各种疼痛量表
Measures of Adult Pain
Visual Analog Scale for Pain (VAS Pain),Numeric Rating Scale for Pain (NRS Pain),McGill Pain Questionnaire (MPQ),Short-Form McGill Pain Questionnaire (SF-MPQ),Chronic Pain Grade Scale (CPGS),Short Form-36Bodily Pain Scale (SF-36BPS),and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)
GILLIAN A.HAWKER,SAMRA MIAN,TETYANA KENDZERSKA,AND MELISSA FRENCH
INTRODUCTION
Our purpose is to provide an overview of available generic and rheumatology population–speci?c questionnaires suitable for evaluating pain in adult rheumatology popu-lations.The content,ease of use,and measurement prop-erties of the questionnaires are presented and compared in order to assist both clinicians and researchers select the questionnaire that is most appropriate for their pur-pose.The questionnaires are presented in the following order:generic unidimensional pain questionnaires (Visual Analog Scale and Numeric Rating Scale),generic multi-dimensional pain questionnaires (Short-form McGill Pain Questionnaire,Chronic Pain Grade Scale,and Short Form-36Bodily Pain Scale),and ?nally an arthritis-speci?c pain questionnaire (Measure of Intermittent and Constant Os-teoarthritis Pain).Composite measures of arthritis symp-toms,including pain and associated disability,speci?cally the Western Ontario and McMaster Universities Osteo-arthritis Index and the Arthritis Impact Measurement Scales,are described in Measures of Knee Function and Measures of Disability,respectively.
VISUAL ANALOG SCALE (VAS)FOR PAIN Description
Purpose.The pain VAS is a unidimensional measure of pain intensity (1),which has been widely used in diverse adult populations,including those with rheumatic dis-eases (2–5).
Content.The pain VAS is a continuous scale comprised of a horizontal (HVAS)or vertical (VVAS)line,usually 10centimeters (100mm)in length,anchored by 2verbal descriptors,one for each symptom extreme (2,6).Instruc-tions,time period for reporting,and verbal descriptor an-chors have varied widely in the literature depending on intended use of the scale (7).
Number of items.The pain VAS is a single-item scale.Response options/scale.For pain intensity,the scale is most commonly anchored by “no pain”(score of 0)and “pain as bad as it could be”or “worst imaginable pain”(score of 100[100-mm scale])(6–8).To avoid clustering of scores around a preferred numeric value,numbers or ver-bal descriptors at intermediate points are not recom-mended (4,9).
Recall period for items.Varies,but most commonly respondents are asked to report “current”pain intensity or pain intensity “in the last 24hours.”
Practical Application
How to obtain.The pain VAS is available in the public domain at no cost (7).Graphic formats for the VAS may be obtained from Scott &Huskisson (9)or online:https://www.wendangku.net/doc/214993053.html,/tools/library/whitepapers/hospiceinltc/appendix-a.pdf.
Method of administration.The pain VAS is self-completed by the respondent.The respondent is asked to place a line perpendicular to the VAS line at the point that represents their pain intensity (2,9,10).
https://www.wendangku.net/doc/214993053.html,ing a ruler,the score is determined by mea-suring the distance (mm)on the 10-cm line between the “no pain”anchor and the patient’s mark,providing a range of scores from 0–100(6).
Score interpretation.A higher score indicates greater pain intensity.Based on the distribution of pain VAS scores in postsurgical patients (knee replacement,hyster-ectomy,or laparoscopic myomectomy)who described their postoperative pain intensity as none,mild,moderate,or severe,the following cut points on the pain VAS have been recommended:no pain (0–4mm),mild pain (5–44
Gillian A.Hawker,MD,MSc,FRCPC,Samra Mian,MSc,Tetyana Kendzerska,MD,Melissa French,MSc:University of Toronto,Toronto,Ontario,Canada.
Address correspondence to Gillian Hawker,MD,MSc,FRCPC,Canadian Osteoarthritis Research Program,76Grenville Street,8th Floor,Room 815,Women’s College Hospital,University of Toronto,Toronto,ON,M5S 1B2.E-mail:gillian.hawker@wchospital.ca.
Submitted for publication February 2,2011;accepted in revised form June 20,2011.
Arthritis Care &Research
Vol.63,No.S11,November 2011,pp S240–S252DOI 10.1002/acr.20543
?2011,American College of Rheumatology
MEASURES OF PATHOLOGY AND SYMPTOMS
S240
mm),moderate pain(45–74mm),and severe pain(75–100mm)(11).Normative values are not available. Respondent burden.The VAS takes?1minute to com-plete(3,7).
Administrative burden.The VAS is administered as a paper and pencil measure.As a result,it cannot be admin-istered verbally or by phone.No training is required other than the ability to use a ruler to measure distance to determine a score(7,9).Caution is required when photo-copying the scale as this may change the length of the 10-cm line(6).As slightly lower scores have been reported on the HVAS compared to the VVAS(12),the same align-ment of scale should be used consistently within the same patient.
Translations/adaptations.Minimal translation dif?cul-ties have led to an unknown number of cross-cultural adaptations.
Psychometric Information
Method of development.The pain VAS originated from continuous visual analog scales developed in the?eld of psychology to measure well-being(13,14).Woodforde and Merskey(15)?rst reported use of the VAS pain scale with the descriptor extremes“no pain at all”and“my pain is as bad as it could possibly be”in patients with a variety of conditions.Subsequently,others reported use of the scale to measure pain in rheumatology patients receiving phar-macologic pain therapy(2,6,9).While variable anchor pain descriptors have been used,there does not appear to be any rationale for selecting one set of descriptors over an-other.
Acceptability.The pain VAS requires little training to administer and score and has been found to be acceptable to patients(2,10).However,older patients with cognitive impairment may have dif?culty understanding and there-fore completing the scale(6,16).Supervision during com-pletion may minimize these errors(9).
Reliability.Test–retest reliability has been shown to be good,but higher among literate(r?0.94,P?0.001)than illiterate patients(r?0.71,P?0.001)before and after attending a rheumatology outpatient clinic(8). Validity.In the absence of a gold standard for pain, criterion validity cannot be evaluated.For construct valid-ity,in patients with a variety of rheumatic diseases,the pain VAS has been shown to be highly correlated with a 5-point verbal descriptive scale(“nil,”“mild,”“moder-ate,”“severe,”and“very severe”)and a numeric rating scale(with response options from“no pain”to“unbear-able pain”),with correlations ranging from0.71–0.78and 0.62–0.91,respectively)(3).The correlation between ver-tical and horizontal orientations of the VAS is0.99(12). Ability to detect change.In patients with chronic in-?ammatory or degenerative joint pain,the pain VAS has demonstrated sensitivity to changes in pain assessed hourly for a maximum of4hours and weekly for up to4 weeks following analgesic therapy(P?0.001)(10).In patients with rheumatoid arthritis,the minimal clinically signi?cant change has been estimated as1.1points on an 11-point scale(or11points on a100-point scale)(17).A minimum clinically important difference of1.37cm has been determined for a10-cm pain VAS in patients with rotator cuff disease evaluated after6weeks of nonopera-tive treatment(18).
Critical Appraisal of Overall Value to the Rheumatology Community
Strengths/caveats and cautions/clinical and research usability.The VAS is widely used due to its simplicity and adaptability to a broad range of populations and set-tings.Its acceptability as a generic pain measure was dem-onstrated in the early1970s.Limitations to the use of the pain VAS include the following:older patients may have dif?culty completing the pain VAS due to cognitive im-pairments or motor skill issues,scoring is more compli-cated than that for the Numeric Rating Scale for pain (described below),and it cannot be administered by tele-phone,limiting its usefulness in research.
NUMERIC RATING SCALE(NRS)FOR PAIN Description
Purpose.The NRS for pain is a unidimensional measure of pain intensity in adults(19–21),including those with chronic pain due to rheumatic diseases(3,8).Although various iterations exist,the most commonly used is the 11-item NRS(22),which is described here.
Content.The NRS is a segmented numeric version of the visual analog scale(VAS)in which a respondent se-lects a whole number(0–10integers)that best re?ects the intensity of their pain(21).The common format is a hori-zontal bar or line(23).Similar to the pain VAS,the NRS is anchored by terms describing pain severity extremes (3,20,21).
Number of items.The pain NRS is a single11-point numeric scale(3).
Response options/scale.An11-point numeric scale (NRS11)with0representing one pain extreme(e.g.,“no pain”)and10representing the other pain extreme(e.g.,“pain as bad as you can imagine”and“worst pain imag-inable”)(20,21).
Recall period for items.Varies,but most commonly respondents are asked to report pain intensity“in the last 24hours”or average pain intensity(24).
Practical Application
How to obtain.Available from the web site:http:// https://www.wendangku.net/doc/214993053.html,/printouts/A7012AS2.pdf. Method of administration.The NRS can be adminis-tered verbally(therefore also by telephone)or graphically for self-completion(6).The respondent is asked to indicate the numeric value on the segmented scale that best de-scribes their pain intensity.
Scoring.The number that the respondent indicates on the scale to rate their pain intensity is recorded.Scores range from0–10.
Score interpretation.Higher scores indicate greater pain intensity.
Pain Measures for Adults S241
Respondent burden.The pain NRS takes?1minute to complete.
Administrative burden.The pain NRS is easy to admin-ister and score(6,25).
Translations/adaptations.Like the pain VAS,minimal language translation dif?culties support the use of the NRS across cultures and languages(26).
