Grevitt M, Pande K, O'Dowd J, Webb J
Centre for Spinal Studies and Surgery, University Hospital, Queen's Medical Centre, Nottingham, UK.
Eur Spine J. 1998;7(3):218-23. doi: 10.1007/s005860050059.
Psychologic factors may have a major influence on the outcome of treatment for back pain. Psychologic disturbance is manifest as emotional distress and may be associated with inappropriate symptoms and signs. Few outcome studies describe the patient population in terms of their psychologic profile. Anecdotal evidence suggested that the routine use of psychologic screening tests in British spine practice was rare. An audit of the prevalent use of psychologic testing amongst a selected group of British spinal surgeons was conducted. This was followed by a prospective, double blind comparison of subjective evaluations of patients with formal psychologic tests. The principal aim was to determine how accurately treating physicians could identify psychologically distressed patients. A postal questionnaire was sent to all consultant members of the British Orthopaedic Spine Society. Details of their current practice and frequency of use of psychologic tests was obtained. In a subsequent study, 125 consecutive new patients attending a back pain clinic were initially evaluated by questionnaires and classified as either psychologically distressed or non-distressed. These patients were then interviewed and examined by treating physicians, who then allocated them to one of four psychologic categories, using predefined criteria. The two results were compared and sensitivity, specificity and predictive values for the subjective evaluations were calculated. Sixty-three percent of respondents to the postal survey either never or only occasionally used any form of psychologic testing in assessing back pain patients. The follow-up prospective study demonstrated that experienced spinal surgeons achieved only a 26% sensitivity when trying to identify distressed patients. The specificity for identifying non-distressed patients was 96%. The predictive value of a "distressed" evaluation was 69%. The predictive value for non-distressed patients was 77%. Subjective psychologic assessment of back pain patients has a low sensitivity and predictive value for distressed patients. Formal psychologic screening should be routinely included in the clinical decision making process.
心理因素可能对背痛的治疗结果产生重大影响。心理障碍表现为情绪困扰，可能与不适当的症状和体征相关。很少有结局研究根据心理特征描述患者群体。轶事证据表明，在英国脊柱诊疗中常规使用心理筛查测试的情况很少见。对一组选定的英国脊柱外科医生中心理测试的普遍使用情况进行了审计。随后对患者的主观评估与正式心理测试进行了前瞻性、双盲比较。主要目的是确定治疗医生识别心理困扰患者的准确程度。向英国骨科脊柱协会的所有顾问成员发送了一份邮政问卷。获得了他们当前的诊疗情况和心理测试使用频率的详细信息。在随后的一项研究中，对125名连续到背痛诊所就诊的新患者最初通过问卷进行评估，并分为心理困扰或非心理困扰两类。然后由治疗医生对这些患者进行访谈和检查，治疗医生随后使用预定义标准将他们分配到四个心理类别之一。比较这两个结果，并计算主观评估的敏感性、特异性和预测值。邮政调查的63%的受访者在评估背痛患者时从未或仅偶尔使用任何形式的心理测试。后续的前瞻性研究表明，经验丰富的脊柱外科医生在试图识别困扰患者时的敏感性仅为26%。识别非困扰患者的特异性为96%。“困扰”评估的预测值为69%。非困扰患者的预测值为77%。对背痛患者的主观心理评估对困扰患者的敏感性和预测值较低。正式的心理筛查应常规纳入临床决策过程。
