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  • Patient expectations about a clinical diagnostic test may influence the clinician's test interpretation

    Author(s)
    Coppieters, Michel W
    Rehn, Börje
    Plinsinga, Melanie L
    Griffith University Author(s)
    Coppieters, Michel
    Plinsinga, Melanie
    Year published
    2021
    Metadata
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    Abstract
    Background With medical information widely available, patients often have preconceived ideas regarding diagnostic procedures and management strategies. Objectives To investigate whether expectations, such as beliefs about the source of symptoms and knowledge about diagnostic tests, influence pain perception during a clinical diagnostic test. Design Cross-sectional study. Methods Pain was induced by intramuscular hypertonic saline infusion in the thenar muscles. In line with sample size calculations, fifteen participants were included. All participants received identical background information regarding basic median nerve ...
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    Background With medical information widely available, patients often have preconceived ideas regarding diagnostic procedures and management strategies. Objectives To investigate whether expectations, such as beliefs about the source of symptoms and knowledge about diagnostic tests, influence pain perception during a clinical diagnostic test. Design Cross-sectional study. Methods Pain was induced by intramuscular hypertonic saline infusion in the thenar muscles. In line with sample size calculations, fifteen participants were included. All participants received identical background information regarding basic median nerve biomechanics and basic concepts of differential diagnosis via mechanical loading of painful structures. Based on different explanations about the origin of their induced pain, half of the participants believed (correctly) they had ‘muscle pain’ and half believed (incorrectly) they had ‘nerve pain’. Pain intensity and size of the painful area were evaluated in five different positions of the median nerve neurodynamic test (ULNT1 MEDIAN). Data were analysed with two-way analyses of variance. Results /findings: Changes in pain in the ULNT1 MEDIAN positions were different between the ‘muscle pain’ and ‘nerve pain’ group (p < 0.001). In line with their expectations, the ‘muscle pain’ group demonstrated no changes in pain throughout the test (p > 0.38). In contrast, pain intensity (p ≤ 0.003) and size of the painful area (p ≤ 0.03) increased and decreased in the ‘nerve pain’ group consistent with their expectations and the level of mechanical nerve loading. Conclusion Pain perception during a clinical diagnostic test may be substantially influenced by pain anticipation. Moreover, pain was more aligned with beliefs and expectations than with the actual pathobiological process.
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    Journal Title
    Musculoskeletal Science and Practice
    Volume
    54
    DOI
    https://doi.org/10.1016/j.msksp.2021.102387
    Subject
    Clinical sciences
    Publication URI
    http://hdl.handle.net/10072/404357
    Collection
    • Journal articles

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