视觉模拟评分法比 WOMAC 疼痛量表在检测治疗效果的组间差异方面具有更高的检测灵敏度：一项meta 流行病学研究。

Visual Analogue Scale has higher assay sensitivity than WOMAC pain in detecting between-group differences in treatment effects: a meta-epidemiological study.

机构信息

Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

出版信息

Osteoarthritis Cartilage. 2021 Mar;29(3):304-312. doi: 10.1016/j.joca.2020.10.004. Epub 2020 Nov 30.

DOI:10.1016/j.joca.2020.10.004

PMID:33271331

Abstract

OBJECTIVE

To compare assay sensitivity of the Visual Analogue Scale (VAS) for global osteoarthritis pain and the Western Ontario and McMaster University (WOMAC) pain subscale, and the associated between-trial heterogeneity in effect sizes (ES).

DESIGN

We included trials with placebo, sham or non-intervention control that included at least 100 patients with hip or knee osteoarthritis per arm, reporting both VAS and WOMAC pain scores. ES were calculated as between-group difference in means divided by the pooled standard deviation and compared using a paired t-test. ES and τ as a measure of between-trial heterogeneity were combined using random-effects meta-regression with robust variance estimation to account for the correlation of data within trials and meta-analyses.

RESULTS

Twenty-eight trials with 44 randomized comparisons were included. In 28 comparisons (64%), ES from VAS favoured the intervention more than those from WOMAC pain (P = 0.003). Twenty-six p-values (59%) were smaller according to VAS (P = 0.008). The 44 comparisons contributed to 12 meta-analyses. Eleven meta-analyses (92%) showed larger benefits of interventions according to VAS, with a combined overall difference in ES of -0.08 (95% CI -0.14 to -0.02). τ was similar for VAS and WOMAC pain (difference in τ, -0.003, 95% CI -0.009 to 0.004).

CONCLUSION

The VAS for global pain had slightly higher assay sensitivity at trial and meta-analysis levels than the WOMAC pain subscale without relevant increase in between-trial heterogeneity.

摘要

目的

比较视觉模拟评分法（VAS）和西部安大略省和麦克马斯特大学（WOMAC）疼痛量表在评估整体骨关节炎疼痛方面的测定灵敏度，并比较其在效应量（ES）方面的试验间异质性。

设计

我们纳入了至少每臂包含 100 例髋或膝关节骨关节炎患者、同时报告 VAS 和 WOMAC 疼痛评分的安慰剂、假治疗或非干预对照试验。ES 计算为组间均值差异除以汇总标准差，并使用配对 t 检验进行比较。使用随机效应 meta 回归结合稳健方差估计来合并 ES 和 τ，以考虑试验内和 meta 分析数据的相关性。

结果

纳入了 28 项试验，共 44 项随机比较。在 28 项比较（64%）中，VAS 的 ES 比 WOMAC 疼痛的 ES 更有利于干预（P=0.003）。根据 VAS，26 个 P 值（59%）更小（P=0.008）。这 44 项比较共进行了 12 项 meta 分析。根据 VAS，11 项 meta 分析（92%）显示干预的益处更大，ES 的综合总体差异为-0.08（95%CI-0.14 至-0.02）。VAS 和 WOMAC 疼痛的 τ 相似（τ 的差异，-0.003，95%CI-0.009 至 0.004）。