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Biased Reality (Part I): self-fulfilling prophecy. Confirmation Bias

The confirmation bias or confirmation bias is the tendency to investigate and interpret the information so confirming our previous hypothesis or ideas, causing misunderstanding and bias of reality. Give more weight to evidence that confirms the beliefs and underestimate those that disparage or deny.

http://es.wikipedia.org/wiki/Sesgo_de_confirmaci% C3% B3n

The effect of the expectant observer (experimenter) or expectant subject (patient) is cognitive bias that occurs in science when a subject expects a given result and therefore unconsciously manipulates an experiment data. Is especially true in medicine where is called the placebo effect or nocebo , depending on whether the handling of the subject has been to include a fact or to omit it. Used to eliminate the double-blind or blind.

The prophecy autocumplia is the conditioning due of an attitude. It is the tendency to infer that something will happen because we think that will happen, and thus or conditioned urge you to pass.

assimilation bias. We understand what we understand, as grandmothers only hear what they want. The brain receives a lot of information and conducts a screening of storing and using that information he considers relevant. Relevance is determined by the vision of reality with predetermined ideas, preconceptions. Opinions, after all, based on our filters and labels.

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In a study by Harvard University psychologists Rosenthal and Jacobson, which they called "Pygmalion in the classroom." ( see Pygmalion Effect) Teachers received false information about the achievements they could expect from some of his students (20% of the total, chosen at random). Based on the expectations created by this information, teachers rated with highest scores on tests conducted subsequent to these students.

Wason As concluded in the triple experiment (see link confirmation bias) when establish a hypothesis, we tend to search for evidence to confirm our hypothesis and avoid those who deny it. Instead of trying to deny it, try to confirm this as soon as possible because it makes us feel more secure with what we do.

much to do scientific research to treat a patient prior expectations might affect results or diagnoses.

DETERMINING THE EXPECTATIONS
OBSERVATION OBSERVATION CONDITIONS OF EXPECTATIONS

OBSERVATION CONDITIONS DIAGNOSIS

DIAGNOSIS TREATMENT CONDITIONS

PATIENT OBSERVATION CONDITIONS

CONDITIONS PATIENT EVOLUTION

Depending on the expectations, conditioned observation, diagnosis the treatment, the patient and evolution.

Maitland, in Chapter 3 of his books talks about communication and its difficulties. Makes an important reflection on how easy it is to get false information on the history. Specifically on page 30, discusses bias. It is difficult to formulate an unbiased question. We must always ensure that our issues are neutral.

Are you better than last week? This formulation is more correct, because we are already hinting that should be better, or hope to hear you are better.

What this about last week? This is the correct formula to refer to what we know. The neutral forms often require clarification, and sometimes you need to ask them in various ways to get the answer you want

Are you better, worse or the same last week? not easy to get information and when you practice the collection of unbiased information realizes how extremely easy it is to communicate with bias errors.

Sometimes I like to use a negative bias on purpose, are you a bit worse than last week? Are you sure? or you sure you're better? , because some patients tend to be complacent, we are more comfortable expressing themselves. It is curious to see how easily they sometimes change their minds and inconsistent, and on what we know through the patient. In some cases, communication is practically impossible. Assuming

communication constraints. We must always seek the truth above what we want is the truth. It is very easy to manipulate the history, assessment, examination, diagnosis ... unconsciously.

I strongly recommend reading the first chapters of Maitland. Be critical of ourselves and our treatments. Observe the prejudice of conditioning and try to challenge our assumptions ... All this while conveying confidence and patient safety. An art.

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psoas

Origin in the transverse processes of lumbar vertebrae (L1-L5) and the lateral aspect of the vertebral bodies from T12 to L5. His insertion into the lesser trochanter of the femur.

Of all the muscles, probably the most controversial in terms of their function is the psoas. In the only function that seems to be no controversy is in its main action: hip flexor. In fact it is by far the primary hip flexor, could itself perform the full range of travel of the hip flexion ... Or maybe not?

http://www.springerlink.com/content/5h16783j5h750626/fulltext.pdf

In this study of Hai Hu, Hodges and colleagues evaluates the activity of the various hip flexors straight leg raising ( SLR). And again the graph of this article when we discuss the component tilted, but the 4 hip flexors, by far the most powerful was the iliac crest, followed by adductor greater rectus femoris and finally the psoas major.

At least if there's any consensus on which is the largest hip flexor, we can say that its most important action is flexion of the hip. Where much consensus there is in other functions.

