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Institute
- Fakultät WiSo (120)
Möglichkeiten und Grenzen: Muss man bei Patienten mit Kopfschmerzen in der Diagnostik und Therapie zwischen den verschiedenen Kopfschmerzarten unterscheiden oder nicht? Professor Harry von Piekartz von der Osnabrücker Hochschule meint, ja. Trotz vieler Gemeinsamkeiten lässt sich zervikogener Kopfschmerz von anderen Kopfschmerzarten unterscheiden. Was Klassifikationen dabei leisten können und was nicht und welche Rolle die Neuroanatomie dabei spielt, erfahren Sie hier.
Zervikogene Kopfschmerzen
(2011)
Zervikogene Kopfschmerzen
(2013)
Bei 44–65 % aller Schulterbeschwerden ist die Ursache ein multifaktorielles mechanisches Impingement-Syndrom infolge einer Kompression subakromialen Gewebes.
Zervikothorakale und thorakale Manipulationen haben kurzfristig einen positiven Effekt auf die Schmerzen und die Bewegungsfunktionen, die langfristige Wirkung ist jedoch nicht signifikant.
Die Lumbale Spinalkanalstenose (LSS) bezeichnet eine symptomatische Verengung des Spinalkanals aufgrund einer kongenitalen Erkrankung (primäre LSS) oder eines degenerativen Prozesses (sekundäre LSS). Laut Schätzungen unterziehen sich 40 % aller von LSS betroffenen Patienten innerhalb der ersten 10 Jahre einem chirurgischen Eingriff. Ziel dieses Reviews ist, die Effektivität einer Rehabilitation, einschließlich individualisierter Physiotherapie, mit der herkömmlichen Versorgung nach einer Operation der LSS zu vergleichen.
Die Datenbanken CENTRAL, MEDLINE, DIMDI, PEDro und PubMed wurden systematisch nach randomisierten kontrollierten Studien durchsucht, die bis November 2018 durchgeführt wurden. Vier Studien wurden in den Review eingeschlossen. Die Gesamtqualität der Evidenz erwies sich dabei als moderat. Die Interventionen erfolgten unmittelbar während des Krankenhausaufenthalts oder innerhalb von 6–12 Wochen postoperativ und beinhalteten statt individualisierter Physiotherapie lediglich unspezifische Gruppentherapie. Die Kontrollgruppen erhielten herkömmliche Versorgung oder Empfehlungen zum postoperativen Verhalten. Die Analyse ergab keine Unterschiede zwischen den Gruppen in Bezug auf funktionellen Status und Rückenschmerzen kurz- und langfristig. Lediglich bezüglich Beinschmerzen zeigte sich eine signifikante Differenz zugunsten der Interventionsgruppe (SMD –0,22, 95 % KI –0,43 bis –0,01).
Nicht individuelle Physiotherapie zeigt demnach im Vergleich zur herkömmlichen Versorgung keine kurzfristigen Effekte hinsichtlich Funktion und Schmerz, jedoch einen kleinen klinisch relevanten und signifikanten langfristigen Effekt im Hinblick auf Beinschmerzen. Die geringe Anzahl an eingeschlossenen Studien und die moderate Qualität der Evidenz unterstreichen die dringende Notwendigkeit qualitativ hochwertiger Studien, die die Wirkung einer individualisierten, patientenzentrierten und evidenzbasierten Physiotherapie untersuchen.
Warum ein Kind Kopfschmerzen bekommt oder dauerhaft darunter leidet, kann viele Faktoren haben. Manche sind beeinflussbar. So kann es zum Beispiel hilfreich sein, wenn ein Kind vor dem Schlafen nicht mehr fernsieht oder wenn belastende Schulsituationen in die Therapie einbezogen werden. Harry von Piekartz und Kim Budelmann geben einen Überblick, was kindliche Kopfschmerzen beeinflussen kann.
Volkskrankheit Kopfschmerz
(2018)
Objectives
To develop a time-efficient motor control (MC) test battery while maximising diagnostic accuracy of both a two-level and three-level classification system for patients with non-specific low back pain (LBP).
Design
Case–control study.
Setting
Four private physiotherapy practices in northern Germany.
Participants
Consecutive males and females presenting to a physiotherapy clinic with non-specific LBP (n=65) were compared with 66 healthy-matched controls.
Primary outcome measures
Accuracy (sensitivity, specificity, Youden index, positive/negative likelihood ratio, area under the curve (AUC)) of a clinically driven consensus-based test battery including the ideal number of test items as well as threshold values and most accurate items.
