Sommerfeld Assessment System

Abstract

Introduction: Chronic musculoskeletal pain syndromes (CMSPS) are one of the major health issues in the modern world. Treatment and differential diagnosis of CMSPS continue to present problems.The Sommerfeld Assessment System (SAS, Sommerfelder Diagnostisches System) is a multiprofessional assessment tool for patients suffering from chronic musculoskeletal pain syndromes (CMSPS). In 4 axes morphological, psychosocial and manual medical findings are obtained and weighted for their clinical relevance. The assessment generates an individual treatment program based on the clinical and para clinical findings.Method: Development of the SAS: The SAS was developed over 5 years based on clinical experience working in a inpatient setting and treating approximately 2000 patients suffering from CMSPS a year.Evaluation: After a training period inter examiner reliability was tested. Two examiners performed the standardized assessment and evaluation procedure independently. The overall agreement and kappa values were assessed. For external validity the results of the SAS axes were evaluated in relation to the pain intensity (VAS) and pain chronicity (MPSS), psychometric scales (CED-D, SCL 90 R) and scales assessing daily function (PDI, FFbH). Statistical analysis was performed using SPSS software.Results: The results of inter examiner reliability tests show overall agreements between 70% and 87,5% with acceptable kappa results.A majority of patients had high-grade somatic dysfunction and more than 50% medium to major psychological influence on the pain syndrome.The individual axes of the SAS representing morphological, manual medical, psychological and social findings show no or only minor correlation and seem to be independent factors influencing CMSPS.Somatic dysfunction and psychosocial factors are correlated to the pain chronicity and the psychological axis correlates well with the psychometric scales.All subgroups of patients showed a significant pain reduction during the treatment. The functional SAS axis was positively correlated and the psychosocial axes were inversely correlated to the pain reduction during treatment.Discussion. The SAS is a reasonably reliable system for differential diagnosis of CMSPS. It obtains data in 4 axes related to the development of chronic pain syndromes. It is possible to develop an individual multimodal treatment program with stress on one or more of the axes for each individual patient with good results for the different subgroups.Conclusion. The SAS is a diagnostic system usable for specialist multi professional assessment and subsequent treatment for patients suffering from CMSPS. It can further be used for research specially regarding the influence of somatic dysfunction to chronic pain syndromes.