A new clinical model for facilitating the development of pattern recognition skills in clinical pain assessment. (August 2018)

• Record Type: Journal Article
• Authors: Walton, David M.; Elliott, James M.
• Is Part Of: Musculoskeletal science and practice. Volume 36(2018)
• Page Start: 17
• Page End: 24
• Publication Date: 2018-08
• Subjects: Clinical reasoning -- Radar plot -- Triangulation -- Pain; Manipulation (Therapeutics) -- Periodicals; Physical therapy -- Periodicals; Neuromuscular diseases -- Treatment -- Periodicals; Musculoskeletal system -- Diseases -- Periodicals; Manipulation (Therapeutics); Neuromuscular diseases -- Treatment; Physical therapy; Manipulation, Orthopedic; Musculoskeletal Diseases -- therapy; Neuromuscular Diseases -- therapy; Physical Therapy Modalities; Electronic journals; Periodicals; 615.82
• DOI: 10.1016/j.msksp.2018.03.006
• Languages: English
• ISSNs: 2468-8630

Abstract

Abstract: Common, enigmatic musculoskeletal conditions such as whiplash-associated disorder, myofascial pain syndrome, low back pain, headache, fibromyalgia, osteoarthritis, and rotator cuff pathology, account for significant social, economic, and personal burdens on a global scale. Despite their primacy (and shared sequelae) there remains a paucity of available and effective management options for patients with both acute and chronic conditions. Establishing an accurate prognostic or diagnostic profile on a patient-by-patient basis can challenge the insight of both novice and expert clinicians. Questions remain on how and when to choose the right tool(s), at the right time(s), for the right patient(s), for the right problem(s). The aim of this paper is to introduce a new clinical reasoning framework that is simple in presentation but allows interpretation of complex clinical patterns, and is adaptable across patient populations with acute or chronic, traumatic or non-traumatic pain. The concepts of clinical phenotyping (e.g. identifying observable characteristics of an individual resulting from the interaction of his/her genotype and their environment) and triangulation serve as the foundation for this framework. Based on our own clinical and research programs, we present these concepts using two patient cases; a) whiplash-associated disorder (WAD) following a motor vehicle collision and b) mechanical low back pain. Highlights: A new radar plot-based clinical reasoning framework is presented. The framework uses clinical phenotyping and triangulation for musculoskeletal pain. The framework appears to resonate with clinicians. The new framework requires formal empirical study to determine its overall usefulness.