- Email: [email protected]
Do measures of pain sensitivity predict pain and disability at 1-year follow up in people with chronic neck pain?
Abstracts / Manual Therapy 25 (2016) e33ee56
Purpose: This review aimed to assess the comparative effectiveness of physical, behavioural/psychological, and combined interventions on pain and disability in patients with NSCSP. Methods: The MEDLINE, CINAHL, SPORTDiscus, Biomedical Reference Collection, AMED, PsycINFO, PsycARTICLES, EMBASE and Web of Science databases were searched. Randomised controlled trials (RCTs), published in English, with participants reporting NSCSP were included. Studies were required to have an “active” conservative control group for comparison. Studies were not eligible if the interventions were from the same domain (e.g. if the study compared two physical interventions/treatments). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioural/psychological and combined interventions were assessed using meta-analyses. Results: 24 studies were included. While some comparisons reached statistical significance, there were no clinically relevant differences between physical, behavioural/psychological and combined interventions for reducing pain and disability in patients with NSCSP. Conclusion: There were no clinically relevant differences between physical, behavioural/psychological and combined interventions for reducing pain and disability in patients with NSCSP. All interventions had modest effectiveness, suggesting the most cost-efficient, feasible rehabilitation choice should be considered. Further work is needed to investigate whether tailoring rehabilitation to the needs of individual patients and their perceived risk of chronicity, which has been seen in recent RCTs for low back pain (LBP), can enhance outcomes in NSCSP. Implications: This review suggests the most cost-efficient and feasible rehabilitation should be used for spinal pain patients and that physiotherapists may need to tailor treatment to the patient. Funding acknowledgements: Mary O'Keeffe was funded by the Irish Research Council. Ethics approval: Not applicable. Disclosure of interest: None declared Keywords: Conservative interventions, Non-specific chronic spinal pain, Systematic review Advanced assessment/practice and managing complex patients OR-MT-030 CHARACTERISING PAIN MODULATION MECHANISMS UNDERPINNING LATERAL ELBOW TENDINOPATHY: A CASE CONTROL STUDY L. Bisset 1, *, C. Pinfildi 1,2, K. Evans 1, L. Laakso 1, S. Dhupelia 3. 1 School of Allied Health Sciences, Griffith University, Gold Coast Campus, Australia; 2 Departamento de Ci^ encias do Movimento Humano, Federal University of Sao Paulo, Sao Paulo, Brazil; 3 Qld XRay, Gold Coast, Australia * Corresponding author.
Background: Lateral epicondylalgia (LE) is a debilitating musculoskeletal condition that is often resistant to treatment and causes long-term pain and disability. The lack of treatment success may be due to the way people with LE process pain within their central nervous system. There is evidence of altered pain modulation (i.e. descending facilitation and/or inhibition) in people with LE, yet specific impairments in pain modulation are currently unknown. Furthermore, interventions that target local tissue pathology may not be effective when pain modulation processes are affected. Purpose: A case control observational study design was used to examine pain modulation profiles in participants with LE compared to healthy controls. A secondary aim is to determine the relationship between pain modulation profile, clinical characteristics and local tissue pathology in people with LE. Methods: Twenty participants with a clinical diagnosis of LE and 10 ageand sex-matched healthy control participants underwent ultrasound and MRI investigations of their affected (or matched) elbow. In addition, static and dynamic quantitative sensory testing was conducted, including pressure pain threshold, cold pain threshold, conditioned pain modulation, and temporal summation. Demographic and other clinical characteristics (pain-free grip strength, PFG; Patient-Rated Tennis Elbow Evaluation, PRTEE) were also collected.
