Comparison of Back Pain Prognostic Risk Stratification Item Sets
Comparison of Back Pain Prognostic Risk Stratification Item Sets
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DOI：
10.1016/j.jpain.2013.09.013
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发表时间：
2014-01-01
期刊：
影响因子：
4
通讯作者：
Turner, Judith A.
中科院分区：
文献类型：
--
作者：
Von Korff, Michael;Shortreed, Susan M.;Turner, Judith A.
通过风险分层护理，背痛的结果可能会得到改善，成本降低，但预测背痛结果的替代项目集的相对性能尚未得到很好的表征。我们比较了基于STarT背部和慢性疼痛风险筛查的替代预后项目集，这些项目集在一组开始接受背部疼痛初级护理的患者中进行。STarT Back项目集很简短，依赖于二元反应，而慢性疼痛风险项目集采用了缩放反应，并评估了疼痛持续性和弥漫性疼痛。患者（N = 571）在首次访视后不久进行了评估，502例（88%）在4个月后进行了重新评估。基于STartT背部和慢性疼痛风险预后筛查的项目集，以及两者的项目组合，用于预测4个月时慢性疼痛II-IV级背部疼痛。基于STarT背部的项目的受试者工作特征曲线下面积估计值（95%置信区间）为0.79（0.74 - 0.83），基于慢性疼痛风险的项目为0.80（0.75 - 0.83），复合项目集为0.81（0.77 - 0.85）。预测的差异是适度的。项目从2预后筛选，两者结合，实现了可接受的和类似的预测不利的背痛outcomes.Perspective：鉴于可比的预测效度，预后项目集之间的选择应基于临床相关性，项目数量，易于管理，项目简单。(C)2014年美国疼痛协会American Pain Society
Back pain outcomes may be improved and costs lowered through risk-stratified care, but relative performance of alternative item sets for predicting back pain outcomes has not been well characterized. We compared alternative prognostic item sets based on STarT Back and Chronic Pain Risk screeners in a cohort of patients initiating primary care for back pain. The STarT Back item set was brief and relied on binary responses, whereas the Chronic Pain Risk item set employed scaled responses and assessed pain persistence and diffuse pain. Patients (N = 571) were assessed soon after their initial visit and 502 (88%) were reassessed 4 months later. Items sets based on STarT Back and Chronic Pain Risk prognostic screeners, as well as a combination of items from both, were used to predict Chronic Pain Grade II-IV back pain at 4 months. The area under the receiver operating characteristic curve estimates (95% confidence intervals) were .79 (.74-.83) for items based on the STarT Back, .80 (.75-.83) for items based on Chronic Pain Risk, and .81 (.77-.85) for a composite item set. Differences in prediction were modest. Items from 2 prognostic screeners, and both combined, achieved acceptable and similar prediction of unfavorable back pain outcomes.Perspective: Given comparable predictive validity, choice among prognostic item sets should be based on clinical relevance, number of items, ease of administration, and item simplicity. (C) 2014 by the American Pain Society