Psychometric Information
Method of development.To improve discrimination for detecting relatively small changes,an NRS comprised of numbers along a scale was used in a population of100 patients with a variety of rheumatic diseases(3).Varia-tions in pain descriptors used as anchors for end points on the pain NRS have been reported in the literature(3,6,24). However,the methodology used to develop these various anchor terms is unknown.
Acceptability.Chronic pain patients prefer the NRS over other measures of pain intensity,including the pain VAS,due to comprehensibility and ease of completion (27).However,focus groups of patients with chronic back pain and symptomatic hip and knee osteoarthritis(OA) have found that the pain NRS is inadequate in capturing the complexity and idiosyncratic nature of the pain expe-rience or improvements due to symptom?uctuations (28,29).
Reliability.High test–retest reliability has been ob-served in both literate and illiterate patients with rheuma-toid arthritis(r?0.96and0.95,respectively)before and after medical consultation(8).
Validity.For construct validity,the NRS was shown to be highly correlated to the VAS in patients with rheumatic and other chronic pain conditions(pain?6months):cor-relations range from0.86to0.95(3,8).
Ability to detect change.In clinical trials of pregabalin for diabetic neuropathy,postherpetic neuralgia,chronic low back pain,?bromyalgia,and OA,analyses of the rela-tionships between changes in pain NRS scores and patient reports of overall improvement,measured using a stan-dard7-point patient global impression of change,demon-strated a reduction of2points,or30%,on the pain NRS scores to be clinically important(22).Similar results were found in low back pain patients when changes in pain NRS scores were compared to patient improvements in pain after physical therapy,using a15-point Global Rating of Change scale(19).
Critical Appraisal of Overall Value to the Rheumatology Community
Strengths/caveats and cautions/clinical and research usability.The pain NRS is a valid and reliable scale to measure pain intensity.Strengths of this measure over the pain VAS are the ability to be administered both verbally (therefore by telephone)and in writing,as well as its simplicity of scoring.However,similar to the pain VAS, the pain NRS evaluates only1component of the pain experience,pain intensity,and therefore does not capture the complexity and idiosyncratic nature of the pain expe-rience or improvements due to symptom?uctuations.MCGILL PAIN QUESTIONNAIRE(MPQ) Description
Purpose.A multidimensional pain questionnaire de-signed to measure the sensory,affective and evaluative aspects of pain and pain intensity in adults with chronic pain,including pain due to rheumatic diseases(30,31). Content.The scale contains4subscales evaluating the sensory,affective and evaluative,and miscellaneous as-pects of pain,responses to which comprise the Pain Rating Index,and a5-point pain intensity scale(Present Pain Intensity).
Number of items.The Pain Rating Index contains78 pain descriptor items categorized into20subclasses,each containing2–6words that fall into4major subscales: sensory(subclasses1–10),affective(subclasses11–15), evaluative(subclass16),and miscellaneous(subclasses 17–20).There is also a1-item pain intensity scale(30). Response options/scale.The value(score)associated with each descriptor is based on its position or rank order within the word set.The Present Pain Intensity scale,a measure of the magnitude of pain experienced by an indi-vidual,is a numeric-verbal combination that indicates overall pain intensity(31)and includes6levels:none(0), mild(1),discomforting(2),distressing(3),horrible(4),and excruciating(5)(32).
Recall period for items.Present pain(31).
Examples of use.The MPQ can be used to evaluate the ef?cacy and effectiveness of pain interventions and to identify qualities of pain associated with distinct nocio-ceptive disorders and neuropathic pain disorders,includ-ing arthritis(30).
Practical Application
How to obtain.The MPQ is available at no cost from the developer,Ronald Melzack,PhD,Department of Psy-chology,McGill University,1205Dr.Pen?eld Avenue, Montreal,Quebec H3A1B1,Canada,and online(http:// https://www.wendangku.net/doc/214993053.html,)by paying a membership fee.
Method of administration.The MPQ is interviewer-administrated using paper and pencil.The interviewer must read instructions to the respondent and de?ne any words that the respondent does not understand.For each subclass of words,the respondent is instructed to select 1word that?ts their present pain.If none of the words describe their pain,then no word is selected(30,33). Scoring.The MPQ is scored by hand by?rst counting the number of words selected to obtain a Number of Words Chosen score(0–20words).Pain Rating Index scores range from0–78based on the rank values of the chosen words. The value(score)associated with each descriptor is based on its position or rank order in the word set,such that the ?rst word is given a value of1,the next a value of2and so on.Rank values are summed within each subclass as well as overall.Scores on the Present Pain Intensity scale range from0–5(31).