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Results: Participants with LE who exhibited a pro-nociceptive pain profile also exhibited higher levels of pain and disability (PRTEE 65.3 ± 9.6, CPT 19.0 ± 16.6 C, PFG affected/unaffected 19.7 ± 10.2 N, PPT 137 ± 27 kPa) compared to participants with LE who did not exhibit a pro-nociceptive pain profile (PRTEE 35.2 ± 14.8, CPT 11.9 ± 12 C, PFG affected/unaffected 53.8 ± 28.9 N, PPT 238 ± 66 kPa). Demographic and clinical characteristics will be presented for each group. Between-group comparisons and linear regression analyses will be used to identify the association between pain modulation characteristics, clinical characteristics and structural pathology. Conclusion: It is hypothesised that a sub-group of people with LE who exhibit a pro-nociceptive pain profile will also exhibit clinical and structural characteristics that are recognised poor prognostic indicators. In addition, it is anticipated that people with LE will exhibit characteristics of altered pain modulation compared with healthy controls. Future research should investigate whether pain modulation profile is associated with treatment effect in people with LE. Implications: This is the first study to investigate dynamic pain modulation processes in people with LE. A better understanding of these pain modulation processes will provide information to guide the development of treatment strategies which target pain modulation, thereby improving treatment outcomes for people with chronic LE. Funding acknowledgements: School of Allied Health Sciences Project Grant; Griffith Health Institute Grant Scheme. Ethics approval: This study has been approved by the Griffith University Human Research Ethics Committee (AHS/55/14/HREC). Disclosure of interest: None declared. Keywords: Imaging, Pain management, Tennis elbow Advanced assessment/practice and managing complex patients OR-MT-033 DO MEASURES OF PAIN SENSITIVITY PREDICT PAIN AND DISABILITY AT 1-YEAR FOLLOW UP IN PEOPLE WITH CHRONIC NECK PAIN? N. Moloney*, T. Rebeck, R. Azoory, M. Huebscher, R. Waller, D. Beales. * Corresponding author.
Background: Neck pain is a global health burden. Data tracking the course of recovery for idiopathic neck pain and whiplash indicate that recovery is poor for many. Besides patient characteristics and psychological factors, quantitative measures of pain sensitisation have been identified as predictive of poor recovery in some categories of neck pain e.g. acute whiplash. Recent research has proposed clinical measures of pain sensitisation suitable for use in clinical practice; the predictive ability of these methods has yet to be determined. Purpose: The purpose of this study was to examine the unique contributions of quantitative and clinical measures of pain sensitisation to predict pain and disability at long term follow up in people with chronic neck pain. Methods: A prospective cohort study involving adults with chronic neck pain was conducted. Participants (n ¼ 64) completed self-reported measures of pain, disability, psychological factors and co-morbidities, and underwent quantitative measures of cold and pressure pain thresholds. They also underwent assessment of sensitivity to clinical measures of cold and pressure and provided pain ratings for brachial plexus provocation tests. Univariate and multivariable hierarchical regression analyses were conducted to examine the relationship between these measures and pain intensity or neck disability at 12-month follow-up. Results: Univariate regression analyses revealed that depression, anxiety and stress, poor sleep, pain catastrophizing, higher baseline pain, higher manual pressure pain sensitivity and higher pain ratings with brachial plexus provocation testing were associated with higher levels of disability at 12 months (r > 0.3; p < 0.05). Poorer sleep, more co-morbidities, depression, anxiety and stress, as well as higher pain on manual pressure also demonstrated significant associations with pain at 12 months (r > 0.3; p < 0.05). Multivariable regression analyses yielded models explaining 34.6% of the variance in disability and 44.4% of the variance in pain at 12 months. The resultant models comprised self-reported measures (neuropathic
e40
Abstracts / Manual Therapy 25 (2016) e33ee56
symptoms, sleep, depression, co-morbidities). Neither QST nor clinical measures of pain sensitivity contributed to either model. Conclusion: The results of this study indicate that self-reported measures of pain and psychological factors were predictive of pain and disability at long-term follow up. Measures of pain sensitivity did not predict long term pain and disability. These findings differ to those from acute whiplash populations, with the chronic nature of pain in this cohort potentially explaining the difference. Implications: Clinical and quantitative measures of pain sensitivity may be useful for profiling patients with chronic neck pain but have limited use in predicting ongoing pain and disability in this population. Funding acknowledgements: TR and DB are supported by a NHMRC Research Fellowship. MH was supported by a postdoctoral fellowship from the German Academic Exchange Service (DAAD). Ethics approval: Human ethics approval was obtained from University of Sydney (Protocol No. 14417) and Curtin University (Protocol No. PT0205) Human Research Ethics Committees. Disclosure of interest: None declared. Keywords: Chronic neck pain, Clinical pain sensitivity, Quantitative sensory testing Advanced assessment/practice and managing complex patients OR-MT-034 SENSORIMOTOR CONTROL IN INDIVIDUALS WITH IDIOPATHIC NECK PAIN AND HEALTHY INDIVIDUALS: A SYSTEMATIC REVIEW AND META-ANALYSIS R. de Zoete*, P. Osmotherly, D. Rivett, S. Farrell, S. Snodgrass. School of Health Sciences, The University of Newcastle, Callaghan, Australia * Corresponding author.
