The following is a summary of “Development and Feasibility Study of a Triage Tool for Early Referral to Spinal Cord Stimulation for Patients With Chronic Low Back and Leg Pain,” published in the January 2025 issue of Pain by Bastiaens et al.
Recent years saw delayed elective care and growing waiting lists, leading to postponed surgeries for individuals with chronic back and leg pain.
Researchers conducted a retrospective study to develop, implement, and assess the feasibility of a triage tool for identifying individuals with chronic back and leg pain eligible for spinal cord stimulation (SCS) consultation.
They developed a triage tool based on Dutch SCS guidelines, a literature review, and expert panel input. The triage process was identified and implemented in collaboration with a multidisciplinary team before the first orthopedic consultation. Feasibility, reliability, and predictive accuracy were analyzed during the evaluation of the triage tool.
The results showed the triage indicators included leg/mixed pain location, Douleur Neuropathique 4 (DN4) > 3, pain duration ≥ 3 months, leg pain ≥ back pain, and Numeric Pain Rating Scale (NPRS) leg pain ≥ 5. The tool was applied to 1,025 orthopedic patients with chronic back and leg pain on the waiting list, followed by a full orthopedic review for those who were not excluded. The triage tool was found feasible with a mean System Usability Score of 74.2 (SD 11.5), reliable with an inter-rater reliability of Fleiss’ Kappa 0.79 and intra-rater reliability of Cohen’s Kappa 0.89, and accurate with sensitivity of 100%, specificity of 98.8%, positive predictive value of 40%, and negative predictive value of 100%.
Investigators concluded that the early triage of potential candidates of SCS could facilitate efficient care allocation, reduce waiting times, and improve clinical outcomes, while further research was warranted to optimize the tool’s efficacy in identifying patients most likely to benefit from SCS therapy.
Source: onlinelibrary.wiley.com/doi/full/10.1002/ejp.4780