Results
For both the two and three-level categorisation system, the ideal number of test items was 10. With increasing number of failed tests, the probability of having LBP increases. The overall discrimination potential for the two-level categorisation system of the test is good (AUC=0.85) with an optimal cut-off of three failed tests. The overall discrimination potential of the three-level categorisation system is fair (volume under the surface=0.52). The optimal cut-off for the 10-item test battery for categorisation into none, mild/moderate and severe MC impairment is three and six failed tests, respectively.
Conclusion
A 10-item test battery is recommended for both the two-level (impairment or not) and three-level (none, mild, moderate/severe) categorisation of patients with non-specific LBP.
Zervikogene Kopfschmerzen werden als durch Dysfunktionen in der hochzervikalen Wirbelsäule verursachte Kopfschmerzen beschrieben. Einige medizinische Disziplinen betrachten diese Kopfschmerzform aufgrund unzureichender pathobiologischer Erklärungsmodelle kritisch oder halten sie teilweise sogar für nicht existent, während sie die neuromuskeloskeletale Therapie als eigenständige Entität anerkennt.
Anhand einer systematischen Literaturrecherche reflektiert die vorliegende Arbeit sowohl die gängigen Diagnosekriterien als auch die Unterschiede und Überlappungen von zervikogenem Kopfschmerz zu Migräne ohne Aura bzw. Spannungskopfschmerz unter Einbeziehung des tatsächlich vorherrschenden pathobiologischen Mechanismus.
Mit der Überlegung peripherer und zentraler Sensibilisierungsprozesse zeigten sich deutliche Überschneidungen im Bereich der pathobiologischen Mechanismen von zervikogenem Kopfschmerz, Migräne ohne Aura und Spannungskopfschmerz. Daher sollten die Diagnosekriterien um diesen Hintergrund erweitert bzw. angepasst werden. Aus manualtherapeutischer Sicht ergibt sich die mögliche Behandlung dieser Kopfschmerzarten nach eingehender struktureller Untersuchung und Screening angrenzender Faktoren unter Beachtung der zugrundeliegenden Schmerzmechanismen.
Objective
The aim of this study was to assess the influence of cranio-cervical posture on the maximal mouth opening (MMO) and pressure pain threshold (PPT) in patients with myofascial temporomandibular pain disorders.
Materials and Methods
A total of 29 patients (19 females and 10 males) with myofascial temporomandibular pain disorders, aged 19 to 59 years participated in the study (mean years±SD; 34.69±10.83 y). MMO and the PPT (on the right side) of patients in neutral, retracted, and forward head postures were measured. A 1-way repeated measures analysis of variance followed by 3 pair-wise comparisons were used to determine differences.
Results
Comparisons indicated significant differences in PPT at 3 points within the trigeminal innervated musculature [masseter (M1 and M2) and anterior temporalis (T1)] among the 3 head postures [M1 (F=117.78; P<0.001), M2 (F=129.04; P<0.001), and T1 (F=195.44; P<0.001)]. There were also significant differences in MMO among the 3 head postures (F=208.06; P<0.001). The intrarater reliability on a given day-to-day basis was good with the interclass correlation coefficient ranging from 0.89 to 0.94 and 0.92 to 0.94 for PPT and MMO, respectively, among the different head postures.
Conclusions
The results of this study shows that the experimental induction of different cranio-cervical postures influences the MMO and PPT values of the temporomandibular joint and muscles of mastication that receive motor and sensory innervation by the trigeminal nerve. Our results provide data that supports the biomechanical relationship between the cranio-cervical region and the dynamics of the temporomandibular joint, as well as trigeminal nociceptive processing in different cranio-cervical postures.
Background
Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far.
Objective
The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee.
Methods
MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach.
Results
The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=−0.31, 95% CI −0.58 to −0.04, low quality; QoL SMD=0.24, 95% CI 0.05-0.43, moderate quality) and long-term effects (pain −0.30, 95% CI −0.07 to −0.53, moderate quality; physical function 0.41, 95% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95% CI 0.06-0.47, high quality).
Conclusions
eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence.
Methods: Systematic review of randomized controlled trials (RCT). Searches were conducted in five electronic databases. Studies were selected if they included patients with NP over 18 years old treated with aerobic exercise (AE) (e.g., cycling, running, hiking, and walking). The main outcome of interest was pain intensity. Qualitative and quantitative data were extracted. The risk of bias (RoB) was determined using the Cochrane RoB Tool-2 and the overall certainty of the evidence with the GRADE recommendations.
