Variability of "optimal" cut points for mild, moderate, and severe pain: Neglected problems when comparing groups
Variability of "optimal" cut points for mild, moderate, and severe pain: Neglected problems when comparing groups
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DOI：
10.1016/j.pain.2012.10.008
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发表时间：
2013-01-01
期刊：
影响因子：
7.4
通讯作者：
Zernikow, Boris
中科院分区：
文献类型：
--
作者：
Hirschfeld, Gerrit;Zernikow, Boris
根据功能干扰的差异定义轻度、中度和重度疼痛强度的分界点具有直观的吸引力。Serlin等人在1995年提出的推导它们的统计方法已被广泛使用。人群之间的对比临界点被解释为不同慢性疼痛人群之间存在有意义的差异。我们探讨了与最佳定义的切割点在一个大样本的慢性疼痛患者和同质子样本的变异性。最大疼痛强度（0-10数字评分量表，NRS）和疼痛相关的残疾的评级收集在一个样本的2249名儿童慢性疼痛管理的三级疼痛诊所。首先，确定整个样品的“最佳”切割点。其次，通过自举技术量化这些临界点的变异性。第三，在650名持续疼痛儿童、430名慢性每日头痛儿童和295名肌肉骨骼疼痛儿童的同质子样本中也评估了这种变异性。本研究发现：（1）在整个样本中，轻度、中度和重度疼痛的最佳切割点分别为4和8（0-10 NRS）。(2)整个样本中这些临界点的变异性非常高，仅在40%的时间内确定了最佳临界点。(3)同样，在具有相同疼痛病因的患者子样本中也发现了较大的变异性。最佳切割点受样本内随机波动的强烈影响。研究组之间最佳临界点的差异可能由偶然变化解释;不需要其他实质性解释。未来旨在解释组间差异的研究需要包括最佳切割点的变异性测量。(C)2012年国际疼痛研究协会。由Elsevier B出版。V.保留所有权利。
Defining cut points for mild, moderate, and severe pain intensity on the basis of differences in functional interference has an intuitive appeal. The statistical procedure to derive them proposed in 1995 by Serlin et al. has been widely used. Contrasting cut points between populations have been interpreted as meaningful differences between different chronic pain populations. We explore the variability associated with optimally defined cut points in a large sample of chronic pain patients and in homogeneous subsamples. Ratings of maximal pain intensity (0-10 numeric rating scale, NRS) and pain-related disability were collected in a sample of 2249 children with chronic pain managed in a tertiary pain clinic. First, the "optimal" cut points for the whole sample were determined. Second, the variability of these cut points was quantified by the bootstrap technique. Third, this variability was also assessed in homogeneous subsamples of 650 children with constant pain, 430 children with chronic daily headache, and 295 children with musculoskeletal pain. Our study revealed 3 main findings: (1) The optimal cut points for mild, moderate, and severe pain in the whole sample were 4 and 8 (0-10 NRS). (2) The variability of these cut points within the whole sample was very high, identifying the optimal cut points in only 40% of the time. (3) Similarly large variability was also found in subsamples of patients with a homogeneous pain etiology. Optimal cut points are strongly influenced by random fluctuations within a sample. Differences in optimal cut points between study groups may be explained by chance variation; no other substantial explanation is required. Future studies that aim to interpret differences between groups need to include measures of variability for optimal cut points. (C) 2012 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.