Score interpretation.A higher score on the MPQ indi-cates worse pain.The Pain Rating Index is interpreted both in terms of quantity of pain,as evidenced by the number of
S242Hawker et al
words used and the rank values of the words,as well as the quality of pain,as evidenced by the particular words that are chosen.The normative mean scores across painful con-ditions ranged from24–50%of the maximum score(7). Respondent https://www.wendangku.net/doc/214993053.html,pletion of the MPQ can take up to20minutes(33).
Administrative burden.No training is required to score and interpret the MPQ,other than the ability of the inter-viewer to de?ne each word(30,33).Time to score is2–5 minutes.
Translations/adaptations.There are a total of44differ-ent versions of the MPQ,representing26different languag-es/cultures(34).The MPQ has been translated into Eng-lish,French(35),German(36–38),Norwegian(39),Danish (40),Italian(41),Japanese(42),Finnish(43),Spanish(44), Chinese(45),Dutch(46),Amharic(47),Slovak(48),Turk-ish(49),and Portuguese(50–52).
Psychometric Information
Method of development.Pain descriptors were derived from recording the words used by chronic pain patients to describe their pain;these descriptors were then catego-rized into subclasses and rank ordered by intensity using a numerical scale by groups of physicians,patients,and students(31,53).
Acceptability.Some respondents have dif?culty with the complexity of the vocabulary used,resulting in failure to read the instructions carefully and to see essential fea-tures(54).
Reliability.In a study of general rheumatology clinic patients,test–retest reliability for the3MPQ pain items (“nagging,”“aching,”and“stabbing”)ranged from a high of0.81for1-day recall to a low of0.59for7-day recall(55). These?ndings are consistent with those of other studies evaluating test–retest reliability in populations with a va-riety of other conditions including arthritis and other mus-culoskeletal conditions(r??0.70)(31,56,57). Validity.Content validity.Arthritis patients,regardless of their disease severity,used similar words to describe the sensory aspects of their pain.MPQ words have been shown to differentiate between4different circumstances of rheu-matoid arthritis(RA)pain(i.e.,overall pain at rest,overall pain on movement,joint pain at rest,and joint pain on movement)(58).The MPQ has the ability to detect mild pain due to the multidimensional nature of the scale and the large number of pain descriptor options(59). Construct validity.In RA,the number of sensory and affective MPQ words selected has been positively corre-lated with visual analog scale(VAS)scores of severity of pain at rest and on movement(r?0.27,P?0.01and r?0.17,P?0.05,respectively)(58).Higher Pain Rating Index scores are associated with negative affect(e.g.,Minnesota Multiphasic Personality Inventory,Pain Catastrophizing Scale)(60).In knee pain or knee osteoarthritis patients, higher MPQ scores were associated with greater anxiety and depression(r?0.30,P?0.05and r?0.31,P?0.05, respectively)(60),and greater symptoms and disability using the Western Ontario and McMaster Universities pain scale(r?0.34–0.38)(61).
Ability to detect change.In clinical trials designed to evaluate the ef?cacy of different pain therapies on post-operative pain after general surgical and orthopedic pro-cedures,the relative effect sizes for the MPQ-Pain Rating Index compared with a4-point categorical verbal rating scale and a pain VAS were 1.08(moderate)and 1.12 (good),respectively(62).
Critical Appraisal of Overall Value to the Rheumatology Community
Strengths/caveats and cautions/clinical and research usability.The MPQ is a valid and reliable tool that eval-uates both the quality and quantity of pain through use of unique pain descriptors.This may be useful in epide-miologic studies and clinical trials of older patients with multimorbidity,in whom pain may arise from multiple causes.Speci?cally,use of the MPQ may help to identify neuropathic type pain from nocioceptive type pain.A limitation of the MPQ is the rich vocabulary required of respondents for completion.Further,sex and ethnic dif-ferences may affect selection of pain descriptors.However, the interviewer can facilitate MPQ completion by provid-ing respondents with clear de?nitions of words during administration.
SHORT-FORM MCGILL PAIN QUESTIONNAIRE (SF-MPQ)
Description
Purpose.The SF-MPQ,a shorter version of the MPQ,is a multidimensional measure of perceived pain in adults with chronic pain,including pain due to rheumatic dis-eases(30,33).
Content.The SF-MPQ is comprised of15words(11 sensory and4affective)from the original MPQ(33). Number of items.The Pain Rating Index is comprised of 2subscales:1)sensory subscale with11words or items and2)affective subscale with4words or items,which are rated on an intensity scale as0?none,1?mild,2?moderate,or3?severe.The SF-MPQ also includes1item for present pain intensity and1item for a10-cm visual analog scale(VAS)for average pain(33).
Recall period for items.Present time.
Examples of use.To discriminate among different pain syndromes(33,63,64)and evaluate the responsiveness of different symptoms to treatment(65,66).
Practical Application
How to obtain.See this section for the MPQ above. Method of administration.See this section for the MPQ above.