Results: Out of 21,585 initial records screened, a total of six individual studies published in ten manuscripts were included. There was a great heterogeneity between protocols, comparisons, and studies’ results (different magnitudes and directions). When looking at the effect of aerobic exercise versus control groups or other interventions on pain intensity measured with the VAS, not statistically (nor clinical) significant differences between aerobic exercise and control groups (MD [95%CI] 5.16 mm [-6.38, 16.70]) were identified. The combined effect of AE plus other interventions seems to be effective. Strength exercise obtained better effects than aerobic exercises (MD [95%CI]: -11.34 mm [-21.6, -1.09]).
Conclusions: Aerobic exercise presented positive results to reduce pain intensity, and improving disability, and physical and emotional functioning. However, the evidence is restricted, low quality, and heterogeneous.
Methods: The searches were conducted on five electronic databases. RCTs or CTs with patients over 18 years old of both sexes with OFP diagnoses were targeted. The intervention of interest was AE (i.e., walking, cycling, and running), compared to any other conservative and non-conservative therapy. The primary outcome was pain intensity. Risk of bias (RoB) was done with the Cochrane RoB tool (RoB 2). The overall certainty of the evidence was evaluated with GRADE.
Results: Out of 21,585 initial records found in the initial database search, only one study (reported on three manuscripts) was included. The diagnosis of interest was headache plus temporomandibular disorders (TMD). Three treatment groups (strengthening (Str) exercise + manual therapy (MT) (G1); AE + MT + Str exercises (G2); AE (G3)) were compared. The main outcome was pain; the secondary outcomes included disability, strength, anxiety, and quality of life. The combined treatment (AE+MT+Str exercises) had the strongest effect to decrease pain and headache intensity in patients with OFP (SMD: 9.99 [95%CI: 7.19, 12.80].
Conclusions: a multimodal treatment strategy achieved the greatest positive effects on pain and other outcomes in the short/medium term. AE seems to be an important component of this strategy. However, the scientific evidence supporting AE’s isolated effect is limited, indicating a research gap in this scientific field.
Das 10-jährige Bestehen physiotherapeutischer Studiengänge in Deutschland gibt Gelegenheit, Bilanz zu ziehen und die weitere Entwicklung zu überlegen. Der Artikel soll insbesondere auch jungen Kollegen Orientierung darüber geben, was es mit den verschiedenen Programmen und Abschlüssen auf sich hat und auf welche Qualitätsmerkmale zu achten ist.
„Hands-on!“ heißt der Schwerpunkt dieser Ausgabe der MSK, in der Hands-on/Hands-off- Herangehensweisen debattiert werden. Arne Vielitz und Dr. Claus Beyerlein, beide Herausgeber der MSK, baten daher Vertreter/-innen der 5 Mitglieder der Dachorganisation OMT-Deutschland um ein Statement zu folgenden Fragen: Was beinhaltet die muskuloskelettale Physiotherapie für Sie? Wie sieht eine gelungene/zeitgemäße praktische Umsetzung/Anwendung aus? Wie sehen Sie die muskuloskelettale Physiotherapie in der Zukunft? Wo geht die Reise hin?
Die Statements der 5 auf diese Fragen sind in alphabetischer Reihenfolge geordnet.
Ein Silvesterböller verletzt ein Kind schwer im Gesicht. Trotz Operation und Physiotherapie bleiben schlimmste Schmerzen und gravierende zentralnervöse Störungen. Der Elfjährige kann sich nur schwerlich mimisch artikulieren oder die Gesichtsausdrücke seiner Eltern interpretieren. Geholfen hat ihm eine Kombination aus Hands-on-Techniken und zeitgemäßen Behandlungsmethoden auf neurowissenschaftlicher Basis.
