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Quantitative Sensory Testing: Fiabilidade teste-reteste, erro padrão de medida e diferença mínima detetável de um protocolo de avaliação lombar em adultos saudáveis
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Abstract(s)
Introdução: O Quantitative Sensory Testing (QST) é um método de avaliação quantitativa
da função do sistema somatossensorial, que permite identificar potenciais mecanismos
neurofisiológicos subjacentes à experiência de dor do individuo, possibilitando uma
abordagem mais personalizada nos programas de reabilitação. No entanto, ainda persiste a
carência de dados e garantias da fiabilidade deste instrumento em indivíduos saudáveis.
Assim, estabelecer dados acerca da fiabilidade do QST, contribuirá para a melhor
interpretação dos valores das medições em indivíduos saudáveis, a sua reprodutibilidade e
utilização como referência em futuros estudos e prática clínica.
Objetivo: Avaliar a fiabilidade teste-reteste, erro padrão de medida (EPM) e diferença
mínima detetável (DMD) deste instrumento em indivíduos saudáveis.
Métodos: Um protocolo de avaliação do QST para a região lombar foi avaliado com 1
semana de diferença em 14 indivíduos saudáveis. Todas as medições foram efetuadas pelo
mesmo investigador. Para analisar a fiabilidade e a concordância do QST, foram calculados
os coeficientes de correlação intraclasse (ICC) e respetivos 95% intervalos de confiança, os
diagramas Bland-Altman e os 95% limites de concordância (LDC), e os valores absolutos e
de percentagem em relação à média do erro padrão de medida (EPM) e diferença mínima
detetável (DMD).
Resultados: Obtiveram-se resultados para a fiabilidade teste-reteste moderados a excelentes
(ICC>0.6), exceto nos parâmetros de deteção térmicos onde foi baixa (ICC<0.5) e com
pequenos limites de concordância. Os valores de EPM obtidos para todos os parâmetros
térmicos foram inferiores a 3ºC, e para o PPT variou de 21.16Kpa a 56.54Kpa. Os valores
de DMD para o parâmetro mecânico, PPT, apresentaram valores superiores a 130Kpa na
região lombar e pé. Uma grande variabilidade de valores de %EPM e %DMD foi encontrada,
com valores entre de 0.51% a 20.33, e 1.42% e 56.34%, respetivamente.
Conclusão: Este estudo contribuiu para estabelecer valores de fiabilidade intra avaliador do
QST, e definir intervalos associados à magnitude do erro, para 6 parâmetros de um protocolo
de avaliação lombar. Os valores para esta bateria de teste mostraram-se aceitáveis,
persistindo ainda algumas dúvidas nos parâmetros de deteção térmica. Estes achados ajudam
a estabelecer uma base para utilização do QST em contexto de investigação e avaliação de
outcomes na prática clínica.
Introduction: Quantitative Sensory Testing (QST) is a method of quantitative assessment of the function of the somatosensory system, which allows the identification of potential neurophysiological mechanisms underlying the individual's pain experience, enabling a more personalized approach in rehabilitation programs. However, there is still a lack of data and assurances of the reliability of this instrument in healthy subjects. Establishing QST reliability will contribute to better interpretation of measurements on healthy subjects, its reproducibility and use as reference in future studies and clinical practice. Purpose: Assess the test-retest reliability, standard error measurement (SEM) and minimal detectable change (MDC) of this instrument in healthy subjects. Methods: A lower back QST protocol was assessed with 1 week difference for 14 healthy volunteers. All measurements were performed by the same investigator. To assess reliability and agreement, the intraclass correlation coefficients (ICC) and respective 95% CI, Bland– Altman plots and its 95% limits of agreement, and standard error of measurement (SEM) and minimal detectable change (MDC) absolute and percentage values were used. Results: Moderate to excellent test-retest reliability results were found (ICC>0.6), except in thermal detection parameters where it was low (ICC<0.5) with small limits of agreement. The SEM values for all thermal parameters were less than 3ºC, and for the PPT ranged from 21.16Kpa to 56.54Kpa. The MDC values for the mechanical parameter, PPT, presented values greater than 130Kpa in the lumbar region and foot. A large variability in %SEM and %MDC values was found, with values from 0.51% to 20.33, and 1.42% to 56.34%, respectively. Conclusion: This study contributed to the establishment of intra-rater QST reliability values and error magnitude ranges for the values for 6 parameters of a lumbar assessment protocol. The values for this test battery were acceptable, remaining some doubts about the thermal detection parameters. These findings help to establish a basis for the use of QST in the context of research and outcomes assessment in clinical practice.
Introduction: Quantitative Sensory Testing (QST) is a method of quantitative assessment of the function of the somatosensory system, which allows the identification of potential neurophysiological mechanisms underlying the individual's pain experience, enabling a more personalized approach in rehabilitation programs. However, there is still a lack of data and assurances of the reliability of this instrument in healthy subjects. Establishing QST reliability will contribute to better interpretation of measurements on healthy subjects, its reproducibility and use as reference in future studies and clinical practice. Purpose: Assess the test-retest reliability, standard error measurement (SEM) and minimal detectable change (MDC) of this instrument in healthy subjects. Methods: A lower back QST protocol was assessed with 1 week difference for 14 healthy volunteers. All measurements were performed by the same investigator. To assess reliability and agreement, the intraclass correlation coefficients (ICC) and respective 95% CI, Bland– Altman plots and its 95% limits of agreement, and standard error of measurement (SEM) and minimal detectable change (MDC) absolute and percentage values were used. Results: Moderate to excellent test-retest reliability results were found (ICC>0.6), except in thermal detection parameters where it was low (ICC<0.5) with small limits of agreement. The SEM values for all thermal parameters were less than 3ºC, and for the PPT ranged from 21.16Kpa to 56.54Kpa. The MDC values for the mechanical parameter, PPT, presented values greater than 130Kpa in the lumbar region and foot. A large variability in %SEM and %MDC values was found, with values from 0.51% to 20.33, and 1.42% to 56.34%, respectively. Conclusion: This study contributed to the establishment of intra-rater QST reliability values and error magnitude ranges for the values for 6 parameters of a lumbar assessment protocol. The values for this test battery were acceptable, remaining some doubts about the thermal detection parameters. These findings help to establish a basis for the use of QST in the context of research and outcomes assessment in clinical practice.
Description
Keywords
Quantitative sensory testing Indivíduos saudáveis Fiabilidade Teste- Reteste Erro padrão de medida Diferença mínima detetável Quantitative sensory testing Healthy Individuals Test-Retest Reliability Standard Error of Measurement Minimal Detectable Change