Original Title: Patrones de dolor lumbar: fiabilidad de un modelo de clasificación

Authors' objectives: Establish the physiopathological bases and differential criteria of Lower Back Pain Models through a review of the literature. Preparation of a patient classification instrument according to clinical models of lower back pain based on the minimum data obtained in anamnesis and physical exploration. Determine the interobserver agreement.

Authors' results and conclusions: After classifying a total of 181 patients, the interobserver agreement was considered to be weak (Kappa 0.21-0.40) or moderate (Kappa 0.41-0.60). The agreement was worse if the drawing made by the patient showing the distribution of his pain was used. The intraobserver agreement -each evaluator with himself- in the cataloguing of the model according to the sheet was irregular, ranging between weak (1 observer k=0.299) and very good (1 observer k=0.849). The evaluators group was able to establish a dominating model in 122 of the 181 (67%) assessable patients. On 102 occasions, a diagnosis was reached with «certainty» and in 20, with a diagnosis of a «doubtful» nature. It was not possible to establish a dominating model in the remaining cases. CONCLUSIONS The results suggest that, although moderate overall, the system interobserver agreement is acceptable in order to sustain this classification model. The relatively modest level of total agreement for all the patients as a whole might indicate that the usefulness of the system for general Lower Back Pain classifi cation purposes is limited, compared with its usefulness in the identifi cation of particular syndromes. The large number of variables in the questionnaire, the excessive number of observer is, the absence of direct contact with the patient, the lack of consideration for age in a dynamic process, the confused approach of some questions and insufficient training of observer is in the TADA's health pain models, require more work to test the validity and feasibility of this classification system.

Authors' recommendations: The classification of lower back pain models based on possible known sources of pain and the development of lower back degenerative disease, may be recommended for the clinical examination and classification of Lower Back Pain and may enhance the management of affected patients, deduced from evidence-based clinical guidelines. The lower back pain and model classification questionnaire must be improved. The clinical interview and examination of the patient cannot be replaced.

Authors' methods: Preparation of a lower back pain classification sheet based on minimum clinical data and on the patient's description of the pain. Ten specialists from different health care areas (primary care, traumatology, rehabilitation, inspection) filled in the sheet through anamnesis and the clinical examination of 20 patients each. With this data they classified patients in accordance with five established pain models: discogenic, facetary, radicular, stenosis of the spinal canal and pychogene. The remaining participants established their diagnosis solely on the basis of a hard copy of the sheet. The category designated by the professional and which included each patient, was considered to be the reference model. The participants were invited to reassess their own patients without knowing their identity. The inter and intraobserver agreement was calculated. The dominating model was also determined according to the classification of all the participants and whether this was «certain», «doubtful» or «indeterminate».

Project Status: Completed

Year Published: 2008

URL for published report: https://www.euskadi.eus/contenidos/informacion/2008_osteba_publicacion/es_def/adjuntos/D_08_10%20dolor%20lumbar.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment (OSTEBA)</p>