Background: Idiopathic neck pain is a common condition presenting in physiotherapy practice. However, treatment is often ineffective: 50e85% of individuals with neck pain will experience recurrent neck pain within 1e5 years after the initial onset of neck pain. One aspect of assessment that may provide some insight into possible reasons for neck pain recurrence is cervical sensorimotor control testing. Cervical sensorimotor control is defined as all the afferent and efferent information streams, as well as the central integration components contributing to joint stability. However, consensus lacks on the measurement of sensorimotor control in individuals with idiopathic neck pain. Purpose: To systematically review and analyse reported outcomes of sensorimotor control in individuals with idiopathic neck pain, compared to healthy individuals. Methods: Systematic review and meta-analysis of English and Dutch language observational and intervention studies, identified through searching the databases AMED, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, PEDro, SCOPUS and SportDiscus. Studies were included if they investigated individuals with idiopathic neck pain and/or healthy individuals, and reported outcomes of at least one sensorimotor control test. The aim of this systematic review is to determine whether sensorimotor control tests can identify and quantify differences between individuals with idiopathic neck pain and healthy individuals. Results: Reported outcome measures for sensorimotor control tests were: joint position error (JPE), postural sway, subjective visual vertical (SVV), smooth pursuit neck torsion (SPNT), The Fly® and head steadiness. In included studies (n ¼ 43), sensorimotor control was most commonly assessed by JPE and postural sway. Pooled means from 22 studies for JPE following cervical rotation in individuals with neck pain (range 2.2 e9.8 , median 3.14 , IQR 2.79 e3.33 ) differed significantly (p ¼ 0.04) compared to healthy individuals (range 1.66 e5.1, median 2.67, IQR 2.1 e3.5 ). Clinical significance of this difference was not reported. Postural sway, eyes open (EO), ranged from 3.0e10.5 cm2 (median 7.68, IQR 4.85e10.5) for individuals with idiopathic neck pain and 2.7e6.6 cm2 (median 4.36 cm2, IQR 3.76cm2e5.65 cm2) for healthy individuals, and for eyes closed (EC), 2.5e16.6 cm2 (median 8.84 cm2, IQR 2.51cm2e16.6 cm2) (neck pain) and 2.0e10.9 cm2 (median 6.53 cm2, IQR 4.19cm2e6.99 cm2) (healthy). Individual studies, but not meta-analysis, demonstrated differences between
neck pain and healthy groups for postural sway (EO: n ¼ 4, EC: n ¼ 6). Other test conditions and other tests (15 studies) were not sufficiently investigated to enable pooling of data. Conclusion: Six sensorimotor control tests were identified that have been used to investigate individuals with idiopathic neck pain. Metaanalysis demonstrated differences between individuals with idiopathic neck pain and healthy individuals for JPE testing following rotation. Individual studies found significant differences between idiopathic neck pain and healthy groups for postural sway, but not on meta-analysis. Although for some tests clinical usefulness of sensorimotor testing is suggested by these results, further research is needed to investigate clinical meaningfulness of differences in outcomes for sensorimotor tests. Implications: This systematic review and meta-analysis informs clinicians about the measurement methods of sensorimotor control in individuals with idiopathic neck pain. Meta-analyses found a significant difference between individuals with idiopathic neck pain and healthy individuals in JPE testing, and this test may clinically be useful in assessing sensorimotor control. Tests for postural sway, SPNT, SVV, head steadiness and The Fly® test show some differences in individuals with idiopathic neck pain compared to healthy individuals. Funding acknowledgements: This work was unfunded. Ethics approval: No ethics approval was required for this review. Disclosure of interest: None declared. Keywords: Cervical spine, Idiopathic neck pain, Sensorimotor control Advanced assessment/practice and managing complex patients OR-PA-036 DOES IMPROVEMENT OF KNOWLEDGE ABOUT NEUROPHYSIOLOGY OF PAIN OCCUR AND PERSIST IN PATIENTS WITH CHRONIC LOW BACK PAIN AFTER A SINGLE GROUP SESSION OF PAIN PHYSIOLOGY EDUCATION? C. Demoulin 1, 2, *, P. Brasseur 2, N. Roussel 3, 4, S. Grosdent 1, 2, S. Wolfs 1, 2, T. Osinski 5, S. Bornheim 1, 2, J.-M. Crielaard 1, 2, M. Vanderthommen 1, 2, O. re 2, 6. 1 Department of Physical Medicine and Rehabilitation, Liege Bruye University Hospital Center, Belgium; 2 Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium; 3 Pain in Motion Research Group, International, Belgium; 4 Department of Physiotherapy and Rehabilitation Sciences (REVAKI), Faculty of Medicine and Health Sciences, ^pital University of Antwerp, Antwerp, Belgium; 5 INSERM, U-987, Ho Ambroise Par e, Centre d'Evaluation et de Traitement de la Douleur, F92100, France; 6 Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium * Corresponding author. Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium.
