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Bessere Verlaufsdokumentation bei Patienten mit lumboradikulären Schmerzsyndromen

Der modifizierte NASS-Fragebogen

Optimized assessment of the outcome in patients with radicular back pain of the lumbar spine

The modified NASS questionnaire

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Zusammenfassung

Hintergrund

Zweck dieser Studie war es, ein zuverlässiges und einfach anzuwendendes Instrument zur Erfassung des Krankheitsverlaufs und des Therapieerfolgs bei Rückenschmerzpatienten mit lumboradikulären Syndromen vorzustellen.

Methodik

Es wurden Daten von Patienten, welche sich einer Mikrodiskektomie wegen lumboradikulärem Syndrom unterzogen, in die Studie eingeschlossen und mittels des 17-teiligen NASS-Fragebogens (North American Spine Society) in Form eines Interviews vor und nach dem operativen therapeutischen Eingriff befragt. Außerdem wurden die demographischen Daten und Komorbiditäten erhoben. Über die Auswertung der Effektstärke bzw. Standardized Response Mean konnten die Fragen mit der stärksten Veränderung (vorher/nachher) für das Behandlungsergebnis ausgewählt werden.

Ergebnisse

Es konnten die Datensätze von 139 Patienten ausgewertet werden. Aus den 3 Dimensionen Schmerz, neurologische Symptome und Beeinträchtigung im Alltag wurden jeweils diejenigen Fragen mit der höchsten Veränderung ausgewählt (hohe E. S. bzw. S. R. M.). In Abstimmung mit der klinischen Relevanz ergab sich schließlich die Auswahl von 8 Fragen als konzentrierte Kurzform des NASS-Fragebogens.

Schlussfolgerung

In dem von uns vorgestellten Instrument eines kurzen und aussagekräftigen Fragebogens sehen wir eine nützliche und in der Klinik einfach einzusetzende Möglichkeit zur verbesserten Dokumentation bei Patienten mit lumboradikulären Syndromen, insbesondere auch zur Effektmessung therapeutischer Interventionen im Sinne einer patientenorientierten Ergänzung der klinischen Befunderhebung und Diagnostik. Dieses neue Instrument könnte helfen, die Qualitätssicherung bei der konservativen und interventionellen Schmerzbehandlung der Patienten mit lumboradikulären Schmerzsyndromen zu verbessern.

Abstract

Background

The purpose of the study was to present a reliable instrument with easy application to assess the outcome and improvement of therapy in patients with radicular symptoms of the lumbar spine.

Methods

Data from patients who underwent microdiscectomy because of lumbar radicular symptoms were collected and analyzed and interviews were performed using the well-known North American Spine Society (NASS) lumbar spine questionnaire (17 items) before and after the intervention. In addition patient data including comorbidities were collected. By calculating effect size (ES) and standardized response mean (SRM) for each item of the questionnaire, the questions with the highest change before and after the intervention could be selected.

Results

A total of 139 patients undergoing microdiscectomy for lumbar radicular symptoms due to a disc herniation were included in the analysis. Concerning the three dimensions pain, neurological symptoms and impairment of activities in daily life, the questions with best predictive value (high ES and SRM) were selected. According to their clinical relevance eight questions of the NASS questionnaire were finally selected for the short form.

Conclusion

This short, significant and easy to use questionnaire is in our opinion a useful instrument to assess the course of patients with radicular back pain and especially to measure and monitor the outcome of therapeutic interventions, in addition to conventional clinical diagnostics and examinations. This novel instrument could be a useful tool for improving quality assurance in conventional and interventional pain management of these patients.

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Authors and Affiliations

  1. Klinik für Rheumatologie, Stadtspital Triemli, Birmensdorferstr. 497, 8055, Zürich, Schweiz

    M. Janousek, S. Ferrari, U.D. Schmid, H.A. Bischoff, M. Balsiger & R. Theiler

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  1. M. Janousek
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  2. S. Ferrari
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  3. U.D. Schmid
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  4. H.A. Bischoff
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  5. M. Balsiger
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  6. R. Theiler
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Correspondence to M. Janousek.

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Janousek, M., Ferrari, S., Schmid, U. et al. Bessere Verlaufsdokumentation bei Patienten mit lumboradikulären Schmerzsyndromen. Schmerz 25, 552–557 (2011). https://doi.org/10.1007/s00482-011-1099-z

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