Documentation
Thanks to Dr. Frank Painter for providing the following information.
GRADING FORMAT: SOFT TISSUE TENDERNESS GRADING SCHEME
GRADE DEFINITION
0 = No tenderness.
I = Tenderness to palpation WITHOUT grimace or flinch.
II = Tenderness WITH grimace &/or flinch to palpation.
III = Tenderness with WITHDRAWAL (+ Jump Sign).
IV = Withdrawal (+ Jump Sign) to non-noxious stimuli (ie. superficial palpation, pin prick, gentle percussion)Hubbard, DR, & Berkoff, GM
Myofascial trigger points show spontaneous needle EMG activity
Spine 1993; 18: 1803-1807
See also: Soft Tissue Grading Format (For flawless documentation)
PROVOCATIVE TEST GRADING:
1. LOCATION of the provoked pain.
2. TYPE and INTENSITY of provoked pain (ie. sharp pain 4/10 = a 4 out of a 1-10 scale)
- SP = Sharp pain, DP = Dull pain, 1 = no pain and 10 = worst pain possible
3. PAIN RESPONSE scale:+1 = the pain WORSENS with movement and/or PERIPHERALIZATION occurs.
4. ESTIMATED POINT OF PAIN ONSET = at what point of the test's range of motion did the pain provocation occur. (ie. the first 20% of movement, or at 25 degrees)
0 = NO CHANGE in pain
-1 = the pain REDUCES and/or CENTRALIZEDNOTE: If peripheralization occurs, note WHERE. This is especially useful with ROM testing. Disc pain often centralizes with extension and peripheralizes with flexion, so this is a simple way to make note during testing.
FORMULA = L. SI, SP, 5/10, +1, L gluts/post thigh, 25 degrees would translate as sharp, 5/10 severity, sharp pain at the left SI joint, which perperipheralizes to the gluteal and posterior thigh when flexed @ the waist to 25 degrees.
DOCUMENTATION / OUTCOME TOOLS: RESOURCE LIST
A. QUESTIONNAIRES:
1. SF-36
Goertz, Christine M
Hawk, Cheryl
Measuring Functional Health Status in the
Chiropractic Office Using Self-Report Questionnaires
Topics in Clinical Chiropractic 1994; 1 (1): 51–59
QUESTIONNAIRE ON PAGE 81-3
Update on the Research Network: Use of the SF-36 Health Survey (RAND-36)
Palmer J Res 1995; 2(2): 32-33 Stewart, A
The M.O.S. short form general health survey: Reliability and validity in a patient population
Medical Care 1988; 26(7): 724- Measuring results: The new importance of patient questionnaires
The Chiropractic Report 1992; 7(1): 1-6
2. Visual Analog Scale (VAS)Love, A
Osterbauer, Paul J
Chiropractic chronic LBP sufferers and self-report assessment methods.
PART I: A reliability study of the visual analogue scale (VAS),
the pain drawing and the McGill Pain Questionnaire
JMPT 1989; 12: 21-5
Users guide for the visual analogue scale
Activator Methods, Inc.
Phoenix, Az, 602-224-0220 Price, Donald D
The validation of visual analogue scales as ratio scale measures
for chronic and experimental pain
Pain 1983; 17 : 45-56 Wallace, Harry L.
The relationship of changes in cervical curvature to visual analog scale,
neck disability index scores and pressure algometry with neck pain
Chiro: Jour of Chiro Res and Clin Invest 1994; 9(1): 19-23Wallace, Harry L.
3. Neck Disability Index (NDI)Vernon, H
The Neck Disability Index (NDI): A study of reliability and validity
JMPT 1991; 14(7): 409-15
The relationship of changes in cervical curvature to visual analog scale,
neck disability index scores and pressure algometry with neck pain
Chiro: Jour of Chiro Res and Clin Invest 1994; 9(1): 19-23
Fairbanks, J
Main, Chris J
4. Oswestry Low Back Pain
The Oswestry low back pain disability questionnaire
Physiotherapy 1980; 66: 271
5. Other Questionnaires
The distress and risk assessment method: A simple patient classification
to identify distress and evaluate the risk of poor outcome
Spine 1992; 17(1): 42-52
The modified somatic perception questionnaire
J Psychosom Res 1983; 27(6): 503-514
The McGill Pain Questionnaire: Major properties and scoring methods
Pain 1975; 1: 277-99