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Thermal Quantitative Sensory Testing: Relative and Absolute Reliabilities

溫度感覺量化測試:相對信度與絕對信度分析

摘要


Background and purpose: Somatosensory functions can be assessed by thermal quantitative sensory testing (QST). QST is recommended in diagnosis of somatosensory dysfunction or as an outcome measure. The purpose of this study was to evaluate the test-retest reliabilities of experimental thermal and pain assessment of thermal QSTs. Methods: The test-retest reliability for thermal detection, pain detection, and pain tolerance were analyzed. Six testing parameters (cold detection threshold, CDT; warm detection threshold, WDT; cold pain threshold, CPT; heat pain threshold, HPT; cold pain tolerance, CPTol; and heat pain tolerance, HPTol) were tested twice on 28 participants with an interval of 1 week. Both relative and absolute reliability statistics were estimated. Results: The relative reliabilities were excellent for CDT, CPT, HPT, CPTol and HPTol, with intraclass correlation coefficient (ICC) ≥ 0.75. Both heat and cold tolerance assessment had the best reliability (ICC = 0.94 and 0.91, respectively), while WDT had the lowest ICC (0.65). The absolute reliabilities were better for CDT, WDT, and HPTol, with small standard error of measurement (SEM) (0.38 to 0.64°C). The values of smallest real difference (SRD) for CDT, WDT, and HPTol were also small (1.05 to 1.77°C). On the other hand, CPT and CPTol had large SEM values (3.56 and 1.24°C) and SRD values (9.87 and 5.57°C). Bland-Altman plots also showed a large mean difference in CPT and CPTol. Conclusion: All tests have good to excellent relative reliability; however, only CDT, WDT, and HPTol have small SEM and SRD. CDT, WDT, and HPTol are useful for clinical practice because they have good relative and absolute reliability.

並列摘要


背景與目的:體感覺功能表現可以以溫度感覺量化測試(quantitative sensory testing)做較精確的量化評估,此測試方式被用來協助診斷或做為療效評估的工具,而好的評估工具必須具有良好信度。本研究目的檢驗溫度感覺量化測試(溫度與疼痛偵測能力及疼痛耐受力)之再測信度。方法:健康成人受試者(n = 28)接受六種測試,包括冷與熱溫度感覺閾值(CDT和WDT)、冷痛與熱痛感覺閾值(CPT和HPT)及冷痛與熱痛耐受力(CPTol和HPTol)測試,受試者在一週後接受第二次施測。統計分析相對信度(relative reliability)與絕對信度(absolute reliability)。結果:相對信度中有五種測試其組內相關係數(intraclass correlation coefficient, ICC)≥0.75,其信度極佳。其中HPTol和CPTol信度最佳,ICC高達0.94和0.91,而WDT之ICC最低(0.65)。絕對信度只有CDT、WDT和HPTol有較佳的信度,其測量標準誤(standard error of measurement, SEM)很小,介於0.38至0.64°C,最小真正變化量(smallest real difference, SRD)也很小,介於1.05至1.77°C。而CPT和CPTol有大的SEM值(3.56和1.24°C)及SRD值(9.87和5.57°C)。由布蘭德-奧特曼圖(Bland-Altman plots)也顯示CPT和CPTol有較大的平均差異。結論:雖然所有溫度感覺量化測試有好到極佳的相對信度,只有CDT、WDT和HPTol同時具有較佳的絕對信度,此三種溫度感覺量化測試相當穩定,適合臨床評估體感覺功能使用。

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