Standardized pain mapping for diagnosing Achilles tendinopathy

• Published in: Journal of science and medicine in sport 2022-03, Vol.25 (3), p.204-208
• Main Authors: Sleeswijk Visser, Tjerk S.O., van Es, Eline M., Meuffels, Duncan E., Verhaar, Jan A.N., de Vos, Robert-Jan
• Format: Article
• Language: English
• Subjects: Achilles Tendon; Adult; Agreements; Cross-Sectional Studies; Epidemiological; Family physicians; Female; Humans; Male; Medical diagnosis; Medicine; Middle Aged; Musculoskeletal Diseases; Orthopedics; Pain; Pain - diagnosis; Patients; Questionnaires; Self-administered; Self-reported outcome measure; Software; Sports medicine; Tendinopathy - diagnosis; Tendons
• ISSN: 1440-2440; 1878-1861
• DOI: 10.1016/j.jsams.2021.10.010

To assess the level of agreement between patient-reported pain using a standardized pain map and the physician-determined clinical diagnosis of Achilles tendinopathy. Cross-sectional study. Eligible patients were adults visiting a sports physician for symptoms in the Achilles tendon region. Patients completed a digital questionnaire and indicated one location on a pain map where they experienced their pain. The primary outcome measure was level of agreement (% and Kappa coefficient) between patient-reported pain on the pain map and the physician-determined clinical diagnosis (defined as localized pain associated with tendon-loading activities and pain on palpation with or without tendon thickening). The secondary outcome measure was the agreement between the location on the pain map (midportion/insertional region) with the clinical diagnosis of midportion/insertional Achilles tendinopathy. 110 patients (mean (SD) age 48 (13), 61% men) with pain in the Achilles region were included. In 102 (93%, Kappa = 0.86, CI 0.78–0.95) patients who indicated pain in the Achilles tendon region on the pain map, the clinical diagnosis of Achilles tendinopathy was made by the sports physician. 82% of the patients had the clinical diagnosis of tendinopathy in the specific region of the tendon they marked on the pain map (Kappa = 0.67, CI 0.54–0.79). There is almost perfect agreement between patient-reported pain on a pain map and a physician-established clinical diagnosis of Achilles tendinopathy. There was substantial agreement between the localization of the pain that was selected by the patient and the diagnosis of insertional/midportion Achilles tendinopathy by the physician. This tool could potentially aid in adequate triage for specialized care and for researchers performing large epidemiological studies.