An Improved CREAM Model Based on DS Evidence Theory and DEMATEL

Cognitive Reliability and Error Analysis Method(CREAM)is widely used in human reliability analysis(HRA).It defines nine common performance conditions(CPCs),which represent the factors thatmay affect human reliability and are used to modify the cognitive failure probability(CFP).However,the levels of CPCs are usually determined by domain experts,whichmay be subjective and uncertain.What’smore,the classicCREAMassumes that the CPCs are independent,which is unrealistic.Ignoring the dependence among CPCs will result in repeated calculations of the influence of the CPCs on CFP and lead to unreasonable reliability evaluation.To address the issue of uncertain information modeling and processing,this paper introduces evidence theory to evaluate the CPC levels in specific scenarios.To address the issue of dependence modeling,the Decision-Making Trial and Evaluation Laboratory(DEMATEL)method is used to process the dependence among CPCs and calculate the relative weights of each CPC,thus modifying the multiplier of the CPCs.The detailed process of the proposed method is illustrated in this paper and the CFP estimated by the proposed method is more reasonable.

Real-World Evidence in Localized Pancreatic: Coping with Uncertainty in Unselected Populations

Background: Localized pancreatic cancer, including resectable (R), borderline resectable (BR) and locally advanced unresectable disease (LAU), is considered in clinical guidelines for diverse treatment options based on clinical trials in selected populations. Hence, exploring with real world evidence (RWE) clinicians’ preferences for treatment options and their results seems pertinent. Methods: In a set of consecutive patients with localized pancreatic cancer assisted in a third level hospital from January 2013 to December 2022, medical records, symptoms, diagnostic process, distribution between subtypes, and treatment plans, with safety and efficacy results, were assessed. Results: A total of 152 patients with localized disease were included (43.4% R, 21.0% BR, 33.6% LAU). The population characteristics exemplified differences between daily practice and clinical trials. Tumor location and symptoms were as expected. Treatment plan was conditioned by PS or comorbidities in 23.0% of patients. In patients with R disease, surgery followed by different adjuvant chemotherapy (CT) regimes was the antineoplastic treatment of choice (64.8%) with efficacy results (OS 37.5 months;95% CI 18.4 - 56.7), in the range of contemporary standards. The common use of neoadjuvant CT for BR disease (94.4%), with surgery in 50% of them, and its results (OS 30.8 months;95% CI 10.5 - 51.2) reflected current controversies of treatment recommendations and evolution in this scenario. Paliative CT with or without radiotherapy was the standard specific treatment in LAU disease (95.1%) with survival results (PFS: 10.8 months;95% CI 8.8 - 12.7. OS: 20.3 months;95% CI 13.5 - 27.2) that justify the distinct character and the specific study of this entity. Conclusion: RWE for localized pancreatic cancer aroused from the analysis of this population confirms the distinct nature of patients assisted in daily practice, as well as mirrors the complexity of decision making in clinical assumptions in which achieving stronger evidence should be paramount.

Genetic Evidence for Causal Association Between Hypertension and Chronic Pain:A Bidirectional Two-Sample Mendelian Randomization Study

Objective The extent to which the association between hypertension and chronic pain in observational studies is either causally linked or influenced by other shared risk factors has not been substantially addressed.In the present study,Mendelian randomization(MR)was employed to examine the potential causal relationship between hypertension and risk of chronic pain.Methods The study data were derived from the pooled dataset of the genome-wide association study(GWAS),enabling the evaluation of the causal effects of hypertension on various types of chronic pain including chronic headache as well as chest,abdominal,joint,back,limb,and multisite chronic pain.We performed a bidirectional two-sample MR analysis using random effect inverse variance weighting(IVW),MR-Egger,weighted median,and weighted mode,quantified by odds ratio(OR).Results Genetically predicted essential hypertension was associated with an increased risk of chronic headache(OR=1.007,95%CI:1.003-1.011,P=0.002)and limb pain(OR=1.219,95%CI:1.033-1.439,P=0.019).No potential causal associations were identified between chronic pain and essential hypertension in the reverse direction MR(P>0.05).In addition,there was no potential causal association between secondary hypertension and chronic pain(P>0.05).Conclusion This study provided genetic evidence that a unidirectional causal relationship exists between essential hypertension and the increased risks of chronic headache and limb pain,and no causal relationship was found between secondary hypertension and chronic pain.These findings offer theoretical underpinnings for future research on managing hypertension and chronic pain.

