背景:骶髂关节(SIJ)注射在评估SIJ病理学的诊断工具包中至关重要。召回偏倚是患者报告结果的重要组成部分,在SIJ注射中未得到很好的研究。
目的:本研究的目的是表征准确性,方向,和SIJ类固醇注射后疼痛水平回忆偏差的程度,并研究影响患者回忆的因素。
方法:前瞻性队列研究。
方法:一级学术医学中心。
方法:使用标准化问卷,在注射前对接受SIJ类固醇注射的患者记录基线数字评定量表(NRS-11)评分,注射后4小时,注射后24小时。在注射后至少2周,患者被要求回忆他们的注射前,4小时,注射后24小时NRS-11评分。使用配对t检验对每个时间间隔的实际和召回的NRS-11得分进行比较。多变量线性回归用于确定与一致性召回相关的因素。
结果:纳入60例平均年龄66岁的患者(65%为女性)。与他们注射前的疼痛评分相比,患者在两个4小时均显示出相当大的改善(平均差异[MD]=3.28;95%CI,2.68-3.89),注射后24小时(MD=3.23;95%CI,2.44-4.03)。患者对注射前症状的回忆比实际严重(MD=0.65;95%CI,0.31-0.99)。患者在注射后4小时(MD=0.50;95%CI.04-1.04)以及24小时(MD=0.80;95%CI,0.16-1.44)时的症状回忆也比实际严重。回忆偏差的程度是轻微的,没有超过最小的临床重要差异。当比较注射前与注射后4小时NRS-11评分时,实际疼痛水平与回忆疼痛水平之间存在中度相关性(相关系数[r]=0.64;P<0.001),当比较注射前与注射后24小时NRS-11评分时,存在中度相关性(r=0.62;P<0.001)。线性回归模型显示,在预注射时,体重指数较低、同时存在精神病诊断的患者在回忆疼痛方面表现更好(P<0.05).与注射前和注射后4小时NRS-11评分相比,体重指数较高的患者疼痛缓解较少(P<0.05)。
结论:回忆疼痛评分是通过电话调查获得的,这可能会导致面试偏见。一个病人死了,3人失去了随访。我们没有控制患者使用辅助疼痛缓解方式,这可能会调节对注射的整体反应。SIJ注射也可以诊断,因此,一些患者可能没有相同的注射指征或产生疼痛的诊断。
结论:在实际和回忆调查中,患者对SIJ类固醇注射的疼痛水平反应良好。尽管患者在注射前表现出对绝对疼痛评分的不良回忆,注射后4小时,注射后24小时,他们在注射后4小时和24小时均表现出稳健的净疼痛评分改善.这些发现表明,使用患者回忆来描述骶髂关节功能障碍治疗后疼痛缓解的程度是有用的。
BACKGROUND: Sacroiliac joint (SIJ) injections are crucial in the diagnostic toolkit for evaluating SIJ pathology. Recall bias is an important component in patient-reported outcomes that has not been well studied in SIJ injection.
OBJECTIVE: The purpose of this study was to characterize the accuracy, direction, and magnitude of pain level recall bias following SIJ steroid injection and study the factors that affect patient recollection.
METHODS: Prospective cohort study.
METHODS: Level 1 academic medical center.
METHODS: Using standardized questionnaires, baseline Numeric Rating Scale (NRS-11) scores were recorded for patients undergoing SIJ steroid injections at preinjection, at 4 hours postinjection, and at 24 hours postinjection. At a minimum of 2 weeks postinjection, patients were asked to recall their preinjection, 4-hour, and 24-hour postinjection NRS-11 scores. Actual and recalled NRS-11 scores were compared using paired t tests for each time interval. Multivariable linear regression was used to identify factors that correlated with consistent recall.
RESULTS: Sixty patients with a mean age of 66 years (65% women) were included. Compared to their preinjection pain score, patients showed considerable improvement at both 4 hours (mean difference [MD] = 3.28; 95% CI, 2.68 - 3.89), and 24 hours (MD = 3.23; 95% CI, 2.44 - 4.03) postinjection. Patient recollection of preinjection symptoms was more severe than actual (MD = 0.65; 95% CI, 0.31 - 0.99). Patient recollection of symptoms was also more severe than actual at 4 hours (MD = 0.50; 95% CI .04 - 1.04) as well as at 24 hours postinjection (MD = 0.80; 95% CI, 0.16 - 1.44). The magnitude of recall bias was mild and did not exceed the minimal clinically important difference. There was a moderate correlation between actual and recalled pain levels when comparing preinjection with the 4-hour postinjection NRS-11 score (correlation coefficient [r] =0.64; P < 0.001) and moderate correlation when comparing preinjection with the 24-hour postinjection NRS-11 score (r = 0.62; P < 0.001). Linear regression models showed that at preinjection, patients with a lower body mass index and the presence of coexisting psychiatric diagnoses were better at recalling their pain (P < 0.05). Patients with a higher body mass index also experienced less pain relief when comparing preinjection with the 4-hour postinjection NRS-11 score (P < 0.05).
CONCLUSIONS: Recall pain scores were obtained via telephone surveys, which can lead to interview bias. One patient died, and 3 were lost to follow-up. We did not control for patient use of adjunctive pain relief modalities, which may modulate the overall response to injection. SIJ injections can also be diagnostic, so some patients may not have shared the same indication for injection or pain-generating diagnosis.
CONCLUSIONS: Patients had favorable pain level responses to their SIJ steroid injection for both actual and recall surveys. Although patients demonstrated poor recall of absolute pain scores at preinjection, 4-hour postinjection, and 24-hour postinjection, they demonstrated robust recall of their net pain score improvement at both 4- and 24-hours postinjection. These findings suggest that there is utility in using patient recollection to describe the magnitude of pain relief following treatment for sacroiliac joint dysfunction.