Copyrighted Material Craniofacial Dysfunction and Pain Copyrighted Material Copyrighted Material Copyrighted Material Butterworth-Heinemann Linacre House, J o r d a n Hill, Oxford O X D P 225 Wildwood Avenue, W o b u r n , MA 01801-2041 A division of Reed Educational and Professional Publishing Ltd A member of the Reed Elsevier pic group First published 2001 Reed Educational and Professional Publishing Ltd 2001 All rights reserved No part of this publication may be reproduced in any material form (including photocopying or storing in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright holder except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 T o t t e n h a m C o u r t R o a d , London, England W P 0LP Applications for the copyright holder's written permission to reproduce any part of this publication should be addressed to the publishers British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloguing in Publication Data A catalogue record for this book is available from the Library of Congress ISBN 7506 2963 Typeset by Bath Typesetting Printed and b o u n d by M P G Books Ltd, Bodmin, Cornwall FOR EVERY TITLE THAT WE PUBLISH BLTTERWORTH-HEINEMANN WILL FAY FOR BTCV TO PLANT AND CARE FOR A TREE Copyrighted Material Copyrighted Material Copyrighted Material Copyrighted Material Copyrighted Material Copyrighted Material 232 Craniofacial Dysfunction and Pain Table 2,2, The Neck Disability Index (Reformatted with permission of authors Vernon/HaglnO 1987, for publication and distribution) This questionnaire has been designed to give the doctor information as to how neck has affected your ability to manage in everyday life, Please answer every section and mark in each only ONE box which applies to you, We realize you may consider that two of the statements in any one section relate to you, but please just mark the one box which mosl closely describes your problem, o o o o Pain intensity I have no pain at the moment The pain is very mild at the moment moderate at the moment The pain The pain is fairly severe at the moment The pain is very severe at the moment The pain is the worst imaginable at the moment 2, Personal care (washing, dressing etc,) D I can look after myself normally without causing extra pain o I can look after myself normally but it causes extra It is painful to look after myself, I am slow and personal care o I need some help but manage most of self care o I need help every day in most aspects o I don't get dressed, wash with difficulty and stay in bed, o o o Lifting without extra pain I can lift heavy I can lift heavy me extra but it the floor, but I can manage if they are conveniently positioned, for weights Pain prevents me from lifting example on a table, o Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned I can lift very light weights o I cannot lift or carry anything at all Reading o I can read as much as I want to with no pain in my neck, o I can read as much as I want to with slight pain in my neck D I can read as much as I want with moderate neck pain, o I can't read as much as I want because of moderate neck pain o I can hardly read at all because of severe pain in my neck I cannot read at all Headaches o I have no headaches at all headaches which come infrequently o I have headaches which come infrequently o I have o I have moderate headaches which come frequently o I have severe headaches which come frequently o I have headaches almost all the time Concentration D I can concentrate fully when I want to with no difficulty o ! can concentrate fully when I want to with slight difficulty when I want to o I have a fair degree of difficulty in o I have a lot of difficulty in concentrating when want to o I have a great deal of difficulty in concentrating when I want to, o I cannot concentrate at all 7, Work o I can as much work as I want to o I can only my usual work, but no more o I can most of my usual work, but no more o I cannot my usual work D I can hardly any work at all D I can't any work at all [] o o Driving I can drive my car without neck pain, neck I can drive my car as long as want with my neck I can drive my car as long as I want with pain in my neck I can't drive my car as long as I want because of D I can hardly drive at all because of severe pain in my neck I can't drive my car at all Copyrighted Material Clinimetrics for the clinician Table 12.2 The Neck Disability Index 233 (continued) Sleeping