Perez Roberto S G M, Burm Peter E T, Zuurmond Wouter W A, Bezemer P Dick, Brink Harry E J, de Lange Jaap J
Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
Clin J Pain. 2005 May-Jun;21(3):272-6. doi: 10.1097/00002508-200505000-00010.
To assess the validity of physician's judgements of symptoms associated with Complex Regional Pain Syndrome Type 1.
The validity of physicians' judgments was assessed using measurements with regard to presence and severity of pain, temperature and volume asymmetry, and reduction in active range of motion in 66 Complex Regional Pain Syndrome Type 1 outpatients. Measurements were performed using Visual Analog Scales and McGill (number of words chosen total) for pain, infrared thermography for temperature differences, water displacement volumeters for volume differences, and hand-held goniometers for active range of motion. Physicians were blind to the outcomes of the measurements.
In general, physicians were capable of determining presence or absence of measured symptoms and indicate the direction of the symptom asymmetry. Establishing presence of temperature and volume asymmetries was, however, inadequate. Poor to moderate correspondence was found for the severity of individual symptoms between physicians' judgments and measurements. For the total number of assessments, correlation coefficients ranged from 0.39 for Volume to 0.68 for Pain. In general, lower correlations and percentages of association for Volume and Temperature were found. Monitoring changes between consecutive patient assessments showed poor correspondence between both assessment methods, with correlation coefficients ranging from 0.25 for Volume to 0.37 for Pain.
We conclude that establishing the presence of Complex Regional Pain Syndrome Type 1 symptoms, except for temperature and volume asymmetries, and monitoring of disease progression based on these symptoms can be performed by clinical judgment. The severity of the individual symptoms evaluated in this study should be measured with reliable and valid measurement instruments.
评估医生对1型复杂性区域疼痛综合征相关症状判断的有效性。
采用视觉模拟量表和麦吉尔疼痛问卷（选择的单词总数）评估66例1型复杂性区域疼痛综合征门诊患者的疼痛存在情况和严重程度、温度和体积不对称以及主动活动范围减小情况，使用红外热成像仪测量温度差异，水置换体积计测量体积差异，手持测角仪测量主动活动范围。医生对测量结果不知情。
总体而言，医生能够确定所测量症状的存在与否，并指出症状不对称的方向。然而，确定温度和体积不对称的存在并不充分。医生的判断与测量之间，个体症状严重程度的对应性较差至中等。对于所有评估项目，相关系数范围从体积的0.39到疼痛的0.68。总体而言，体积和温度的相关性及关联百分比更低。监测连续患者评估之间的变化显示，两种评估方法之间的对应性较差，相关系数范围从体积的0.25到疼痛的0.37。
我们得出结论，除温度和体积不对称外，1型复杂性区域疼痛综合征症状的存在以及基于这些症状的疾病进展监测可通过临床判断进行。本研究中评估的个体症状严重程度应以可靠有效的测量工具进行测量。