Background: Pain neurophysiology education is now being considered as a key component in the management of patients with chronic pain. Several studies have reported its effectiveness to reduce pain and disability but studies evaluating the effect on the patients' knowledge are lacking. Yet, the Neurophysiology of Pain Questionnaire (NPQ) has been developed by Moseley to assess knowledge about pain neurophysiology and has been translated and validated in several languages (Dutch and French). Purpose: The aims of the present study were the followings: 1) to investigate if a two-hour pain education group session is effective to improve the knowledge about neurophysiology of pain in patients with chronic low back pain (CLBP); 2) to study whether these changes persist at a one-week follow-up. Methods: 52 patients with non-specific CLBP attended a two-hour pain education session in groups of 4e6 patients. Prior to the session (pretest), participants filled in the French versions of the NPQ, which consists of 19 (True/False/I do not know) questions with good psychometric properties (valid, reliable, SEM one-week: 1.5), the Roland-Morris Disability Questionnaire (RMDQ) and a 0e10 pain visual analogue scale (VAS). The NPQ was also filled in immediately after the session (post-test) as well as one week later (follow-up). An ANOVA with post-hoc analysis were used to compare the changes in NPQ total scores (/19 and expressed
Purpose: This review aimed to assess the comparative effectiveness of physical, behavioural/psychological, and combined interventions on pain and disability in patients with NSCSP. Methods: The MEDLINE, CINAHL, SPORTDiscus, Biomedical Reference Collection, AMED, PsycINFO, PsycARTICLES, EMBASE and Web of Science databases were searched. Randomised controlled trials (RCTs), published in English, with participants reporting NSCSP were included. Studies were required to have an “active” conservative control group for comparison. Studies were not eligible if the interventions were from the same domain (e.g. if the study compared two physical interventions/treatments). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioural/psychological and combined interventions were assessed using meta-analyses. Results: 24 studies were included. While some comparisons reached statistical significance, there were no clinically relevant differences between physical, behavioural/psychological and combined interventions for reducing pain and disability in patients with NSCSP. Conclusion: There were no clinically relevant differences between physical, behavioural/psychological and combined interventions for reducing pain and disability in patients with NSCSP. All interventions had modest effectiveness, suggesting the most cost-efficient, feasible rehabilitation choice should be considered. Further work is needed to investigate whether tailoring rehabilitation to the needs of individual patients and their perceived risk of chronicity, which has been seen in recent RCTs for low back pain (LBP), can enhance outcomes in NSCSP. Implications: This review suggests the most cost-efficient and feasible rehabilitation should be used for spinal pain patients and that physiotherapists may need to tailor treatment to the patient. Funding acknowledgements: Mary O'Keeffe was funded by the Irish Research Council. Ethics approval: Not applicable. Disclosure of interest: None declared Keywords: Conservative interventions, Non-specific chronic spinal pain, Systematic review Advanced assessment/practice and managing complex patients OR-MT-030 CHARACTERISING PAIN MODULATION MECHANISMS UNDERPINNING LATERAL ELBOW TENDINOPATHY: A CASE CONTROL STUDY L. Bisset 1, *, C. Pinfildi 1,2, K. Evans 1, L. Laakso 1, S. Dhupelia 3. 1 School of Allied Health Sciences, Griffith University, Gold Coast Campus, Australia; 2 Departamento de Ci^ encias do Movimento Humano, Federal University of Sao Paulo, Sao Paulo, Brazil; 3 Qld XRay, Gold Coast, Australia * Corresponding author.