o I have no trouble sleeping o My sleep is slightly disturbed (less than h sleepless) o My sleep is mildly disturbed (1-2 h sleepless) o My sleep is moderately disturbed (2-3 h sleepless) o My sleep is greatly disturbed (3-5 h sleepless) o My sleep is completely disturbed (5-7 h sleepless) 10 Recreation o I am able to engage in all my recreation activities with no neck pain at all o I am able to engage in all my recreation activities, with some pain in my neck o I am able to engage in most but not all of my usual recreation activities because of pain in my neck o I am able to engage in a few of my usual recreation activities because of pain in my neck o I can hardly any recreation activities because of pain in my neck o I can't any recreation activities at all Scoring the Neck Disability Index (NDI) This is a 'neck' variation of the Oswestry Low Back Disability Scale, but fashioned with modern Canadian language Score each section out of total 10, top box gets 10, next 8, then 6, down to For example: Pain intensity 10 I have no pain at the moment The pain is very mild at the moment The pain is moderate at the moment The pain is fairly severe at the moment The pain is very severe at the moment ° The pain is the worst imaginable at the moment This sample is constant for each section Note that the total score is a positive 100, meaning a fully functional person with no disabilities Range: Severe < 50, moderate> 50, mild> 80, near normal > 90 Beaton et ? l, af for instance, compared 23 indicative o f good reliability Only the five generic indexes in workers with mus­ Duke Health Profile overall score appeared culoskeletal disorders They included the 22 S F -36, Nottingham Health Profile to be of insufficient reliability in the study l of Beaton? (NHP), Health Status Ontario Health Survey of the Section (OHS), As the S F-36 and the Sickness Impact Duke Profile are widely used in studies worldwide Health Profile and Sickness Impact Profile and in several languages, (SIP) next to a self-report of change in elaborated upon A wealth of information these will be health between repeated tests In subjects concerning the SF-36 can be found at their with reported change in health the S F-36 Internet site (www.sf36.com) According to appeared to be the most responsive, with their site: 'This comprehensive short-form moderate to large effect sizes (0.55-0.97) with only 36 questions yields an 8-scale The authors also determined the test-retest health profile as well as summary measures reliability of the indexes which were: for of health-related quality of life' As docu­ SF-36 overall, ICC mented in more than 750 publications, the = 0.85; for NHP overall, ICC=0.95; for Duke overall, ICC=059; SF-36 has proven useful in monitoring for OHS overall, ICC=0.78; and for SIP 2l overall, ICC=0.93 Beaton also presents general and specific populations, compar­ reliability coefficients for subscales of the entiating the health benefits produced by ing the burden of different diseases, differ­ indexes such as SF-36-pain and SF-36- different treatments, and in screening in­ physical function and SI P-physical func­ 23 tion Portney and Watkins have sug­ dividual patients Next to the SF-36 there gested page, 2-minute survey form has been shown that an I CC above 0.75 is exists the SF-12 This even shorter one­ Copyrighted Material 234 Craniofacial and Pain to yield summary physical internationally acceptable 12, populations shortform, which was published is already one early most surveys Translations of the used SF-36 and SF- 12 are being tested more than countries as part the International Discussion ( IQOLA) Pro- Quality of An important both for clinicians and researchers, is whether one be to assess the patient or (such as a a condition-specific and a use routinely granted to indivi- duals and organizations their own use Via the website it is possible to 36 to ul" a�'c the SF- been applied The changes severity, as a measure index) should be used to fully understand the patient's Enloe and question in patients 34 ease They used the 35 Inventory (DHI ) as a and the relevant to craniocervical tions; example, by Gliklich a n d Hilinski2 for ethmoid sinus for chronic sinusitis and by Boline randomized clinical effectiveness in a el to determine spinal manipulation for chronic tension-type more, the SF-36 has researched for all reliability and validity items showing erties? ,2 