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How should we define and assess painful sensitivity in the hand? An international e-Delphi study
Andrea Hebert1, Joy MacDermid2, Jocelyn Harris1
1School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada.
Summary
Hand pain sensitivity impacts daily life and rehabilitation. This study established consensus definitions and assessment guidance for hypersensitivity and allodynia in hand therapy, improving clinical practice.
Area of Science:
- Hand rehabilitation
- Neuropathic pain
- Sensory assessment
Background:
- Hand hypersensitivity is common in neuropathic pain, affecting daily activities and rehabilitation.
- Current terminology and assessment guidance for hand hypersensitivity are lacking.
Purpose of the Study:
- To identify common terminology for hand hypersensitivity in therapy.
- To develop a consensus definition for hypersensitivity.
- To establish consensus guidance for assessing allodynia.
Main Methods:
- An international e-Delphi consensus study involving hand rehabilitation experts.
- Four rounds of consensus-seeking with a 75% agreement threshold.
- Experts from 21 countries participated, using snowball sampling.
Main Results:
- While hypersensitivity definitions varied, a working definition was achieved.
- Definitions for allodynia and tactile hyperesthesia showed high concordance with existing taxonomies.
- Consensus was reached on 38 assessment items for allodynia, reflecting eight constructs.
Conclusions:
- Therapist definitions for allodynia align with existing taxonomies.
- A working definition for hypersensitivity was established despite varied conceptualizations.
- Internationally consistent, holistic assessment recommendations for allodynia were developed, suggesting a link to central sensitization.
