Rosedale R1, Rastogi R1, Kidd J2, Lynch G3, Supp G4, Robbins S5
1London Health Sciences Centre, Occupational Health and Safety, London, Canada, 2Advance Sports and Spine Therapy, Portland, United States, 3Inform Physio, Wellington, New Zealand, 4Pulz Physiotherapy, Freiburg, Germany, 5McGill University, Montreal, Canada
Background: It is established that the spine can refer pain into the extremities. However,
with no established process for spinal/extremity differentiation, this can present a challenge to therapists. Extremity pain of spinal source if interpreted as originating from the extremity, leads to inappropriate patient management and wasted resources. It would be helpful for therapists to be able to evaluate whether their proportion of patients with extremity pain of spinal origin identified is similar to what has been documented in research. Currently, no such research is available for all extremity locations.
Purpose: The primary purpose was to establish the proportion of patients presenting with extremity pain that have a spinal source of symptoms. The secondary objective was to evaluate how these patients with a spinal source of extremity symptoms respond to solely spinal intervention as compared to those where extremity is the source of symptoms and the extremity is treated.
Methods: A multi-centre prospective cohort study recruited 369 consecutive patients presenting with extremity pain. Study participants from four centres were assessed using the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) system and treated as the MDT trained therapists would normally treat. Once baselines (activities producing patients´ pain) were established, the spine was screened using end-range repeated movements and various loading strategies. Symptomatic response was consistently evaluated throughout the examination process. If the spinal movements had an effect on the symptoms or the activity baselines, the spine was assessed in further detail. Once the effect was deemed clear and repeatable, a provisional MDT classification was established. The intervention was based upon this classification. The source of the pain was considered to be spinal if the patient´s chief extremity complaint for seeking care was resolved with spinal treatment only. Self-report pain, function and psychosocial factors were collected at baseline, 2 weeks, 4 weeks and discharge using the Numerical Pain Rating Scale, Upper /Lower Extremity Functional Index, Orebro Musculoskeletal Pain Questionnaire and Global Rating of Change.
Results: Overall, 43.5% of participants had a spinal source of symptoms, 48.3% in the upper extremity and 39.4% in the lower extremity. ANOVAs revealed that the outcomes for pain, function and psychosocial factors for those patients with a spinal source of symptoms was significantly better than patients who did not have a spinal source of their symptoms.
Conclusion(s): Over 40% of patients with extremity pain had a spinal source of symptoms and responded significantly better than those patients whose extremity pain did not have a spinal source. The results suggest the spine is a common source of extremity pain and adequate screening needs to be in place to ensure the patients´ source of symptoms is addressed.
Implications: Therapists will be able to compare their proportion of patients with extremity pain of spinal source to this cohort of patients if their clinical setting is similar. Therapists may draw on the process outlined in the study to evaluate if this changes their findings. Researchers on extremity problems can note these proportions and may take the differentiation process into account when establishing exclusion criteria.
Keywords: extremity pain, spinal source, differentiation
Funding acknowledgements: No funding
with no established process for spinal/extremity differentiation, this can present a challenge to therapists. Extremity pain of spinal source if interpreted as originating from the extremity, leads to inappropriate patient management and wasted resources. It would be helpful for therapists to be able to evaluate whether their proportion of patients with extremity pain of spinal origin identified is similar to what has been documented in research. Currently, no such research is available for all extremity locations.
Purpose: The primary purpose was to establish the proportion of patients presenting with extremity pain that have a spinal source of symptoms. The secondary objective was to evaluate how these patients with a spinal source of extremity symptoms respond to solely spinal intervention as compared to those where extremity is the source of symptoms and the extremity is treated.
Methods: A multi-centre prospective cohort study recruited 369 consecutive patients presenting with extremity pain. Study participants from four centres were assessed using the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) system and treated as the MDT trained therapists would normally treat. Once baselines (activities producing patients´ pain) were established, the spine was screened using end-range repeated movements and various loading strategies. Symptomatic response was consistently evaluated throughout the examination process. If the spinal movements had an effect on the symptoms or the activity baselines, the spine was assessed in further detail. Once the effect was deemed clear and repeatable, a provisional MDT classification was established. The intervention was based upon this classification. The source of the pain was considered to be spinal if the patient´s chief extremity complaint for seeking care was resolved with spinal treatment only. Self-report pain, function and psychosocial factors were collected at baseline, 2 weeks, 4 weeks and discharge using the Numerical Pain Rating Scale, Upper /Lower Extremity Functional Index, Orebro Musculoskeletal Pain Questionnaire and Global Rating of Change.
Results: Overall, 43.5% of participants had a spinal source of symptoms, 48.3% in the upper extremity and 39.4% in the lower extremity. ANOVAs revealed that the outcomes for pain, function and psychosocial factors for those patients with a spinal source of symptoms was significantly better than patients who did not have a spinal source of their symptoms.
Conclusion(s): Over 40% of patients with extremity pain had a spinal source of symptoms and responded significantly better than those patients whose extremity pain did not have a spinal source. The results suggest the spine is a common source of extremity pain and adequate screening needs to be in place to ensure the patients´ source of symptoms is addressed.
Implications: Therapists will be able to compare their proportion of patients with extremity pain of spinal source to this cohort of patients if their clinical setting is similar. Therapists may draw on the process outlined in the study to evaluate if this changes their findings. Researchers on extremity problems can note these proportions and may take the differentiation process into account when establishing exclusion criteria.
Keywords: extremity pain, spinal source, differentiation
Funding acknowledgements: No funding
Topic: Musculoskeletal; Orthopaedics
Ethics approval required: Yes
Institution: Western University (Canada), Pacific University (USA)
Ethics committee: Western/Pacific Universities Ethics Review Boards, New Zealand Ethics Committee
Ethics number: 108630 (Western University)
All authors, affiliations and abstracts have been published as submitted.