There is clinical evidence that cervical lateral glide (CLG) improves neurodynamics and alleviates pain in patients who suffer from neurogenic arm pain. Cervical lateral flexion (CLF) is also a treatment method and a means of testing neurodynamics. However, for both techniques nerve movement has not yet been investigated using ultrasound imaging (US). The purpose of this study was to quantify median nerve movement in the arm during CLG and CLF. For this study 27 healthy participants were recruited. Longitudinal movement of the median nerve was measured using US during CLG and CLF with the shoulder in 30° abduction in the middle and distal forearm (Fad). Data could be obtained from 11 participants (6 women and 5 men, average age 25.6 years, ±2.25) at the middle forearm (Fam) and from 9 participants (5 women and 4 men, average age 27.2 years, ±2.75) at the Fad. When applying CLF, the median nerve moved 2.3 mm (SEM ± 0.1 mm) at the Fam. At the same measuring point the median nerve moved 3.3 mm (SEM ± 0.3 mm, p = 0.005) by applying CLG. At the Fad the difference between CLF and CLF amounted to 0.6 mm (CLF: 1.9 mm (SEM ± 0.2 mm, CLG: 2.5 mm (SEM ± 0.2 mm, p ≤ 0.05). The movements during CLG are larger than during CLF. This difference is statistically significant. However, the statistical relevance cannot be extrapolated to a clinical relevance.
Risiken der Physiotherapie
(2013)
Ausgehend von zwei Fällen, bei denen Säuglinge während einer Behandlung gestorben sind, werden die möglichen Risiken manueller Therapien im Nackenhalsbereich beschrieben. Welche Möglichkeiten gibt es, um das richtige Vorgehen bei der passenden Therapie zu überprüfen und einen qualifizierten Therapeuten zu finden?
Chronic facial pain has many of the clinical characteristics found in other persistent musculoskeletal conditions, such as low back and cervical pain syndromes. Unique to this condition, however, is that painful facial movements may result in rigidity or altered ability to demonstrate mimicry, defined as the natural tendency to adopt the behavioral expressions of other persons involved in the interaction. Loss of ability to communicate through emotional expression can lead to impaired processing of emotions and ultimately social isolation. Diminished quality and quantity of facial expression is associated with chronic face pain, tempromandibular dysfunction, facial asymmetries, and neurological disorders. This report provides a framework for assessment of impaired emotional processing and associated somatosensory alterations. Principles for management for chronic facial pain should include graded motor imagery, in addition to standard treatments of manual therapy, exercise, and patient education. A case study is provided which illustrates these principles.
Bert Hummel hat seit zwei Wochen starke Schulterschmerzen. Seit Kurzem schwindet zudem seine Kraft in der Schultermuskulatur. Sein Hausarzt diagnostiziert ein „zervikobrachiales Syndrom“. Doch für Physiotherapeut Harry von Piekartz stellt sich die Schulterproblematik ganz untypisch dar. Das gilt besonders für die neurologischen Symptome.
Ernst Kober ist seit mehreren Monaten krankgeschrieben – aufgrund von Schmerzen im Nacken, Rücken und der Hand. Er denkt, seine Arbeit sei der Grund für seine Beschwerden – eine Yellow Flag? Physiotherapeut Harry von Piekartz findet noch mehr dieser Flaggen. Doch es stellt sich heraus: Deren Farbe hätte eigentlich eine andere sein müssen.
Seit der Trennung von ihrem Freund klagt die 32-jährige Anne über morgendliche Kopfschmerzen, Parästhesien am Hinterkopf, Schwindel und verspannte Kiefermuskeln. Lange bleibt für ihren Hausarzt, die Psychologin und Physiotherapeut Professor Harry von Piekartz unklar, was die Symptome auslöst. Denn der Unruhestifter ist unsichtbar.
Mitten in der Vorbereitung auf ein Turnier bekommt Wasserballerin Anja stechende Schmerzen in ihrer linken Flanke. Physiotherapeut Dr. Harry von Piekartz vermutet zunächst eine Nierenpathologie. Doch die bestätigt sich nicht. Bei der körperlichen Untersuchung entdeckt der Therapeut die eigentliche Schmerzquelle: eine Laune der Natur.
Als Jane mit ihrer kleinen Schwester tobt, schießt ihr plötzlich ein starker Schmerz in Nacken und Kopf. So weit nicht ungewöhnlich und eine Indikation für Physiotherapie. Doch als die junge Studentin erzählt, dass der Kopfschmerz pulsierend ist, wird ihr Therapeut hellhörig und stellt die entscheidenden Fragen.
Seit Jahren schon hat Sarah J. das Gefühl, immer müder und weniger belastbar zu werden. Selbst im Garten schafft sie kaum noch was. Liegt es wirklich nur am Verlust ihres Mannes? Zunehmende Zahn- und Kieferschmerzen und Schmerzen im Thorax führen sie zur Physiotherapie. Dort rückt eine andere Vermutung in den Fokus.
