Chronische Kreuzschmerzen – Nutzertypen ambulanter Versorgung

Daniel, Tiziana; Koetsenruijter, Jan; Wensing, Michel; Wronski, Pamela

doi:10.1007/s00482-021-00565-2

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…This choice has been a major challenge in ours and many other studies that sought to investigate this condition in medico-administrative databases using the International Classification of Diseases system. 8,12,22,35,40,46 Through a rigorous methodology (literature review and expert opinion), we were able to identify many diagnostic codes that could be associated with nonspecific LBP. Our study differs from others on this in that it tested several algorithms over several time windows using a wide range of diagnostic codes for nonspecific LBP.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity and specificity of algorithms for the identification of nonspecific low back pain in medico-administrative databases

Sirois

Dionne

2023

Pain

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Identifying nonspecific low back pain (LBP) in medico-administrative databases is a major challenge because of the number and heterogeneity of existing diagnostic codes and the absence of standard definitions to use as reference. The objective of this study was to evaluate the sensitivity and specificity of algorithms for the identification of nonspecific LBP from medico-administrative data using self-report information as the reference standard. Self-report data came from the PROspective Qu ébec Study on Work and Health, a 24-year prospective cohort study of white-collar workers. All diagnostic codes that could be associated with nonspecific LBP were identified from the International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10) in physician and hospital claims. Seven algorithms for identifying nonspecific LBP were built and compared with self-report information. Sensitivity analyses were also conducted using more stringent definitions of LBP. There were 5980 study participants with (n 5 2847) and without (n 5 3133) LBP included in the analyses. An algorithm that included at least 1 diagnostic code for nonspecific LBP was best to identify cases of LBP in medico-administrative data with sensitivity varying between 8.9% (95% confidence interval [CI] 7.9-10.0) for a 1-year window and 21.5% (95% CI 20.0-23.0) for a 3-year window. Specificity varied from 97.1% (95% CI 96.5-97.7) for a 1year window to 90.4% (95% CI 89.4-91.5) for a 3-year window. The low sensitivity we found reveals that the identification of nonspecific cases of LBP in administrative data is limited, possibly due to the lack of traditional medical consultation.

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Section: Discussionmentioning

confidence: 99%

Sensitivity and specificity of algorithms for the identification of nonspecific low back pain in medico-administrative databases

Sirois

Dionne

2023

Pain

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“…70 %) mit lumbalen Nervenwurzelschmerzen erholt sich innerhalb von 2–4 Wochen. Daher müssen relevante Hinweise und Informationen erfragt und insbesondere die „Red, yellow and blue flags“ erfasst werden 2 4 6 11 .…”

Section: Diagnostikunclassified

“…Diese erfolgt nach dem WHO-Stufenschema unter Berücksichtigung der Kontraindikationen 1 2 3 6 11 . Folgende Aspekte sind zu beachten:…”