Scoring.For the Pain Rating Index,each selected word is scored from0(none)to3(severe).The total Pain Rating Index score is obtained by summing the item scores(range 0–45).Scores on the Present Pain Intensity range from0–5 and on the VAS from0–10.
Pain Measures for Adults S243
Score interpretation.There are no established critical cut points.As for the MPQ,a higher score indicates worse pain.
Respondent burden.The SF-MPQ takes?2–5minutes to complete(33).
Administrative burden.No training is required to score and interpret the SF-MPQ other than the ability of the interviewer to de?ne each word(33).Time to score is ?1minute.
Translations/adaptations.The SF-MPQ has been trans-lated into the following languages:English,French,Am-haric(47),Chinese(67),Czech(68),Danish(69),Farsi(70), Greek(71,72),Hebrew(73),Hindi(74),Korean(75,76), Norwegian(77),Swedish(78),Thai(79),and Turkish (49,80).
Psychometric Information
Method of development.In addition to indices of over-all pain intensity(the Present Pain Intensity[31]and VAS [81]),a selection of pain descriptors representing sensory and affective categories were retained from the original version of the MPQ(31).Other than for one descriptor (“splitting”),those selected for inclusion in the SF-MPQ were those chosen by greater than one-third of patients with various types of pain(31,82–84).
Acceptability.Standardized instructions for patient completion have not been published.Some dif?culties with completion have been reported and attributed to un-familiar descriptors and unclear written instructions. However,experience in completing the SF-MPQ and ver-bal instructions improved completion among osteoarthri-tis(OA)patients(85).
Reliability.For internal consistency,using the SF-MPQ in rheumatoid arthritis(RA)and?bromyalgia patients, Cronbach’s alphas were estimated at??0.73–0.89(78). In the same study(78),test–retest reliability ranged from 0.45–0.73for1-month and3-month intervals.Among rheumatology patients,test–retest reliability was0.79–0.93at intervals of1to3days(86).In an OA population, high intraclass correlations were demonstrated for the total,sensory,affective,and average pain scores(5-day period):0.96,0.95,0.88,and0.89,respectively(85). Validity.The SF-MPQ was found to have more content validity among patients with?bromyalgia than for those with RA.Percentage of use of15pain descriptors by2 groups was signi?cantly different for all words except “throbbing”and“punishing-cruel.”The mean intensity score for each word ranged from1.69for“sickening”to 2.60for“tender”in the?bromyalgia group and1.57for “fearful”to2.18for“aching”in the RA group(78).For construct validity,the SF-MPQ was found to be moder-ately correlated with both the Western and Ontario and McMaster Universities Osteoarthritis Index and the Short Form36Health Survey bodily pain scales(r?0.36and ?0.36,respectively;P?0.01)in200patients with hip and knee OA(61).
Ability to detect change.Although designed for descrip-tive purposes,the SF-MPQ has been found to be sensitive to the effects of pain therapies in a variety of population settings(86–88).In patients with a range of musculoskel-etal conditions reporting improvements in pain after reha-bilitation and surgical interventions,the Norwegian SF (NSF)-MPQ scores were found to be responsive to change (standardized response mean values?0.80):a mean im-provement in NSF-MPQ total scores?5on the0–45scale demonstrated a clinically important change(86).In an OA population,the minimum detectable change for total,sen-sory,affective,average,and current pain components have been estimated as5.2,4.5,2.8,1.4,and1.4cm,respec-tively(85).
Critical Appraisal of Overall Value to the Rheumatology Community
Strengths/caveats and cautions/clinical and research usability.The SF-MPQ is easier to use and takes less time to administer and complete than the longer form.The word choices are not as complex,and the intensity rank-ing of mild,moderate,and severe is better understood by patients(33).However,suf?cient experience is required to adequately complete the SF-MPQ;therefore,new users require supervision during completion(85).In2009,the short form was further revised for use in neuropathic and nonneuropathic pain conditions(SF-MPQ-2).The SF-MPQ-2includes7additional symptoms relevant to neuropathic pain,for a total of22items with0–10numer-ical response options(89).We await further psychometric testing of this revised measure,which may play a useful role in the future with respect to identifying rheumatic disease patients with neuropathic versus nociceptive pain patterns.
CHRONIC PAIN GRADE SCALE(CPGS) Description
Purpose.The CPGS is a multidimensional measure that assesses2dimensions of overall chronic pain severity: pain intensity and pain-related disability.It is suitable for use in all chronic pain conditions,including chronic mus-culoskeletal(MSK)and low back pain(90).
Content.Subscale scores for pain intensity and dis-ability are combined to calculate a chronic pain grade that enables classi?cation of chronic pain patients into 5hierarchical categories:grades0(no pain)to IV(high disability-severely limiting)(90).
