Resources for clinical use

Here you will find resources from PIRL-related research that clinicians can use to facilitate their practice.  A brief description of each resource follows the link.  Please feel free to use these and distribute them as you wish, just don't modified them without seeking permission from dwalton5@uwo.ca first.  


The Brief Illness Perceptions Questionnaire - Revised, and Interpretation

The Brief Illness Perceptions Questionnaire (BIPQ) has become one of my favourite clinical tools for opening dialogue with patients around their understanding, or representation, of their condition. It was built off of Leventhal's Common Sense Model of Health Regulation, often referred to as just the 'Common Sense Model' or the 'Illness Representations' model. If you want to learn more about the model there are scads of on-line resources, here's a nice one. The BIPQ was originally described by Broadbent and colleagues (2006) as a set of 9 perceptions each captured on a familiar 0-10 Numeric Rating Scale. A few years back some students and I explored the value of the BIPQ in identifying clinically relevant subgroups for PT patients with neck pain. You can read that paper here. That analysis led to a slight revision of the tool, where the question on symptoms, that originally had scoring options from 'no symptoms at all' to 'many severe symptoms', was split into two. This was due to some conflation of number of symptoms with severity of those symptoms (so, hard to know where to score if a single severe symptom, or many mild symptoms). This has led to a revised 10-item version of the tool. It's not meant as a tool to routinely evaluate change over time, but it is quite useful as an intake questionnaire to see how patients are making sense of their condition, and could be useful as a discharge questionnaire to see if anything appears to have changed or if the person is ready for independent self-management. The final question (11 on the revised version) asks for patients to indicate the 3 most important causes of their symptoms. Understanding causation is important, and in a separate analysis we found that those who nominate a traumatic cause for their neck pain showed higher scores on most other tools than did those who described non-traumatic causes.

We've created some tools to facilitate interpretation. The first is a Google Drive spreadsheet in which you enter just the 6 scores that are described there from the revised version, and the other is an Android-based smartphone app that does largely the same thing. Please note that as with all apps on this site, I provide no guarantee of functionality, compatibility or security, and am no longer supporting them, so use at your own risk.


The Traumatic Injuries Distress Scale (TIDS) and User's Guide

The TIDS is a 12-item self-report tool intended for use in people following non-catastrophic musculoskeletal injuries (those that did not require surgery or hospitalization). It has been built from the ground up for use in those with acute symptoms following trauma (2 days to 4 weeks), with a focus on identifying not only the likelihood that someone may transition from acute to chronic pain or disability, but to give clinicians a sense of why the patient is at risk by providing scores on subscales capturing potentially modifiable risk factors. The tool has been rigorously designed and tested and continues to undergo additional testing, so this section will be updated periodically. The tool is free for personal / clinical or research use as long as it is not modified. If you would like to include the tool in industry-sponsored research please contact the copyright holder Dave Walton at dwalton5@uwo.ca.

TIDS-English

TIDS-French

TIDS-Spanish (coming soon)

TIDS User's Guide (English version only)


New 7-point Radar Plot for Multidimensional Pain Assessment

For those who have participated in our Assess, Predict, Treat or Comprehensive Pain Assessment courses, here is a blank copy of the new 7-point radar plot that you can use for your clinical interpretation of patient assessment and clinical decision making.  If you want to see how to use this in action, here's a short video.


Body Diagram v2.0

Updated to include head, feet and hands!

  • It is surprisingly hard to find a good, androgynous, nicely segmented body diagram.  I've been using this one for years and it seems to do the trick.  Sure, there are fancier options out there (I personally like the Iconic Pain Assessment Tool for example) but sometime you just need a quick and printable option.  Why might you need one?  It's interesting, but every time I conduct an evaluation and include results from a body diagram, it always ends up explaining some significant variance in a patient's experience, beyond that explained by things like intensity and frequency.  Seems number of locations is a potentially valuable aid for things like diagnosis, prognosis, treatment planning, and evaluating outcomes.  Problem is, I've never been able to publish on it for two reasons: 1. I've never formally evaluated the properties of this tool (e.g. reliability, validity, etc..) and 2. I actually can't remember where I got the original version of this that I've since adapted, so I can't cite anyone.  Anyway, I generally recommend that a simple body diagram form part of your clinical assessment, and this one is as good as any I've come across.

Can Physical Therapists identify malingered pain in the clinical setting?

  • This is a narrative review paper that a group of students completed under the supervision of Dave Walton in 2012.  For what I'll call rather interesting political reasons, we couldn't find a journal home for this one (in a nutshell the journals didn't want to give the optics that they were endorsing research in this area).  However, it was well done and well written and deserves to be seen, so we've posted it here for free public access.
  • CAN PHYSICAL THERAPISTS IDENTIFY MALINGERED PAIN IN THE CLINICAL SETTING? (click to download)

The Neck Disability Index - 5 item version (NDI-5)

  • This is the NDI-5 as described in Walton and MacDermid 2013.  The scale offers sound measurement properties and the advantage of brevity.  It is strongly suggested that you also use a pain or symptom-specific scale together with the function-specific NDI-5 for a more complete picture of your patient's status.

