Abstract
Background: Musculoskeletal (MSK) disorders are the second most common cause of disability. Persistent MSK pain has been associated with altered central pain mechanisms (CPMs), particularly somatosensory abnormalities. In research, a range of objective tools, such as quantitative sensory testing (QST) procedures are used to measure somatosensory abnormalities. QST procedures have a potential use in clinical practice for recognizing somatosensory abnormalities associated with pain. However, the knowledge in psychometric properties and the clinical utility of these test procedures in clinical practice remains unclear.
Aim: The aim of this thesis was to synthesize knowledge and resources on the assessment of CPMs for translation into musculoskeletal physiotherapy clinical practice.
Methods: Using the Knowledge to Action (KTA) model, a series of steps were undertaken to accomplish the aim of the thesis. Three systematic reviews were conducted to review the literature on psychometric properties (PMPs) of test procedures utilized to identify altered CPMs in individuals with MSK pain, including peripheral joint pain (PJP), neck pain, and back pain. This was followed by an online survey of New Zealand physiotherapists to collect information on current clinical practice related to the assessment of CPMs. The next step was a content analysis of YouTube™ and Google™ videos related to testing procedures, which demonstrated adequate PMPs. Finally, a focus group study was conducted to explore physiotherapists’ perceptions on the features of the identified videos with the aim of identifying better quality resources that can be used for educational medium for upskilling clinicians.
Results: The level of evidence for PMPs varied across various test procedures in different types of MSK pain. The following test procedures have adequate PMPs for assessment of CPMs: the hand-held pressure algometer in individuals with chronic knee OA; the digital hand-held algometer and the neurometer CPT/C in individuals with chronic neck pain; the electronic pressure algometer, cross friction algometry, and conditioned pain modulation in individuals with back pain.
The survey indicated that the majority of physiotherapists were assessing central sensitization (CS), but objective assessment of CPMs is not a part of routine clinical practice. In addition, physiotherapists reported lack of knowledge and training, limited clinical time, and unavailability of the testing equipment were the most common cited barriers for using QST procedures in clinical practice.
The content analysis of YouTube™ and Google™ videos identified only two videos, which received better quality scores based on the primary criteria of the developed 17-item checklist. However, the qualitative study reported that physiotherapists viewed both videos were simple and lacked information that is necessary to reproduce the test procedure (i.e. algometer). Physiotherapists stated that poor technical quality and lack of professionalism in the videos lessened their credibility.
Conclusion:
This thesis identified the level of evidence of PMPs for different test procedures, such as algometer for the assessment of CPMs. However, such procedures were not a part of routine clinical practice. YouTube™ and Google™ videos related to testing procedures lacked essential content and technical quality to be used as educational resources. Therefore, physiotherapists recommended incorporating additional information on CS, standardization of test application and the position of the test subject. Additionally, future videos should have higher technical quality and professionalism to increase their trustworthiness.