Impact Lumbar

Lordosante "or Cifosante?

Classically, the psoas lordosantes has properties. In numerous articles and books listed as a contributor to muscle lumbar extension taking fixed point in the hip. This was the proposal of an anatomical view. Seen in profile, psoas fibers descend vertically and anteriorly, beyond the pelvis to the address change to the rear to anchor the lesser trochanter, as if the pelvis serve pulley to increase the time of lumbar lordosis.

Later, some authors, such as Janda, began to postulate that the psoas contributed significantly in lumbar flexion. It was then that the paradox of the psoas, which stated that the psoas behaved both flexor and lumbar extensor function of the position of the column. If it was based on a marked lordosis (spinal erectors shortening) the psoas and behaved as if he was lordosante contrribuía flexural bending. The video is well appreciated the paradox of the psoas: hip flexion with knee extension increases the lordosis, the lever arm, and passes from flexor to extensor. Resorting back to the article of Hu Hai, increased lordosis in straight leg raises could be explained by the action of the iliac, very strong in the SLR, which causes pelvic anteversion, and is the one who carries the lumbar pelvis.

Still later, it was suggested that perhaps the action of the psoas was to maintain the physiologic lordosis and began to talk about their stabilizing role. Bogduk in their analysis showed that in the anatomical position, the psoas generated an extensor moment in high lumbar and lower thoracic and lumbar bending moment in low.

Rotator "back?

In this blog: it is devoted several entries to the psoas. The psoas dogmatic III defends the idea of \u200b\u200bthe psoas and lumbar rotator and tilter. Less consistent in research, lumbar rotation psoas has its advocates, some of the theories, supported by the multi-costitución psoas muscle bundles with a length of between 3 and 8 cm and originating at the segmental level.

Tilt "trunk?

Provision psoas side invites us to think that may have a lateral component tilter.

studies Santaguida show that the psoas not control the lordosis, or extend or flex the lumbar spine, or buffered the rotations, but exerts a compressive force by associating a lateral bending motion on lumbar spine, and contributes to the stabilization of the lumbar segments.

In another study, Farfan concluded that the psoas is in a good position for lateral flexion.

If the psoas had a lateral bending component of the psoas should be understood as an antagonist of himself to the role of lateral tilter. Proposed Peninou psoas contraction to reciprocal inhibition of its antagonist, the psoas on the opposite side, in his role as lumbar lateral bending.

Returning to study Hu Hai, published in Spine last year, see this chart. The contralateral psoas is activated even more strongly that performing hip flexion. Based on this study, the reciprocal inhibition for the psoas, your action should be main antagonist: ipsilateral hip extension, and not to the contralateral psoas activation in elevation of the leg in supine.

To roll a little more the thing Andersson (1995) established that the psoas major lumbar controls lateral movement eccentrically

lumbar stabilizer.

In recent years, several authors have been giving more weight to the role of stabilizer and is now considered that the psoas has no component relevant to the movements on the spine.

is based on the idea that the direction of the fibers is too vertical, and more than a movement of lumbar flexion or extension, is an axial compression of the vertebrae, which keeps them aligned. Bogduk was the first to say that the psoas could hardly generate movement on the lumbar spine,

Santaguida studies with EMG showed psoas activation when performing flexion with arms, as with the transversus and multifidus , supporting the idea of \u200b\u200bpostural stabilization.

showed Bogduk that the psoas was little action on the lumbar motion, even if eregi as a postural muscle that maintains the physiologic lordosis. Postural muscle function is well understood with the changes in length. The iliopsoas should allow hip extension. A limitation of 10 ° in most muscles is not a big problem. However, a limitation of 10 degrees in the iliopsoas prevents proper gear.

Gibbons, in his model of the role of the psoas major, dismisses any rotation, tilt or flexion and extension of the lumbar spine and determine its role in stabilizing back as the main action.

http://www.kineticcontrol.com/document/Publication/FunctionofPsoasMajor.pdf

Pelvic Stabilizer

is the head of the pelvic alignment in the anteroposterior plane. The psoas slows the anterior displacement of the pelvis. In the position of "sway back" the weakness of the psoas and gluteus maximus cause an anterior translation of the pelvis and sacroiliac pain. (Lower crossed syndrome Janda)

impact on the hip

Adductor and Abductor "?

seems to be no consensus even on the component or spacer adductor muscle. It is clear that the psoas can not have a great time abductor or adductor. If you have any contribution to these movements depend, again, from the initial position of the hip. While in add may abduct and adduct may abd being in the midline, and only from the theory.

or "External Rotator Internal Rotator?

