慢性腰腿痛患者早期转介脊髓刺激的分诊工具的开发和可行性研究。

IF 3.5 2区 医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2025-01-05 DOI:10.1002/ejp.4780
Ferdinand Bastiaens, Miranda L. van Hooff, Ivar J. Bruaset, Els van den Eede, Natasja J. G. Maandag, Erkan Kurt, Monique C. M. Schel-Huisman, Jessica T. Wegener, Kris C. P. Vissers
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引用次数: 0

摘要

背景:近年来,延迟选择性护理和日益增长的等待名单越来越多地导致延迟手术的慢性背部和腿部疼痛患者。目的:开发、实施和评估慢性背部和/或腿部疼痛患者分诊工具的可行性,以确定哪些患者有资格转介到脊髓刺激(SCS)咨询。方法:根据荷兰SCS指南、文献回顾和专家小组咨询,开发一种分诊工具。在第一次骨科会诊之前,与多学科团队合作检测并实施了分诊过程。作为评估分诊工具的一部分,分析了可行性、可靠性和预测准确性。结果:分诊指标包括:疼痛部位(腿部/混合)、DN4 > 3、疼痛持续时间≥3个月、腿部疼痛≥背部疼痛、NPRS腿部疼痛≥5。分诊工具应用于骨科等待名单上的患者,如果他们没有被排除在外,则进行全面的骨科检查。采用分诊工具对1025例慢性背痛和腿部疼痛的骨科患者进行评估。评估该分诊工具的可行性(平均系统可用性评分74.2 [SD 11.5])、可靠性(评分者间信度[Fleiss' Kappa 0.79]、评分者内信度[Cohen' Kappa 0.89])和准确性(灵敏度[100%]、特异性[98.8%]、阳性预测值[40%]和阴性预测值[100%])。结论:早期分类潜在的SCS候选人可能支持快速和适当的护理分配,缩短等候名单时间并改善临床结果。未来的研究应该探索策略,以优化该工具在识别最有可能从SCS治疗中受益的患者方面的表现。意义:开发了一种新的分诊工具,用于识别慢性背部和腿部疼痛的患者,以便早期转诊到SCS。经过可行性、可靠性和预测准确性的评估,该工具有望减少等待时间,改善患者选择。这可能是进一步发展SCS决策支持和加速SCS候选人护理过程的前奏。
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Development and Feasibility Study of a Triage Tool for Early Referral to Spinal Cord Stimulation for Patients With Chronic Low Back and Leg Pain

Background

In recent years, delayed elective care and growing waiting lists increasingly resulted in postponed surgeries for patients with chronic back and leg pain.

Objective

To develop, implement, and evaluate the feasibility of a triage tool for patients with chronic back and/or leg pain to identify those eligible for referral to spinal cord stimulation (SCS) consultation.

Methods

A triage tool was developed, based on Dutch SCS guidelines, literature review and expert panel consultation. The triage process was detected and implemented in collaboration with a multidisciplinary team, prior to first orthopaedic consultation. Feasibility, reliability and predictive accuracy were analysed as part of the evaluation of the triage tool.

Results

The triage indicators included: Pain location (leg/mixed), DN4 > 3, pain duration ≥ 3 months, leg pain ≥ back pain and NPRS leg pain ≥ 5. The triage tool was applied on patients on the orthopaedic waiting list, followed by a full orthopaedic review if they were not excluded. A total of 1025 orthopaedic patients with chronic back and leg pain were assessed with the triage tool. The triage tool was evaluated as feasible (mean System Usability Score 74.2 [SD 11.5]), reliable (inter-rater reliability [Fleiss' Kappa 0.79], intra-rater reliability [Cohen's Kappa 0.89]) and accurate (sensitivity [100%], specificity [98.8%], positive predictive value [40%] and negative predictive value [100%]).

Conclusion

Early triage of potential SCS candidates potentially supports rapid and appropriate care allocation, shortens waiting list time and improves clinical outcomes. Future research should explore strategies to optimise the tool's performance in identifying patients most likely to benefit from SCS therapy.

Significance

A novel triage tool was developed to identify patients with chronic back and leg pain for an early referral to SCS. This tool, evaluated for feasibility, reliability, and predictive accuracy, shows promise in reducing waiting times and improving patient selection. It can be a prelude to the further development of decision support for SCS and an acceleration in the care process for SCS candidates.

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来源期刊
European Journal of Pain
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.
期刊最新文献
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