methodological prop­ emotional score J4 Shields Enloe that conclude two indexes different information about status patients with vestibular Ul"'",a,,c; An important conclusion for both clinician IS health measures can found in the literature international (ran- cannot on a that one this index to fully describe patients In contrast, Riddle and Stratford3 found in with that when NDI and substantial generic Copyrighted Material Clinimetrics for the clinician overlap, thus inferring that the two indexes are fairly interchangeable and only one index should suffice There appears to be a promising field of research into the (non)interchangeability of disease- or condition-specific, dimension­ specific and generic indexes in patients with diseases in the craniofacial region 235 References Wright, G and Feinstein, A R (1992) A compara­ tive contrast of clinimetric and psychometric methods for constructing indexes and rating scales J Clin Epidemiol.,45, 1201-1218 Feinstein, A R (1987) Clinimetrics Yale University Press Blumenthal, D (1996).Quality of health care Part I: Quality of care - what is it? N Engl Merl., 335, 891894 Brook, R H and McGlynn, E A (1996) Quality of health care Part 2: Measuring quality of care N Engl Med., 335, 96Cr-970 Conclusion Chassin, M R (1996) Quality of health care Part 3: Improving the quality of care N Engl J Med., 335, Much research has already been performed on a large number of indexes applicable in the craniocervical and craniofacial regions Although some issues still need to be addressed, the applicability of indexes in this specific region of the human body seems clear Many other indexes have not been described but can be found via Med­ Qj' line or other retrieval systems or via the Internet Blumenthal, D (1996) Quality of health care Part 4: The origins of the quality-of-care debate N Engl Med., 335, I 14Cr-1149 Berwick, D M (1996) Quality of health care Part 5: Payment by capitation and the quality of care N Engl Med., 335,1227-1231 Blumenthal, D and Epstein, A M (1996) Quality of health care Part 6: The role of physicians in the future of quality management N Eng/ J Med., 335, 13281331 European Research Group on Health Outcomes (ER­ GHO) Although indexes may be researched for reliability and validity issues, they are ultimately intended for clinicians and their patients, 1060-1063 and policy makers Clinicians should be aware of the powerful properties of indexes for evaluation of individual patients in an era where payment for therapy is no longer unlimited Indexes are important instruments that enable the production of reliable outcome measures for the chosen therapy Furthermore, indexes can be used to evaluate the patients' progress during treatment periods and thus enable the clinician to adjust the amount or type of therapy given during this period Health indexes can serve as a vehicle to emancipate clinicians and to convince society at large of the effectiveness and efficiency of thera­ Outcome Measurement ERGHO/ERGHO_Iustruments.html 10 World Health Organization (1989) International Classi­ fication of Impairments, Disabili/ies and Handicaps (ICIDH) WHO II Medical Outcomes Trust SAC Instrument Rel'iew Criteria hllp://www.Outcomes-Trust.Org/bulletin/ 34sacrev.htm 12 Cole, B., Finch, E., Gowland, C and Mayo, N (1994) Physical Rehabilitation au/come Measures, 2nd edn Canadian Physiotherapy Associftlion 13 Benninger, M S and Brent, A Sr (1997) The development of the Rhinosinusitis Disability Index Arch Otolaryngol Head Neck S1Irg., 123, 1175-1179 14 VanSwearingen, J M and Brach, J S (1996) The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system Phys Ther., 76, 1288- 1300 15 VanSwearingen, J M and Brach, J S (1998) Valida­ tion of a treatment-based Finally, the use of (reliable and valid) pies given to patients Choosing a Instrument htt p://www.meb.uni-boon.de/standards/ individuals with facial classification system for neuromotor disorders Phys Ther., 78, 678-{i89 16 Vernon, H and Mior, S (1991) The Neck Disablity Index: a study of reliability and validity Mani" Physiol Ther., 14, 409-415 17 Fairbank, J C T., Couper, J., Davies, J B and O'Brien, J P (1980) The Oswestry Low Back Pain Disability Index Physiother (London), 66, 271-273 Copyrighted Material 236 Craniofacial Dvsfunction and Pain 18 Haines, F., Waalen, j and Mior, S (1998) Psycho­ scaling assumptions and reliability across diverse patient groups