Background: Lateral epicondylalgia (LE) is a debilitating musculoskeletal condition that is often resistant to treatment and causes long-term pain and disability. The lack of treatment success may be due to the way people with LE process pain within their central nervous system. There is evidence of altered pain modulation (i.e. descending facilitation and/or inhibition) in people with LE, yet specific impairments in pain modulation are currently unknown. Furthermore, interventions that target local tissue pathology may not be effective when pain modulation processes are affected. Purpose: A case control observational study design was used to examine pain modulation profiles in participants with LE compared to healthy controls. A secondary aim is to determine the relationship between pain modulation profile, clinical characteristics and local tissue pathology in people with LE. Methods: Twenty participants with a clinical diagnosis of LE and 10 ageand sex-matched healthy control participants underwent ultrasound and MRI investigations of their affected (or matched) elbow. In addition, static and dynamic quantitative sensory testing was conducted, including pressure pain threshold, cold pain threshold, conditioned pain modulation, and temporal summation. Demographic and other clinical characteristics (pain-free grip strength, PFG; Patient-Rated Tennis Elbow Evaluation, PRTEE) were also collected.
e39
Results: Participants with LE who exhibited a pro-nociceptive pain profile also exhibited higher levels of pain and disability (PRTEE 65.3 ± 9.6, CPT 19.0 ± 16.6 C, PFG affected/unaffected 19.7 ± 10.2 N, PPT 137 ± 27 kPa) compared to participants with LE who did not exhibit a pro-nociceptive pain profile (PRTEE 35.2 ± 14.8, CPT 11.9 ± 12 C, PFG affected/unaffected 53.8 ± 28.9 N, PPT 238 ± 66 kPa). Demographic and clinical characteristics will be presented for each group. Between-group comparisons and linear regression analyses will be used to identify the association between pain modulation characteristics, clinical characteristics and structural pathology. Conclusion: It is hypothesised that a sub-group of people with LE who exhibit a pro-nociceptive pain profile will also exhibit clinical and structural characteristics that are recognised poor prognostic indicators. In addition, it is anticipated that people with LE will exhibit characteristics of altered pain modulation compared with healthy controls. Future research should investigate whether pain modulation profile is associated with treatment effect in people with LE. Implications: This is the first study to investigate dynamic pain modulation processes in people with LE. A better understanding of these pain modulation processes will provide information to guide the development of treatment strategies which target pain modulation, thereby improving treatment outcomes for people with chronic LE. Funding acknowledgements: School of Allied Health Sciences Project Grant; Griffith Health Institute Grant Scheme. Ethics approval: This study has been approved by the Griffith University Human Research Ethics Committee (AHS/55/14/HREC). Disclosure of interest: None declared. Keywords: Imaging, Pain management, Tennis elbow Advanced assessment/practice and managing complex patients OR-MT-033 DO MEASURES OF PAIN SENSITIVITY PREDICT PAIN AND DISABILITY AT 1-YEAR FOLLOW UP IN PEOPLE WITH CHRONIC NECK PAIN? N. Moloney*, T. Rebeck, R. Azoory, M. Huebscher, R. Waller, D. Beales. * Corresponding author.
