Bedside-sensorische-Testungen bei Menschen mit Nackenschmerzen im klinischen Alltag: Äquivalent zur Quantitativen Sensorischen Testung?

Zusammenfassung

Hintergrund Nackenschmerzen gehören zu den häufigsten muskuloskelettalen Erkrankungen des physiotherapeutischen Behandlungsspektrums. Für ein angemessenes Management, v. a. bezüglich der Prognostik und Erfassung zentraler Schmerzprozesse, ist die Beurteilung sensorischer Veränderungen unerlässlich. Bisher ist die Quantitative Sensorische Testung (QST) die einzige Methode, die eine umfassende Bewertung veränderter Sensorik ermöglicht. Es handelt sich dabei jedoch um ein kosten- und zeitaufwendiges Verfahren. Daher besteht Bedarf an einer einfach zu handhabenden und kostengünstigen Alternative.

Ziel Untersuchung der Validität und Reliabilität der Bedside-sensorischen-Testung (BST) bei Menschen mit Nackenschmerzen.

Methode Es handelt sich um ein systematisches Review im Rahmen einer Bachelorarbeit an der Hochschule für Gesundheit Bochum. Die Berichterstattung folgte den Empfehlungen der PRISMA-2020-Checkliste. Im Oktober 2022 wurden die Datenbanken Embase (Ovid), Medline (PubMed), CINAHL (EBSCO), Web of Science und CENTRAL nach Studien durchsucht, die verschiedene BST-Verfahren mit der QST vergleichen. Die methodische Qualität der Studien wurde anhand der COSMIN-Risk-of-Bias-Checkliste bewertet.

Ergebnisse Es wurden 3 Studien mit 286 Patient*innen und 71 Kontrollpersonen einbezogen. Die Hauptergebnisse betrafen die Kriteriumsvalidität der Druckschmerzschwellen (manuelle Druckapplikation: ρ = –0,1 bis –0,37 und φ = 0,11; Stift-Ende: φ = 0,31), Kältedetektionsschwellen (Eisapplikation: ρ = 0,32–0,42; Münze: φ = 0,42) und Kälteschmerzschwellen (Eisapplikation: φ = –0,1; ρ = 0,64–0,65) sowie die Interrater-Reliabilität und die Test-Retest-Reliabilität der Druckschmerzschwellen (ICC = 0,87–0,89 und ICC = 0,75–0,85 für Messprotokolle mit 1–3 Messwiederholungen). Es wurden keine Ergebnisse bzgl. des Messfehlers und der Konstruktvalidität berichtet. Die methodische Qualität der eingeschlossenen Studien reichte von zweifelhaft bis sehr gut. Die Ergebnisse der Studien weisen eine konsistente Qualität der Testgütekriterien sowie eine positive Bewertung der Reliabilität der BST auf. Dennoch zeigt die BST keine mit der QST vergleichbaren Testgütekriterien.

Schlussfolgerung Gemäß der aktuellen Studienlage kann die BST nicht als gleichwertiges Äquivalent der QST angesehen werden. Es besteht die Notwendigkeit, standardisierte BST-Protokolle zu erstellen und deren Testgütekriterien, insbesondere den Messfehler, zu untersuchen.

Abstract

Background Neck pain is one of the most frequent musculoskeletal disorders seen in physiotherapy practice. For proper management, especially regarding the prognosis and measurement of central pain processing, the evaluation of sensory abnormalities is essential. Currently, the Quantitative Sensory Testing (QST) is the only method providing a comprehensive assessment of these. However, it is a cost- and time-consuming procedure. For that reason, there is a need for an easy-to-use alternative.

Aim To investigate the validity and reliability of bedside sensory testing (BST) in people with neck pain.

Methods This systematic review was written for the purpose of achieving bachelor’s degree at the University of Applied Sciences in Bochum. Its reporting followed the PRISMA 2020 checklist. Embase (Ovid), Medline (PubMed), CINAHL (EBSCO), Web of Science and CENTRAL were searched for studies evaluating the measurement properties of different BST tools in comparison to the QST in October 2022. Methodological quality of the studies was rated using the COSMIN Risk of Bias Checklist.

Results 3 studies were included reporting on 286 patients and 71 controls. The main findings describe criterion validity on pressure pain thresholds (thumb: ρ = –0.1 to –0.37 and φ = 0.11; eraser of pencil: φ = 0.31) cold detection thresholds (ice: ρ = 0.32–0.42; metal coin: φ = 0.42) and cold pain thresholds (ice: φ = –0.1; ρ = 0.64–0.65) as well as interrater reliability and test-retest reliability of pressure pain thresholds (ICC = 0.87–0.89 and ICC = 0.75–0.85 for 1–3 repetitions). There have been no results concerning the measurement error and construct validity. Methodological quality ranged from doubtful to very good. The data of the studies showed consistent quality for measurement properties – showing poor to moderate correlation of BST with QST in criterion validity as well as positive rating of reliability of BST. Nevertheless, none of the findings of the BST measurement properties are comparable to those of the QST.

Conclusion With the current state of evidence, BST should not be considered as an equivalent to the QST. There is a need to establish standardized BST-protocols and further research is warranted to investigate measurement properties, especially measurement error, of those.

Schlüsselwörter

Nackenschmerzen - Testgütekriterien - Bedside-sensorische-Testung - quantitative sensorische Testung

Keywords

neck pain - measurement properties - bedside Sensory Testing - quantitative Sensory Testing

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