Effect of Specific Verbal Instructions on the Identification of Pain Location during a Passive Straight Leg Raise Test

Musculoskeletal pain is common. Because pain is subjective, objectively describing it is crucial. However, pain assessment may cause distress in patients;therefore, physical therapists (PTs) should conduct these tests quickly and accurately. Simple and clear instructions are recommended for pain assessment. However, few studies have provided evidence to support this hypothesis. Correspondingly, this study aimed to confirm the effectiveness of specific verbal instructions for pain location during five consecutive Passive Straight Leg Raise (PSLR) tests. The 28 asymptomatic participants (age 27.4 ± 9.6 years) who provided informed consent received five consecutive PSLR tests: three without and two with specific verbal instructions to ascertain pain intensity, quality, and location. The participants drew pain locations on a body chart and described the pain intensity and quality after each test. All participants were interviewed regarding the differences they noted in the presence and absence of specific verbal instructions. Each pain location was classified into one of ten areas for statistical analysis. The proportion of participants who changed the pain location was compared between the tests using McNemar’s test, and the kappa coefficient was confirmed for consistency of pain location. There was a significant difference in the proportion of participants who changed their pain location between the second and third tests and from the third to the fourth test (McNemar’s test: p = 0.003). Kappa coefficients had low consistency (κ = 0.28) just after receiving the specific verbal instructions in the fourth test compared to the third test. Consistency improved in the fifth test (κ = 0.57);93% of the participants answered that the pain location had become clearer. This study revealed the effects of specific verbal instructions in identifying pain locations. This detailed information may help PTs provide appropriate treatment and contribute to reducing pain in clinical settings.

Effect of Verbal Instructions in Pain Assessment during a Passive Straight Leg Raise Test in People with Chronic Low Back Pain

The most prevalent issue in physical therapy is pain. Due to the subjective nature of pain, assessment tools are essential in understanding it as objective data. However, assessment of pain may result in distress for the patient. A physical therapist (PT) should conduct these tests as quickly and accurately as possible. Straightforward instructions are vital in such cases. This study aimed to clarify the effect of verbal instructions for pain assessment during a passive straight leg raise (PSLR) test for participants with chronic low back pain (CLBP). This study included 22 participants who provided informed consent and received three consecutive PSLR tests with measurement of the hip flexion range of motion (HFROM) and were instructed to cease the test at submaximal pain before the first test. Following the second and third tests, participants were given specific verbal instructions to remember pain intensity, quality, and location. After each test, participants were to circle the pain location on the body chart and rate their pain intensity on a numeric rating scale (NRS) and pain quality. All participants were then interviewed about the differences between having and not having specific verbal instructions. The results of HFROM, NRS, and pain extent were not significantly different between the first and second tests or between the second and third tests using a paired t-test. Eleven changes in pain location were found in the second test compared to those in the first test. In the third test, only three participants circled a different area than in the second test. Ten participants showed similar changes with pain location in pain quality in the three PSLR tests. This study revealed the effect of specific verbal instructions prior to PSLR tests. Particularly, participants could notice exact pain location. Our findings may help PT to understand pain cause and reduce patients’ stress during pain assessment in clinical settings.

Changes in arterial blood pressure induced by passive leg raising predict hypotension during the induction of sedation in critically ill patients without severe cardiac dysfunction

Background Hypotension due to the induction of sedation with dexmedetomidine infusion may be harmful in critically ill patients. Changes in pulse pressure induced by the passive leg raising test （PLR-APP） as marker of fluid responsiveness, assessed prior to sedation, may predict hemodynamic changes. The present study was to investigate the power of the PLR test in critically ill patients in predicting hypotension induced by the induction of dexmedetomidine sedation. Methods Fluid responsiveness was estimated by a passive leg raising （PLR） test before dexmedetomidine sedation. Patients were assigned to either the ＂Nonresponders＂ or ＂Responders＂ group according to their hemodynamic responses to the PLR test （＂Nonresponders＂, PLR-APP 〈10.3%; ＂Responders＂, PLR-APP 〉10.3%）. Sedation was performed with a dexmedetomidine infusion （0.5 pg/kg over a 10-minute loading period, then 0.2-0.7 pg.kg-l.h1） and titrated to maintain the target Richmond agitation sedation scale （RASS） score in the range of -2 to -1 and the bispectral index value in the range of 60 to 75. Radial artery pulse pressure, heart rate （HR）, and central venous pressure （CVP） were measured at each phase of the study procedure. Hemodynamic fluctuations during the use of dexmedetomidine sedation were recorded and compared between the two groups. Results Fifty patients had a median （25%-75% interquartile range） of 71 （61-78） years old were studied. At baseline, 39 of the 50 patients were ＂Nonresponders＂ and 11 were ＂Responders＂. Following dexmedetomidine sedation, patients classified as ＂Responders＂ had a significantly greater systolic blood pressure decrease during the induction of dexmedetomidine sedation than the ＂Nonresponders＂ （（-26.3 ＋ 6.8）% vs. （-11.8 ＋ 8.5）%, P 〈0.001）. In addition, the ＂Responders＂ group required significantly more fluid boluses （8 vs. 3; P 〈0.001） and vasopressors （2 vs. 0; P 〈0.05） than the ＂Nonresponders＂ group to restore blood pressure. Finally, PLR-APP was positively correlated with changes in systolic blood pressure （PLR-ASBP） （P = 0.576; P 〈0.001） and significantly correlated with dexmedetomidine infusion- induced changes in SBP （P=0.202; P 〈0.05）. AUC for PLR-APP was 0.84 （95%C/0.71-0.93）. PLR-APP predicted hypotension with a sensitivity of 73% and a specificity of 92%. Conclusions The fluid responsiveness assessment pre-sedation was found to predict blood pressure fluctuation during the induction of dexmedetomidine sedation. The PLR test conducted prior to sedation may be a useful tool to identify patients with a high risk of hemodynamic events and may be used to indicate the need for prophylactic treatment.