Clinically important outcomes in low back pain
Clinically important outcomes in low back pain
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DOI：
10.1016/j.berh.2005.03.003
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发表时间：
2005-08-01
影响因子：
5.2
通讯作者：
de Vet, HCW
中科院分区：
文献类型：
--
作者：
Ostelo, RWJG;de Vet, HCW
与腰痛直接相关的四个重要领域是：疼痛强度、腰痛特异性残疾、患者对治疗结果的满意度和工作残疾。在每个领域中，都提出了不同的调查问卷。本章的重点是有效的和广泛使用的问卷。详细介绍了背景和测量特性，以及使用这些问卷的最小临床重要变化（MCIC）。MCIC可以用各种方法估计，文献中没有关于最合适的技术是什么的共识。本章主要集中在两种适当的和经常使用的方法来估计MCIC。我们认为，MCIC不应被视为一个固定值，本章中提出的MCIC值被用作指示。对于亚急性或慢性腰痛患者，视觉模拟量表（VAS）疼痛的MCIC应至少为20毫米，对于急性腰痛，MCIC应至少在大约35毫米的水平上似乎是合理的。如果使用数字评定量表（NRS），建议急性和慢性腰痛患者的MCIC分别至少为3.5和2.5似乎是合理的。对于罗兰残疾问卷测量的功能性残疾，MCIC至少应为3.5分似乎是合理的，而当使用Oswestry残疾指数时，MCIC至少为10分。对于全球感知效应，我们认为MCIC最合适的定义是至少“大大改善”或“非常满意”，而不是包括“略有改善”。最后，我们认为，从成本效益的角度来看，每天提前返回工作是重要的。综合考虑测量的目的、初始分数、目标人群和评估MCIC的方法，可以确定MCIC的确切值。
Four important domains directly related to low back pain are: pain intensity, low-back-painspecific disability, patient satisfaction with treatment outcome, and work disability. Within each of the domains, different questionnaires have been proposed. This chapter focuses on validated and widely used questionnaires. Details of the background and the measurement properties, and of the minimally clinically important change (MCIC) using these questionnaires, are described. The MCIC can be estimated using various methods and there is no consensus in the literature on what the most appropriate technique is. This chapter focuses primarily on two adequate and frequently used methods for estimating the MCIC. We argue that the MCIC should not be considered as a fixed value and that the MCIC values presented in this chapter are used as indications. For patients with subacute or chronic low back pain, the MCIC for pain on a visual analogue scale (VAS) should at least be 20 mm and for acute low back pain it seems reasonable to suggest that the MCIC should at least be at the level of approximately 35 mm. If a numerical rating scale (NRS) is used it seems reasonable to suggest that the MCIC should at least be 3.5 and 2.5 for patients with acute and chronic low back pain, respectively. For functional disability as measured with the Roland Disability Questionnaire it seems reasonable that the MCIC should at least be 3.5 points, whereas an MCIC of at least 10 points when the Oswestry Disability Index is used. For global perceived effect, we argue that the MCIC is most appropriately defined in terms of at least 'much improved' or 'very satisfied', instead of including 'slightly improved'. Finally, we argue that, from the point of view of cost effectiveness, every day of earlier return to work is important. The exact value for the MCIC can be determined, taking into account the aim of the measurement, the initial scores, the target population and the method used to assess MCIC.