Publications
14 results found
Kennedy D, Hettiaratchy S, Alexander C, 2024, Clinical evaluation of post-surgical scar hyperesthesia: a longitudinal observational pilot study, Scars, Burns & Healing, Vol: 10, ISSN: 2059-5131
IntroductionThe mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective clinical scar evaluation measures for future trials.MethodsWith ethical approval and consent, adults undergoing planned hand surgery were enrolled from one NHS hospital. At 1- and 4-months post-surgery scar thermal and mechanical pain thresholds were evaluated with quantitative sensory testing; peri-scar inflammation with infrared thermometry and pliability with durometry. Participation data were analysed with descriptive statistics; the association of clinical measures with patient reported scar pain was analysed.ResultsTwenty-one participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No adverse events or dropouts resulted from clinical scar evaluation. Seventy percent of participants reported undertaking topical, nonprescription scar treatment independently. Neuropathic Pain Symptom Inventory (NPSI) scores were dispersed across the score range, capturing variability in participant-reported scar symptoms. Scar morphology, pliability and inflammation were not associated with scar pain. Differences between scar and contralateral skin in thermal and mechanical pain sensitivity were identified.ConclusionPeople with acute hand scars participate in clinical research and independently initiate scar treatment. Clinical testing of acute post-surgical hand scars is well tolerated. The NPSI demonstrates utility for exploring scar pain symptoms and may support the elucidation of mechanisms of persistent scar pain. Clinical tests of thermal and mechanical and sensitivity are promising candidate clinical measures of scar pain for future trials.
Kemp HI, Kennedy DL, Vollert J, et al., 2023, Chronic pain and cognitive impairment: a cross-sectional study in people living with HIV, AIDS Care: psychological and socio-medical aspects of AIDS-HIV, Vol: 35, Pages: 1201-1214, ISSN: 0954-0121
Cognitive impairment and chronic pain are amongst the most prevalent neurological sequelae of HIV infection, yet little is understood about the potential bidirectional relationship between the two conditions. Cognitive dysfunction can occur in chronic pain populations whilst those with cognitive impairment can display modified responses to experimentally induced painful stimuli. To date, this has not been explored in HIV cohorts.This study aimed to identify any contribution of chronic pain to cognitive impairment in HIV and to determine differences in pain characteristics between those with and without cognitive dysfunction.This was an observational cohort study involving people living with HIV (n = 148) in the United Kingdom. Participants underwent validated questionnaire-based measurement of pain severity, interference and symptom quality as well as conditioned pain modulation and quantitative sensory testing. All participants completed a computer-based cognitive function assessment.Fifty-seven participants met the criteria for cognitive impairment and 73 for chronic pain. The cognitive impairment group had a higher prevalence of chronic pain (p = 0.004) and reported more neuropathic symptoms (p = 0.001). Those with chronic pain performed less well in emotional recognition and verbal learning domains. The interaction identified between chronic pain and cognitive dysfunction warrants further exploration to identify causal links or shared pathology.
Kennedy DL, Chism-Balangue T, Furniss D, 2023, Reporting of scar outcomes in the hand and wrist; a state-of-the-art literature review, BMC Musculoskeletal Disorders, Vol: 24, Pages: 1-11, ISSN: 1471-2474
ObjectivesThe aim of this literature review was to synthesise and report current practice in evaluation and reporting of scar outcomes in hand and wrist clinical research.MethodsA systematic search from inception to 2022 was conducted using three electronic databases. English language randomized controlled trials and observational cohort studies reporting standardised scar outcome measures and/or scar symptoms, appearance, impairment, function, or mental health outcomes in patients with hand and wrist scars were included. Two independent reviewers determined study eligibility and performed data extraction of a priori identified scar outcome domains. Data analysis included descriptive statistics and identification of discordance in taxonomy.ResultsFifty-nine studies were included. Elective surgery cohorts were the most frequently included clinical population (n = 28; 47%) followed by burns (n = 16; 27%). Six different standardised scar outcome measures were reported by 25% of studies however only 7% of studies utilised a patient-reported measure. Scar symptoms were the most frequently reported outcome domain (81%); but taxonomy was incongruous, constructs lacked working definitions required for generalisability and outcome measurement was variable and unreported. Nineteen different measures of scar appearance and structure were reported by 30 (51%) of studies however only nine (23%) were patient-reported. Seven different hand function PROMs were reported by 25 (43%) studies. Person-centred domains including scar acceptability (12%), mental health impact (5%), and social participation (4%) were rarely reported.ConclusionsThis review highlights that evaluation and reporting of hand and wrist scar outcomes is not standardised, assessment methods and measures are under-reported and there is discordance in taxonomy. Evaluation is not person-centred, rather it is dependent on clinician assessment. Domains including scar acceptability, mental hea
