A primary care back pain screening tool: Identifying patient subgroups for initial treatment
A primary care back pain screening tool: Identifying patient subgroups for initial treatment
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DOI：
10.1002/art.23563
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发表时间：
2008-05-15
期刊：
影响因子：
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通讯作者：
Hay, Elaine M.
中科院分区：
文献类型：
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作者：
Hill, Jonathan C.;Dunn, Kate M.;Hay, Elaine M.
Objective.开发和验证一种工具，筛选背痛预后指标相关的初步决策，在初级保健。背景是英国初级保健成人非特异性背痛。从2个现有队列和已发表文献的二次分析中确定了作为持续性独立预后指标的构建体。受试者工作特征曲线分析确定了相关结构的单一筛选问题。在新开发的样本（n = 131）中评估了该工具的心理测量学特性，包括并发和判别效度、内部一致性和可重复性，并建立了工具评分截止值，以分配至3个亚组（低、中和高风险）。在一个独立的外部样本（n = 500）中评估预测和外部效度。该工具包括9个项目：牵涉性腿部疼痛、共病疼痛、残疾（2个项目）、困扰、灾难性、恐惧、焦虑和抑郁。后5项被确定为心理社会分量表。该工具表现出良好的信度和效度，是可以接受的患者和临床医生。评分为0-3的患者被归类为低风险，心理社会子量表评分为4或5的患者被归类为高风险。其余被归类为中等风险。结论。我们验证了一个简短的筛选工具，这是一个有前途的工具，确定亚组的患者，以指导提供早期二级预防的初级保健。进一步的工作将确定使用该工具分配到治疗亚组，与适当的靶向治疗相关联，是否会改善患者的结局。
Objective. To develop and validate a tool that screens for back pain prognostic indicators relevant to initial decision making in primary care.Methods. The setting was UK primary care adults with nonspecific back pain. Constructs that were independent prognostic indicators for persistence were identified from secondary analysis of 2 existing cohorts and published literature. Receiver operating characteristic curve analysis identified single screening questions for relevant constructs. Psychometric properties of the tool, including concurrent and discriminant validity, internal consistency, and repeatability, were assessed within a new development sample (n = 131) and tool score cutoffs were established to enable allocation to 3 subgroups (low, medium, and high risk). Predictive and external validity were evaluated within an independent external sample (n = 500).Results. The tool included 9 items: referred leg pain, comorbid pain, disability (2 items), bothersomeness, catastrophizing, fear, anxiety, and depression. The latter 5 items were identified as a psychosocial subscale. The tool demonstrated good reliability and validity and was acceptable to patients and clinicians. Patients scoring 0-3 were classified as low risk, and those scoring 4 or 5 on a psychosocial subscale were classified as high risk. The remainder were classified as medium risk.Conclusion. We validated a brief screening tool, which is a promising instrument for identifying subgroups of patients to guide the provision of early secondary prevention in primary care. Further work will establish whether allocation to treatment subgroups using the tool, linked with targeting treatment appropriately, improves patient outcomes.