Background: Neck pain is a global health burden. Data tracking the course of recovery for idiopathic neck pain and whiplash indicate that recovery is poor for many. Besides patient characteristics and psychological factors, quantitative measures of pain sensitisation have been identified as predictive of poor recovery in some categories of neck pain e.g. acute whiplash. Recent research has proposed clinical measures of pain sensitisation suitable for use in clinical practice; the predictive ability of these methods has yet to be determined. Purpose: The purpose of this study was to examine the unique contributions of quantitative and clinical measures of pain sensitisation to predict pain and disability at long term follow up in people with chronic neck pain. Methods: A prospective cohort study involving adults with chronic neck pain was conducted. Participants (n ¼ 64) completed self-reported measures of pain, disability, psychological factors and co-morbidities, and underwent quantitative measures of cold and pressure pain thresholds. They also underwent assessment of sensitivity to clinical measures of cold and pressure and provided pain ratings for brachial plexus provocation tests. Univariate and multivariable hierarchical regression analyses were conducted to examine the relationship between these measures and pain intensity or neck disability at 12-month follow-up. Results: Univariate regression analyses revealed that depression, anxiety and stress, poor sleep, pain catastrophizing, higher baseline pain, higher manual pressure pain sensitivity and higher pain ratings with brachial plexus provocation testing were associated with higher levels of disability at 12 months (r > 0.3; p < 0.05). Poorer sleep, more co-morbidities, depression, anxiety and stress, as well as higher pain on manual pressure also demonstrated significant associations with pain at 12 months (r > 0.3; p < 0.05). Multivariable regression analyses yielded models explaining 34.6% of the variance in disability and 44.4% of the variance in pain at 12 months. The resultant models comprised self-reported measures (neuropathic
e40
Abstracts / Manual Therapy 25 (2016) e33ee56
symptoms, sleep, depression, co-morbidities). Neither QST nor clinical measures of pain sensitivity contributed to either model. Conclusion: The results of this study indicate that self-reported measures of pain and psychological factors were predictive of pain and disability at long-term follow up. Measures of pain sensitivity did not predict long term pain and disability. These findings differ to those from acute whiplash populations, with the chronic nature of pain in this cohort potentially explaining the difference. Implications: Clinical and quantitative measures of pain sensitivity may be useful for profiling patients with chronic neck pain but have limited use in predicting ongoing pain and disability in this population. Funding acknowledgements: TR and DB are supported by a NHMRC Research Fellowship. MH was supported by a postdoctoral fellowship from the German Academic Exchange Service (DAAD). Ethics approval: Human ethics approval was obtained from University of Sydney (Protocol No. 14417) and Curtin University (Protocol No. PT0205) Human Research Ethics Committees. Disclosure of interest: None declared. Keywords: Chronic neck pain, Clinical pain sensitivity, Quantitative sensory testing Advanced assessment/practice and managing complex patients OR-MT-034 SENSORIMOTOR CONTROL IN INDIVIDUALS WITH IDIOPATHIC NECK PAIN AND HEALTHY INDIVIDUALS: A SYSTEMATIC REVIEW AND META-ANALYSIS R. de Zoete*, P. Osmotherly, D. Rivett, S. Farrell, S. Snodgrass. School of Health Sciences, The University of Newcastle, Callaghan, Australia * Corresponding author.
Background: Idiopathic neck pain is a common condition presenting in physiotherapy practice. However, treatment is often ineffective: 50e85% of individuals with neck pain will experience recurrent neck pain within 1e5 years after the initial onset of neck pain. One aspect of assessment that may provide some insight into possible reasons for neck pain recurrence is cervical sensorimotor control testing. Cervical sensorimotor control is defined as all the afferent and efferent information streams, as well as the central integration components contributing to joint stability. However, consensus lacks on the measurement of sensorimotor control in individuals with idiopathic neck pain. Purpose: To systematically review and analyse reported outcomes of sensorimotor control in individuals with idiopathic neck pain, compared to healthy individuals. Methods: Systematic review and meta-analysis of English and Dutch language observational and intervention studies, identified through searching the databases AMED, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, PEDro, SCOPUS and SportDiscus. Studies were included if they investigated individuals with idiopathic neck pain and/or healthy individuals, and reported outcomes of at least one sensorimotor control test. The aim of this systematic review is to determine whether sensorimotor control tests can identify and quantify differences between individuals with