From the *Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern; †Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; ‡Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; §Clinical Trials Unit Bern, Department of Clinical Research, University of Bern, Bern, Switzerland; ∥Applied Health Research Centre (AHRC) Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and **Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Reg Anesth Pain Med. 2017 Sep/Oct;42(5):660-668. doi: 10.1097/AAP.0000000000000640.
Large-scale application of Quantitative Sensory Tests (QST) is impaired by lacking standardized testing protocols. One unclear methodological aspect is the number of records needed to minimize measurement error. Traditionally, measurements are repeated 3 to 5 times, and their mean value is considered. When transferring QST to a clinical setting, reducing the number of records would be desirable to meet the time constraints encountered in a routine clinical environment and to reduce the testing burden to chronic pain patients. However, there might be a trade-off between measurement error and number of records. We determined the measurement error of a single versus the mean of 3 records of pressure pain detection threshold (PPDT), electrical pain detection threshold (EPDT), and nociceptive withdrawal reflex threshold (NWRT) in 429 chronic pain patients recruited in a routine clinical setting.
We calculated intraclass correlation coefficients and performed a Bland-Altman analysis.
Intraclass correlation coefficients were all clearly greater than 0.75, and Bland-Altman analysis showed minute systematic errors with small point estimates and narrow 95% confidence intervals. Reducing the number of records from traditionally 3 to only 1 did not lead to relevant measurement error in PPDT, EPDT, or NWRT.
This study contributes to a standardized QST protocol, and based on the minimal measurement error of 1 single record of PPDT, EPDT, and NWRT, we submit to reduce the testing burden. This would allow saving time, resources, and patient discomfort.
由于缺乏标准化的测试方案，大规模应用定量感觉测试（QST）受到了限制。一个不明确的方法学方面是需要多少记录来最小化测量误差。传统上，测量重复 3 到 5 次，并取其平均值。当将 QST 转移到临床环境中时，为了满足常规临床环境中遇到的时间限制并减少慢性疼痛患者的测试负担，减少记录数量是可取的。然而，测量误差和记录数量之间可能存在权衡。我们在常规临床环境中招募的 429 名慢性疼痛患者中，确定了单次记录与 3 次记录的平均值（压力疼痛检测阈值（PPDT）、电疼痛检测阈值（EPDT）和伤害性撤退反射阈值（NWRT））的测量误差。
我们计算了组内相关系数并进行了 Bland-Altman 分析。
组内相关系数均明显大于 0.75，Bland-Altman 分析显示出微小的系统误差，其点估计值较小且 95%置信区间较窄。将记录数量从传统的 3 次减少到仅 1 次，不会导致 PPDT、EPDT 或 NWRT 的测量误差显著增加。
本研究为标准化 QST 方案做出了贡献，基于 PPDT、EPDT 和 NWRT 的 1 次记录的最小测量误差，我们建议减少测试负担。这将节省时间、资源并减少患者不适。
Zotero 插件