Avoiding Catch-22

Autor: Nick T van Dasselaar, Marcel J. Schenkels, Monique A H Steegers, Ewald M. Bronkhorst, Hans Timmerman, Oliver H.G. Wilder-Smith, André Wolff, Frank J P M Huygen, Kris Vissers
Přispěvatelé: Anesthesiology, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Neurology
Cross-sectional study
Clinical assessment
Screening tool
Disease
Neuropathic pain
lcsh:RC346-429
PainDETECT questionnaire
0302 clinical medicine
Sensitivity
Surveys and Questionnaires
030212 general & internal medicine
education.field_of_study
Chronic pain
General Medicine
Middle Aged
Reliability
Low back pain
3. Good health
Specificity
Female
medicine.symptom
Chronic Pain
Neck shoulder arm pain
Research Article
Adult
medicine.medical_specialty
Population
Pain
Sensitivity and Specificity
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Validity
03 medical and health sciences
medicine
Humans
education
lcsh:Neurology. Diseases of the nervous system
Aged
business.industry
Gold standard
Reproducibility of Results
medicine.disease
Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10]
Cross-Sectional Studies
Physical therapy
Neuralgia
Neurology (clinical)
business
030217 neurology & neurosurgery
Peripheral nerve damage
Zdroj: Timmerman, H, Wolff, A P, Bronkhorst, E M, Wilder-Smith, O H G, Schenkels, M J, van Dasselaar, N T, Huygen, F J P M, Steegers, M A H & Vissers, K C P 2018, ' Avoiding Catch-22 : Validating the PainDETECT in a in a population of patients with chronic pain ', BMC Neurology, vol. 18, no. 1, 91 . https://doi.org/10.1186/s12883-018-1094-4
BMC Neurology, 18, 1, pp. 91
Timmerman, H, Wolff, A P, Bronkhorst, E M, Wilder-Smith, O H G, Schenkels, M J, van Dasselaar, N T, Huygen, F J P M, Steegers, M A H & Vissers, K C P 2018, ' Avoiding Catch-22 : validating the PainDETECT in a in a population of patients with chronic pain ', BMC Neurology, vol. 18, no. 1, pp. 91 . https://doi.org/10.1186/s12883-018-1094-4
BMC Neurology, 18(1). BioMed Central
BMC Neurology
BMC Neurology, 18, 91
BMC Neurology, Vol 18, Iss 1, Pp 1-14 (2018)
BMC NEUROLOGY, 18:91. BioMed Central Ltd.
BMC Neurology, 18:91. BioMed Central Ltd.
ISSN: 1471-2377
DOI: 10.1186/s12883-018-1094-4
Popis: Background Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system and is a major therapeutic challenge. Several screening tools have been developed to help physicians detect patients with neuropathic pain. These have typically been validated in populations pre-stratified for neuropathic pain, leading to a so called “Catch-22 situation:” “a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule”. The validity of screening tools needs to be proven in patients with pain who were not pre-stratified on basis of the target outcome: neuropathic pain or non-neuropathic pain. This study aims to assess the validity of the Dutch PainDETECT (PainDETECT-Dlv) in a large population of patients with chronic pain. Methods A cross-sectional multicentre design was used to assess PainDETECT-Dlv validity. Included where patients with low back pain radiating into the leg(s), patients with neck-shoulder-arm pain and patients with pain due to a suspected peripheral nerve damage. Patients’ pain was classified as having a neuropathic pain component (yes/no) by two experienced physicians (“gold standard”). Physician opinion based on the Grading System was a secondary comparison. Results In total, 291 patients were included. Primary analysis was done on patients where both physicians agreed upon the pain classification (n = 228). Compared to the physician’s classification, PainDETECT-Dlv had a sensitivity of 80% and specificity of 55%, versus the Grading System it achieved 74 and 46%. Conclusion Despite its internal consistency and test-retest reliability the PainDETECT-Dlv is not an effective screening tool for a neuropathic pain component in a population of patients with chronic pain because of its moderate sensitivity and low specificity. Moreover, the indiscriminate use of the PainDETECT-Dlv as a surrogate for clinical assessment should be avoided in daily clinical practice as well as in (clinical-) research. Catch-22 situations in the validation of screening tools can be prevented by not pre-stratifying the patients on basis of the target outcome before inclusion in a validation study for screening instruments. Trial registration The protocol was registered prospectively in the Dutch National Trial Register: NTR 3030. Electronic supplementary material The online version of this article (10.1186/s12883-018-1094-4) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE