Background & Aims
Athlete Pain is underreported and has a significant impact on both performance and quality of life.1,2
The IASP definition of pain encompasses both physical and sensory elements.3 Additionally, the predictive processing model of pain established how pain affects how one interacts in the world.4 Athlete pain literature has embraced the biopsychosocial model with 5 domains being proposed for pain assessment; (neurophysiological, biomechanical, affective, cognitive, and socioenvironmental).5 Findings from a recent scoping review and focus groups provide contemporary data on athlete pain experiences and assessment highlighting key gaps in the use of affective, cognitive and socioenvironmental pain assessment tools to capture context-specific aspects of the athlete pain assessment experience.6,7,8
Aim: To develop an upper and lower limb athlete pain assessment framework through international Sport Physiotherapist consensus using real-time Delphi.
Methods
A real-time Delphi approach was chosen as a method of consensus generation.9
Sports Physiotherapists, with a minimum of 3 years’ experience, working with athletes weekly were recruited through national (Chartered Physiotherapists in Sports and Exercise Medicine, Ireland) and International ( International Federation for Sports Physical Therapists) bodies.
The initial survey, developed by combining findings of a recent scoping review with qualitative insights from athletes and physiotherapists contained a multidimensional, biopsychosocial range of 86 pain assessment items.
Participants were asked to rate their level of agreement regarding the inclusion of each assessment item on a 6-point Likert scale, alongside the frequency they felt each assessment item is required. Consensus criteria were set a priori as items where 70% of participants voted agree or strongly agree.10 Participants were invited to review their responses every 2 weeks over the 8-week duration of the study.
Results
A real-time Delphi approach was chosen as a method of consensus generation.9
Sports Physiotherapists, with a minimum of 3 years’ experience, working with athletes weekly were recruited through national (Chartered Physiotherapists in Sports and Exercise Medicine, Ireland) and International ( International Federation for Sports Physical Therapists) bodies.
The initial survey, developed by combining findings of a recent scoping review with qualitative insights from athletes and physiotherapists contained a multidimensional, biopsychosocial range of 86 pain assessment items.
Participants were asked to rate their level of agreement regarding the inclusion of each assessment item on a 6-point Likert scale, alongside the frequency they felt each assessment item is required. Consensus criteria were set a priori as items where 70% of participants voted agree or strongly agree.10 Participants were invited to review their responses every 2 weeks over the 8-week duration of the study.
Conclusions
A multidimensional athlete upper and lower limb pain assessment framework based on international sports physiotherapist consensus, qualitative insights and recent scoping review findings has been presented
Many traditional pain assessment items (neurophysiological & biomechanical) achieved consensus. Pain diaries for reflection, establishing the underlying mechanism, and screening for neuropathic pain were not included, perhaps due to time. Just 1 out of 4 severity scales, the Numerical Pain Rating Scale was included. Establishing current rehab and training load were voted essential aspects of wider biological assessments. Some multidimensional assessment tools from the affective, cognitive and socioenvironmental domains met consensus to be used often or sometimes. Aspects related to developing a strong therapeutic relationship and clear and open communication with the athlete and their wider network met consensus to always be included. Integrating technology into pain assessment divided opinions and should be carefully considered when developing future pain assessment solutions.
This research highlights a multidimensional international sport physiotherapist consensus-generated pain assessment framework to improve the assessment of athletes experiencing pain. The voice of the patient (athlete) has been integral in generating this framework including focus groups and a patient public involvement consultation, ensuring the relevance of this pain assessment framework to patient (athlete) care. The essential assessment items that should always be considered when assessing athletes are presented. Additionally, the wider list of multidimensional pain assessment items presented facilitates Physiotherapists to use their clinical reasoning and choose the relevant assessment items to deliver an individualised, tailored patient assessment that will lead to more targeted treatment and management choices and ultimately, improved patient care.
References
- Bahr, R. 2009. ‘No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports’, Br J Sports Med, 43: 966-72.
- Heerey, J. J., J. L. Kemp, A. B. Mosler, D. M. Jones, T. Pizzari, M. J. Scholes, R. Agricola, and K. M. Crossley. 2019. ‘What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis’, Sports Med, 49: 951-72.
- Raja, S. N., D. B. Carr, M. Cohen, N. B. Finnerup, H. Flor, S. Gibson, F. J. Keefe, J. S. Mogil, M. Ringkamp, K. A. Sluka, X. J. Song, B. Stevens, M. D. Sullivan, P. R. Tutelman, T. Ushida, and K. Vader. 2020. ‘The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises’, Pain, 161: 1976-82.
- Kiverstein, J, Kirchhoff, MD. and Thacker, M. 2022. ‘An Embodied Predictive Processing Theory of Pain Experience’, Review of Philosophy and Psychology.
- Hainline, B., W. Derman, A. Vernec, R. Budgett, M. Deie, J. Dvorak, C. Harle, S. A. Herring, M. McNamee, W. Meeuwisse, G. Lorimer Moseley, B. Omololu, J. Orchard, A. Pipe, B. M. Pluim, J. Raeder, C. Siebert, M. Stewart, M. Stuart, J. A. Turner, M. Ware, D. Zideman, and L. Engebretsen. 2017. ‘International Olympic Committee consensus statement on pain management in elite athletes’, Br J Sports Med, 51: 1245-58.
- Purcell C, Duignan C, Fullen BM, et al. Comprehensive assessment and classification of upper and lower limb pain in athletes: a scoping review. British Journal of Sports Medicine 2023:bjsports-2022-106380. doi: 10.1136/bjsports-2022-106380
- Purcell C, Barry Walsh C, Van Oirschot G, et al. Exploring athlete pain and pain assessment experiences and priorities; A three part qualitative series of athlete and physiotherapist interactions. Part One. “Through their eyes” – Athlete and physiotherapist pain experiences and perspectives. medRxiv
- Purcell C, Barry Walsh C, Van Oirschot G, Fullen BM, Ward T, & Caulfield BM. (2024). Exploring athlete pain and pain assessment experiences and priorities; A three-part qualitative series of athlete and physiotherapist interactions. Part Two. ‘Gauging and discerning – Athlete and physiotherapist pain assessment experiences and interactions. medRxiv, 2024.2001.2005.24300908. doi:10.1101/2024.01.05.2430090
- Gnatzy, Tobias, Johannes Warth, Heiko Von Der Gracht, and Inga-Lena Darkow. 2011. ‘Validating an innovative real-time Delphi approach – A methodological comparison between real-time and conventional Delphi studies’, Technological Forecasting and Social Change, 78: 1681-94.
- Diamond IR, Grant RC, Feldman BM, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 2014;67(4):401-9. doi: 10.1016/j.jclinepi.2013.12.002 [published Online First: 2014/03/04]
Presenting Author
Ciaran Purcell
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Pain in Athletes