5 95 Standardized Pain Mapping for Diagnosing Achilles Tendinopathy DISCUSSION This is the first study to explore the utility of a patient-administered standardized pain map for the diagnosis of Achilles tendinopathy. This study showed that in 9 out of 10 patients who reported pain in the Achilles tendon region on a pain map the clinical diagnosis of Achilles tendinopathy was made. The Kappa coefficient of 0.86 was considered to be almost perfect. There was also substantial agreement (82%, kappa = 0.67) between the location of most pain on the pain map and the location of symptoms that was established by the sports physician. This level of agreement was higher in patients who marked the midportion region compared to patients who marked the insertional region (92% vs. 72%). Overall, approximately 4 out of 5 patients selected the same region as the sports physician. These findings show that a patient-administered standardized pain map could aid clinicians and researchers in estimating the likelihood of the diagnosis Achilles tendinopathy. This is important information for the development of future self-management programs in first line healthcare and for accurate diagnosis in large epidemiological studies. The pain map could also be used as a screening tool for potentially eligible patients in clinical studies or for triage in clinical care. Self-reported injury locations are frequently used as an outcome measure in epidemiological studies.21-24 These locations are often interpreted as self-reported diagnoses, but for many injuries the agreement between pain location and a specific diagnosis is unknown. Several studies on Achilles tendinopathy did not use a pain map when assessing the location of the pain.21,23,24 Other studies did use a pain map, but without knowledge of the agreement between this outcome measure and the diagnosis. It is therefore important that the level of agreement between self-reported outcome measures, such as a pain map, and specific diagnoses are known. We compared the use of pain mapping in the current study with previous studies on this subject. A previous study used a self-administered pain map to classify participants with patellar tendinopathy.13 45 participants who were diagnosed with patellar tendinopathy with this method were asked to take part in a randomized control trial. In order to confirm eligibility to participate in this trial, participants were assessed by a senior sports medicine physician who confirmed the diagnosis of patellar tendinopathy in 44 of the 45 (97%) participants. This suggests the level of agreement between patient reported pain and the diagnosis of patellar tendinopathy to be similar compared to Achilles tendinopathy (97% vs 93%). In a recent randomized controlled trial, the same method was used for screening purposes.25 While the pain map suggested the diagnosis of patellar tendinopathy in 101 subjects, this could only be confirmed in 76 subjects (75%) using clinical examination and ultrasound as confirmation. Patients with knee osteoarthritis were able to adequately identify different pain locations on a pain map, with good test-retest reliability.26 Trained researchers could reliably record
RkJQdWJsaXNoZXIy MTk4NDMw