Section: Praktisches Vorgehen Bei Nicht Spezifischen Rückenschmerzenunclassified

Kreuzschmerzen aus hausärztlicher-internistischer Sicht

Burchert¹,

Schwill²

2022

Dtsch Med Wochenschr

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Kreuzschmerzen sind weltweit die führende Ursache für körperliche Beeinträchtigungen. In über 80 % der Fälle finden sich keine organischen Ursachen. Bei 20 % gilt es, eine spezifische Ursache frühzeitig zu erkennen, um potenziell gefährliche oder entsprechend therapierbare Verläufe abzuwenden. Entscheidende Hinweise zur Ätiologie liefert eine gründliche Anamnese, die oftmals durch die körperliche Untersuchung nur ergänzend bestätigt wird. EinleitungDie häufigste Form des Rückenschmerzes ist der lumbale Schmerz (Kreuzschmerzen, Lumbago, unterer Rückenschmerz, Lower Back Pain), der definitionsgemäß vom unteren Rippenbogen bis zu den Glutealfalten reicht. Er kann auch in die Beine, ein-oder beidseitig, ausstrahlen (Lumboischialgie). Hier müssen radikuläre von pseudoradikulären Beschwerden abgrenzt werden. Der obere Rückenschmerz hingegen betrifft die gesamte BWS bis zum Nacken. Rückenschmerzen werden nach Ursache, Dauer, Schweregrad und Chronifizierungsstadium (z. B. mit dem Mainzer Pain Staging System, MPSS) klassifiziert. Man bezeichnet Schmerzen mit einer Dauer von ▪ < 6 Wochen als akute Rückenschmerzen, ▪ 6-12 Wochen als subakuter Rückenschmerz [1-3], und ▪ > 12 Wochen als chronische Schmerzen. Klinische Fälle aus der Praxis zeigen die Fallbeispiele 1-3. FALLBEISPIEL 1 Junger Mann, 24 Jahre alt, athletisch-trainierter Körper, hat Beschwerden im thorakolumbalen Übergang. Befund: Leichtgradige S-förmige Fehlhaltung der mittleren BWS, muskulärer Hartspann rechts. Finger-Boden-Abstand (FBA): 0 cm. Vorgehen: Keine weitere Diagnostik bei sonst negativer Anamnese. Nur kurzzeitige NSAR-Gabe. Trainingsprogramm anpassen, passive Seite im Training stärken. Evtl. Chirotherapie.

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“…There is also a too frequent and prematureuse of imaging, spinal injection therapies, and surgical procedures in the treatment of chronic lower back pain (CLBP) 7 . In a recently published study, Daniel and colleagues used administrative data from a large statutory health insurance (SHI) in Germany and stated that only 23% of newly diagnosed patients with CLBP receive guideline-based multimodal therapy in the first year of the occurrence 19 . There is still a large gap between evidence and practice in the treatment of BP 11 , 18 .…”

Section: Introductionmentioning

confidence: 99%

A cross-sectional study to validate an administrative back pain severity classification tool based on the graded chronic pain scale

Hochheim

Ramm²,

Wunderlich³

et al. 2022

Sci Rep

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Treatment of chronic lower back pain (CLBP) should be stratified for best medical and economic outcome. To improve the targeting of potential participants for exclusive therapy offers from payers, Freytag et al. developed a tool to classify back pain chronicity classes (CC) based on claim data. The aim of this study was to evaluate the criterion validity of the model. Administrative claim data and self-reported patient information from 3,506 participants (2014–2021) in a private health insurance health management programme in Germany were used to validate the tool. Sensitivity, specificity, and Matthews’ correlation coefficient (MCC) were calculated comparing the prediction with actual grades based on von Korff’s graded chronic pain scale (GCPS). The secondary outcome was an updated view on direct health care costs (€) of patients with back pain (BP) grouped by GCPS. Results showed a fair correlation between predicted CC and actual GCPS grades. A total of 69.7% of all cases were correctly classified. Sensitivity and specificity rates of 54.6 and 76.4% underlined precision. Correlation between CC and GCPS with an MCC of 0.304 also indicated a fair relationship between prediction and observation. Cost data could be clearly grouped by GCPS: the higher the grade, the higher the costs and the use of health care. This was the first study to compare the predicted severity of BP using claim data with the actual severity of BP by GCPS. Based on the results, the usage of CC as a single tool to determine who receives CLBP treatment cannot be recommended. CC is a good tool to segment candidates for specific types of intervention in BP. However, it cannot replace a medical screening at the beginning of an intervention, as the rate of false negatives is too high. Trial registration The study was conducted using routinely collected data from an intervention, which was previously evaluated and registered retrospectively in the German Registry of Clinical Trials under DRKS00015463 (04/09/2018). Informed consent and the self-reported questionnaire have remained unchanged since the study and, therefore, are still valid according to the ethics proposal.

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Chronische Kreuzschmerzen – Nutzertypen ambulanter Versorgung

Cited by 5 publications

References 23 publications

Sensitivity and specificity of algorithms for the identification of nonspecific low back pain in medico-administrative databases

Sensitivity and specificity of algorithms for the identification of nonspecific low back pain in medico-administrative databases

Kreuzschmerzen aus hausärztlicher-internistischer Sicht

A cross-sectional study to validate an administrative back pain severity classification tool based on the graded chronic pain scale

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