ) . A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers ( P = .04 ) . In contrast , the SOT composite was not significantly different between fallers and nonfallers ( P = 0.31 ) . Discussion : The results suggest that the i-mCTSIB may be a valid and clinical ly meaningful measure of sensory organization in persons with PD , even those with mild postural instability as measured by the median Hoehn and Yahr score ( 2.0 ) . Future research should evaluate predictive validity of the i-mCTSIB for prospect i ve falls . Conclusion : The instrumented mCTSIB with portable , body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT . Instrumenting mCTSIB may also distinguish between fallers and nonfallers Objective : To examine the reliability , validity and responsiveness of the generic Current Perceived Health 42 ( CPH42 ) Profile in Chinese patients with neck pain in Hong Kong . Design : A prospect i ve observational study . Setting : Physiotherapy outpatient departments . Subjects : Two sample s with 472 consecutive adult patients with neck pain from seven physiotherapy outpatient departments in Hong Kong . Methods : Subjects were requested to complete the CPH42 Profile , and their pain intensity was measured using the 11-point numerical rating scale ( NRS ) . They were observed and measured at the beginning of physiotherapy , at seven days , at week 3 and at week 6 after treatment began . Results : The CPH42 Profile had very good test – retest reliability and internal consistency ( intraclass correlation coefficient 0.91 , Cronbach 's alpha 0.90 ) . Validity was confirmed by a moderate correlation with the NRS at the beginning of treatment and week 6 ( rank correlation 0.41–0.53 ) . Moreover , a significant difference in scores was found between those who had sought medical consultation and /or had taken medication because of neck pain than those who did not . The responsiveness measured from the beginning of treatment to week 3 and week 6 ( st and ard response means of 0.33 and 0.36 ) was comparable to the respective changes in pain intensity . Conclusion : The CPH42 Profile has been shown to demonstrate good reliability and validity , and it is sensitive to changes in severity over time . It is suitable for use as an outcome measure for evaluation of patients with neck pain The aim of this study was to compare the intra- and inter-rater reliability of  pressure pain threshold ( PPT ) and manual palpation ( MP ) of orofacial structures in symptomatic and symptom-free children for temporom and ibular disorders ( TMD ) . Fourteen children reporting pain in masticatory muscles or the temporom and ibular joint and 16 symptom-free children were r and omly assessed on three different occasions : by rater-1 in the first and third session and by rater-2 in the second session . The trained raters applied algometry and MP as recommended by the Research Diagnostic Criteria for TMD . Intraclass correlation coefficients and the Kappa statistic were used to assess the levels of reliability of PPT and MP , respectively . Excellent intra- and inter-rater reliability levels were observed for PPT values at most of the examined sites for symptom-free children and excellent and moderate reliability levels for children reporting pain . For MP , moderate and poor intra-rater and inter-rater reliability levels were observed for most sites in both groups . Algometry showed higher reliability levels for both groups of children and is recommended for pain assessment in children in association with MP BACKGROUND AND PURPOSE The purpose of this study was to examine the interrater reliability of measurements obtained by examiners administering tests proposed to be important for classifying low back pain ( LBP ) problems . SUBJECTS Ninety-five subjects with LBP ( 41 men , 54 women ) and 43 subjects without LBP ( 17 men , 26 women ) were examined by 5 therapists trained in the techniques used . METHODS A manual was developed by the first author that described the clinical examination procedures . The therapists were trained by the first author in the test procedures and definitions . The training included instruction through videotapes , practice and a written examination . Each examination was conducted by a pair of therapists . Within a pair , a therapist was the primary examiner for half of the subjects and an observer was the primary examiner for half of the subjects . Examination findings were recorded independently , without discussion . RESULTS Percentage of agreement and generalized kappa coefficients were used to analyzed the data . Kappa values were > or = .75 for all 28 items related to the symptoms elicited and > or = .40 for 72 % of the 25 items related to alignment and movement . CONCLUSION AND DISCUSSION The results suggest that experienced therapist who had trained together were able to agree on the results of examinations and obtain an acceptable level of reliability . Future work should focus on testing of reliability when more than one therapist performs the examination and when therapist not trained by the test developer to administer the examination perform the tests . [ Van Dillen LR , Sahrmann SA , Norton BJ , et al. Reliability of physical examination items used for classification of patients with low back pain OBJECTIVE To compare functional changes and cortical neuroplasticity associated with h and and upper extremity use after massed ( repetitive task-oriented practice ) training , somatosensory stimulation , massed practice training combined with somatosensory stimulation , or no intervention , in persons with chronic incomplete tetraplegia . DESIGN Participants were r and omly assigned to 1 of 4 groups : massed practice training combined with somatosensory peripheral nerve stimulation ( MP+SS ) , somatosensory peripheral nerve stimulation only ( SS ) , massed practice training only ( MP ) , and no intervention ( control ) . SETTING University medical school setting . PARTICIPANTS Twenty-four subjects with chronic incomplete tetraplegia . INTERVENTIONS Intervention sessions were 2 hours per session , 5 days a week for 3 weeks . Massed practice training consisted of repetitive practice of functional tasks requiring skilled h and and upper-extremity use . Somatosensory stimulation consisted of median nerve stimulation with intensity set below motor threshold . MAIN OUTCOME MEASURES Pre- and post-testing assessed changes in functional h and use ( Jebsen-Taylor H and Function Test ) , functional upper-extremity use ( Wolf Motor Function Test ) , pinch grip strength ( key pinch force ) , sensory function ( monofilament testing ) , and changes in cortical excitation ( motor evoked potential threshold ) . RESULTS The 3 groups showed significant improvements in h and function after training . The MP+SS and SS groups had significant improvements in upper-extremity function and pinch strength compared with the control group , but only the MP+SS group had a significant change in sensory scores compared with the control group . The MP+SS and MP groups had greater change in threshold measures of cortical excitability . CONCLUSIONS People with chronic incomplete tetraplegia obtain functional benefits from massed practice of task-oriented skills . Somatosensory stimulation appears to be a valuable adjunct to training programs design ed to improve h and and upper-extremity function in these subjects Introduction Pain is the dominant symptom of knee osteoarthritis ( OA ) , and recent evidence suggests factors outside of local joint pathology , such as pain sensitisation , can contribute significantly to the pain experience . It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy . The aims of this study are , first , to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA . Second , we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy . Methods and analysis This is a multicentre prospect i ve cohort study with 140 participants . Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics . A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination , quantitative sensory testing , and vali date d question naires measuring pain and functional capacity . Participants will then undergo physiotherapy treatment . The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria . A principal component analysis will identify measures related to pain sensitisation to include in the predictive model . Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders . Ethics and dissemination This study has been approved by St James ’ Hospital/AMNCH Research Ethics Committee and by the St Vincent 's Healthcare Group Ethics and Medical Research Committee . The results will be presented at international conferences and published in a peer review journal . Trial registration number NCT02310945 UNLABELLED Persistent shoulder pain is a common complication after stroke . Its etiology and underlying mechanisms are not well understood and treatment is generally unsatisfactory . The objective of this study was to assess the role of central sensitization and disinhibition in chronic stroke patients with chronic PSSP ( n = 19 ) , pain-free stroke patients ( n = 29 ) , and healthy controls ( n = 23 ) .  Positive and negative somatosensory symptoms and signs were assessed using clinical examination and electrical and mechanical quantitative sensory testing ( QST ) . Conditioned pain modulation ( CPM )  was assessed by comparing QST thresholds before and after applying a cold pressor test .  Sensory abnormalities were more frequently observed and more severe in patients with PSSP , including positive signs such as allodynia at the affected side and generalized hyperalgesia at the unaffected side . CPM was similar in stroke patients and healthy controls . This study showed that chronic PSSP was associated with several positive and negative somatosensory signs , implicating a role for central sensitization and possibly for disinhibition . Since the causal relationship remains unclear , and may be related to either neuroplasticity induced by ongoing nociception as well as to the neuropathic brain lesion , prospect i ve studies are warranted . PERSPECTIVE The assessment of somatosensory symptoms and signs and endogenous pain modulation demonstrated a role for central sensitization and possibly for disinhibition in chronic PSSP . Prevention and treatment of PSSP could benefit from a more detailed analysis of both peripheral and central pain mechanisms
The level of evidence for PMPs varied across different test procedures in different types of PJP .
H and -held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability , agreement , and responsiveness , simultaneously , when it was investigated in patients with chronic knee osteoarthritis .
BACKGROUND Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties ( PMPs ) to be used in clinical practice .
The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain ( PJP ) .