Reliability of a clinical sensory test battery in patients with spine-related leg and arm pain

IF 3.5 2区医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-03-25 DOI:10.1002/ejp.2267

Cedric Bender, Sven Karstens, Fabian Muth, Georgios Baskozos, Annina B. Schmid

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Abstract

Background

The current standard to evaluate the presence of somatosensory dysfunctions is quantitative sensory testing, but its clinical utility remains limited. Low-cost and time-efficient clinical sensory testing (CST) batteries have thus been developed. Recent studies show moderate to substantial reliability in populations with neuropathic pain. This study evaluates the inter- and intra-tester reliability of people with spine-related leg and arm pain, representing mixed pain mechanisms.

Methods

Fifty-three patients with spine-related leg (n = 41) and arm pain (n = 12) attended three CST sessions. The CST battery consisted of eleven tests, determining loss and gain of sensory nerve function. CST was performed by the same investigator twice and by an additional investigator to determine inter- and intra-tester reliability. Fleiss' (inter-tester) and Cohen's (intra-tester) kappa were calculated for dichotomized and intraclass correlation coefficients (ICC) for continuous outcomes.

Results

Fleiss' kappa varied among modalities from fair to substantial (κ = 0.23–0.66). Cold, warm, and vibration detection thresholds and cold and pressure pain thresholds reached kappa >0.4 (moderate to substantial reliability). Cohen's kappa ranged from moderate to substantial (κ = 0.45–0.66). The reliability of the windup ratio was poor (ICC <0.18).

Conclusion

CST modalities with moderate to substantial inter-tester reliability could be of benefit as a screening tool. The moderate to substantial intra-tester reliability for all sensory modalities (except windup ratio) supports their potential use in clinical practice and research to monitor somatosensory changes over time in patients with spine-related limb pain of mixed pain mechanisms.

Significance

We already know that most modalities of clinical sensory test (CST) batteries achieve moderate to substantial inter- and intra-tester reliability in populations with neuropathic pain.

This study evaluates the reliability of a CST battery in populations with mixed pain mechanisms. We found inter-tester reliability varied from poor to substantial for sensory modalities, questioning the value of some CST modalities. The CST battery showed moderate to substantial intra-tester reliability, suggesting its usefulness to monitor sensory changes over time in this cohort.

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脊柱相关腿部和手臂疼痛患者临床感觉测试组合的可靠性。

背景：目前评估躯体感觉功能障碍的标准是定量感觉测试，但其临床实用性仍然有限。因此，人们开发了成本低、时间效率高的临床感觉测试（CST）电池。最近的研究显示，在神经病理性疼痛患者中，该测试具有中等至相当高的可靠性。本研究评估了代表混合疼痛机制的脊柱相关腿部和手臂疼痛患者的测试间和测试内可靠性：53 名脊柱相关腿痛（41 人）和手臂痛（12 人）患者参加了三次 CST 课程。CST 测试包括 11 项测试，以确定感觉神经功能的丧失和增强。CST 由同一研究人员和另一名研究人员分别进行两次，以确定测试者之间和测试者内部的可靠性。弗莱斯卡帕（测试员之间）和科恩卡帕（测试员内部）用于计算二分结果，类内相关系数（ICC）用于计算连续结果：不同模式的弗莱斯卡帕从一般到相当不等（κ = 0.23-0.66）。冷、热和振动检测阈值以及冷和压力疼痛阈值的卡帕值均大于 0.4（可靠性为中等至相当高）。Cohen's kappa 为中度至高度可信（κ = 0.45-0.66）。卷绕比率的可靠性较差（ICC 结论）：测试者之间具有中度至高度可靠性的 CST 模式可作为筛查工具发挥作用。所有感觉模式（除卷绕比值外）在测试者内部都具有中度到高度的可靠性，这支持将它们用于临床实践和研究，以监测混合疼痛机制的脊柱相关肢体疼痛患者随时间推移而发生的体感变化：我们已经知道，在神经病理性疼痛人群中，大多数临床感觉测试（CST）电池模式在测试者之间和测试者内部都具有中等至相当高的可靠性。本研究评估了混合疼痛机制人群中 CST 测试的可靠性。我们发现感觉模式的测试者之间的可靠性从较差到很高不等，这对某些 CST 模式的价值提出了质疑。CST 电池在测试者内部显示出中等到相当高的可靠性，这表明它在监测该人群随着时间推移而发生的感觉变化方面非常有用。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.