Number of items.The CPGS is comprised of7items. Response options/scale.All items are scored on an11-point Likert scale,with responses ranging from0–10. Recall period for items.Pain in the past3–6months. Examples of use.The CPGS has been used in epidemi-ologic studies and clinical trials to evaluate and compare pain severity across groups and in response to treatment effects,and in clinical practice to improve the prognostic judgments of physicians(91–93).
Practical Application
How to obtain.Please note that the scale is available in the original reference(90),as well as directly from the author.
S244Hawker et al
Method of administration.The CPGS is an interview-administered questionnaire that can also be self-completed by respondents.
Scoring.Scores are calculated for3subscales:the char-acteristic pain intensity score,which ranges from0–100, is calculated as the mean intensity ratings for reported current,worst,and average pain;the disability score, which ranges from0–100,is calculated as the mean rating for dif?culty performing daily,social,and work activities; and the disability points score,which ranges from0–3,is derived from a combination of ranked categories of num-ber of disability days and disability score.
Score interpretation.The3subscale scores(character-istic pain intensity,disability score,and the disability points score)are used to classify subjects into1of the5 pain severity grades:grade0for no pain,grade I for low disability-low intensity,grade II for low disability-high intensity,grade III for high disability-moderately limiting, and grade IV for high disability-severely limiting. Respondent burden.Time to complete the CPGS does not exceed10minutes.
Administrative burden.The CPGS is easy to adminis-ter.Scoring is complex.
Translations/adaptations.The CPGS has been adapted into UK English(94).An Italian version has been devel-oped to evaluate severity in chronic pain patients(95). Psychometric Information
Method of development.Interviews were conducted with primary care patients with back pain,headache, and temporomandibular disorder(96).The development of the graded classi?cation drew on concepts by Turk and Rudy of chronic pain severity(97,98).Two of the items used in the disability score were adapted from their Multi-dimensional Pain Inventory(99).The Guttman scaling method was used to develop the graded classi?cation of chronic pain(90).
Acceptability.The CPGS is easy to understand and complete based on a high response rate(76.3%)to a postal survey sent to general practice patients in the UK(94). Among MSK chronic pain patients,missing values were only noted in?3%of each of the questions in an Italian version of the CPGS(100).
Reliability.For internal consistency,Cronbach’s alpha was shown to be??0.74among patients with chronic back pain(90).In an Italian version of CPGS,Cronbach’s alpha ranged from0.81–0.89for subscales and global scores in patients with chronic MSK pain(95).In UK general practice patients with low back pain,test–retest reliability was high after a2-week interval(weighted??0.81[95%con?dence interval0.65–0.98])(101). Validity.For construct validity,cross-sectional and lon-gitudinal studies of general practice patients have shown that higher scores on the CPGS,indicating greater chronic pain,are signi?cantly associated with higher rates of un-employment,greater pain impact scale scores,greater use of opioid analgesics and physician visits,depressed mood, and lower self-rated health status(90,94,102).Compari-sons of CPGS scores with the Short Form36Health Survey (SF-36)indicate that a higher chronic pain grade using the CPGS is associated with poorer physical,psychological, social,and general health as measured by the SF-36(P?0.001)(102)and worse scores on the SF-36bodily pain scale(???0.545,P?0.0001)(95).Spearman’s correla-tion coef?cients for the CPGS scores and the various di-mensions of SF-36were highest for the pain dimension (r??0.71to?0.84)and lowest for the mental health dimension(r??0.28to?0.38)(94).
Ability to detect change.Among patients with moderate to severe chronic MSK pain,the CPGS has been shown to be modestly responsive to changes after12months of treatment with an ef?cacious pain intervention,with stan-dardized effect sizes for the intensity and disability sub-scales of0.41and0.43,respectively.Among participants with chronic knee or hip pain,the standardized effect size for the CPGS intensity was0.32(91).
Critical Appraisal of Overall Value to the Rheumatology Community
Strengths/caveats and cautions/clinical and research usability.The CPGS is a valid and reliable tool that is useful for the evaluation of chronic MSK pain;it allows for grading of the global severity of chronic pain and there-fore analysis of the qualitative changes in chronic pain over time.Further,the CPGS assesses not only aspects of the pain itself,but also the impact of the pain on daily, social,and work activities,which is a signi?cant advan-tage over many other pain questionnaires.A limitation of the CPGS relative to the other scales reported here is the complexity of scoring,which renders it less useful for assessment of pain at point of care.Additionally,further research is needed to be able to compare scoring methods and cut points.
SHORT FORM36BODILY PAIN SCALE
(SF-36BPS)
Description
Purpose.The SF-36BPS is1of8subscales of the Med-ical Outcomes Study SF-36questionnaire(103,104),a generic measure of health status designed for use in pop-ulation surveys(105).In1996,version2.0of the SF-36 (SF-36v2)was introduced to correct de?ciencies identi?ed in the original version,SF-36v1(106).The2-item SF-36 BPS subscale assesses bodily pain as a dimension of health status(104,105).