Most texts exposes the psoas and external rotator. For some a more important component than others, but most considered external rotator (flippers). However, some authors argue that the psoas is a component of internal rotator (dove feet).

Here , another entry in the same blog: The psoas dogmatic I.

others on both sides and suggest something similar to the paradox of psoas in lordosis: the psoas is internal or external rotator function of the position to leave.

Here , Psoas as the study of hip rotator depends on your starting position.

An analysis of the role of the psoas in a newborn shows illustratively as the psoas is rotator cuff internal and external expansion hip flexion. Click here , to read the full article.

hip stabilizer.

one hand, makes a coaptation of the head against the acetabulum and on the other side stops the anterior displacement of the femoral head, and has the tendon anterior to the head of the femur.

Following the role model of Gibbons psoas major, psoas takes a shortening of the coaptation FAI member, but this was taken into account before limb differences in ratings lower limbs.

This no longer a matter of debate for anatomists, and with respect to physical therapists and clinicians, it is worth an anatomic view, but in the end everything is translated into the practical aspect of functional and global motion and perhaps not as analytical anatomy ... but it's fun!.

If at the end of this reading has been made clear the role of the psoas, sorry, it was not my intention.

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Parsimony Principle (IV): Skepticism

It goes without saying that the world needs more gullible.

radical philosophical skepticism is contradictory, because the statement "we must doubt everything" contradicts the truth claim that he proposes.

not easy to prove things. If we confine ourselves to operate with that which is highly evident, we would cease to have much of our therapeutic arsenal. The more information and knowledge you have, the easier it is to identify the grain in the straw.

Common sense, logic and the principle of parsimony should be used also in disbelief. If it looks like shit and smells like shit ... taste it is unnecessary to confirm.

I leave you with a story of German children's writer, Peter Bichsel.

just see what I

"I met a man who only believed in what he could see and experience personally. Learned in school that the Earth was round and everyone repeated. But he said: "I'll believe it only if I can make the experience: I leave my house by the front door, go straight on and once I get done all the way to the back door. Only then is found in fact that the Earth is round.

wanted to implement its purpose immediately. She bought clothes for different seasons, winter clothing, shoes and boots. He said: "I need a car to get it inside." Vio also across the street was a house. To pass over the house would need a ladder. He recalled that there was a river below. Need a boat to cross. To transport the boat needed another larger car. And someone to drive it. This person would also need clothes and other belongings.

later recalled that there was a lush mountain forest. How do the two cars up the ladder and the boat up the mountain? Need at least five men. For those men need at least two other cars, because everyone would have to carry their belongings. And to pass it all over the house would require a crane. And a truck to transport the crane. And a man who handled the lift. It would also have to carry things. And even greater need another ship to carry the crane. And more still ... trolley

Here she stopped. He took a sheet of paper and made the first calculations, needed supplies for eight people, including himself, four cars, a truck, two boats, a crane and a ladder. Should not forget the salary of those hired. It was agreed that later would face the ocean and should to have a ship to load everything and make the crossing. Did the math and saw that it would require a large fortune.

Upon realizing the mess he had gotten was very sad. More sorry was when he realized he was already 65. He had to hurry if he wanted to return before his death.
But not deterred. Do not buy anything from that long list. Only a big step. It threw her over his shoulder and slowly walked to the house opposite. Put a ladder and started climbing slowly.
People who knew what they wanted from the street shouted: 'Man, leave it. No need to prove that the Earth is round. Everyone knows'. But he was deaf. He climbed to the top of the roof and raising the ladder it disappeared on the other side.

never returned to see the man. Maybe he changed his mind, he may have died already, but occasionally I like to go to the window and look westward. How happy would be if I saw one day come to me saying, 'Now I know from experience: the Earth is round'. "

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irrational Principle of Parsimony (Part III): From Myth to Logos

From the beginning, humankind is to seek an explanation for what unknown.

People need to believe. Everything happens for a reason. There

destination. A higher being gives meaning to what happens.

not rely on ourselves.

Big Brother takes care of us, and beyond our knowledge and understanding capacity, there is a plan.

We are nothing ...

It's the same reason that keeps the paternalistic medicine. The patient is a passive and not have to do anything. He needs to heal. He does not own their health. That rests with health professionals.

