RESUMEN
PURPOSE: To determine the reliability and validity of self-reported questionnaires to measure pain and disability in adults with grades I-IV neck pain and its associated disorders (NAD). METHODS: We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and systematically searched databases from 2005 to 2017. Independent reviewers screened and critically appraised studies using standardized tools. Evidence from low-risk-of-bias studies was synthesized according to best evidence synthesis principles. Validity studies were ranked according to the Sackett and Haynes classification. RESULTS: We screened 2823 articles, and 26 were eligible for critical appraisal; 18 were low risk of bias. Preliminary evidence suggests that the Neck Disability Index (original and short versions), Whiplash Disability Questionnaire, Neck Pain Driving Index, and ProFitMap-Neck may be valid and reliable to measure disability in patients with NAD. We found preliminary evidence for the validity and reliability of pain measurements including the Body Pain Diagram, Visual Analogue Scale, the Numeric Rating Scale and the Pain-DETECT Questionnaire. CONCLUSION: The evidence supporting the validity and reliability of instruments used to measure pain and disability is preliminary. Further validity studies are needed to confirm the clinical utility of self-reported questionnaires to assess pain and disability in patients with NAD. These slides can be retrieved under Electronic Supplementary Material.
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Evaluación de la Discapacidad , Dolor de Cuello/complicaciones , Dimensión del Dolor , Humanos , Reproducibilidad de los Resultados , Autoinforme , Encuestas y CuestionariosRESUMEN
PURPOSE: To determine the reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with grades I-IV neck pain and associated disorders (NAD). METHODS: We systematically searched electronic databases to update the systematic review of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Eligible reliability and validity studies were critically appraised using modified versions of the QAREL and QUADAS-2 instruments, respectively. Evidence from low risk of bias studies were synthesized following best evidence synthesis principles. RESULTS: We screened 14302 articles, critically appraised 46 studies, and found 32 low risk of bias articles (14 reliability and 18 validity studies). We found preliminary evidence of: 1) reliability of visual inspection, aided with devices (CROM and digital caliper) to assess head posture; 2) reliability and validity of soft tissue palpation to locate tender/trigger points in muscles; 3) reliability and validity of joint motion palpation to assess stiffness and pain provocation in combination; and 4) range of motion tests using visual estimation (in cervical extension only) or devices (digital caliper, goniometer, inclinometer) to assess cervical mobility. CONCLUSIONS: We found little evidence to support the reliability and validity of clinical tests to assess head posture, pain location and cervical mobility in adults with NAD grades I-III. More advanced validity studies are needed to inform the clinical utility of tests used to evaluate patients with NAD.
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Vértebras Cervicales/fisiopatología , Dolor de Cuello/diagnóstico , Dolor de Cuello/fisiopatología , Dimensión del Dolor/métodos , Postura/fisiología , Rango del Movimiento Articular/fisiología , Lesiones por Latigazo Cervical/diagnóstico , Lesiones por Latigazo Cervical/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: To update findings of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) on the validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck. METHODS: We searched four databases from 2005 to 2015. Pairs of independent reviewers critically appraised eligible studies using the modified QUADAS-2 and QAREL criteria. We synthesized low risk of bias studies following best evidence synthesis principles. RESULTS: We screened 679 citations; five had a low risk of bias and were included in our synthesis. The sensitivity of the Canadian C-spine rule ranged from 0.90 to 1.00 with negative predictive values ranging from 99 to 100%. Inter-rater reliability of the Canadian C-spine rule varied from k = 0.60 between nurses and physicians to k = 0.93 among paramedics. The inter-rater reliability of the Nexus Low-Risk Criteria was k = 0.53 between resident physicians and faculty physicians. CONCLUSIONS: Our review adds new evidence to the Neck Pain Task Force and supports the use of clinical prediction rules in emergency care settings to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck. The Canadian C-spine rule consistently demonstrated excellent sensitivity and negative predictive values. Our review, however, suggests that the reproducibility of the clinical predictions rules varies depending on the examiners level of training and experience.