Kennedy DL, Vollert J, Ridout D, et al., 2021, The responsiveness of quantitative sensory testing-derived sensory phenotype to disease-modifying intervention in patients with entrapment neuropathy: a longitudinal study, Pain, Vol: 162, Pages: 2881-2893, ISSN: 0304-3959
ABSTRACT: The German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) method for sensory phenotyping is used to stratify patients by mechanism associated sensory phenotype, theorised to be predictive of intervention efficacy. We hypothesised that change in pain and sensory dysfunction would relate to change in sensory phenotype. We investigated the responsiveness of sensory phenotype to surgery in patients with an entrapment neuropathy.With ethical approval and consent, this observational study recruited patients with neurophysiologically confirmed carpal tunnel syndrome. Symptom and pain severity parameters and DFNS QST were evaluated prior to and after carpal tunnel surgery. Surgical outcome was evaluated by patient-rated change. Symptom severity score of the Boston Carpal Tunnel Questionnaire and associated pain and paraesthesia subgroups were comparators for clinically relevant change.QST results (n=76) were compared to healthy controls (n=54). At 6 months post-surgery 92% participants reported a good surgical outcome and large decrease in pain and symptom severity (p<.001). Change in QST parameters occurred for thermal detection, thermal pain and mechanical detection thresholds with a moderate to large effect size. Change in mechanical pain measures were not statistically significant. Change occurred in sensory phenotype post-surgery (p<.001); sensory phenotype was associated with symptom subgroup (p=.03) and patient-rated surgical outcome (p =.02).QST derived sensory phenotype is sensitive to clinically important change. In an entrapment neuropathy model, sensory phenotype was associated with patient-reported symptoms and demonstrated statistically significant, clinically relevant change after disease modifying intervention. Sensory phenotype was independent of disease severity and may reflect underlying neuropathophysiology.
Kennedy DL, Ridout D, Lysakova L, et al., 2021, The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery, BMC Musculoskeletal Disorders, Vol: 22, Pages: 1-19, ISSN: 1471-2474
BackgroundUp to 25% of people who have had carpal tunnel release surgery (CTR) fail to report improvement; however, evidence for prognostic indicators in this surgical cohort is limited. To identify candidate prognostic factors, this study investigated the association of quantitative sensory testing (QST) derived sensory phenotype and attendant impairment with patient-reported surgical outcome.MethodsWith ethical approval and informed consent, this prospective observational longitudinal study recruited patients from two London hospitals. Multimodal phenotyping measures including quantitative sensory testing (QST), pain parameters, insomnia, pain-related worry, mood and function, were evaluated prior to; and at 3- and 6-months post-surgery. Pain in median nerve distribution with electrophysiologically confirmed conduction delay and DN4 score ≥ 4 was defined as neuropathic. Primary outcome was patient-rated change at 6 months, dichotomised as poor outcome; “worse” or “no change” and good outcome; “slightly better”, “much better” or “completely cured”.ResultsSeventy-six patients participated. Prior to surgery, substantial heterogeneity in established categories of somatosensory function was observed with 21% of participants categorised as having a healthy sensory phenotype; 29% with thermal hyperalgesia; 32% mechanical hyperalgesia and 18% sensory loss. Seventy six percent of participants were classified as having neuropathic pain, 33% with high levels of pain related worry and 64% with clinical insomnia. Observed differences in pain, sleep impairment, psychological factors and function, between sensory phenotypic groups, was not significant. At 3- and 6-months post-surgery there was significant improvement in all phenotyping measures with a moderate to large effect size. Thermal and mechanical measures of somatosensation improved (p < 0.001), as did functional ability
Karantana A, Davis T, Kennedy D, et al., 2021, Common hand and wrist conditions: creation of UK research priorities defined by a James Lind Alliance Priority Setting Partnership, BMJ Open, Vol: 11, Pages: 1-9, ISSN: 2044-6055
