PMID- 35051145
OWN - NLM
STAT- MEDLINE
DCOM- 20220324
LR  - 20220324
IS  - 2150-1149 (Electronic)
IS  - 1533-3159 (Linking)
VI  - 25
IP  - 1
DP  - 2022 Jan
TI  - Do Patients Accurately Recall Their Pain Levels Following Epidural Steroid 
      Injection? A Cohort Study of Recall Bias in Patient-Reported Outcomes.
PG  - 59-66
AB  - BACKGROUND: Although patient-reported outcomes (PROs) have become important in 
      the evaluation of spine surgery patients, the accuracy of patient recall of pre- 
      or post-intervention  symptoms following epidural steroid injection remains 
      unknown. OBJECTIVES: The purpose of this study was to: 1) characterize the 
      accuracy of patient recollection of back/leg pain following epidural steroid 
      injection; 2) characterize the direction and magnitude of recall bias; and 3) 
      characterize factors that impact patient recollection. STUDY DESIGN: A 
      prospective cohort study. SETTING: Level 1 Academic Medical Center. METHODS: 
      Using standardized questionnaires, we recorded numeric pain scores for patients 
      undergoing lumbar epidural steroid injections at our institution. Baseline pain 
      scores were obtained prior to injection, 4-hours and 24-hours postinjection. At a 
      minimum of 2 weeks following the injection, patients were asked to recall their 
      symptoms preinjection and at 4 hours and 24-hours postinjection. Actual and 
      recalled scores, at each time point, were compared using paired t tests. 
      Multivariable linear regression was used to identify factors that impacted 
      recollection. RESULTS: Sixty-one patients with a mean age of 61.4 years (56% 
      women) were included. Compared to their preinjection pain score, patients showed 
      considerable improvement at both 4 hours (Mean Difference [MD] = 2.18, 95% 
      Confidence Interval [CI] 1.42 to 2.94) and 24 hours (MD = 2.64, 95% CI 1.91 to 
      3.34) postinjection. Patient recollection of preinjection symptoms was 
      significantly more severe than actual at the 2-week time point (MD = 1.39, 95% CI 
      4.82 to 6.08). The magnitude of recall bias was mild and exceeded the minimal 
      clinically important difference (MCID). No significant recall bias was noted on 
      patient recollection of postinjection symptoms at 4 hours (MD = 0.41, 95% CI 
      -1.05 to 0.23). Patient recollection of symptoms was also significantly more 
      severe than actual at 24 hours (MD = 0.63, 95% CI -1.17 to -0.07), mild magnitude 
      of bias that did not exceed MCID. Linear regression models for differences 
      between actual and recalled pain scores reveal that for recall at 4 hours 
      postinjection, older patients were better at recalling pain. LIMITATIONS: 
      Baseline pain scores were completed in person, in front of a provider. The 
      short-term pain scores were completed while at home, and then recalled scores 
      were obtained by phone call encounter. Telephone surveys can lead to interview 
      bias. All patients received incentive for completion of study. It is unclear if 
      patient incentives have any impact on patient recall. Patients were contacted 2 
      weeks postinjection; this time point is standard at our institution, but could 
      vary depending on practice location. Lastly, the enrolled patients did not all 
      share the same indication for injection, and pain was not stratified between back 
      and leg pain. CONCLUSIONS: Relying on patient recollection does not provide an 
      accurate measure of preinjection status after lumbar epidural steroid injection, 
      although patients did recall their 4-hour postinjection status. These findings 
      support previous studies indicating that relying on patient recollection does not 
      provide an accurate measure of preintervention symptoms. Patient recollection of 
      postintervention symptoms, however, may have some clinical utility and requires 
      further study.
FAU - Butt, Bilal B
AU  - Butt BB
AD  - University of Michigan, Ann Arbor, MI.
FAU - Kagan, David
AU  - Kagan D
AD  - University of Michigan, Ann Arbor, MI.
FAU - Gagnier, Joel
AU  - Gagnier J
AD  - University of Michigan, Ann Arbor, MI.
FAU - Wasserman, Ronald
AU  - Wasserman R
AD  - University of Michigan, Ann Arbor, MI.
FAU - Nassr, Ahmad
AU  - Nassr A
AD  - Mayo Clinic, Rochester, MN.
FAU - Patel, Rakesh
AU  - Patel R
AD  - University of Michigan, Ann Arbor, MI.
FAU - Aleem, Ilyas
AU  - Aleem I
AD  - University of Michigan, Ann Arbor, MI.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Pain Physician
JT  - Pain physician
JID - 100954394
RN  - 0 (Steroids)
SB  - IM
MH  - *Back Pain
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Patient Reported Outcome Measures
MH  - Prospective Studies
MH  - Steroids
OTO - NOTNLM
OT  - injection
OT  - lumbar
OT  - nonoperative
OT  - patient-reported outcomes
OT  - Recall bias
EDAT- 2022/01/21 06:00
MHDA- 2022/03/25 06:00
CRDT- 2022/01/20 17:44
PHST- 2022/01/20 17:44 [entrez]
PHST- 2022/01/21 06:00 [pubmed]
PHST- 2022/03/25 06:00 [medline]
PST - ppublish
SO  - Pain Physician. 2022 Jan;25(1):59-66.