Department of Clinical Sciences, Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden.
Blekinge Wound Healing Centre, Karlshamn, Sweden.
J Wound Care. 2020 Aug 1;29(Sup8):S18-S27. doi: 10.12968/jowc.2020.29.Sup8.S18.
To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment.
This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses.
The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ, p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ, p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation.
To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.
比较视频会诊与面对面会诊治疗疼痛、愈合困难的溃疡患者的效果，重点关注溃疡疼痛和疼痛治疗。进一步的目的是研究疼痛和疼痛治疗的预测因素。
这是一项基于瑞典溃疡治疗登记处（RUT）数据的基于登记的准实验研究。总共对 100 名通过视频会诊诊断为愈合困难的溃疡患者进行了研究，将他们与 1888 名通过面对面会诊诊断为愈合困难的溃疡患者进行了比较，比较内容包括疼痛评估、疼痛强度和疼痛治疗。使用视觉模拟量表（VAS）评估溃疡疼痛强度。使用学生 t 检验比较两组之间正态分布变量（年龄、VAS），使用曼-惠特尼 U 检验比较非正态分布变量（溃疡大小、溃疡持续时间），除愈合时间外，愈合时间使用对数秩检验进行分析。使用皮尔逊卡方检验（χ²）比较分类变量（性别、溃疡病因和开处的镇痛药）。p 值小于 0.05 被认为具有统计学意义。使用多元回归分析分析疼痛和疼痛治疗的预测因素。
结果显示疼痛的存在率较高；71%的疼痛患者报告有严重的溃疡疼痛。通过视频会诊诊断的患者（90%）与通过面对面会诊诊断的患者（86%）相比，在 VAS 评估疼痛的能力方面没有显著差异（χ²，p=0.233）。通过视频会诊诊断的患者开具的镇痛药明显多于通过面对面评估诊断的患者（84%比 68%）（χ²，p=0.044）。高强度疼痛的预测因素是女性或因炎症性血管疾病导致的溃疡，而接受镇痛药的预测因素是年龄较大、愈合时间较长和通过视频会诊诊断。
通过视频会诊识别、评估和治疗溃疡疼痛与面对面会诊同样可行。本研究的结果证实，患有愈合困难的溃疡的患者患有高强度的溃疡疼痛，存在疼痛与疼痛缓解之间的差异。需要进一步进行精心设计的随机对照研究，以了解如何最好地在溃疡疼痛治疗中使用远程医疗。