Med Care, 32, 40-66 metric properties of the Neck Disability Index J 28 Bergner, M., Bobbit, R A., Pollard, W E el al (1976) Manip Physio/ Ther., 21, 75-80 The sickness impact profile: validation of a health status 19 Verhoef, M J., Page, S A and Waddell, S C (1997) measure Med Care, 14 , 57-67 The Chiropractic Outcome Study: pain, functional ability and satisfaction with care Manip Physiol 29 Pollard, W, E., Bobbitt, R A., Bergner, M Ther., 0, 235-240 el al ( The sickness impact profile: reliability of a health status measure :'vfed Care, 14, 146-155 20 Weslaway, M D., Stratford, P W and Binkley, j M (1998) The Patient-Specinc Functional Scale: validation 30 De Bruin, A P., Diederiks, J P M., de Witte, L P of its use in persons with neck dysfunction JOSPT, 27, el al (1994) The development of a short generic of the sickness impact profile Clin Epidemiol., 47,407-418 331-338 21 Beaton, D E., Hogg-]ohnson, S and Bombardier, C 31 De Bruin, A F., Buys, M., de Witte, L P and (1997) Valuating changes in health status: reliability Diedcriks, j P M (1994) The sickness impact profile: and responsiveness of five generic health status measures SIP68, a short generic version, first evaluation of the in workers with musculoskeletal disorders J Clin Epidemiol., 50, 79-93 reliability and reproducibility Clin Epidemiv{., 47, 863-871 22 SF-36.htlp:jjwww.sf36.com 32 Carlsson, J., Augustinsson, L E., Blomstrand, C and 23 Portney L G and Watkins, M P (1993) Foundations o f Clinical Research Applica/ions IV Pra c tice Appleton Sullivan, M (1990) Health status in patients with tension headache treated with acupuncture or phy· & Lange siotherapy Headache, 30, 593-599 24 Gliklich, R E and Hilinski, M (1995) Longitudinal 33 Hammill, J M., Cook, T M and Rosecrance, J C sensitivity of generic and specific health measures in (1996) Effectiveness of a physical therapy regimen in the chronic sinusitis Qual Life Res , 4, 27-32 treatment 25 Boline, P D., Kassak, K., Bronfort, G et a/ (1995) tension-type headache Headache, 36, 149- 153 amitriptyline for the treatment 34 Enloe, L j and Shields, R K (1997) Evaluation of of chronic tension-type headaches: a randomized clinical health-related quality of life in individuals with vestib­ trial J Manip Physiol Ther., 18, 148-154 ular disease using disease-specific and general outcome Spinal manipulation measures Phys The!'., 77, 890-903 26 McHorney, C A.,Ware, j E and Raczck, A E (1993) The MOS 36-Item Short-Form Health Survey (SF-36): 35 Jacobson, G P and Newman, C W (1990) The II Psychometric and clinical tests of validity in development of the dizziness handicap inventory Arch measuring physical and mental health constructs Aled Care, 31, 247�263 O/o/aryngo/ Head Neck SlIrg., 116, 424-427 36 Riddle, D L and Stratford, P W (1998) Usc of generic 27 McHorney, C A., Ware, j E., Lu, J F R and versus region-specitic functional status measures on Sherbourne, C D (1994) The MOS 36-ltem Short­ patients with cervical spine disorders Phy.) Ther" 78 Form Health Survey (SF-36): III Test of data quality, 951-963 Copyrighted Material Glossary Abnormal generating sites (AIGS) CGRP (Calcitonin gene related peptide) A Persistent sites abnormal neurotransmitter dominantly gen- by the axon These sites may be the result Injury or pathobioiogical consequences of or axoplasmatic Cleft palate Congenital fissure with cleft Adenoidectomy An operation moval of unencapsulated tissue nasopharynx (adenoids) in P with median line of the palate, often changes the perseen which is nervous in the U"�'V'-"'U occurs as a feature of a syndrome or Syno- nym: palatoschisis ALiodynia Pain that from a Clinical pattern Collection of which would not be symptoms commonly presenting situation be primary (from the 111 (from the Clivus The a from the average or Anomaly norm: anything that is structurally unusual magnum composed of of the body of the sphenoid and part of the basal part of or contrary to the or surface from the dorsum to the occipital Connection between branches of Concurrent validity nerves is an example of an anomaly deals with whether an inference is Impulses Antidrome a peri ph- opposite direction Are an important role able at the Concurrent validity time Conjunctivitis Inflammation of tiva (the mucous membrane In eyeball surface Axonal transport The mechanisms by surface of axoplasm is moved in the axon cylinder, Construct validity including argument in