Objective Prioritisation of important treatment uncertainties for ‘Common Conditions Affecting the Hand and Wrist’ via a UK-based James Lind Alliance Priority Setting Partnership.Setting This process was funded by a national charitable organisation and based in the UK.Participants Anyone with experience of common conditions affecting the adult hand and wrist, including patients, carers and healthcare professionals. All treatment modalities delivered by a hand specialist, including therapists, surgeons or other allied professionals, were considered.Interventions Established James Lind Alliance Priority Setting Partnership methods were employed.Electronic and paper questionnaires identified potential uncertainties. These were subsequently confirmed using relevant, up-to-date systematic reviews. A final list of top 10 research uncertainties was developed via a face-to-face workshop with representation from patients and clinicians. Impact of research was sought by surveying hand clinicians electronically.Outcome measures The survey responses and prioritisation—both survey and workshop based.Results There were 889 individually submitted questions from the initial survey, refined to 59 uncertainties across 32 themes. Eight additional uncertainties were added from published literature before prioritisation by 261 participants and the workshop allowed the final top 10 list to be finalised. The top 10 has so far contributed to the award of over £3.8 million of competitively awarded funding.Conclusions The Common Conditions in the Hand and Wrist Priority Setting Partnership identified important research questions and has allowed research funders to identify grant applications which are important to both patients and clinicians
Meyer-Friessem CH, Attal N, Baron R, et al., 2020, Pain thresholds and intensities of CRPS type I and neuropathic pain in respect to sex, EUROPEAN JOURNAL OF PAIN, Vol: 24, Pages: 1058-1071, ISSN: 1090-3801
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Kennedy DL, Kemp H, Wu C, et al., 2020, Determining real change in conditioned pain modulation: a repeated measures study in healthy volunteers, Journal of Pain, Vol: 21, Pages: 708-721, ISSN: 1526-5900
Conditioned pain modulation (CPM) is a potentially useful biomarker in pain populations; however, a statistically robust interpretation of change scores is required. Currently, reporting of CPM does not consider measurement error. Hence, the magnitude of change representing a “true” CPM effect is unknown. This study determined the standard error of measurement (SEM) and proportion of healthy participants showing a “true” CPM effect with a standard CPM paradigm. Fifty healthy volunteers participated in an intersession reliability study using pressure pain threshold (PPT) test stimulus and contact heat, cold water, and sham conditioning stimuli. Baseline PPTs were used to calculate SEM and >±2 × SEM to determine CPM effect. SEM for PPT was .21 kg/cm2. An inhibitory CPM effect (>+2 SEM) was elicited in 59% of subjects in response to cold stimulus; in 44% to heat. Intrasession and intersession reliability of within-subject CPM response was poor (kappa coefficient <.36). Measurement error is important in determining CPM effect and change over time. Even when using reliable test stimuli, and incorporating measures to limit bias and error, CPM intersession reliability was fair and demonstrated a large degree of within-subject variation. Determining “true” change in CPM will underpin future interrogations of intraindividual differences in CPM.
Kennedy DL, Kemp HI, Ridout D, et al., 2016, Reliability of Conditioned Pain Modulation: a Systematic Review, Pain, Vol: 157, Pages: 2410-2419, ISSN: 1872-6623
A systematic literature review was undertaken to determine if conditioned pain modulation (CPM) is reliable. Longitudinal, English language observational studies of the repeatability of a CPM test paradigm in adult humans were included. Two independent reviewers assessed the risk of bias in six domains; study participation; study attrition; prognostic factor measurement; outcome measurement; confounding and analysis using the Quality in Prognosis Studies (QUIPS) critical assessment tool [17]. Intraclass correlation coefficients (ICCs) less than 0.4 were considered to be poor; 0.4 and 0.59 to be fair; 0.6 and 0.75 good and greater than 0.75 excellent [37]. Ten studies were included in the final review. Meta-analysis was not appropriate due to differences between studies. The intersession reliability of the CPM effect was investigated in 8 studies and reported as good (ICC = 0.6-.75) in 3 studies and excellent (ICC > .75) in subgroups in 2 of those 3. The assessment of risk of bias demonstrated that reporting is not comprehensive for the description of sample demographics, recruitment strategy and study attrition. The absence of blinding, a lack of control for confounding factors and lack of standardisation in statistical analysis are common. CPM is a reliable measure, however the degree of reliability is heavily dependent upon stimulation parameters and study methodology and this warrants consideration for investigators. The validation of CPM as a robust prognostic factor in experimental and clinical pain studies may be facilitated by improvements in the reporting of CPM reliability studies.
