ABSTRACT
BACKGROUND: The purpose of this study was to describe the diagnostic performance of the Neuropathic Pain Subscale of McGill [NP-MPQ (SF-2)] and the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire in differentiating people with neuropathic chronic pain post total joint arthroplasty (TJA). METHODS: This study was a survey of a cohort of individuals who had undergone primary, unilateral total knee, or hip joint arthroplasty. The questionnaires were administered by mail. The time interval from operation to the completion of the postal survey varied from 1.5 to 3.5 years post-surgery. Receiver Operating Characteristic (ROC) analysis was used to assess the overall diagnostic power and determine the optimal threshold value of the NP-MPQ (SF-2) in identification of neuropathic pain. RESULTS: S-LANSS identified 19 subjects (28%) as having neuropathic pain (NP), while NP-MPQ (SF-2) subscale identified 29 (43%). When using the S-LANSS as the reference standard, a Receiver Operating Characteristic (ROC) analysis for NP-MPQ (SF-2) had an area under the curve of 0.89 (95% CI: 0.82, 0.97); a cut off score of 0.91 NP-MPQ (SF-2) maximized sensitivity (89.5%) and specificity (75.0%). Correlation between the measures was moderate (r = 0.56; 95% CI: 0.40, 0.68). CONCLUSION: These finding suggest some conceptual overlap but some variability in diagnosis of NP which may relate to scale-tapping into different dimensions of the pain experience, or the different scoring metrics.
ABSTRACT
Purpose: This study aimed to (1) estimate the point prevalence of persistent postoperative pain (PPP) identified using the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) after unilateral primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using data from a registry of total joint arthroplasty (TJA) patients in Ontario, (2) estimate the effect of PPP on function, (3) estimate the prevalence of neuropathic pain (NP) features among patients with persistent pain, (4) determine participant characteristics in order to estimate the potential predictors of NP classification among individuals with persistent pain after TJA, (5) estimate the extent to which the estimates of prevalence depended on the measure used (i.e., S-LANSS vs. NP sub-scale of the Short-Form McGill Pain Questionnaire 2 [NP-SF-MPQ-2]), and (6) determine the difference in characteristics between those with and without NP. Method: This was a prospective follow-up study of a historical cohort of individuals who had undergone primary unilateral THA or TKA. Persistent pain was operationally defined as pain rated as 3 or more (out of 5) on the Oxford Pain Questionnaire 6 months or 1 year after THA or TKA. Participants with persistent pain completed the S-LANSS and the NP-SF-MPQ-2. Results: A total of 1,143 participants were identified as having had a TJA, 148 (13%) of whom had PPP. A total of 67 recipients completed the S-LANSS and the NP-SF-MPQ-2. Of these, an NP subtype was identified among 19 (28%; those with an S-LANSS score ≥ 12) to 29 (43%; those with an NP-SF-MPQ-2 score ≥ 0.91). Individuals with persistent pain of the NP subtype after TJA reported severe pain intensity and higher disability levels 1.5-3.5 years after surgery compared with those without persistent pain. Conclusions: A significant proportion of patients have persistent pain post-unilateral THA or TKA.
Objectif : 1) évaluer la prévalence ponctuelle de la douleur postopératoire persistante indéterminée au moyen de l'évaluation autoadministrée des signes et symptômes de la douleur neuropathique de Leeds (S-LANSS) après une intervention unilatérale primaire sous forme d'arthroplastie totale de la hanche (ATH) ou d'une arthroplastie totale du genou (ATG), à partir d'un registre de patients ayant subi une arthroplastie par prothèse totale (APT) en Ontario; 2) évaluer l'effet de cette douleur sur la fonction; 3) évaluer la prévalence des manifestations de douleur neuropathique (DN) chez les patients souffrant des douleurs persistantes; 4) déterminer les caractéristiques des participants pour évaluer les prédicteurs potentiels de DN chez les personnes qui souffrent de douleur persistante après une APT; 5) évaluer dans quelle mesure les évaluations de prévalence dépendaient de la mesure utilisée (S-LANSS ou sous-échelle de DN du questionnaire court de la douleur de McGill 2 [SF-MPQ-2 ou NP-SF-MPQ-2]); 6) déterminer la différence entre les caractéristiques de ceux qui souffrent de DN et de ceux qui n'en souffrent pas. Méthodologie : étude prospective de suivi auprès d'une cohorte historique de personnes ayant subi une ATH ou un ATG unilatérale primaire. La douleur persistante était définie sur le plan opérationnel comme une douleur d'au moins 3 sur 5 au questionnaire de la douleur d'Oxford, de six mois à un an après l'ATH ou l'ATG. Les participants souffrant de douleur persistante ont rempli l'évaluation S-LANSS et la sous-échelle NP-SF-MPQ-2. Résultats : il a été établi que 148 des 1 143 participants ayant subi une APT ont souffert de douleur postopératoire persistante (13 %). Au total, 67 ont rempli l'évaluation S-LANSS et la sous-échelle NP-SF-MPQ-2. De ce nombre, 19 (28 %; S-LANSS ≥ 12) à 29 (43 %; NP-SF-MPQ-2 ≥ 0,91) personnes ont présenté un sous-type de DN. Les personnes souffrant de douleur persistante du sous-type des DN après une APT ont déclaré une douleur d'intensité marquée et un taux d'incapacité élevé de 1,5 à 3,5 ans après l'opération par rapport à ceux qui ne souffraient pas de douleur persistante. Conclusion : une forte proportion de patients souffre de douleurs persistantes après une ATH ou une ATG unilatérale.
ABSTRACT
BACKGROUND: The role of an advanced practice physiotherapist has been introduced in many countries to improve access to care for patients with hip and knee arthritis. Traditional models of care have shown a gender bias, with women less often referred and recommended for surgery than men. This study sought to understand if patient gender affects access to care in the clinical encounter with the advanced practice provider. Our objectives were: (1) To determine if a gender difference exists in the clinical decision to offer a consultation with a surgeon; (2) To determine if a gender difference exists in patients' decisions to accept a consultation with a surgeon among those patients to whom it is offered; and, (3) To describe patients' reasons for not accepting a consultation with a surgeon. METHODS: This was a prospective study of 815 patients presenting to a tertiary care centre for assessment of hip and knee arthritis, with referral onward to an orthopaedic surgeon when indicated. We performed a multiple logistic regression analysis adjusting for severity to address the first objective and a simple logistic regression analysis to answer the second objective. Reasons for not accepting a surgical consultation were obtained by questionnaire. RESULTS: Eight hundred and fifteen patients (511 women, 304 men) fulfilled study eligibility criteria. There was no difference in the probability of being referred to a surgeon for men and women (difference adjusted for severity = - 0.02, 95% CI: - 0.07, 0.02). Neither was there a difference in the acceptance of a referral for men and women (difference = - 0.05, 95% CI: - 0.09, 0.00). Of the 14 reasons for declining a surgical consultation, 5 showed a difference with more women than men indicating a preference for non-surgical treatment along with fears/concerns about surgery. CONCLUSIONS: There is no strong evidence to suggest there is a difference in proportion of males and females proceeding to surgical consultation in the model of care that utilizes advanced practice orthopaedic providers in triage. This study adds to the evidence that supports the use of suitably trained alternate providers in roles that reduce wait times to care and add value in contexts where health human resources are limited. The care model is a viable strategy to assist in managing the growing backlog in orthopaedic care, recently exacerbated by the COVID-19 pandemic.
