• Simon Thomson, Frank Huygen, Simon Prangnell, Ganesan Baranidharan, Hayat Belaïd, Bart Billet, Sam Eldabe, Giuliano De Carolis, Laura Demartini, Kliment Gatzinsky, Jan Willem Kallewaard, Mery Paroli, Matthias Winkelmüller, Nicky Helsen, and Herman Stoevelaar.
• Pain and Neuromodulation Centre, Mid and South Essex University Hospitals, Basildon, UK.
• Neuromodulation. 2023 Jan 1; 26 (1): 164171164-171.

ObjectivesTo 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 MethodsA 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.ResultsIn 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".ConclusionsRetrospective 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.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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