Are case reports valuable?Exploring their role in evidence based medicine and patient care

Case reports,often overlooked in evidence-based medicine(EBM),play a pivotal role in healthcare research.They provide unique insights into rare conditions,novel treatments,and adverse effects,serving as valuable educational tools and generating new hypothesis.Despite their limitations in generalizability,case reports contribute significantly to evidence-based practice by offering detailed clinical information and fostering critical thinking among healthcare professionals.By acknowledging their limitations and adhering to reporting guidelines,case reports can contribute significantly to medical knowledge and patient care within the evolving landscape of EBM.This editorial explores the intrinsic value of case reports in EBM and patient care.

Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

An Evidence-Based CoCoSo Framework with Double Hierarchy Linguistic Data for Viable Selection of Hydrogen Storage Methods

Hydrogen is the new age alternative energy source to combat energy demand and climate change.Storage of hydrogen is vital for a nation’s growth.Works of literature provide different methods for storing the produced hydrogen,and the rational selection of a viable method is crucial for promoting sustainability and green practices.Typically,hydrogen storage is associated with diverse sustainable and circular economy(SCE)criteria.As a result,the authors consider the situation a multi-criteria decision-making(MCDM)problem.Studies infer that previous models for hydrogen storage method(HSM)selection(i)do not consider preferences in the natural language form;(ii)weights of experts are not methodically determined;(iii)hesitation of experts during criteria weight assessment is not effectively explored;and(iv)three-stage solution of a suitable selection of HSM is unexplored.Driven by these gaps,in this paper,authors put forward a new integrated framework,which considers double hierarchy linguistic information for rating,criteria importance through inter-criteria correlation(CRITIC)for expert weight calculation,evidence-based Bayesian method for criteria weight estimation,and combined compromise solution(CoCoSo)for ranking HSMs.The applicability of the developed framework is testified by using a case example of HSM selection in India.Sensitivity and comparative analysis reveal the merits and limitations of the developed framework.

Non-alcoholic fatty liver disease in type 2 diabetes:Emerging evidence of benefit of peroxisome proliferator-activated receptors agonists and incretin-based therapies

Nonalcoholic fatty liver disease(NAFLD)is a global epidemic,affecting more than half of the people living with type 2 diabetes(T2D).The relationship between NAFLD and T2D is bidirectional and the presence of one perpetuates the other,which significantly increases the hepatic as well as extrahepatic complications.Until recently,there was no approved pharmacological treatment for NAFLD/nonalcoholic steatohepatitits(NASH).However,there is evidence that drugs used for diabetes may have beneficial effects on NAFLD.Insulin sensitizers acting through peroxisome proliferator-activated receptor(PPAR)modulation act on multiple levels of NAFLD pathogenesis.Pioglitazone(PPARγ agonist)and saroglitazar(PPARα/γagonist)are particularly beneficial and recommended by several authoritative bodies for treating NAFLD in T2D,although data on biopsyproven NASH are lacking with the latter.Initial data on elafibanor(PPARα/δ agonist)and Lanifibranor(pan PPAR agonist)are promising.On the other hand,incretin therapies based on glucagon-like peptide-1(GLP-1)receptor agonists(GLP-1RA)and dual-and triple-hormone receptor co-agonists reported impressive weight loss and may have anti-inflammatory and antifibrotic properties.GLP-1 RAs have shown beneficial effects on NAFLD/NASH and more studies on potential direct effects on liver function by dual-and triple-agonists are required.Furthermore,the long-term safety of these therapies in NAFLD needs to be established.Collaborative efforts among healthcare providers such as primary care doctors,hepatologists,and endocrinologists are warranted for selecting patients for the best possible management of NAFLD in T2D.

Sedimentary environment and organic matter accumulation of Wufeng-Longmaxi shales,southwest Yangtze Plate,China:Insights from geochemical and petrological evidence

