Torture Survivors: Pain Pattern and Disability

Prip, K. (2005). Lunds University. 37 pages.
This booklet is available free of charge from Dignity-Danish Institute Against Torture. Please email them at library@dignityinstitute.dk and include a list of desired articles and your mailing address.
This booklet was reviewed by Victor Chow, doctoral physical therapy student at the University of Minnesota.
Background: In “Torture Survivors: Pain Pattern and Disability”, the researchers strived to categorize their subjective and objective findings regarding physical impairments of torture victims. The categorization of this information would provide a method to more effectively describe the impairments and determine appropriate treatments. The researchers recruited 72 patients from the Rehabilitation and Research Centre for Torture Victims in Copenhagen and assessed pain and disability using measured described in the study. Treatment implications are described for torture survivors.
Research methods: Most of the participants were Middle Eastern. 61 of the participants were men and 11 were women. The researchers obtained information regarding pain and function and disability from the participants and the researchers consisted of five physical therapists. To measure pain intensity, the researchers used a Visual Analog Scale to determine the participant’s average pain in the past 14 days and the least pain during the past 14 days. To determine pain location, the researchers used a body chart and had the participants fill out the location of his or her pain on the body chart. Tender points were determined by the physical therapists palpating eighteen identified tender point locations. Sacroiliac pain was determined using a posterior pelvic pain provoking test. Joint mobility was also assessed using both passive range of motion and active range of motion of the participants. Hypermobility was determined using Beighton’s hypermobility 9 point test. Foot function was assessed having the participants standing and walking on the heels, toes, and lateral and medial sides of their feet. The participants also completed the Disability Rating Index to determine their disability. The physical therapists had the participants perform activities similar to the ones described on the Disability Rating Index so that the physical therapists could also assess the disability levels of the participants.
Findings: The results of the study showed that many of the participants had high levels of pain and the pain was in various locations including the head, neck, shoulders, arms, back, legs, and feet of the participants. Range of motion deficits were also found in the participants. Decreased knee flexion in one knee was found in 16/69 participants. 1/3 of the participants had decreased hip range of motion. ½ of the participants had decreased back and active shoulder range of motion. Many of the participants also had difficulty standing on their feet. 49/65 could not stand on their toes and 45/65 could not stand on their heels. 41/65 could not walk on their toes and 33/65 could not walk on their heels. 31/64 participants also had dysfunctional toe-off. The physical disabilities reported by the participants was also greater than that determined by the physical therapists. In conclusion, this study showed that victims of torture demonstrate experiences of great pain, pain in various location of their bodies, range of motion deficits in numerous body parts, dysfunctional standing and walking, and reports of greater disability compared to the assessments of physical therapists. This information can be used to help describe the physical impairments that affect victims of torture and they can help guide future research and treatment of these victims.

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