idiopathic neck pain and healthy individuals. Results: Reported outcome measures for sensorimotor control tests were: joint position error (JPE), postural sway, subjective visual vertical (SVV), smooth pursuit neck torsion (SPNT), The Fly® and head steadiness. In included studies (n ¼ 43), sensorimotor control was most commonly assessed by JPE and postural sway. Pooled means from 22 studies for JPE following cervical rotation in individuals with neck pain (range 2.2 e9.8 , median 3.14 , IQR 2.79 e3.33 ) differed significantly (p ¼ 0.04) compared to healthy individuals (range 1.66 e5.1, median 2.67, IQR 2.1 e3.5 ). Clinical significance of this difference was not reported. Postural sway, eyes open (EO), ranged from 3.0e10.5 cm2 (median 7.68, IQR 4.85e10.5) for individuals with idiopathic neck pain and 2.7e6.6 cm2 (median 4.36 cm2, IQR 3.76cm2e5.65 cm2) for healthy individuals, and for eyes closed (EC), 2.5e16.6 cm2 (median 8.84 cm2, IQR 2.51cm2e16.6 cm2) (neck pain) and 2.0e10.9 cm2 (median 6.53 cm2, IQR 4.19cm2e6.99 cm2) (healthy). Individual studies, but not meta-analysis, demonstrated differences between
neck pain and healthy groups for postural sway (EO: n ¼ 4, EC: n ¼ 6). Other test conditions and other tests (15 studies) were not sufficiently investigated to enable pooling of data. Conclusion: Six sensorimotor control tests were identified that have been used to investigate individuals with idiopathic neck pain. Metaanalysis demonstrated differences between individuals with idiopathic neck pain and healthy individuals for JPE testing following rotation. Individual studies found significant differences between idiopathic neck pain and healthy groups for postural sway, but not on meta-analysis. Although for some tests clinical usefulness of sensorimotor testing is suggested by these results, further research is needed to investigate clinical meaningfulness of differences in outcomes for sensorimotor tests. Implications: This systematic review and meta-analysis informs clinicians about the measurement methods of sensorimotor control in individuals with idiopathic neck pain. Meta-analyses found a significant difference between individuals with idiopathic neck pain and healthy individuals in JPE testing, and this test may clinically be useful in assessing sensorimotor control. Tests for postural sway, SPNT, SVV, head steadiness and The Fly® test show some differences in individuals with idiopathic neck pain compared to healthy individuals. Funding acknowledgements: This work was unfunded. Ethics approval: No ethics approval was required for this review. Disclosure of interest: None declared. Keywords: Cervical spine, Idiopathic neck pain, Sensorimotor control Advanced assessment/practice and managing complex patients OR-PA-036 DOES IMPROVEMENT OF KNOWLEDGE ABOUT NEUROPHYSIOLOGY OF PAIN OCCUR AND PERSIST IN PATIENTS WITH CHRONIC LOW BACK PAIN AFTER A SINGLE GROUP SESSION OF PAIN PHYSIOLOGY EDUCATION? C. Demoulin 1, 2, *, P. Brasseur 2, N. Roussel 3, 4, S. Grosdent 1, 2, S. Wolfs 1, 2, T. Osinski 5, S. Bornheim 1, 2, J.-M. Crielaard 1, 2, M. Vanderthommen 1, 2, O. re 2, 6. 1 Department of Physical Medicine and Rehabilitation, Liege Bruye University Hospital Center, Belgium; 2 Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium; 3 Pain in Motion Research Group, International, Belgium; 4 Department of Physiotherapy and Rehabilitation Sciences (REVAKI), Faculty of Medicine and Health Sciences, ^pital University of Antwerp, Antwerp, Belgium; 5 INSERM, U-987, Ho Ambroise Par e, Centre d'Evaluation et de Traitement de la Douleur, F92100, France; 6 Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium * Corresponding author. Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium.
Background: Pain neurophysiology education is now being considered as a key component in the management of patients with chronic pain. Several studies have reported its effectiveness to reduce pain and disability but studies evaluating the effect on the patients' knowledge are lacking. Yet, the Neurophysiology of Pain Questionnaire (NPQ) has been developed by Moseley to assess knowledge about pain neurophysiology and has been translated and validated in several languages (Dutch and French). Purpose: The aims of the present study were the followings: 1) to investigate if a two-hour pain education group session is effective to improve the knowledge about neurophysiology of pain in patients with chronic low back pain (CLBP); 2) to study whether these changes persist at a one-week follow-up. Methods: 52 patients with non-specific CLBP attended a two-hour pain education session in groups of 4e6 patients. Prior to the session (pretest), participants filled in the French versions of the NPQ, which consists of 19 (True/False/I do not know) questions with good psychometric properties (valid, reliable, SEM one-week: 1.5), the Roland-Morris Disability Questionnaire (RMDQ) and a 0e10 pain visual analogue scale (VAS). The NPQ was also filled in immediately after the session (post-test) as well as one week later (follow-up). An ANOVA with post-hoc analysis were used to compare the changes in NPQ total scores (/19 and expressed