Clinical Specialist Physiotherapist, Pain Management Service, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, United Kingdom.
University of the West of England, Faculty of Health and Applied Science, Glenside Campus, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom.
Physiotherapy. 2020 Mar;106:128-135. doi: 10.1016/j.physio.2019.01.017. Epub 2019 Feb 4.
BACKGROUND: There is no consensus regarding the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) for chronic musculoskeletal or low back pain. A review of previous trial methodology identified problems with treatment fidelity. Qualitative research with experienced TENS users identified specific contexts for TENS use, leading to individualised outcomes. There is little information available to guide the selection of Patient Reported Outcome Measures (PROMs) appropriate for TENS evaluation. OBJECTIVE: To determine the capability of previously used PROMs to capture the perceived benefits of TENS reported by secondary care Pain Clinic patients who successfully used TENS to manage chronic musculoskeletal pain. DESIGN: The World Health Organisation International Classification of Functioning, Disability and Health (ICF) was used to match the perceived benefits of TENS against previously used PROMS. METHODS: Semi-structured interviews conducted with nine patients (6 women) as well as three other qualitative datasets (88 patients in total) generated patient-reported benefits which were matched against previously used PROMs using the ICF. FINDINGS: There were 18 items in the final list of benefits, and none of the four functional outcome measures used in previous RCTs captured more than 8 of these 18 items. The data analysis complemented the inductive thematic analysis but could not replace it, indicating the value of both forms of analysis. CONCLUSIONS: This study highlights a low level of match between outcome measures used in previous TENS studies, and the benefits perceived by experienced TENS users. This suggests that further work is required if the patient-reported benefits of TENS are to be evaluated.
背景:经皮神经电刺激(TENS)对慢性肌肉骨骼或下腰痛的疗效尚无定论。对以往试验方法学的综述发现了治疗一致性方面的问题。对有经验的 TENS 用户进行的定性研究确定了 TENS 使用的具体情况,从而产生了个体化的结果。几乎没有信息可用于指导选择适合 TENS 评估的患者报告结局测量(PROM)。
目的:确定以前使用的 PROM 能否捕捉到在二级保健疼痛诊所接受 TENS 治疗成功管理慢性肌肉骨骼疼痛的患者所报告的 TENS 感知益处。
设计:采用世界卫生组织国际功能、残疾和健康分类(ICF)将 TENS 的感知益处与以前使用的 PROM 进行匹配。
方法:对 9 名患者(6 名女性)进行半结构式访谈,并对另外 3 个定性数据集(总共 88 名患者)进行访谈,得出患者报告的益处,并用 ICF 将这些益处与以前使用的 PROM 进行匹配。
结果:最终列出了 18 项益处,以前的 RCT 中使用的 4 项功能结局测量中,没有一项能捕捉到这 18 项中的 8 项以上。数据分析补充了归纳主题分析,但不能替代它,这表明两种分析形式都有价值。
结论:本研究强调了以前 TENS 研究中使用的结局测量与有经验的 TENS 用户感知到的益处之间存在低水平的匹配。这表明,如果要评估 TENS 的患者报告益处,还需要进一步的工作。