Sabine Krener ist enttäuscht. Sie bereitet sich auf einen Halbmarathon vor, hat aber zunehmend Probleme beim Laufen. Dass ihre Achillessehne schmerzt, kennt sie schon seit Jahren – nun wird es aber schlimmer, und es treten zudem ständig Krämpfe im rechten Bein auf. Zu allem Überfluss hat sie in den letzten sechs Wochen acht Kilo zugenommen.
Renate K. hat Schmerzen im Nacken, in der Schulter, im Arm und in der gesamten Hand. Doch die Symptome kommen Physiotherapeut Prof. Dr. Harry von Piekartz seltsam vor. Sie entsprechen keinem muskuloskeletalen Muster. Zudem ist Frau K. grundlos heiser – und hat eine verdickte Stelle hinter dem M. pectoralis major.
Ein Fallbericht mit medizinischem Hintergrundwissen von Prof. Dr. Christoff Zalpour.
Beate Hansen kommt mit akuten thorakolumbalen rechtsseitigen Schmerzen in die Physiotherapiepraxis von Harry von Piekartz. Auf den ersten Blick scheint sie ein klassischer „manueller“ Fall zu sein. Warum sie es nicht ist und was eine Diät mit Rückenschmerzen zu tun haben kann, lesen Sie in diesem Fall.
Der 8-jährige Roy kommt wegen massiver Kopfschmerzen in die Praxis des Physiotherapeuten Dr. Harry von Piekartz. Dieser entschließt sich zu einer Mobilisation des Neurokraniums. An den beiden nächsten Tagen geht es Roy so gut wie seit langem nicht mehr. Am dritten Tag jedoch verschlechtern sich seine Symptome dramatisch.
Prof. Harry von Piekartz arbeitet als Physiotherapeut in den Niederlanden. Im Direct Access muss er erkennen, ob Physiotherapie indiziert ist oder ob er den Patienten besser zum Arzt schickt. Bei Herrn S. wird er stutzig. Denn dieser hat nicht nur Rückenbeschwerden, sondern auch Schmerzen beim Wasserlassen.
Ein Fallbericht – mit medizinischem Hintergrundwissen von Prof. Christoff Zalpour.
Paul Brand, 51 Jahre, hat seit sechs Wochen Schmerzen im rechten Nacken-, Hals- und Schläfenbereich. Zudem plagen ihn im rechten Auge pulsierende Schmerzen. Vor acht Wochen war er mit dem Rad auf Glatteis ausgerutscht. Doch in der Therapie wird schnell klar, dass der Unfall nichts mit den jetzigen Beschwerden zu tun hat.
Ludwig ist irritiert. Auf seiner rechten Schulter hat sich eine sichtbare Beule entwickelt, die vor allem am Schreibtisch Schmerzen auslöst. Seinem Hobby, dem Kickboxen, kann er glücklicherweise noch nachgehen. Da die Beule weiter wächst und ihn seine Freundin darauf aufmerksam macht, dass er seinen Kopf schief hält, geht er zum Arzt und schließlich zu Physiotherapeut Prof. Dr. Harry von Piekartz.
Recognition of Emotional Facial Expressions and Alexithymia in Patients with Chronic Facial Pain
(2018)
Objectives
Alexithymia, conceived as difficulties to identify emotions, is said to be related with several pain syndromes. This study examined the recognition of facially expressed emotions and its relation to alexithymia in subjects with chronic facial pain.
Methods
A total of 62 subjects were recruited, with n=20 patients with chronic facial pain and n=42 healthy controls. All subjects were tested for the recognition of facially expressed emotions (Facially Expressed Emotion Labelling Test (FEEL test). The Toronto Alexithymia Scale (TAS-26) was used for the diagnosis of alexithymia.
Results
Patients with chronic facial pain performed worse than controls at the FEEL task (p<.001) and showed higher total TAS scores (p<.001). This indicates the presence of alexithymia and facial emotion recognition deficits in the facial pain group.
Discussion
It was concluded from the results that both the recognition of facially expressed emotions, and the ability to identify and describe one’s own feelings (TAS), are restricted in chronic orofacial pain patients. This relationship is particularly important in the treatment of chronic facial pain, indicating that it should become part of the treatment in addition to the therapeutic key issues, to influence the quality of life of the affected patients positively.