Content.The SF-36BPS assesses bodily pain intensity and interference of pain with normal activities.
Number of items.The SF-36BPS is a2-item scale. Response options/scale.Intensity of bodily pain is eval-uated using a6-point rating scale of“none”to“very se-vere.”The extent to which pain has interfered with work is evaluated on a5-point rating scale from“not at all”to “extremely.”
Recall period for items.The SF-36BPS is available in both standard(4week)and acute(1week)recall versions (105,106).
Pain Measures for Adults S245
Examples of use.The SF-36and its subscales,including the BPS,have been used in epidemiologic studies to com-pare health status across populations and within popula-tion subgroups,such as in estimating the relative burden of different diseases,including rheumatic diseases(107), and differentiating the health bene?ts of different treat-ments(108).
Practical Application
How to obtain.The SF-36and its various versions have been developed by the Rand Corporation and John E.Ware (SF-36Health Survey,The Health Institute,New England Medical Center Hospitals,Box345,750Washington Street, Boston,MA,02111).The Medical Outcomes Trust,Health Assessment Lab,and Quality Metric Incorporated are co-copyright holders of all SF-36and SF-12surveys.All SF-36survey instruments,scoring manuals,and licenses for use are available from QualityMetric at www.quality https://www.wendangku.net/doc/214993053.html,.Different charges are levied for academic and commercial use.
Method of administration.The SF-36BPS is suitable for self-administration,computerized administration,or administration by a trained interviewer in person or by telephone.Telephone voice recognition interactive sys-tems and online administrations are currently being evaluated.
Scoring.Responses for each of the2SF-36BPS items are recoded into?nal item values(109).The raw scale score is computed as a simple algebraic sum of the recoded item values.The raw scale score is then transformed to a 0–100scale.Norm-based scores may be calculated for SF-36v2by including population normative data in the scoring algorithms.The BPS score is only calculated if both items are completed.
Score interpretation.SF-36v1BPS scores range from 0–100.A higher score indicates lack of bodily pain. SF-36v2uses norm-based scoring,where50is the“aver-age”for the population.Therefore,scores above or be-low50can be considered above or below,respectively, the population average health status for bodily pain,and scores can be interpreted based on deviance from the mean (10points?1SD).Population normative data are avail-able for the US and UK.
Respondent burden.The BPS takes?2minutes to com-plete.
Administrative burden.Training to administer,score, and interpret is minimal.Administration guidelines are speci?c and clearly outlined.
Translations/adaptations.SF-36has been translated and adapted for use in more than50countries as part of the International Quality of Life Assessment(IQOLA)Proj-ect.Currently,published forms include the German(110), Spanish(111),Swedish(112),and Italian(113)transla-tions and English-language adaptations for use in Austra-lia/New Zealand,Canada,and the https://www.wendangku.net/doc/214993053.html,rmation about translations is available from the IQOLA Program of the Health Assessment Lab in Boston,Massachusetts(http:// https://www.wendangku.net/doc/214993053.html,).Psychometric Information
Method of development.The Medical Outcomes Study researchers selected and adapted questionnaire items from instruments in use since the1970s and1980s(114–117)to develop a new149-item Functioning and Well-Being Pro-?le.Items were subsequently reduced and improvements were made in item wording,format,and scoring to pro-duce the SF-36.One item on pain intensity was retained from an earlier version of the SF-20question regarding bodily pain or discomfort.In order to improve prediction of best total scores for the Behavioural Effects of Pain Scale in the Medical Outcomes Study(114),a second item was added to measure the extent to which pain interferes in activities(105).
Acceptability.Generally easy to administer and com-plete(103,118).
Reliability.For internal consistency,Cronbach’s?for the SF-36BPS administered in hip(118)and knee(119) osteoarthritis(OA)patients was0.72and0.77,respec-tively;using a Chinese version of the SF-36BPS in rheu-matoid arthritis(RA)patients,Cronbach’s?was0.91 (120).In adults with persistent back,hip,or knee pain recruited from primary care,Cronbach’s?was0.59(100). Among patients from2general practices in the UK,the test–retest reliability over a2-week period was0.78(121). Over a14-day interval,test–retest reliability of a Chinese SF-36version used in Chinese-speaking RA patients was 0.82(120).
