基于疼痛机制的分类对非特异性颈痛患者的组间可靠性。
The interrater reliability of a pain mechanisms-based classification for patients with nonspecific neck pain.
机构信息
Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
出版信息
Braz J Phys Ther. 2019 Sep-Oct;23(5):437-447. doi: 10.1016/j.bjpt.2018.10.008. Epub 2018 Oct 29.
OBJECTIVE
To examine the interrater reliability and agreement of a pain mechanisms-based classification for patients with nonspecific neck pain (NSNP).
METHODS
Design - Observational, cross-sectional reliability study with a simultaneous examiner design.
SETTING
University hospital-based outpatient physical therapy clinic.
PARTICIPANTS
A random sample of 48 patients, aged between 18 and 75 years old, with a primary complaint of neck pain was included.
INTERVENTIONS
Subjects underwent a standardized subjective and clinical examination, performed by 1 experienced physical therapist. Two assessors independently classified the participants' NSNP on 3 main outcome measures.
MAIN OUTCOME MEASURES
The Cohen kappa, percent agreement, and 95% confidence intervals (CIs) were calculated to determine the interrater reliability for (1) the predominant pain mechanism; (2) the predominant pain pattern; and (3) the predominant dysfunction pattern (DP).
RESULTS
There was almost perfect agreement between the 2 physical therapists' judgements on the predominant pain mechanism, kappa=.84 (95% CI, .65-1.00), p<.001. There was substantial agreement between the raters' judgements on the predominant pain pattern and predominant DP with respectively kappa=.61 (95% CI, .42-.80); and kappa=.62 (95% CI, .44-.79), p<.001.
CONCLUSION(S): The proposed classification exhibits substantial to almost perfect interrater reliability. Further validity testing in larger neck pain populations is required before the information is used in clinical settings.
CLINICAL TRIAL REGISTRATION NUMBER
NCT03147508 (https://clinicaltrials.gov/ct2/show/NCT03147508).
目的
研究基于疼痛机制的分类方法对非特异性颈痛（NSNP）患者的评定者间信度和一致性。
方法
设计：具有同时检查者设计的观察性、横断面可靠性研究。
设置
大学医院门诊物理治疗诊所。
参与者
随机抽取 48 名年龄在 18 岁至 75 岁之间、以颈部疼痛为主诉的患者。
干预措施
患者接受由 1 名经验丰富的物理治疗师进行的标准化的主观和临床检查。两名评估者独立地使用 3 种主要的结局测量指标对参与者的 NSNP 进行分类。
主要结局测量指标
使用 Cohen κ、百分比一致性和 95%置信区间（CI）来确定 2 位物理治疗师在（1）主要疼痛机制；（2）主要疼痛模式；和（3）主要功能障碍模式（DP）的评定者间信度。
结果
2 位物理治疗师对主要疼痛机制的判断几乎完全一致，κ值为 0.84（95%CI，0.65-1.00），p<0.001。两位评估者在主要疼痛模式和主要 DP 的判断上具有实质性一致性，κ值分别为 0.61（95%CI，0.42-0.80）；和 0.62（95%CI，0.44-0.79），p<0.001。
结论
该分类方法具有很高的评定者间信度。需要在更大的颈痛人群中进行进一步的有效性测试，然后才能在临床环境中使用该信息。
临床试验注册号
NCT03147508（https://clinicaltrials.gov/ct2/show/NCT03147508）。
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