Clinical classification criteria for radicular pain caused by lumbar disc herniation: the radicular pain caused by disc herniation (RAPIDH) criteria

Autor: Stéphane Genevay, Jeffrey N. Katz, Jean-François Kaux, Thomas D. Cha, Marc Marty, Kika Konstantinou, James Rainville, Francisco M. Kovacs, Delphine S. Courvoisier, M. Norberg, Steven J. Atlas
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
Delphi Technique
Radiculopathy/diagnosis
Neurogenic claudication
Physical examination
Lumbar vertebrae
Intervertebral Disc Degeneration
Intervertebral Disc Displacement/complications/pathology
Intervertebral Disc Degeneration/pathology
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Back pain
Medicine
Humans
Orthopedics and Sports Medicine
Radiculopathy
030203 arthritis & rheumatology
Sciatica
ddc:616
Lumbar Vertebrae
medicine.diagnostic_test
business.industry
Lumbar spinal stenosis
Middle Aged
medicine.disease
Low back pain
medicine.anatomical_structure
Radicular pain
Back Pain
Physical therapy
Surgery
Female
Neurology (clinical)
medicine.symptom
business
Back Pain/diagnosis
030217 neurology & neurosurgery
Intervertebral Disc Displacement
Zdroj: Spine Journal, Vol. 17, No 10 (2017) pp. 1464-1471
ISSN: 1529-9430
Popis: Classification criteria are recommended for diseases that lack specific biomarkers to improve homogeneity in clinical research studies. Because imaging evidence of lumbar disc herniations (LDHs) may not be associated with symptoms, clinical classification criteria based on patient symptoms and physical examination findings are required.This study aimed to produce clinical classification criteria to identify patients with radicular pain caused by LDH.The study design was a two-stage process. Phase 1 included a Delphi process and Phase 2 included a cohort study.The patient sample included outpatients recruited from spine clinics in five countries.The outcome measures were items from history and physical examination.In Phase 1, 17 spine experts participated in a Delphi process to select symptoms and signs suggesting radicular pain caused by LDH. In Phase 2, 19 different clinical experts identified patients they confidently classified as presenting with (1) radicular pain caused by LDH, (2) neurogenic claudication (NC) caused by lumbar spinal stenosis, or (3) non-specific low back pain (NSLBP) with referred leg pain. Patients completed survey items and specialists documented examination signs. A score to predict radicular pain caused by LDH was developed based on the coefficients of the multivariate model. An unrestricted grant of less than US$15,000 was received from MSD: It was used to support the conception of the Delphi, data management, and statistical analysis. No fees were allocated to participating spine specialists.Phase 1 generated a final list of 74 potential symptoms and signs. In Phase 2, 209 patients with pain caused by LDH (89), NC (63), or NSLBP (57) were included. Items predicting radicular pain caused by LDH (p.05) were monoradicular leg pain distribution, patient-reported unilateral leg pain, positive straight leg raise test60° (or femoral stretch test), unilateral motor weakness, and asymmetric ankle reflex. The score had an AUC of 0.91. An easy-to-use weighted set of criteria with similar psychometric characteristics is proposed (specificity 90.4%, sensitivity 70.6%).Classification criteria for identifying patients with radicular pain caused by LDH are proposed. Their use could improve the homogeneity of patients enrolled in clinical research studies.
Databáze: OpenAIRE
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