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Home program instructions
I have started working on a draft for home program instructions to try and facilitate the educational component of the session, and support adherence. I have attached here, but would welcome some discussion on what should stay, go, be expanded, etc... and to hear from others what they are doing for this!
Comments
Great point - I often photocopy the allodynography diagram as the basis for this and colour it with red/yellow/green for no touch/caution/good zones for counterstimulation.
Red = do NOT touch
Orange = try not to touch
Green = Distant counterstimulation zone
See how ideas can be similar, discussed, and shared, even thought we're in 2 separated continents!!! That's the greatness of new technologies and this forum!!
My best regards to Toronto from Luxembourg! ;-)
May I ask, would you recommend a body chart style hand image as a standardized assessment tool to draw on rather than drawing a hand?
Hi Jeremy
I have done it both ways - a 'life size' diagram and a chart style image. Advantages to drawing your own is to draw in the plane of interest ie the back of the thumb with the forearm sitting in neutral rotation. Claude Spicher and the team at the Centre in Fribourg use life-size, and make precise, proportional notations. My experience with using the pre-drawn diagram is that works well as long as you are very clear about what your anatomical reference point is, and record your border points with clear measurement marks. In our research study where we generated reliability estimates for allodynography and the rainbow pain scale (unpublished data...working on the manuscript!), the therapists used pre-drawn diagrams that were roughly life-sized - we had left and right hands, and the front of the page represented the volar view, the back the dorsal view. We recorded the border points and drew lines connecting those points to the anatomical reference point with the distance measurement recorded in mm. So for example, if the neuroanatomical hypothesis is for the terminal fibres of the ulnar nerve, 3 of the points may be recorded on the volar view, with one transverse point on the dorsal view. What I can tell you is we saw good to excellent inter-rater (2 raters, same day) and test-retest reliability (same rater, 1 week later with no treatment inbetween), but didn't get sufficient numbers to have stable estimates for responsiveness. We also documented exactly where we tested the rainbow pain scale (and did the same reliability testing, with better inter-rater than test retest...suggesting stability over time may be more of an issue than summation on the day....?)
But more work needed...and replication by others... and would love to hear from anyone who has any other ideas or suggestions!