Upper Ordovician-Lower Silurian Wufeng-Longmaxi Formation is the most developed strata of shale gas in southern China.Due to the complex sedimentary environment adjacent to the Kangdian Uplift,the favorable area for organic-rich shale development is still undetermined.The authors,therefore,focus on the mechanism of accumulation of organic matter and the characterization of the sedimentary environment of the Wufeng-Longmaxi Shales to have a more complete understanding and new discovering of organic matter enrichment and favorable area in the marginal region around Sichuan Basin.Multiple methods were applied in this study,including thin section identification,scanning electron microscopy(SEM)observations and X-ray diffraction(XRD),and elemental analysis on outcrop samples.Five lithofacies have been defined according to the mineralogical and petrological analyses,including mudstone,bioclastic limestone,silty shale,dolomitic shale,and carbonaceous siliceous shale.The paleo-environments have been reconstructed and the organic enrichment mechanism has been identified as a reduced environment and high productivity.The Wufeng period is generally a suboxic environment and the early Longmaxi period is a reducing environment based on geochemical characterization.High dolomite content in the study area is accompanied by high TOC,which may potentially indicate the restricted anoxic environment formed by biological flourishing in shallower water.And for the area close to the Kangdian Uplift,the shale gas generation capability is comparatively favorable.The geochemical parameters implied that new favorable areas for shale gas exploration could be targeted,and more shale gas resources in the mountain-basin transitional zone might be identified in the future.

Preceptors'experiences in guiding nursing students to use research findings and to implement evidence-based practice

Objective:Evidence-based practices(EBPs)have been taught to students by identifying the best evidence/evidence from research results.However,the experiences of Indonesian nurse preceptors in helping students implement research findings have not been explored thoroughly.This study aimed to explore Indonesian nurse preceptors in guiding nursing students to use research findings.Methods:This study used interpretive phenomenology analysis that involves 9 nurse preceptors from hospitals in West Kalimantan,Indonesia.Semi-structured in-depth interviews were recorded and then transcribed verbatim.Results:Three themes were generated during the analysis:“types of student supervision,”“issues during supervision,”and“the need for research literacy and supervision.”Conclusions:Nurse preceptors need support to supervise the nursing students to use research findings.In addition to upgrading nursing skills,nurse preceptors must receive training in research and its utilization.Developing an appropriate strategy to assist students in using research findings will enhance the promotion of evidence-based nursing practices on a daily basis.

Security Risk Assessment in Container Terminals:Empirical Evidence from Greece

The most prominent risk assessment techniques are founded on the values of measuring and controlling the frequency and the consequences of risks in order to assure an“acceptable level”of“safeness”mainly in the lines of environmental,health and hygiene and port product issues.This paper examines security risk assessment approaches within the emerging role of ports.This paper contributes to the current literature by considering the ports of Greece as a case in point and by measuring the degree of its security risk orientation based on certain valid risk factors drawn from the current literature.Moreover,it presents a security risk assessment methodology into the domain of port container terminals.Their potential for ports were quantitatively and qualitatively assessed by discussing issues of security approaches within the maritime industry,in order to facilitate improvement strategies.A two-dimension empirical study was conducted,in a time range of ten years(2010-2020)in order to provide evidence regarding security risk assessment in the port container terminal of Thessaloniki,in Greece.The findings of this study have significant strategic policy implications and shed more light on the role of security risks in the overall risk orientation of container terminals in practice.Finally,further research directions in security risk in ports are proposed.

Summary of the Best Evidence for Tube Feeding Intolerance in Critically Ill Children

Objective:To summarize the evidence of tube feeding intolerance in critically ill children,aiming to provide evidence-based information for clinical nursing staff.Methods:Evidence search was done in Chinese and English databases to guide network and professional associations at home and abroad.The search time limit was from January 2014 to January 2024,nearly 10 years of relevant literature,mainly including guidelines,consensus,expert advice,best practice,evidence summary,system evaluation,and meta-analysis.Literature quality evaluation and evidence extraction were independently performed by two researchers.Results:This paper included 13 articles,including three guidelines,three systematic evaluations,three expert opinions,and four expert consensus.Twenty-six pieces of evidence were summarized from 10 aspects of feeding intolerance definition,team building,nutritional assessment,nutritional preparation,feeding protocol,feeding route,feeding management,pipeline management,gastric residual volume,and drug application.Conclusion:This paper summarized the evidence of tube feeding intolerance in critically ill children,which can provide evidence-based information for clinical practice.The abdominal signs should be closely observed when evaluating feeding intolerance,focusing on the prevention and reduction of feeding interruption.

