Ottenhoff Janna S E, Derkzen Lindy, Reichel Lee M, Vagner Gregg, Loeb Michael D, Ring David
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX.
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX.
J Hand Surg Am. 2019 Jun;44(6):460-466.e1. doi: 10.1016/j.jhsa.2018.10.012. Epub 2018 Nov 27.
Nonspecific upper extremity illnesses (eg,. wrist pain, forearm pain)-where no objectively verifiable pathology is detectable-are common and usually self-limiting. For some patients, a nonspecific diagnosis can contribute to mistrust and disappointment.
This study tested the primary null hypothesis that there is no difference in mean overall satisfaction between patients given a specific compared with a nonspecific diagnosis. Second, we assessed factors associated with satisfaction and with nonspecific upper extremity diagnosis.
There was no significant difference between mean satisfaction with nonspecific and specific diagnoses in bivariate analysis. However, when treated as a categorical variable, 22% of the patients with a nonspecific diagnosis had a satisfaction score of 8 or lower compared with 11% of the patients given a specific diagnosis. First visit and greater pain intensity were significantly associated with a nonspecific diagnosis in bivariate analysis. In the multivariable models, no factors were independently associated with satisfaction or with nonspecific diagnoses.
Although nonspecific diagnoses can sometimes be frustrating for both physician and patient, in this small study using a satisfaction measure with a strong ceiling effect, they were no less satisfying to patients on average and corresponded with slightly greater pain intensity than specific diagnoses.
The degree to which nonspecific diagnoses (perhaps in combination with compassionate care and incremental monitoring) can be part of a satisfying treatment experience merits additional investigation.
非特异性上肢疾病（如手腕疼痛、前臂疼痛）——在其中无法检测到客观可验证的病理学特征——很常见且通常为自限性。对于一些患者而言，非特异性诊断可能会导致不信任和失望。
本研究检验了主要无效假设，即给予特异性诊断与非特异性诊断的患者在总体平均满意度上没有差异。其次，我们评估了与满意度以及非特异性上肢诊断相关的因素。
在双变量分析中，非特异性诊断与特异性诊断的平均满意度之间没有显著差异。然而，当将满意度视为分类变量时，22%的非特异性诊断患者满意度得分在8分及以下，而给予特异性诊断的患者这一比例为11%。在双变量分析中，初诊和更高的疼痛强度与非特异性诊断显著相关。在多变量模型中，没有因素与满意度或非特异性诊断独立相关。
尽管非特异性诊断有时对医生和患者来说都可能令人沮丧，但在这项使用具有强烈天花板效应的满意度测量方法的小型研究中，它们平均而言对患者的满意度并不低，并且与比特异性诊断略高的疼痛强度相关。
非特异性诊断（可能与关怀护理和逐步监测相结合）在多大程度上可以成为令人满意的治疗体验的一部分，值得进一步研究。