Watt FE, Carlisle K, Kennedy D, et al., 2015, Menopause and hormone replacement therapy are important aetiological factors in hand osteoarthritis: results from a cross-sectional study in secondary care, Maturitas, Vol: 81, Pages: 128-128, ISSN: 0378-5122
Sharrock C, Kennedy D, Spencer S, 2014, Patients' expectations, experiences and the determinants of satisfaction related to metacarpophalangeal arthroplasty., Musculoskeletal Care, Vol: 12, Pages: 132-140
PURPOSE: Most previous research has used quantitative patient-rated outcome measures to identify patients' perceptions related to metacarpophalangeal (MCP) arthroplasty. However, little is known about the lived experience of this procedure. The present study aimed to gain an in-depth understanding of patients' expectations and experiences, and the determinants of satisfaction related to MCP arthroplasty and postoperative rehabilitation. METHODS: Semi-structured interviews were conducted with six participants from two London hospitals at four months to three years post-surgery. Interviews were transcribed verbatim and analysed using descriptive phenomenological analysis. RESULTS: Participants' reasons for surgery varied considerably and their expectations were informed by previous surgical experience and information from healthcare professionals. Diverse, and occasionally ambivalent, perceptions of various aspects of postoperative treatment were expressed and all participants emphasized the importance of reassurance and understanding by the healthcare team. When describing the effect of surgery on their lives, all experienced a period of 'frustrating dependence' and adopted a variety of psychological and practical coping mechanisms. Experience of recovery and long-term outcome was influenced by factors extraneous to MCP arthroplasty, including medical condition and disease at adjacent joints. Factors influencing satisfaction included participants' evaluation of the extent to which goals and preoperative expectations had been met and the impact of surgery on their lives. CONCLUSIONS: Joint goal-setting is essential for understanding patients' unique reasons for undergoing MCP arthroplasty and facilitating realistic expectations. Education on all aspects of postoperative care is vital. Patients should be made aware of variability in outcome and the potential for deterioration due to the chronic nature of rheumatoid arthritis.
Watt FE, Kennedy DL, Carlisle KE, et al., 2014, Night-time immobilization of the distal interphalangeal joint reduces pain and extension deformity in hand osteoarthritis, Rheumatology, Vol: 53, Pages: 1142-1149, ISSN: 1462-0332
Objective. DIP joint OA is common but has few cost-effective, evidence-based interventions. Pain anddeformity [radial or ulnar deviation of the joint or loss of full extension (extension lag)] frequently lead tofunctional and cosmetic issues. We investigated whether splinting the DIP joint would improve pain,function and deformity.Methods. A prospective, radiologist-blinded, non-randomized, internally controlled trial of custom splintingof the DIP joint was carried out. Twenty-six subjects with painful, deforming DIP joint hand OA gavewritten, informed consent. One intervention joint and one control joint were nominated. A custom guttersplint was worn nightly for 3 months on the intervention joint, with clinical and radiological assessment atbaseline, 3 and 6 months. Differences in the change were compared by the Wilcoxon signed rank test.Results. The median average pain at baseline was similar in the intervention (6/10) and control joints(5/10). Average pain (primary outcome measure) and worst pain in the intervention joint were significantlylower at 3 months compared with baseline (P = 0.002, P = 0.02). Differences between intervention andcontrol joint average pain reached significance at 6 months (P = 0.049). Extension lag deformity was significantlyimproved in intervention joints at 3 months and in splinted joints compared with matchedcontralateral joints (P = 0.016).Conclusion. Short-term night-time DIP joint splinting is a safe, simple treatment modality that reduces DIPjoint pain and improves extension of the digit, and does not appear to give rise to non-compliance,increased stiffness or joint restriction.
Ball C, Pearse M, Kennedy D, et al., 2011, Validation of a one-stop carpal tunnel clinic including nerve conduction studies and hand therapy, Annals of the Royal College of Surgeons of England, Vol: 93, Pages: 634-638, ISSN: 1478-7083
INTRODUCTIONCarpal tunnel syndrome is the most common hand disorder. We describe a pathway that includes clinical assessment, neurophysiological testing, surgery and physical therapy all at the same visit.METHODSAll referrals for carpal tunnel syndrome were screened for inclusion in a ‘one-stop’ surgeon-led clinic. Prospective clinical data collected included patient reported outcome measures and satisfaction scores, touch threshold, pinch and grip strength. Patients were assessed clinically, underwent nerve conduction studies and surgery as indicated, all on the same day. Baseline and one-year follow-up data were analysed for 57 patients (62 hands).RESULTSThere was significant improvement in all domains of the Boston Carpal Tunnel and Michigan Hand Outcomes questionnaires, grip strength and touch threshold. There were no adverse events. The total mean operating time was 12.8 minutes (range: 5–15 minutes) and the mean tourniquet time was 2.5 minutes (range: 1–11 minutes). Using a dual theatre model produced a short mean turnaround time of 14.8 minutes (range: 2–37 minutes). Patient satisfaction as judged using a Picker questionnaire was very high.CONCLUSIONSA highly efficient clinical service involving both diagnostics and treatment can be delivered at a single hospital visit while maintaining optimal outcomes and high patient satisfaction.
Kennedy D, Jerosch-Herold C, Hickson M, 2010, The Reliability of One vs. Three Trials of Pain-free Grip Strength in Subjects with Rheumatoid Arthritis, JOURNAL OF HAND THERAPY, Vol: 23, Pages: 384-390, ISSN: 0894-1130
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- Citations: 24
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