Assessment of nerve involvement in the lumbar spine: agreement between magnetic resonance imaging, physical examination and pain drawing findings

<p>Abstract</p> <p>Background</p> <p>Detection of nerve involvement originating in the spine is a primary concern in the assessment of spine symptoms. Magnetic resonance imaging (MRI) has become the diagnostic method of choice for this detection. However, the agreement between MRI and other diagnostic methods for detecting nerve involvement has not been fully evaluated. The aim of this diagnostic study was to evaluate the agreement between nerve involvement visible in MRI and findings of nerve involvement detected in a structured physical examination and a simplified pain drawing.</p> <p>Methods</p> <p>Sixty-one consecutive patients referred for MRI of the lumbar spine were - without knowledge of MRI findings - assessed for nerve involvement with a simplified pain drawing and a structured physical examination. Agreement between findings was calculated as overall agreement, the p value for McNemar's exact test, specificity, sensitivity, and positive and negative predictive values.</p> <p>Results</p> <p>MRI-visible nerve involvement was significantly less common than, and showed weak agreement with, physical examination and pain drawing findings of nerve involvement in corresponding body segments. In spine segment L4-5, where most findings of nerve involvement were detected, the mean sensitivity of MRI-visible nerve involvement to a positive neurological test in the physical examination ranged from 16-37%. The mean specificity of MRI-visible nerve involvement in the same segment ranged from 61-77%. Positive and negative predictive values of MRI-visible nerve involvement in segment L4-5 ranged from 22-78% and 28-56% respectively.</p> <p>Conclusion</p> <p>In patients with long-standing nerve root symptoms referred for lumbar MRI, MRI-visible nerve involvement significantly underestimates the presence of nerve involvement detected by a physical examination and a pain drawing. A structured physical examination and a simplified pain drawing may reveal that many patients with "MRI-invisible" lumbar symptoms need treatment aimed at nerve involvement. Factors other than present MRI-visible nerve involvement may be responsible for findings of nerve involvement in the physical examination and the pain drawing.</p

Review of methods used by chiropractors to determine the site for applying manipulation

Background: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods: Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results: A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions: A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.https://doi.org/10.1186/2045-709X-21-3

Psychology of the Scientist: XLX. Frequently Cited Research on Human Aggression

This article reports a citation analysis of research on human aggression. Citations from articles on aggression were culled from Aggressive Behavior, Journal of Experimental Social Psychology, Journal of Personality, Journal of Personality and Social Psychology, Journal of Research in Personality, Journal of Social Psychology, and Personality and Social Psychology Bulletin for the 3-yr. period 1980–1982. Out of 1194 books and journal articles, 35 were cited three or more times and were included in this list of influential publications. The three most often cited publications were Baron's Human aggression, Bandura's Aggression: a social learning analysis, and Buss' The psychology of aggression. The frequency of citation by author was also analyzed and reported. </jats:p

Changing patterns of multimorbidity among patients with ambiguous diagnoses: The case of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Introduction: Increased attention has been given to multimorbidity. This phenomenon often has been explored through associations between diseases based on the frequency of combinations of diagnoses. A more patient-focused strategy, together with a trajectory of the multimorbidity situation, has recently attracted increased interest. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a state that per se includes multimorbidity and is preceded by numerous ambiguous diagnoses. A history of infectious disease is considered the most common denominator and pathophysiological base of ME/CFS, even though no biomarker of such infection has been found. Exploring changing patterns of multimorbidity might contribute to the knowledge about the unknown pathophysiology of this disease.Methods and materials: This was a retrospective register-based cohort study of 549 patients from 2015&ndash;2020 in Region Stockholm, Sweden. We processed the number and type of diagnoses during each year according to the Adjusted Clinical Groups&copy; case-mix system from Johns Hopkins University. The images were visualized with Excel and &ldquo;Gapminder&rdquo; software.Results Fifty percent of all patients had more than eight diagnoses&mdash;up to 32 diagnoses per year&mdash;during the last twelve months of the study period. The most frequent diagnosis clusters were &ldquo;General Signs and Symptoms&rdquo;, &ldquo;Musculoskeletal&rdquo;, &ldquo;Psychosocial&rdquo; and &ldquo;Neurologic&rdquo;. The cluster &ldquo;Infections&rdquo; was found as number fifteen in order. The number of patients with psychiatric or psychosomatic disorders was lower after the registration of ME/CFS diagnoses.Discussion and conclusion: This study illustrates the complexity of the pattern of multimorbidity over time, depicting overlapping diagnoses. Analyses of trajectories of different patterns of multimorbidity might pave the way for a broader understanding of triggers for more complex health conditions, as seen in the case of ME/CFS. The traditional view that ME/CFS is the result of an infectious disease was not confirmed in our cohort. The drive toward patient-oriented analyses may lead to findings of subcategories of patients with similar patterns of multimorbidity over time.</p