Generic Portal

TY - JOUR

T1 - Applicability and Validity of an e-Health Tool for the Appropriate Referral and Selection of Patients With Chronic Pain for Spinal Cord Stimulation

T2 - Results From a European Retrospective Study

AU - Thomson, Simon

AU - Huygen, Frank

AU - Prangnell, Simon

AU - Baranidharan, Ganesan

AU - Belaïd, Hayat

AU - Billet, Bart

AU - Eldabe, Sam

AU - de Carolis, Giuliano

AU - Demartini, Laura

AU - Gatzinsky, Kliment

AU - Kallewaard, Jan Willem

AU - Paroli, Mery

AU - Winkelmüller, Matthias

AU - Helsen, Nicky

AU - Stoevelaar, Herman

N1 - Funding Information: Source(s) of financial support: This study was funded by Boston Scientific . The funder was neither involved in the design, setup, and conduct of this study nor in the preparation of the manuscript. The manuscript has been shared with the funder after submission. Publisher Copyright: © 2021 The Authors

PY - 2023/1

Y1 - 2023/1

N2 - Objectives: To support rational decision-making on spinal cord stimulation (SCS), a European expert panel developed an educational e-health tool using the RAND/University of California at Los Angeles Appropriateness Method. This retrospective study aimed to determine the applicability and validity of the tool using data from patients for whom SCS had been considered. Materials and Methods: A total of 12 European implant centers retrieved data from 25 to 50 consecutive patients for whom SCS was considered in 2018–2019. For each patient, data were captured on the clinical and psychosocial variables included in the e-health tool, center decisions on SCS, and patient outcomes. Patient outcomes included global perception of effect by the patient and observer, and pain reduction (numeric pain rating scale) at six-month follow-up. Results: In total, 483 patients were included, of whom 133 received a direct implant, 258 received an implant after a positive trial, 32 had a negative trial, and 60 did not receive SCS for reasons other than a negative trial. The most frequent indication was persistent spinal pain syndrome type 1 and type 2 (74%), followed by neuropathic pain syndromes (13%), complex regional pain syndrome (12%), and ischemic pain syndromes (0.8%). Data on the clinical and psychosocial variables were complete for 95% and 93% of patients, respectively, and missing data did not have a significant impact on the study outcomes. In patients who had received SCS, panel recommendations were significantly associated with patient outcomes (p < 0.001 for all measures). Substantial improvement ranged from 25% if the e-health tool outcome was “not recommended” to 83% if SCS was “strongly recommended”. In patients who underwent a trial (N = 290), there was 3% of trial failure when SCS was ”strongly recommended” vs 46% when SCS was ”not recommended”. Conclusions: Retrospective application of the e-health tool on patient data showed a strong relationship between the panel recommendations and both SCS trial results and treatment outcomes.

AB - Objectives: To support rational decision-making on spinal cord stimulation (SCS), a European expert panel developed an educational e-health tool using the RAND/University of California at Los Angeles Appropriateness Method. This retrospective study aimed to determine the applicability and validity of the tool using data from patients for whom SCS had been considered. Materials and Methods: A total of 12 European implant centers retrieved data from 25 to 50 consecutive patients for whom SCS was considered in 2018–2019. For each patient, data were captured on the clinical and psychosocial variables included in the e-health tool, center decisions on SCS, and patient outcomes. Patient outcomes included global perception of effect by the patient and observer, and pain reduction (numeric pain rating scale) at six-month follow-up. Results: In total, 483 patients were included, of whom 133 received a direct implant, 258 received an implant after a positive trial, 32 had a negative trial, and 60 did not receive SCS for reasons other than a negative trial. The most frequent indication was persistent spinal pain syndrome type 1 and type 2 (74%), followed by neuropathic pain syndromes (13%), complex regional pain syndrome (12%), and ischemic pain syndromes (0.8%). Data on the clinical and psychosocial variables were complete for 95% and 93% of patients, respectively, and missing data did not have a significant impact on the study outcomes. In patients who had received SCS, panel recommendations were significantly associated with patient outcomes (p < 0.001 for all measures). Substantial improvement ranged from 25% if the e-health tool outcome was “not recommended” to 83% if SCS was “strongly recommended”. In patients who underwent a trial (N = 290), there was 3% of trial failure when SCS was ”strongly recommended” vs 46% when SCS was ”not recommended”. Conclusions: Retrospective application of the e-health tool on patient data showed a strong relationship between the panel recommendations and both SCS trial results and treatment outcomes.

KW - Chronic pain

KW - RAND/UCLA Appropriateness Method

KW - e-health tool

KW - patient selection

KW - spinal cord stimulation

UR - http://www.scopus.com/inward/record.url?scp=85128746073&partnerID=8YFLogxK

U2 - 10.1016/j.neurom.2021.12.006

DO - 10.1016/j.neurom.2021.12.006

M3 - Article

C2 - 35088755

VL - 26

SP - 164

EP - 171

JO - Neuromodulation

JF - Neuromodulation

SN - 1094-7159

IS - 1

ER -