title: The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders.
abstract: OBJECTIVE
  The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement.
  
  
  METHODS
  This cross-sectional study included data collected in a randomized controlled study.
  
  
  METHODS
  Two hundred and sixteen patients with chronic (≥6 months) whiplash-associated disorders, grade 2 or 3, were included in this study.
  
  
  METHODS
  The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings.
  
  
  RESULTS
  Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa =0.11, 95% CI: -0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa =0.64, 95% CI: 0.53 to 0.76).
  
  
  CONCLUSIONS
  The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries.
authors.affiliation: Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Bernhoff
authors.affiliation: Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Rehab Väst, County Council of Östergötland, Östergötland, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Landén Ludvigsson
authors.affiliation: Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
authors.forename: Gunnel
authors.initials: G
authors.lastname: Peterson
authors.affiliation: Musculoskeletal Functions and Pain, Division of Family Medicine, NVS, Karolinska Institutet, Kista, Sweden; Academic Primary Health Care Center, Stockholm County Council, Kista, Sweden.
authors.forename: Bo Christer
authors.initials: BC
authors.lastname: Bertilson
authors.affiliation: Kista Rygg and Idrottsklinik, Kista, Sweden.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Elf
authors.affiliation: Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Anneli
authors.initials: A
authors.lastname: Peolsson
keywords: cervical vertebrae; diagnostic self-evaluation; pain drawing; radiculopathy; reproducibility of results; whiplash injuries