  The Neck Disability Index - 5 item version (NDI-5) Android app

  • First of all, extra special thanks to high-school co-op student extraordinaire Tyler Beattie for putting this app together.  Once again, this is for Android smartphones only (sorry iOS users, Apple makes it really tough for us occasional and non-paid app developers to work with their platform).  This is for the NDI-5 as described above.  The app has two functions: First, patients can complete the NDI-5 directly on the smartphone, after which the app will auto-calculate the total raw score, the linearly-transformed score, and the raw score needed for a clinically significant linear change to occur, which is probably a more accurate reflection of MCID than change in the raw score alone (subject to debate I acknowledge).  The second function is where the patient complete the NDI-5 in paper form, and the clinician just wants to enter the total score and get the target raw score for clinically important change.

    Once again, this is being offered free of charge since it's pretty bare bones, and I'm sure Tyler would welcome feedback if you choose to offer it. Please note that as with all apps on this site, I provide no guarantee of functionality, compatibility or security, and am no longer supporting them, so use at your own risk.


Clinical Diagnosis Helper App

Thanks once again to high school co-op student Tyler Beattie for putting this simple but useful app together for Android-based smartphones.  The Clinical Diagnosis Helper app asks you to enter know information about the pre-test probability of a condition, the positive (Sn/1-Sp) or negative (1-Sn/Sp) likelihood ratios of the test you're using, and then indicate whether the result of the test was positive or negative.  Note that you'll need to corresponding PLR or NLR dependent on whether the test was positive or negative, but don't need both.  Hit the calculate button to get the post-test odds that the condition exists.  If you thought a nomogram was simple, this is even easier.  There are other app options out there that do this, but this one's free and couldn't be easier to use.  Hit the link below on your smartphone to download it. Please note that as with all apps on this site, I provide no guarantee of functionality, compatibility or security, and am no longer supporting them, so use at your own risk.

Enclosure


Pain Catastrophizing Scale - revised (PCS-R)

  •  This is a copy of the revised Pain Catastrophizing Scale, as described in Walton, Wideman and Sullivan 2013.  The revisions, as a result of Rasch analysis, led to a slight change in scoring options for two items, and a total score out of 50 rather than 52 (I love round numbers).  The scale has been posted here with permission of Dr. Michael Sullivan.

Pain Catastrophizing Scale-revised Transformation Tool (Google Drive Spreadsheet)

  •  This little spreadsheet is probably most useful to researchers really, those who would like to convert the ordinal level scores to interval level.  However, it does have relevance for clinicians - if you're using the PCS-R as an evaluative tool to detect change over time (not really its intention but I know some use it as such), then you'll see from this tool that change in the middle of the scale doesn't happen as quickly as change at the poles.

Pain Catastrophizing Scale Android App

  • Once again thanks to high school co-op student extraordinaire Tyler Beattie (who, incidentally, is no longer a high school co-op student but is still pretty extraordinary).  This is an app for Android-based smartphones that allows either completion of the PCS-R right in the app, or simply enter the score of the PCS-R after it has been completed on paper.  The app will then do the Rasch transformation for you, giving you the linear score and the change necessary to be confident that true change has occurred. Please note that as with all apps on this site, I provide no guarantee of functionality, compatibility or security, and am no longer supporting them, so use at your own risk.

  Pressure Pain Threshold for Neck interpretation app for Android smartphones - New app!

  • A new version of the Pressure Pain Detection Threshold testing app for neck pain is now available for free download here.  This is still in BETA mode, so there are some bugs to work out and not all features are operational yet, but the meat of the app is there.  This is for Android smartphones only, or it can be run through PC-based Android emulators like Bluestacks (note that clicking the link will take you to another website).  Features yet to come include: a video tutorial (in the meantime you can watch a demo on YouTube here), options for storing and recalling past measurements on your phone, some additional interpretation, an option for setting default units, and eventually an option for contributing blinded PPDT data to a larger anonymous database to develop an even more accurate sense of how patients differ from each other. The normative values and other properties of PPT measurement for people with neck pain were first described in our series of papers in JOSPT 2011; 41(9):644-665.
  • If you're willing to put up with a few wrinkles then feel free to download (it's free, no ads).  If you find bugs or have suggestions for improvements, please email Dave Walton at dwalton5@uwo.ca.  A user manual is being developed currently, but in a nutshell you need to go to the test page, indicate sex and units, and then enter scores for the neck and tibialis anterior.  On the score entry screen for each region you'll see that the app will tell you if the first 2 measures are close enough that a 3rd isn't needed or if you should do a third.  In the latter case, you also have the ability to uncheck the first measure so that it's not included in calculation of the mean (i.e. use the first measure as a 'practice' or calibration test).  The interpretation screen will give you means, most and least sensitive sides, quartiles that the patient falls within, and minimum change required for meaningful difference.  More information on the quartiles and subgrouping utility will be coming soon in a new publication in The Clinical Journal of Pain, but as a sneak peek: you can expect patients to fall into 1 of 4 categories (named by relative PPDT thresholds at the neck-Tib Ant.):
  1. Low-Low (widespread mechanical sensitivity)
  2. Mod-Mod (normosensitive, 2nd or 3rd quartiles at both sites)
  3. Mod-High (relatively more sensitive at the neck, or relatively less sensitive at the TA.  Easiest interpretation would be local hypersensitivity only)
  4. High-High (widespread hyposensitivity - not sure how to interpret but this is probably a group you needn't worry too much about.

Please note that as with all apps on this site, I provide no guarantee of functionality, compatibility or security, and am no longer supporting them, so use at your own risk.

 


Satisfaction and Recovery Index (SRI)