Strategies for Fostering Interaction in Online Classrooms:A Conversation Analysis of Teacher-Student Verbal Interaction in Random Questioning in Pandemic-Initiated Online Teaching

This paper aims to explore how a veteran teacher organizes online teaching initiated by the pandemic and how she deals with the problems in online teacher-student verbal interaction.By analyzing a corpus of 20 audio-recorded online lessons between a math teacher and her students during the COVID-19 pandemic from April 11 to May 10,2022,four interactional segments are selected as the focus of the study.The results of the conversation analysis of the segments showed that students’modesty,lack of confidence,lack of ability,and network delay are the main factors affecting online teacher-student interaction.By encouraging students to answer questions,enlightening students to give answers,enriching students’answers,and entertaining the teaching atmosphere(“4Es”strategies),the teacher solved the problems successfully.The findings from this study can provide pedagogical experience and implications for practical teaching.

Evidence-Based Nursing Practice of Reducing Immune-Related Skin Toxicity of Tumor Patients Guided by Sensitive Indicators

Purpose research on nursing sensitive indicators in tumor Patients application effect in immune-related skin toxicity management. Method select our hospital April to June, 202360 cases patients with immune therapy settings as the control group. August-October, 2023 60 cases the patients treated with immune therapy were the experimental group. The control group adopted regular nursing methods, while the experimental group sensitive Indicators, evidence-based give preventive care. The social situation, psychological state, physical function, quality of life score, incidence of skin toxicity caused by immune checkpoint inhibitors, moderate and above of the two groups of patients were compared. Incidence of skin toxicity. Result: experience group SAS score, SDS score higher than the control group, the difference was statistically significant (P < 0.05);The incidence of skin toxic reactions caused by immune checkpoint inhibitors and the incidence of moderate and above skin toxic reactions in the experimental group are lower than those in the control group, and the difference is statistically significant (P < 0.05). Conclusion: sensitive indicator guidance evidence-based preventive care can reduce the degree of immune-related skin toxicity, improve the psychological state and quality of life of tumor patients treated with immune therapy and reduce the incidence of adverse reactions, improve nursing quality and patient satisfaction.

Clinical Practice of Evidence-Based PDCA Cycle Management Model in Accelerated Recovery of Lung Cancer Patients

Objective: To explore the nursing effect of evidence-based PDCA cycle management mode in accelerated rehabilitation of patients undergoing thoracoscopic lung cancer radical surgery. Methods: 104 patients who underwent thoracoscopic lung cancer radical surgery in our hospital from June 2022 to February 2023 were randomly divided into control group and intervention group, with 52 cases in each group. The control group implemented evidence-based ERAS clinical pathway management, while the intervention group implemented evidence-based PDCA cycle quality management. The postoperative recovery of the two groups of patients was compared. Results: The postoperative recovery of the intervention group was significantly better than that of the control group. The first time to get out of bed, the first time to eat, the duration of chest drainage tube placement, and the length of hospital stay were significantly shorter than those of the control group. The incidence of postoperative chest complications and hospitalization costs were significantly lower than those of the control group, and patient satisfaction was significantly higher than that of the control group (P Conclusion: Evidence-based PDCA cycle quality management mode can effectively improve the implementation quality of accelerated rehabilitation nursing for patients undergoing thoracoscopic lung cancer radical surgery, and it is worthy of clinical promotion.

Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

Evaluating the quality of evidence for diagnosing ischemic heart disease from verbal autopsy in Indonesia

BACKGROUND Mortality and cause of death data are fundamental to health policy development.Civil Registration and Vital Statistics systems are the ideal data source,but the system is still under development in Indonesia.A national Sample Registration System(SRS)has provided nationally representative mortality data from 128 subdistricts since 2014.Verbal autopsy(VA)is used in the SRS to obtain causes of death.The quality of VA data must be evaluated as part of the SRS data quality assessment.AIM To assess the strength of evidence used in the assignment of Ischaemic Heart Disease(IHD)as causes of death from VA.METHODS The sample frame for this study is the 4,070 deaths that had IHD assigned as the underlying cause in the SRS 2016 database.From these,400 cases were randomly selected.A data extraction form and data entry template were designed to collect relevant data about IHD from VA questionnaires.A standardised categorisation was designed to assess the strength of evidence used to infer IHD as a cause of death.A pilot test of 50 cases was carried out.IBM SPSS software was used in this study.RESULTS Strong evidence of IHD as a cause of death was assigned based on surgery for coronary heart disease,chest pain and two out of:sudden death,history of heart disease,medical diagnosis of heart disease,or terminal shortness of breath.More than half(53%)of the questionnaires contained strong evidence.For deaths outside health facilities,VA questionnaires for male deaths contained acceptable evidence in significantly higher proportions as compared to those for female deaths.(P<0.001).Nearly half of all IHD deaths were concentrated in the 50-69 year age group(48.40%),and a further 36.10%were aged 70 years or more.Nearly two-thirds of the deceased were male(58.40%).Smoking behaviour was found in 44.11%of IHD deaths,but this figure was 73.82%among males.CONCLUSION More than half of the VA questionnaires from the study sample were found to contain strong evidence to infer IHD as the cause of death.Results from medical records such as electrocardiograms,coronary angiographies,and load tests could have improved the strength of evidence and contributed to IHD cause of death diagnosis.