On the other hand, human beings need to explain everything. He's afraid of the unknown. In the challenging search for answers, the truth can end up not being relevant. This is the engine of myth and logos.

The myth provides answers based on magic, fable, fantasy, energy, ethereal, transcendental ... Religion stems from the pursuit of those responses. The power attributed to the gods hold the faith and establishing the dogma. Not only in religion is dogma. Any theory, school, faith or philosophy to maintain the traditions unquestionable dogma feeds.

are born scientists. We are inquisitive by nature and not easy to satisfy and convince us, although we assume no prior knowledge. Children demonstrate his restless spirit of learning by scientific method, but for parents it is easier indoctrinated into the dogma.

• Why?
• Because if.
• Why yes?
• Because I Said So.

disservice to science ...

The logos, however, provides answers based on reflections. Questioning the truth of things, observed and analyzed. It is objective and critical. Rational and consistent. Willing to be proved by anyone who wants to question it. He argues without occult. Logos science.

In every theory should be required to withstand the scrutiny of scientific method, even if it threatens sitema belief that one has. What we now think is correct or may no longer be successful tomorrow. Above personal or financial interest must prevail science. Not long ago it was said that cancer patients could not be treated. The DLM and massage created metastasis. It was argued that massage increased temperature and cell proliferation. If, however, studies say improves the quality of these patients, decreases stress and pain.

Follow the scientific model sometimes involves accepting the fact that most known unknown. And what is known is not immutable and eternal. There is no greater wrong than he who believes to be right.

The evolution of the physiotherapists at the end of the race is uncertain. Start a different degree: the form and gaining knowledge that make you stand out from their peers / competitors in order to offer an exclusive service that will ensure the professional future. It's a bad approach. One should not form in making it exclusive, but in what follows the scientific method. As is serious.

The problem is that many myths masquerading as logos, and if we examine the logos can get the deception. We question everything following the principle of parsimony and logic. Without losing the north. Not everything that is unprovable myth. It is not easy to separate the wheat from the chaff ...

pity not Part IV: Irrational Skepticism

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Principle of Parsimony (Part II): The laws of logic

When you keep a talk with difficult colleagues agree. Sometimes before a clinical case, physical therapists who seek the explanation seems more pompous and twisted to justify the symptoms. I'm not sure if that is learned, or simply want to demonstrate the ability to link things, but if there is a certain trend towards globalization of structures in the conditions. One thing leads to another and finally the murderer was the butler. Categorical statements tend to miss the diagnosis, and ultraelaboradas, made with bobbin lace, too. It is great that now has a global vision of the individual, but without losing the north. We have spent the partitioning globalism centralized holistic accuser. Parceled analyzing anatomical structures as if they belonged to an individual, to avert convoluted equations where things are never what they seem.

How many legs does the elephant? This is an impossible image. One of the many who play with the delusion that apparently convinces the eye, but watched carefully is illogical. Contains some subjective contours, illusory, that seem legs. If this elephant encontrásemos us in reality, we would not hesitate: The answer is 4. Always more probable that we are facing an optical illusion to an elephant with 5 legs.

The Ockham's razor , principle of economy or parsimony , sontiene that the simplest explanation is usually true. The simpler theory is more likely to be correct than complex. Do not rule out the possibility of occurrence of the improbable, but it must not introduce more elements than strictly necessary in scientific explanations. The first thought, the thought directly, should be simple, the logic does the rest. After I 700 years William of Ockham establish the principle of parsimony is fulfilling the adage that common sense is the least common of the senses.

The logic is the language of scientific truth. The logic expressed in mathematical terms that are not due to premature conclusions or subjective reasoning.

propositional logic explains how we can move from A to C, with permission from B.

If it rains I get wet : If A, then B

if I get wet umbrella lame: if B then C

if it rains the umbrella lame: if A , then C

Chaining propositions, we can start with one and get other through the application of transformation rules. This is called writing reasoning. transformation rules are universal and not dependent on beliefs or hunches, or hunches, or "my experience tells me that ..." If you follow the laws of logic to conclude the diagnostic hypothesis, and if not, no.

Logic is the expression of common sense. To correct it should be based on objective premises and achieved some conclusions that follow the principles of logic. When we talk about patients is difficult to establish a premise. Rarely do we say that whenever A, then B. Therefore, if it is difficult to establish a premise, much more to reach a conclusion. That is the great difficulty of diagnosis. Categorical statements can undermine the credibility. The term diagnostic approach may be more accurate in some situations. There will always be more relative than absolute truths.

pretend to explain everything with our finite knowledge is nonsense. We see what we see. We see what we are accustomed to looking. If there are really only in our asses, all I find are asses. Even think about him.