which matrix and parts develop the lids) Is on a supports the idea that a measurement what one wants to measure Bruxism Diurnal or nocturnal Content validity tional including clenching, the gnashing, grinding of teeth Copyrighted Material of validity concerns the 238 Craniofacial Dysfunction and Pain Craniosynostosis Premature Handicap Any the cranial sutures resulting in malforma­ individual, resulting from impairment or a the skull caused by abnormal stress- disability for a given limits or prevents the fulfil­ ment of a role that is normal for that Cystectomy of the bladder or removal of a individual The Diplopia Double society, culture Disability Any or inability from an impairment) to normal range a human being of disturbances are in function at the level the person people's life (definition 111 ICIDH) Hyperalgesia More than normal for a painful stimulus that would Can primary (from the tissue) or secondary (from the central nervous sys­ (definition of the ICIDH) Drop attacks Attacks of tem) or Hypoplasia Underdevelopment of) consciousness experi- Dysaesthesiae absence people who as or an in the manner or within considered handicap deals with the relationship that evolves or organ, usually stimulation to a cells or atrophy source A disturbance language due to emotional stress, to or to paralysis, in and not the reduction in to a Intraclass correlation coefficient (ICC) In­ dex of reliability of Endosteum Tissue that is an analysis Difficulty in swallowing border be­ Impairment Any or abnormality of a tween the medullary cavity and bone matrix psychological or anatomical structure ENT specialist Doctor who function Impairments are level ear, nose, and of of structures of Synonym: otorhinolar- at the organ ICIDH) Incarnation Form Inquiry Face validity Face validity whether a test Investing layer to what it IS to matrix in which it takes Irritability A very little activity to cause the twitching, which then take a long time to subside groups (fasciculi) fibres, a coarser form of muscular contrac­ High tion than highly mechanical F u nc t i o n a l development rceptible (growth) result, logically arising from irritability and matrix, lined by by a fibre i.e a suture of periodontium a result chemically-sensitive secretion of tears, espe- craniometric of the Gomphosis Joint in often structures In Lacrimation direct is and at the lambdoid sutures Malfunction A functional process to pathological Copyrighted Material Glossary variation U nu- Malocclusion 239 Periaqueductal grey (PAG) Region of the and upper sual biological or functional which has a concentration of neurons between the maxillary and mandibular are capable of producing powerful neurotrans- teeth The usual Mitosis that can of conslstmg reproduction of tive impulses quence of modifications of that is the border be- Periosteum formation of two that modulate matrix and surrounding same that Phenomenology The description of cell occurrences of any and Morphology The with the or the structure of human or extraordinary, whether relation to the pathology or clinical pattern Photalgia Light-induced pain (usually eye and pain) To change in shape: the adaptation the Photophobia A voidance of canal Nasion A point on skull corresponding to nasofrontal suture middle of Synonym: an of undue anxiety about eyes, photosensitivity and photalgia Study mals in an evolutionary process point Plagiocephaly An Neural container The direct environment due to the nervous Neuroblastoma A neoplasm by embryonic Neurodynamics doid and coronal sutures on by an oblique nerve cells of the cranium The between Pneumatization The development of air nervous such as of mastoid and bones Nocebo anymore or makes the patient worse, consciousness without the Pneumatized Air developed in the mastoid and ethmoidal bones clinician '>""' rnl Nosology Assumption of au,,,,",,,,,,", from a measurement outcome to the future Ontogeny The study Prognathic Having a forward projection of o individual Open the development jaws beyond from system Pterion A craniometric point at the environment and is not thermodynamic accessory intervertebral movements which test/restore glid- movements one on another \\\\,;�\o\o�ka\ \nte,t�e,tte,\)ta\ mo'ie,­ ments Manual techniques which test/restore physiological movement tebrae tion of the squamous Otorhinolaryngologist Manua! established normal relationship with the cranial An that is in continuous �'''