Dawson Edgar G, Kanim Linda E A, Sra Parveen, Dorey Frederick J, Goldstein Theodore B, Delamarter Rick B, Sandhu Harvinder S
UCLA Comprehensive Spine Center and Department of Orthopaedic Surgery, UCLA School of Medicine, Los Angeles, California 90404, USA.
Spine (Phila Pa 1976). 2002 May 1;27(9):984-93; discussion 994. doi: 10.1097/00007632-200205010-00020.
Patients with low back pain were asked to recall the pain and impaired functioning that they reported 5-10 years previously as part of the National Low Back Pain prospective follow-up study. In 1998, patients completed an additional follow-up.
To compare outcomes using patient-recalled data and prospectively collected data from patients with low back pain and to identify simple, symptom-specific questions that yield reliable responses over an extended period of time.
Outcome assessment based on patient recall may be influenced by a patient's age, gender, reporting tendency, and current health status. The impact of data collected retrospectively on outcome analyses in spinal patients has not been addressed.
Patients enrolled in the National Low Back Pain study from 1986 to 1991 completed a self-administered questionnaire at their initial visit. A sample was interviewed by telephone in 1996 and asked to recall pain characteristics and impaired functioning reported at initial examination. A 10-year follow-up (1998) on current health status was conducted by mail. The 1998 follow-up response was separately compared with recalled and initial responses, such that two patient outcome status values were calculated for each question. Agreement was evaluated using Cohen's kappa.
The follow-up evaluation was completed by 144 patients, with a mean interval of 9.4 years. The overall simple kappa was 0.37, indicating "fair" agreement between outcomes based on initial and recalled accounts of pain. Questions on location of pain had kappa values of 0.12-0.58, radicular symptoms 0.28-0.48, and severity of pain 0.11-0.30.
"Fair" to "moderate" agreement was found between outcomes determined by recalled versus initial reports. Accuracy was greatest for queries on frequency, location of pain, and activities affecting pain. Discrepancies were noted for queries on severity of pain, with error bias toward less pain when using the recalled data. Careful selection of questions may yield more accurate outcome measures.
作为国家腰痛前瞻性随访研究的一部分，患有腰痛的患者被要求回忆他们在5至10年前报告的疼痛和功能障碍情况。1998年，患者完成了一次额外的随访。
比较使用患者回忆数据和前瞻性收集的腰痛患者数据得出的结果，并确定能在较长时间内产生可靠回答的简单、针对症状的问题。
基于患者回忆的结果评估可能会受到患者年龄、性别、报告倾向和当前健康状况的影响。回顾性收集的数据对脊柱疾病患者结果分析的影响尚未得到探讨。
1986年至1991年参加国家腰痛研究的患者在初次就诊时完成了一份自我管理问卷。1996年通过电话对一个样本进行了访谈，要求他们回忆初次检查时报告的疼痛特征和功能障碍情况。通过邮件对当前健康状况进行了10年随访（1998年）。将1998年的随访回复分别与回忆回复和初次回复进行比较，以便为每个问题计算两个患者结果状态值。使用科恩kappa系数评估一致性。
144名患者完成了随访评估，平均间隔时间为9.4年。总体简单kappa系数为0.37，表明基于疼痛初次和回忆描述的结果之间存在“一般”一致性。关于疼痛部位的问题kappa值为0.12 - 0.58，神经根症状为0.28 - 0.48，疼痛严重程度为0.11 - 0.30。
回忆报告与初次报告确定的结果之间存在“一般”到“中等”的一致性。对疼痛频率、部位以及影响疼痛的活动的询问准确性最高。在疼痛严重程度的询问方面存在差异，使用回忆数据时误差偏向于疼痛较轻的情况。仔细选择问题可能会产生更准确的结果测量。