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Principle of Parsimony (Part I): The parable of Physiotherapy

A physiotherapy student went to a Congress. One of the ponenetes was his friend. At lunchtime, his friend invited him to eat with the rest of speakers Congress. The student did not say a word during the meal with so much celebrity and simply to listen carefully and try to learn as much as possible. After the meal, an organizer and speaker, decided to discuss a case to brighten up the desktop, and in the end, he would remedy the case. At the end of exposure, one by one they were discussing the impressions of the case report stated:

muscle chains specialist said: - No doubt this is an imbalance of the chain end and chain opening.

trigger point expert said: - I would rather say that it is referred pain from a trigger point of the muscles around it.

fascial technical specialist made a fascial listening test and said: - this comes from the liver.

neural therapy expert said - mmm, that it seems to be a problem neurodynamic, but I have not clear at what level.

The Holistic Kinesiology said - Well, let's ask for the structure!

The electrotherapy, said - who cares? We put and outside the magnet.

ATM expert said - Well, is that no one sees the relationship craniomandibular!.

The physio-acupuncturist said - this is clearly a disturbance Kidney meridian energy.

The NBP, said: - sure it's for milk ...

- Ah, but what bumped? , asked the student.

- No, unhappy, drinking milk, man. What Ignorance is bold! , said the NBP

The osteopath I looked at them and said: Oh, my friends, is clearly a mixture of everything you have said.

There was silence at the table.

- Well, Who was right? , the expert said in electrotherapy.

- still have not answered all table, said the organizer.

All eyes turned to the student:

- you do not have a hard time the kid, man , they all said.

- No, no. He will also have an opinion , said the organizer.

There was silence again

- The truth is that I have absolutely no idea what's wrong, truth , said the student.

- Do not worry, kid, you're learning, you're still very young ... Well, now you tell us once what happens .

Again silence.

- After several months, having visited 7 specialists and having done all sorts of tests, yet no one has the faintest idea what's wrong, so technically the student has earned .

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apprentice Metatarsal Formula

The metatarsalgias represent a high percentage of the conditions of the forefoot and sole. A large number of them are considered as mechanical metatarsalgia by overloading. Metatarsal overload is given by the morphology metatarsal and heel shoes:

height metatarsal. The internal arch determines the alignment of the metatarsals. The metatarsal arch is reduced with the extension of the fingers. Walking in the boost phase, we conducted a metatarsophalangeal extension of 60 º. When we did the extension of fingers, the 5 metatarsal should be in line for an equitable burden sharing.

metatarsal formula can be analyzed by passive metatarsophalangeal extension and observe the height of the metatarsals. Any assessment of a metatarsal collapse indicates an increase of pressure at that point. The higher pressure zones often coincide with the hardness of the skin (helomas).

length of the metatarsals. metatarsal morphology responds to the need to cushion and spread the load. In the stance phase of gait, the contact starts at the heel and advances at the outer edge to the head of the 5 th goal, and hence, goal for goal until the head of 1 metatarsano, which performs the takeoff momentum of 1 finger.

metatarsal length places the head of each metatarsal at a height. Metatarsal heads describe an increasingly harmonious curve from 5 º to 2 º goal.

On 1 metatarsal should be slightly shorter than the 2 nd. Fick angle is 30 degrees. Foot on the opening angle of 30 ° located at 1 st and 2 nd metatarsal at the same height, for takeoff.

We can analyze the formula of the metatarsal length meatarsofalángica performing passive flexion, so that the head.




Imagine that they had to move a heavy container. What would be the best way? Without doubt, lift one side and rolling it by its circumferential edge. Imagine now that the drum had been struck and was dented. When you roll it over the edge and get to the dented area, the drum would fall precipitously increasing the impact at that point. That's what happens when one of the metatarsal is longer.

A long metatarsal itself is overloaded

A short metatarsal overload neighbors

Viladot, in 1989, established a classification based on the length of the metatarsals, in what he called Metatarsal Formula:

Index minus, when on 1 goal is shorter than the 2 and then the rest are in gradual decline. This is the most frequent (56%).

Index plus-minus, when 1 º and 2 º are equal and greater than 3, 4 and 5, falling. Observed in 28% of the population.

Index plus, when the 1 st metatarsal is larger than 2 and this more than 3 º. Occurs with a frequency of 16% of the population.

