Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.).
Eur J Pain. 2019 Nov;23(10):1826-1838. doi: 10.1002/ejp.1456. Epub 2019 Aug 28.
This study describes a low-cost and time-efficient clinical sensory test (CST) battery and evaluates its concurrent validity as a screening tool to detect somatosensory dysfunction as determined using quantitative sensory testing (QST).
Three patient cohorts with carpal tunnel syndrome (CTS, n = 76), non-specific neck and arm pain (NSNAP, n = 40) and lumbar radicular pain/radiculopathy (LR, n = 26) were included. The CST consisted of 13 tests, each corresponding to a QST parameter and evaluating a broad spectrum of sensory functions using thermal (coins, ice cube, hot test tube) and mechanical (cotton wool, von Frey hairs, tuning fork, toothpicks, thumb and eraser pressure) detection and pain thresholds testing both loss and gain of function. Agreement rate, statistical significance and strength of correlation (phi coefficient) between CST and QST parameters were calculated.
Several CST parameters (cold, warm and mechanical detection thresholds as well as cold and pressure pain thresholds) were significantly correlated with QST, with a majority demonstrating >60% agreement rates and moderate to relatively strong correlations. However, agreement varied among cohorts. Gain of function parameters showed stronger agreement in the CTS and LR cohorts, whereas loss of function parameters had better agreement in the NSNAP cohort. Other CST parameters (16 mN von Frey tests, vibration detection, heat and mechanical pain thresholds, wind-up ratio) did not significantly correlate with QST.
Some of the tests in the CST could help detect somatosensory dysfunction as determined with QST. Parts of the CST could therefore be used as a low-cost screening tool in a clinical setting.
Quantitative sensory testing, albeit considered the gold standard to evaluate somatosensory dysfunction, requires expensive equipment, specialized examiner training and substantial time commitment which challenges its use in a clinical setting. Our study describes a CST as a low-cost and time-efficient alternative. Some of the CST tools (cold, warm, mechanical detection thresholds; pressure pain thresholds) significantly correlated with the respective QST parameters, suggesting that they may be useful in a clinical setting to detect sensory dysfunction.
本研究描述了一种低成本、耗时少的临床感觉测试（CST）组合，并评估了其作为一种筛查工具的同时效性，以检测定量感觉测试（QST）确定的感觉功能障碍。
纳入了三个患者队列，包括腕管综合征（CTS，n=76）、非特异性颈臂痛（NSNAP，n=40）和腰椎神经根痛/神经根病（LR，n=26）。CST 由 13 项测试组成，每项测试对应一个 QST 参数，使用热（硬币、冰立方、热试管）和机械（棉花、冯弗雷毛发、音叉、牙签、拇指和橡皮擦压力）检测以及感觉丧失和获得功能的疼痛阈值测试，评估广泛的感觉功能。计算 CST 和 QST 参数之间的符合率、统计学意义和相关性强度（phi 系数）。
多项 CST 参数（冷觉、温觉和机械觉阈值以及冷觉和压力觉阈值）与 QST 显著相关，其中大多数具有>60%的符合率和中度至较强的相关性。然而，各队列之间的符合率存在差异。获得功能参数在 CTS 和 LR 队列中具有更强的一致性，而丧失功能参数在 NSNAP 队列中具有更好的一致性。其他 CST 参数（16mN 冯弗雷测试、振动觉、热觉和机械觉阈值、波动性比率）与 QST 无显著相关性。
CST 的一些测试有助于检测 QST 确定的感觉功能障碍。因此，CST 的某些部分可作为临床环境中的低成本筛查工具。
尽管定量感觉测试被认为是评估感觉功能障碍的金标准，但它需要昂贵的设备、专门的检查者培训和大量的时间投入，这使其在临床环境中的应用受到挑战。本研究描述了一种 CST，作为一种低成本、省时的替代方法。CST 的一些工具（冷觉、温觉、机械觉阈值；压力觉阈值）与相应的 QST 参数显著相关，表明它们在临床环境中可能有助于检测感觉功能障碍。
