Riewe E, Neubauer E, Pfeifer A C, Schiltenwolf M
Academy of Specialized Health Professions (AGF), Neustadt a. d. W., Germany.
Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
PLoS One. 2016 Jul 21;11(7):e0158850. doi: 10.1371/journal.pone.0158850. eCollection 2016.
10% of all individuals in Germany develop persistent symptoms due to nonspecific back pain (NSBP) causing up to 90% of direct and indirect expenses for health care systems. Evidence indicates a strong relationship between chronic nonspecific back pain and psychosocial risk factors. The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) and the German Heidelberger Kurzfragebogen Rückenschmerz (HKF-R 10) are deemed valid in prediction of persistent pain, functional loss or amount of sick leave. This study provides and discusses validity criteria for these questionnaires using ROC-curve analyses. Quality measurements included sensitivity and specificity, likelihood-ratio related test-efficiencies and clinical utility in regard to predictive values.
265 patients recruited from primary and secondary care units completed both questionnaires during the same timeframe. From the total, 133 patients returned a 6-month follow-up questionnaire to assess the validity criteria for outcomes of pain, function and sick leave.
Based on heterogeneous cut-offs for the ÖMPSQ, sensitivity and specificity were moderate for outcome of pain (72%/75%). Very high sensitivity was observed for function (97%/57%) and high specificity for sick leave (63%/85%). The latter also applied to the HKF-R 10 (pain 50%/84%). Proportions between sensitivity and specificity were unbalanced except for the ÖMPSQ outcome of pain. Likelihood-ratios and positive predictive values ranged from low to moderate.
Although the ÖMPSQ may be considered useful in identification of long-term functional loss or pain, over- and underestimation of patients at risk of chronic noncspecific back pain led to limited test-efficiencies and clinical utility for both questionnaires. Further studies are required to quantify the predictive validity of both questionnaires in Germany.
德国10%的人因非特异性背痛（NSBP）出现持续性症状，这给医疗系统带来了高达90%的直接和间接费用。有证据表明慢性非特异性背痛与心理社会风险因素之间存在密切关系。厄勒布鲁肌肉骨骼疼痛筛查问卷（ÖMPSQ）和德国海德堡简短背痛问卷（HKF-R 10）在预测持续性疼痛、功能丧失或病假天数方面被认为是有效的。本研究使用ROC曲线分析提供并讨论了这些问卷的有效性标准。质量测量包括敏感性和特异性、似然比相关的检验效率以及预测值方面的临床效用。
从初级和二级护理单位招募的265名患者在同一时间段内完成了这两份问卷。其中，133名患者返回了一份6个月的随访问卷，以评估疼痛、功能和病假结果的有效性标准。
基于ÖMPSQ的不同截断值，疼痛结果的敏感性和特异性中等（72%/75%）。功能方面观察到非常高的敏感性（97%/57%），病假方面特异性较高（63%/85%）。后者也适用于HKF-R 10（疼痛50%/84%）。除了ÖMPSQ的疼痛结果外，敏感性和特异性之间的比例不平衡。似然比和阳性预测值范围从低到中等。
尽管ÖMPSQ可能在识别长期功能丧失或疼痛方面有用，但对慢性非特异性背痛风险患者的高估和低估导致这两份问卷的检验效率和临床效用有限。需要进一步研究来量化这两份问卷在德国的预测有效性。