Verbal Dyspraxia: A Case Study

Introduction: While approaching the aspect of learning disorders, particular attention is paid to verbal dyspraxia, a phenomenon that runs its course regularly over the last years. Verbal dyspraxia is inherent in the person without mental disorders and accompanies them throughout the whole spectrum of life. Comorbidity is an added issue. Although dyspraxia is met in homogeneous groups, some common elements such as intelligence, difficulty regarding linguistic skills, low learning performance and low self-esteem are present. Purpose: The object is to research how dyspraxia is manifested and how it affects a 6-year-old boy as well as the possibility of promptly interfering and simplifying his everyday life. Method: In the current case study, Achenbach’s questionnaire was used, combined with the use of expressive vocabulary. Results: The results of the research were unveiled through experts’ references in coordinance with the conferences conducted. Conclusion: Winding up, dyspraxia is a learning disorder that exists within the person through their lifespan. Immediate diagnosis, combined with experts’ personalized intervention programs (and perhaps, a differentiated curriculum, where applicable) can guide the person to live up to the educational needs. Family’s role is to be supportive, intending to eliminate possible emotional strains.

A novel adaptive temporal-spatial information fusion model based on Dempster-Shafer evidence theory

In the field of target recognition based on the temporal-spatial information fusion,evidence the-ory has received extensive attention.To achieve accurate and efficient target recognition by the evi-dence theory,an adaptive temporal-spatial information fusion model is proposed.Firstly,an adaptive evaluation correction mechanism is constructed by the evidence distance and Deng entropy,which realizes the credibility discrimination and adaptive correction of the spatial evidence.Secondly,the credibility decay operator is introduced to obtain the dynamic credibility of temporal evidence.Finally,the sequential combination of temporal-spatial evidences is achieved by Shafer’s discount criterion and Dempster’s combination rule.The simulation results show that the proposed method not only considers the dynamic and sequential characteristics of the temporal-spatial evidences com-bination,but also has a strong conflict information processing capability,which provides a new refer-ence for the field of temporal-spatial information fusion.

Religion and “Zero-Dose” Vaccination Status in Children Aged 12 to 23 Months in Benin and Togo: “Evidence of Demographic and Health Survey and Multiple Indicator Cluster Surveys”

Introduction: The relationship between religion and health has been a topic of interest in the past, and in recent years it has become increasingly visible in the social, behavioural, and health sciences. This work aims to study the influence of religion on the “zero-dose” vaccination status of children aged 12 - 23 months in Benin and Togo. Methods: This was a cross-sectional study which consisted in carrying out secondary analyzes using the databases of the most recent editions of the Demographic and Health Surveys in Benin and the Multiple Indicator Cluster Surveys (MICS) in Togo. We extracted data concerning the vaccination status (“1 = zero-dose”, “0 = vaccinated”) of the children, the religious affiliation of the head of the household or the mother and other variables related to the child, the mother, the household and the environment. By means of a logistic regression, the adjusted effect of the religious affiliation of the head of the household or of the mother on the vaccination status at “zero-dose” was determined. Results: A total of 2430 and 933 children were respectively included in the study on behalf of Benin and Togo. The prevalence of “zero-dose” vaccination status in children aged 12 - 23 months was 33.91% (95% CI = 31.67 - 36.23) in Benin and this prevalence was 26.88% (95% CI = 23.50 - 30.55) in Togo. In Benin, there is no evidence in favour of the influence of the religious affiliation of the mother on the “zero-dose” vaccination status of children. In Togo, children living in households whose head was Muslim (ORa = 3.44;95% CI = 1.29 - 9.13) were more likely to be “zero-dose” than those coming from households run by individuals with no religious beliefs. Conclusion: Further research is needed to understand the basis for the excess risk of “zero-dose” vaccination status in children that appears to be associated with the Muslim religion.

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.