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Vértebras Cervicales/lesiones , Técnicas de Apoyo para la Decisión , Tamizaje Masivo/métodos , Traumatismos Vertebrales/diagnóstico , Adulto , Canadá , Humanos , Traumatismos del Cuello/complicaciones , Dolor de Cuello/diagnóstico , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Sensibilidad y Especificidad , Heridas no Penetrantes/complicacionesRESUMEN
OBJECTIVE: To determine the reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. METHODS: We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders. We also searched the literature to identify studies on the reliability and validity of Doppler velocimetry for the evaluation of cervical arteries. Two independent reviewers screened and critically appraised studies. We conducted a best evidence synthesis of low risk of bias studies and ranked the phases of investigations using the classification proposed by Sackett and Haynes. RESULTS: We screened 9022 articles and critically appraised 8 studies; all 8 studies had low risk of bias (three reliability and five validity Phase II-III studies). Preliminary evidence suggests that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joints. The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling's and the upper limb neurodynamic tests. No evidence was found for doppler velocimetry. CONCLUSIONS: Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension-rotation test, neurological examination, Spurling's and the upper limb neurodynamic tests.
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Vértebras Cervicales , Tamizaje Masivo/métodos , Dolor de Cuello/diagnóstico , Radiculopatía/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Adulto , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Movimientos de la Cabeza , Humanos , Examen Neurológico/métodos , Reproducibilidad de los Resultados , Articulación Cigapofisaria/diagnóstico por imagenRESUMEN
In 36 children with nephrotic syndrome (NS) a significant decrease of their serum levels of the thymic-hormone--thymulin--was found, in parallel with a diminution of their mean blood zinc levels as compared to 33 control children. The serum level of thymulin normalized after the in vitro addition of ZnCl2. Similar results have previously been reported in mice subjected to a long term zinc deficient diet. It can therefore be assumed that the decreased biological activity of the thymic hormone noted in NS is secondary to a low serum zinc level. These data could explain certain anomalies of T lymphocytes described in childhood NS.
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Cloruros , Síndrome Nefrótico/sangre , Factor Tímico Circulante/metabolismo , Hormonas del Timo/metabolismo , Compuestos de Zinc , Adolescente , Niño , Preescolar , Humanos , Lactante , Nefrosis Lipoidea/sangre , Nefrosis Lipoidea/tratamiento farmacológico , Síndrome Nefrótico/tratamiento farmacológico , Zinc/sangre , Zinc/uso terapéuticoRESUMEN
2 brothers with identical HLA antigens presented an idiopathic membranous glomerulonephritis. This is, to our knowledge, the first report of familial membranous glomerulonephritis. The fact that both brothers had identical HLA antigens suggests a genetic predisposing background.
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Glomerulonefritis/genética , Adolescente , Preescolar , Femenino , Antígenos HLA/genética , Antígenos HLA-A , Antígenos HLA-B , Antígenos HLA-DR , Antígenos de Histocompatibilidad Clase II/genética , Humanos , Masculino , LinajeRESUMEN
The effect of methyl prednisolone therapy (PM) was studied in 18 children with severe idiopathic nephrotic syndrome (NS). Eight patients were defined as "corticosteroid-resistant" because there was no response to treatment after a minimum of 4 weeks of 2 mg/kg/day of prednisone; 10 patients had a corticosteroid-dependent NS with frequent relapses which occurred under a high threshold dose of prednisone (1 mg/kg/day). Each patient received 4-6 pulses of 1 g/1.73 m2 methylprednisolone. Tolerance was generally good. PM therapy permitted a more rapid remission than oral prednisone (average 9 +/- 4 days vs. 22 +/- 9 days). Remission occurred in 5 of the 8 corticosteroid-resistant patients three of these 5 patients developed corticosteroid-dependent NS. For the children with a corticosteroid-dependent nephrotic syndrome, PM therapy did not affect the threshold dose of prednisone.