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Original article
Patient pain drawing is a valuable instrument in assessing the causes of exercise-induced leg pain
  1. Kajsa Rennerfelt,
  2. Qiuxia Zhang,
  3. Jón Karlsson,
  4. Jorma Styf
  1. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
  1. Correspondence to Dr Kajsa Rennerfelt, Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy Sahlgrenska University Hospital, University of Gothenburg Gothenburg Sweden ; kajsa.rennerfelt{at}vgregion.se

Abstract

Aim We validated patientpain drawing (PPD) in establishing the diagnosis of chronic anterior compartment syndrome (CACS) in patients with exercise-induced leg pain.

Methods The study comprised 477 consecutive patients, all suspected of having CACS. The diagnosis was based on the patient’s history, a thorough clinical examination and measurements of intramuscular pressure (IMP) following an exercise test. Patients completed a PPD before their hospital visit. Two independent orthopaedic surgeons diagnosed the causes of leg pain based only on the PPD at least 1 year after admission. Based on the results of diagnostic tests, the patients were divided into three groups: CACS (n=79), CACS with comorbidity (n=89) and non-CACS (n=306).

Results The sensitivity of the PPD to identify CACS correctly was 67% (observer 1) and 75% (observer 2). The specificity was 65% and 54%, respectively. The interobserver agreement (n=477) was 80%, and the kappa value was 0.55. The interobserver agreement was 77%, and the kappa value was 0.48 among 168 CACS patients with or without comorbidity. The interobserver agreement was 85%, and the kappa value was 0.56 in 79 CACS, and CACS was correctly diagnosed in 79% (observer 1) and 82% (observer 2). The test–retest showed the same results for the two observers, with an intraobserver agreement of 84%, while the test–retest reliability coefficient was 0.7. Comorbidity was found in 53% of CACS patients.

Conclusion PPD might be a valuable instrument in diagnosing the causes of exercise-induced leg pain. It is useful in identifying CACS with and without comorbidity.

  • exercise physiology
  • lowever extremity
  • muscle damage/injuries
  • muscle

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjsem-2017-000262

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    Footnotes

    • Contributors KR is the principal investigator in charge of the project. QZ, JK and JS have all been involved in designing the intervention and the evaluation. KR prepared the initial draft of the manuscript, and all other authors have contributed. All authors have critically reviewed and approved the final version of the manuscript.

    • Competing interests None declared.

    • Ethics approval The study protocol was approved by Research Ethics Committees at the University of Gothenburg, ID no. 617–08.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available from the corresponding author on reasonable request.