Capturing patient-reported area of knee pain: a concurrent validity study using digital technology in patients with patellofemoral pain

Abstract

BackgroundPatellofemoral pain (PFP) is often reported as a diffuse pain at the front of the knee during knee-loading activities. A patient’s description of pain location and distribution is commonly drawn on paper by clinicians, which is difficult to quantify, report and compare within and between patients. One way of overcoming these potential limitations is to have the patient draw their pain regions using digital platforms, such as personal computer tablets.ObjectiveTo assess the validity of using computer tablets to acquire a patient’s knee pain drawings as compared to paper-based records in patients with PFP.MethodsPatients (N = 35) completed knee pain drawings on identical images (size and colour) of the knee as displayed on paper and a computer tablet. Pain area expressed as pixel density, was calculated as a percentage of the total drawable area for paper and digital records. Bland–Altman plots, intraclass correlation coefficient (ICC), Pearson’s correlation coefficients and one-sample tests were used in data analysis.ResultsNo significant difference in pain area was found between the paper and digital records of mapping pain area (p = 0.98), with the mean difference = 0.002% (95% CI [−0.159–0.157%]). A very high agreement in pain area between paper and digital pain drawings (ICC = 0.966 (95% CI [0.93–0.98], F = 28.834, df = 31, p < 0.001). A strong linear correlation (R2 = 0.870) was found for pain area and the limits of agreement show less than ±1% difference between paper and digital drawings.ConclusionPain drawings as acquired using paper and computer tablet are equivalent in terms of total area of reported knee pain. The advantages of digital recording platforms, such as quantification and reporting of pain area, could be realized in both research and clinical settings.

Distinct patterns of variation in the distribution of knee pain

“…Pain area and location were drawn on high-resolution and detailed digital-body chart using the Navigate Pain Android app (Aalborg University, Version 1) and the digital-body-chart has been validated against paper drawings for patellofemoral pain 8 among other conditions 2 , 3 . Participants drew with a Samsung Galaxy Note accessory stylus ‘S pen’ on a Samsung Galaxy Note 10.1 tablet (Android 4.1.2).…”

“…The location and area of pain drawn relative to visible anatomical features on a body chart reflect pain distribution. Assessing pain distribution by using pain drawings is a clinically relevant and reliable method 1 – 8 . Pain drawings are known as discomfort drawings, pain charts, and pain maps and used to achieve a better understanding of a disease or condition 7 , 9 – 13 .…”

Efficacy of different load intensity and time-under-tension calf loading protocols for Achilles tendinopathy (the LOADIT trial): protocol for a randomised pilot study

“…Researchers will use structured questionnaires to obtain demographic and injury data, including presentation of symptoms (side of injury, dominant leg, pain location, duration of symptoms, perceived cause, previous diagnosis and treatment), level of physical activity (current and ultimate goal), presence of medical conditions (medical history and surgical history) and general health. The location of Achilles pain, pain quality and intensity will be measured via the digital application (Navigate Pain, Aglance Solutions, Aalborg, Denmark) [21].…”

Digital body maps reinvent the way we perceive and discuss pain and discomfort

“…With the introduction of touch-screen technology, patientreported pain drawings can now be acquired with digital applications or drawing platforms as displayed on smartphones and personal computer tablets. These digital applications serve as reliable equivalents to paper-based pain drawings [1,2,10], with added and foreseeable future advantages. in the same way, digital pain drawings provide information about the number of pain sites and pain location.…”