Chorti, Angeliki Georgiou (2009) Towards a uniform definition for the centralisation phenomenon. PhD thesis, University of Warwick.

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Abstract

The focus of this PhD project is on symptom centralisation. Its primary objectives
were to establish a standard operational definition of centralisation and evaluate its
inter-rater reliability in neck pain.
Two systematic reviews on the reliability and prognostic value of clinically induced
symptom responses in spinal pain (Chapters 2 and 3) showed that although the
potential usefulness of centralisation has been demonstrated in low back pain,
concern has been expressed about the observed inconsistency in reported definitions,
and the scarcity of studies in neck pain.
A Delphi survey of experts (Chapter 4) assisted in the development of a uniform
operational definition for centralisation and the identification of future research
questions. Centralisation was generally defined as the progressive and stable
reduction of the most distal presenting pain towards the spine midline in response to
standardised spinal loading strategies.
The support by the Delphi panel of a broader definition allowed for a multitude of
different ways of testing to be included in the assessment procedure which may offer
some flexibility to clinicians assessing, classifying and managing different spinal
pain presentations across different countries. Although the reliability of identifying
centralisation was acceptable, high levels of reliability were not demonstrated
(Chapter 5). However, reliability was greater for the pair of physiotherapists with
prior experience and formal extensive training in symptom response assessment.
Therefore, the optimal type and amount of training for eliciting and interpreting
centralisation and the effect of procedural variations on testing the outcomes of
individuals who centralise require urgent investigation. The prognostic and
management value of centralisation are also unknown.
This investigation may pave the way for the standardisation of centralisation as a
physical sign and stimulate interest for further study of potential sub-groups and
classification of spinal syndromes.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RC Internal medicine
Library of Congress Subject Headings (LCSH):	Neck pain, Spine -- Wounds and injuries, Symptoms
Official Date:	September 2009
Dates:	Date Event September 2009 Submitted
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Lamb, S. E. (Sallie E.) ; Underwood, M. (Martin), M.D. ; McCarthy, Chris
Sponsors:	Hellenic State Scholarships Foundation ; University of Warwick
Extent:	2 v. (various pagings)
Language:	eng

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