No, we haven't dropped off the face of the earth. c-WhIP continues to be working away on a variety of research projects. I've been especially busy of late thanks to a recent move and a very busy time for research projects coming due in July. I thought I might take a few minutes out though to give a sneak peek at some of the things we've either recently finished or are currently working on.
1. Pressure pain threshold: we've got two papers accepted and a third soon to be in JOSPT describing various properties of simple pressure pain threshold measures for people with neck pain. The equipment used in all of the papers is a simple and inexpensive handheld digital algometer that is much more accessible than the highly-accurate (and highly expensive!) Somedic ones that are commonly used for PPT research. Our first paper shows that the less expensive algometer has good reliability estimates for intra-, inter-, and test-retest reliability, almost to the level of much more expensive units. We provide standard error of measurement and minimum detectable change as well to facilitate clinical interpretation of results. The second paper is essentially population norms for people with acute or subacute whiplash, and some descriptive exploration of potential moderating or confounding variables. These numbers will allow clinicians to compare individual patient results to the population means and quartiles, to determine whether this patient is above or below what would be expected. The third paper is a longitudinal study showing that we can predict NDI scores 3 months down the road using pain threshold at either the local (upper traps) or a distal site (tibialis anterior), along with other variables like sex and baseline pain intensity. I'm not going to say that everyone should run out and buy an algometer, but so far I'll call the results 'promising'. You can decide for yourself when the papers are published in the fall of 2011.
2. Is the fear of pain more disabling than pain itself in people with neck pain? That was the question that we set out to answer in a cross-sectional descriptive study of people with mostly chronic neck pain of varying causes. Subjects completed some self-report measures, including the P4 pain intensity scale, the tampa scale for kinesiophobia, the pain catastrophizing scale, and the hospital anxiety and depression scale, as well as the Neck Disability Index as the dependent variable. They also underwent a standardized physical assessment screening protocol that included neck AROM, PPT, spurling's test, and strength/sensation testing in the distal upper extremities. After cleaning the data, transforming it to meet statistical assumptions and all that goodness, a regression model was created that included pain intensity and emotional distress (anxiety/depression), but not kinesiophobia or catastrophizing. There's a lot more to this story than I can tell here, and we've only just done the first pass analysis, things may changes as I explore the results a bit more in depth, but at this point, from a sample of 70 subjects, the 'fear of pain more disabling than pain itself' mantra doesn't seem to bear out in people with neck pain.
3. Speaking of a standardized physical assessment screen for people with acute neck pain, another group has been working on the inter-rater reliability of a screening protocol that we've developed, with the intention of including the protocol as part of a risk-based prognostic screening tool for use in people with acute WAD. Each of the assessment components (there are 7 in total) are adapted and simplified versions of full assessment protocols: supine neck flexion screen (easy/hard), distal sensation to light touch screen (normal/decreased), AROM screen (restricted/full), strength in the extremities (normal/weak), response to Spurling's test, response to cervical traction, and pain threshold. The intention here is that we are able to generate a risk profile for each patient based on the results of the physical screen and some self-reprot measures. First of course we have to make sure that different raters are using the tool the same way. So 4 pairs of raters evaluated 45 subjects on the whole protocol. Without giving too much away, I'm fairly confident now that a simplified version of the von Frey monofilaments test (using only two monofilaments for distal sensation) is just not reliable, after two kicks at the can. But that PPT and number of restricted AROM planes are both fairly reliable. It also seems that relying on patient reports of changes in their symptoms is more reliable than relying on clinician observation, which is not surprising.
4. Useability of the SLANSS in people with neck pain. While this is not a c-WhIP study per se, it's still relevant. Myself, Ashley Smith and Michele Sterling from the University of Queensland have combined databases to evaluate the clinimetric properties of the SLANSS in people with WAD. I'll not give much away here yet, in the interest of protecting intellectual property, but I can say this much: it's not a unifactorial scale, and in fact each of the different subscales may be able to predict different short-medium term outcomes. Ashley will be presenting these results at CPA congress in Whistler in July, so those interested can hear more about the results there.
We've got a few other studies either just wrapping up or still under way. The Recovery questionnaire study is still ongoing and more subjects are needed. We've also finally recruited our first subject for the study evaluating cortisol levels in the acute stage of WAD and how they factor into the trajectory of recovery. One down, 19 more to go on that one. I'll keep a few other studies under wraps for the time being, but suffice to say things are getting kind of exciting around here. More to come in the future.