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- Bernhoff, Gabriella, et al.
(författare)
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A comparison of health-related factors between patients diagnosed with ME/CFS and patients with a related symptom picture but no ME/CFS diagnosis: a cross-sectional exploratory study
- 2022
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Ingår i: Journal of Translational Medicine. - : Springer Science and Business Media LLC. - 1479-5876. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Background: In chronic fatigue syndrome/myalgic encephalomyelitis (ME/CFS), the capacity for activity and participation is strongly limited. The disease definition is very broad, and considering the lack of evidence for best treatment, it is important to understand what is ME/CFS-specific in the biopsychosocial perspective in comparison with similar syndromes. The objective was to study the difference between those diagnosed with ME/CFS and those with similar symptoms but no ME/CFS diagnosis for self-perceived level of physical activity, work ability, anxiety/depression, and health-related quality of life. Methods: This was a clinical cross-sectional study with data collected from mailed questionnaires. The following variables were compared between patients diagnosed with ME/CFS (n = 205) and those with similar symptoms but no diagnosis (n = 57); level of physical activity, Work ability index (WAI), Hospital anxiety and depression scale (HAD-A/HAD-D), and RAND-36 Physical functioning, Role limitations due to physical health problems, Role limitations due to personal or emotional problems, Social functioning, Energy/fatigue, Bodily pain, Emotional well-being, and General health perceptions. The Chi-squared test (nominal data), the Mann-Whitney U test, the Student’s t test and regression analysis were used to analyze the data. Results: The group diagnosed with ME/CFS had a more impaired physical and mental exertion ability as compared to the group that had similar symptoms but was not diagnosed with ME/CFS, shown by a RAND-36 lower index of physical role functioning, social functioning, energy, worse pain and poorer overall health (p ≤ 0.05). In contrast, no significant group differences emerged for weekly level of physical activity, work ability, anxiety/depression, and RAND-36 Emotional role limitation and well-being. Conclusion: Our results indicate that those with a diagnosis of ME/CFS are characterized by an impaired ability for physical or mental exertion, worse pain, and poorer overall health as compared to individuals with similar symptoms but for whom ME/CFS-diagnosis was not established. The results may be cautiously interpreted as support when focusing on patients’ self-care in terms of management of energy levels. The results must however be verified in future studies.
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| 2. |
- Bernhoff, Gabriella
(författare)
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On the clinical assessment of persistent fatigue and pain
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients with persistent fatigue and pain, most of them women, often struggle with decreased function and related concerns. They commonly receive an inconclusive investigation and a delayed diagnosis. Neuropathic aspects of the condition may be missed. Clinical screening is vital because it can support medical and healthcare decision-making early in the course of an illness. Two go-to tools of the typical assessment, the Beighton score and the pain drawing, are appreciated in praxis but lack substantial evidence base. The overarching aim of this thesis was to contribute to improvements in the management and diagnostics for these patients. All research questions originated from clinical praxis. The studies are based on data from one group among the very large population of patients who have persistent fatigue and pain: those presenting with suspected myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). In study I, the Beighton score was evaluated within clinical routine assessment for its capacity to identify a physique with systemic joint laxity. Systemic joint laxity is a risk factor for developing persistent health issues and should warrant considerations in treatment. Normally, this feature would need to be assessed routinely in the investigation of persistent fatigue or pain. This study involved different competencies of the assessors (physician and physiotherapist). Despite these differences and a lack of joint training in the method, inter-rater reliability was acceptable, demonstrating the stability of the Beighton score as a measurement. The sum score, however, must not be interpreted as a definitive answer regarding whether systemic joint laxity is present but must be read instead within the context of a targeted medical history. Study II concerned the pain drawing used to assess body pain extent. Methods of interpretation, however, have not been standardized in clinic and little evidence is available regarding its use for assessing the cervical spine. Study II involved evaluation of a method of screening for cervicogenic headache using a standardized reading in which a predefined C2 pain pattern was applied. Dizziness/imbalance was strongly associated with the C2 pain pattern and those who presented with this pattern had more severe pain and lower health-related quality of life compared with those who did not present with it. Thus, the pain drawing with the C2 pain pattern could distinguish patients with a more complex pain picture. The strong association with dizziness/imbalance strengthened the relevance of the pattern in clinical assessment of cervicogenic headache. Paper III describes self-perceived health in the population with persistent fatigue and pain, from a biopsychosocial perspective. A comparison was made for two subgroups within the study population – those diagnosed with ME/CFS and those who were not but had a related symptom picture. Data were collected with several questionnaires on health-related factors. Characteristics of ME/CFS in this context were impaired tolerance for exertion (mental or physical), impaired energy levels, worse pain, and poorer general health. No between-group differences were found for signs of anxiety and depression, mental role functioning, and mental well-being, so that the identified ME/CFS characteristics did not emerge as causal in the health status of the ME /CFS- subgroup. In conclusion, the Beighton score and the pain drawing can aid in determining the nature and degree of a condition with persistent fatigue and pain. They appear to be tools to retain in the clinical assessment. Screening with the pain drawing also may be beneficial in supporting a patient-centred management and merits further development within the clinical assessment. The experience patients have with ME/CFS places this condition at the far end of the spectrum of persistent fatigue and pain.
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| 3. |
- Bernhoff, Gabriella, et al.
(författare)
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The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders
- 2016
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Ingår i: Journal of Pain Research. - : DOVE MEDICAL PRESS LTD. - 1178-7090. ; 9, s. 397-404
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement. Design: This cross-sectional study included data collected in a randomized controlled study. Patients: Two hundred and sixteen patients with chronic (amp;gt;= 6 months) whiplash-associated disorders, grade 2 or 3, were included in this study. Methods: The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings. Results: Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa = 0.11, 95% CI: -0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa = 0.64, 95% CI: 0.53 to 0.76). Conclusion: The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries.
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