The primary objective of this study was to determine the structural and known-group validity as well as the inter-rater reliability of a test battery to evaluate the motor control of the craniofacial region. Seventy volunteers without TMD and 25 subjects with TMD (Axes I) per the DC/TMD were asked to execute a test battery consisting of eight tests. The tests were video-taped in the same sequence in a standardised manner. Two experienced physical therapists participated in this study as blinded assessors. We used exploratory factor analysis to identify the underlying component structure of the eight tests. Internal consistency (Cronbach's α), inter-rater reliability (intra-class correlation coefficient) and construct validity (ie, hypothesis testing-known-group validity) (receiver operating curves) were also explored for the test battery. The structural validity showed the presence of one factor underlying the construct of the test battery. The internal consistency was excellent (0.90) as well as the inter-rater reliability. All values of reliability were close to 0.9 or above indicating very high inter-rater reliability. The area under the curve (AUC) was 0.93 for rater 1 and 0.94 for rater two, respectively, indicating excellent discrimination between subjects with TMD and healthy controls. The results of the present study support the psychometric properties of test battery to measure motor control of the craniofacial region when evaluated through videotaping. This test battery could be used to differentiate between healthy subjects and subjects with musculoskeletal impairments in the cervical and oro-facial regions. In addition, this test battery could be used to assess the effectiveness of management strategies in the craniofacial region.
Alexithymia, or a lack of emotional awareness, is prevalent in some chronic pain conditions and has been linked to poor recognition of others' emotions. Recognising others' emotions from their facial expression involves both emotional and motor processing, but the possible contribution of motor disruption has not been considered. It is possible that poor performance on emotional recognition tasks could reflect problems with emotional processing, motor processing or both. We hypothesised that people with chronic facial pain would be less accurate in recognising others' emotions from facial expressions, would be less accurate in a motor imagery task involving the face, and that performance on both tasks would be positively related. A convenience sample of 19 people (15 females) with chronic facial pain and 19 gender-matched controls participated. They undertook two tasks; in the first task, they identified the facial emotion presented in a photograph. In the second, they identified whether the person in the image had a facial feature pointed towards their left or right side, a well-recognised paradigm to induce implicit motor imagery. People with chronic facial pain performed worse than controls at both tasks (Facially Expressed Emotion Labelling (FEEL) task P < 0·001; left/right judgment task P < 0·001). Participants who were more accurate at one task were also more accurate at the other, regardless of group (P < 0·001, r2 = 0·523). Participants with chronic facial pain were worse than controls at both the FEEL emotion recognition task and the left/right facial expression task and performance covaried within participants. We propose that disrupted motor processing may underpin or at least contribute to the difficulty that facial pain patients have in emotion recognition and that further research that tests this proposal is warranted.
Objectives
The aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. This is important, since guidelines for pharmacological trials recommend measuring the frequency of headaches with 50% reduction considered a clinically meaningful effect. It is unclear whether the same recommendations apply to complementary (or adjunct) non-pharmacological approaches, whether the same cut-off levels need to be considered for effectiveness when used as an adjunct or stand-alone intervention, and what is meaningful to patients.
Setting
University-initiated international survey.
Participants
The expert panel was chosen based on publications on non-pharmacological interventions in migraine populations and from personal contacts. 35 eligible researchers were contacted, 12 agreed to participate and 10 completed all 3 rounds of the survey. To further explore how migraine patients viewed potential outcome measures, four migraine patients were interviewed and presented with the same measurement tools as the researchers.
Procedures
The initial Delphi round was based on a systematic search of the literature for outcome measures used in non-pharmacological interventions for headache. Suggested outcome measures were rated by each expert, blinded towards the other members of the panel, for its usefulness on a 5-point Likert scale ranging from definitely not useful to extremely useful. Results were combined using median values and IQRs. Tools rated overall as definitely or probably not useful were excluded from subsequent rounds. Experts further suggested additional outcome measures that were presented to the panel in subsequent rounds. Additionally, experts were asked to rank the most useful tools and provide information on feasible cut-off levels for effectiveness for the three highest ranked tools.
Results
Results suggest the use of the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and headache frequency as primary outcome measures. Patient experts suggested the inclusion of a measure of quality of life and evaluation of associated symptoms and fear of attacks.
Conclusions
Recommendations are for the use of the MIDAS, the HIT-6 and headache frequency, in combination with an outcome measure for quality of life. Associated symptoms and fear of attacks should also be considered as secondary outcomes, if relevant for the individual target population. The cut-off level for effectiveness should be lower for non-pharmacological interventions, especially when used as an adjunct to medication.