The SPADE Symptom Cluster in Primary Care Patients With Chronic Pain
The SPADE Symptom Cluster in Primary Care Patients With Chronic Pain
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DOI：
10.1097/ajp.0000000000000286
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发表时间：
2016-05-01
影响因子：
2.9
通讯作者：
Stump, Timothy E.
中科院分区：
文献类型：
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作者：
Davis, Lorie L.;Kroenke, Kurt;Stump, Timothy E.
目的：睡眠障碍、疼痛、焦虑、抑郁和低能量/疲劳是普通人群和临床实践中最常见和共同出现的症状。黑桃症状的共同出现可能会产生额外的损害，并对治疗反应产生负面影响，可能会损害患者的健康和功能。本文的目的是确定：(1)黑桃症状的患病率和共病(即，聚集性)；(2)根据患者报告的结果测量信息系统(PROIS)测量得出的综合黑桃症状评分的内部可靠性和结构效度；(3)以综合评分代表的躯体症状负担的改善是否可以预测随后3个月和12个月功能状态的测量。方法：对步进式护理优化疼痛护理效果研究的数据进行二次分析，这是一项针对患有慢性疼痛的退伍军人进行协同护理干预的随机试验。结果：大多数患者有多个黑桃症状；仅9.6%的患者有单一症状。综合功能障碍症状评分具有较好的内部信度(Cronbach‘sα=0.86)和结构效度，并与功能状态的多项指标显著相关；综合评分的改善与6项功能状态结果中的5项得分较高显著相关。综合T分的标准化测量误差(SEM)为2.84，提示个体综合得分相差3分可能具有临床意义。因为症状负担可以预测功能状态的结果，所以更好地识别和管理并存的症状可能是必要的。
Objectives:Sleep disturbance, pain, anxiety, depression, and low energy/fatigue, the SPADE pentad, are the most prevalent and co-occurring symptoms in the general population and clinical practice. Co-occurrence of SPADE symptoms may produce additive impairment and negatively affect treatment response, potentially undermining patients' health and functioning. The purpose of this paper is to determine: (1) prevalence and comorbidity (ie, clustering) of SPADE symptoms; (2) internal reliability and construct validity of a composite SPADE symptom score derived from the Patient-Reported Outcomes Measurement Information System (PROMIS) measures; and (3) whether improvement in somatic symptom burden represented by a composite score predicted subsequent measures of functional status at 3 and 12 months follow-up.Methods:Secondary analysis of data from the Stepped Care to Optimize Pain care Effectiveness study, a randomized trial of a collaborative care intervention for Veterans with chronic pain.Results:Most patients had multiple SPADE symptoms; only 9.6% of patients were monosymptomatic. The composite PROMIS symptom score had good internal reliability (Cronbach's alpha=0.86) and construct validity and strongly correlated with multiple measures of functional status; improvement in the composite score significantly correlated with higher scores for 5 of 6 functional status outcomes. The standardized error of measurement (SEM) for the composite T-score was 2.84, suggesting a 3-point difference in an individual's composite score may be clinically meaningful.Discussion:Brief PROMIS measures may be useful in evaluating SPADE symptoms and overall symptom burden. Because symptom burden may predict functional status outcomes, better identification and management of comorbid symptoms may be warranted.