Regardless of the morphology of the metatarsals, footwear is a constraint on the amount of pressure to get the forefoot. Under normal conditions, with flat shoes, the forefoot will receive less than half the weight. The higher the heel, the greater the percentage of body weight. A woman with 70 kg which were fit with 10 cm heels will receive 100% of their body weight on the forefoot. Now suppose that this woman has a collapse of the 2nd metatarsal. That means that the head of that goal is enduring, only static, 70 kg of pressure.

With age, fat pad that protects the metatarsal heads, they lose water and collagen becoming thinner, making it increasingly difficult to use heels.

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interim criteria

Everyone knows this picture. Is the map of the 18 points of fibromyalgia pain. These are the diagnostic criteria were established in 1990 by the American College of Rheumatology (ACR). You know: if they have at least 11 of 18 and are present in all four quadrants: top, bottom, left and right, and carries more than 3 months with pain, since it is already, fibromyalgia singing.

1990 These criteria were established after a study conducted by Frederick Wolfe and colleagues with 558 patients: 293 with fibromyalgia and 265 for the control group

http://www.ncbi.nlm.nih.gov/pubmed/2306288?dopt=Abstract

The choice of these points has been widely criticized. Those 18 points, well may have been others, and could have been 23 instead of 18. Nor is it true that the target structure in fibromyalgia was the muscle. It is not the predominant muscle pain is pain, period. Therefore, the diagnostic criteria of 1990, were becoming obsolete as it advanced the knowledge about the disease. In fact, it was initially created to reaizar clinical trials, rather than diagnostic criteria.

Over the years, have appeared various diagnostic criteria, as an alternative to the ACR, but none has come to set.

In May 2010, the same American College of Rheumatology published a new preliminary criteria for the diagnosis of fibromyalgia. 20 years later, Wolfe and colleagues conducted a study of 829 patients previously diagnosed with fibromyalgia.

http://www.ncbi.nlm.nih.gov/pubmed/20461783

The new preliminary criteria could be divided into two parts. The first part is the Widespread Pain Index or Index widespread pain (WPI). who no longer speaks of muscle tender points, but merely refers to areas: the shoulder girdle, arm, buttock, leg ... and has a value or 19 depending on the number of zones has been selected . Each area is selected if the patient has experienced pain in the past week. The WPI is the part that more weight in the criteria, but now also takes into account the cognitive disorders, fatigue, sleep disturbance and other symptoms.

The second is the SS Index Score or severity of symptoms, which could subdivided into two parts. The SS Score 1 takes into account the three most important after the pain: sleep, fatigue and attention disorders, memory and lightheadedness (here, the mood, despite being statistically significant and present, decided not to include) . This value can range between 0 and 9, being between o and 3 each of the 3 symptoms.

segunsa The index of the severity of symptoms (SS Score 2) is a miscellany of symptoms: headache, itching, cramps, irritable bowel ... A list of 40 symptoms that have been in the last week, where:

if you have symptoms score 0 to 0.

between 1 and 10 the score at 1.

between 11 and 24 the score is 2.

and over 25 is a 3,

therefore the value range between 0 and 3. This is the part that has less weight in the criteria, and established according to the symptoms manifested by patients in the study of Wolfe.

They join the 1 st and 2 nd index of the severity of symptoms (SS1 + SS2) and that value will range between 0 and 12.

fibromyalgia is considered if there is widespread pain index (WPI) is of at least 7 and symptom severity index reaches 5 or whether widespread pain index (WPI) is between 3 and 6 and severity index reaches 9, ie

FIBROMYALGIA IF ...

(WPI = 7 and SS Score = 5) or

( WPI 3-6, SS = Score = 9)

Wolfe preliminary criteria for improve diagnosis in fibromyalgia, based on patients diagnosed with fibromyalgia with existing criteria that have become obsolete. However, it is closer to current knowledge. Remains to be seen if curd or to stay on the road. The fact of having no objective parameters enthusiasm seems to minimize the progress on fibromyalgia. We should get used ...

- you have fibromyalgia, provisionally.

http://www.institutferran.org/documentos/2010_ACR_FM_TRAD_FINAL.pdf

Original Article:

http://www.fibromialgia.nom.es/fibromialgia-sindrome-de-fatiga-cronica-sindrome-quimico-mulltiple-Noticias-2010/nuevo-criterios-para -el-diagnostics-de-la% 20fibromialgia.html