Validity.Regarding face and content validity,items were derived from pre-existing questionnaires used in large population studies.However,both?oor and ceiling effects have been reported(118).Regarding construct va-lidity,the proportions reporting no pain on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)and the SF-36BPS were32.2%and13.6%, respectively,and pain scores were modestly correlated (?0.55)(122)among patients who had undergone joint replacement surgery.In the same study,the WOMAC bet-ter discriminated subjects with varying severity of knee problems,whereas the SF-36BPS better discriminated subjects with varying levels of self-reported health status and comorbidity.In patients with hip and knee OA,cor-relations between the WOMAC pain scale and the SF-36 BPS are in the range of0.6–0.7(61,121,123).In Chinese-speaking patients with RA,moderate correlations were reported between the Chinese SF-36BPS and physician global assessment of disease activity(r??0.34),physi-cian’s assessment of global disease activity(r??0.35), and patient pain assessment based on a pain visual analog scale(r??0.48)(120).
Ability to detect change.Although the SF-BPS is de-signed to measure the health status of populations,it has been shown to be responsive to improvements in pain. Among patients undergoing knee replacement surgery, the estimated minimum clinically important difference (MCID)ranged from16.86/100(SD31.83)at6months to 6.69/100(SD29.20)at2years(119).In a similar study on hip replacement,the estimated MCID ranged from14.67/ 100(SD26.46)to18.34/100(SD27.06)at6months and2 years,respectively(118).The minimal detectable change
S246Hawker et al
for the SF-36BPS ranged from37.91/100(knee OA)to 38.09/100(hip OA)at6months(118,119).
Critical Appraisal of Overall Value to the Rheumatology Community
Strengths/caveats and cautions/clinical and research usability.The SF-36BPS is a valid and reliable generic questionnaire designed to evaluate bodily pain as a dimen-sion of overall health status and has been widely used internationally and in diverse populations.Its advantages include simplicity of administration and usefulness in making comparisons across populations for research pur-poses.At point of patient care,a disease-speci?c pain measure may be more useful to discriminate levels of pain severity,and therefore response to treatment.
MEASURE OF INTERMITTENT AND CONSTANT OSTEOARTHRITIS PAIN(ICOAP) Description
Purpose.The ICOAP measure is a multidimensional osteoarthritis(OA)-speci?c measure designed to compre-hensively evaluate the pain experience in people with hip or knee OA,including pain intensity,frequency,and im-pact on mood,sleep,and quality of life,independent of the effect of pain on physical function(28).It is intended for use alongside a measure of physical disability. Content.The ICOAP is an11-item scale evaluating2 pain domains:a5-item scale evaluates constant pain and a6-item scale evaluates intermittent pain or“pain that comes and goes”(28).Two supplementary questions can be used to assess predictability of intermittent pain when present(124).Both a hip and knee joint version of the ICOAP are available(28).
Number of items:11items in2domains with2supple-mentary items on intermittent pain predictability. Response options/scale.All items are constructed as rating scales with5levels of response.For items asking about intensity,response options are“not at all,”“mildly,”“moderately,”“severely,”and“extremely.”For items about frequency,response options are“never,”“rarely,”“sometimes,”“often,”and“very often”(28).For the sup-plementary items asking about predictability of pain,the response options are“never,”“rarely,”“sometimes,”“often,”and“very often”(124).
Recall period for items.Past week.
Endorsements.Osteoarthritis Research Society Inter-national(OARSI)/Outcome Measures in Rheumatology (OMERACT)Initiative.
Practical Application
How to obtain.The ICOAP and ICOAP Users Guide can be obtained free of charge from the OARSI web site, https://www.wendangku.net/doc/214993053.html,.
Method of administration.The measure can be inter-viewer-administered in person or by telephone(28).Re-spondents should complete both subscales(63).
Scoring.Each ICOAP item is scored from0–4.A score is separately produced for each subscale by summing the items’subscale scores and then normalizing each score from0(no pain)to100(extreme pain).A total ICOAP score can be calculated by summing the2subscale scores,and normalizing from0(no pain)to100(extreme pain).Rules have been created to deal with missing data(63).No scor-ing guidelines are available for the2supplementary items. Score interpretation.Higher scores indicate a worse pain experience.
Respondent burden.The ICOAP takes?10minutes to complete.
Administrative burden.Easy to administer and score. Translations/adaptations.To date,the ICOAP has been translated into the following languages:English(North America and UK),Czech,Dutch,French(France),Ger-man(125),Italian,Norwegian,Spanish(Castillan),North and Central American Spanish,Swedish,Portuguese(50), Greek,Romanian,and Russian(126).Translated versions are available at https://www.wendangku.net/doc/214993053.html,.
Psychometric Information
Method of development.Focus groups were conducted in individuals with painful hip or knee OA in4countries (US,UK,Canada,and Australia)to generate items pertain-ing to the OA pain experience(28,127).Content analysis of resulting transcripts was used to identify themes,which were veri?ed with participants.Subsequent psychometric testing was conducted in subjects age?40years with hip or knee OA drawn from rheumatologists’practices,joint replacement wait lists,and from among the members of an existing OA cohort(28).
Acceptability.The ICOAP has been shown to be easy to understand and complete;subjects felt positive about the inclusion of the2distinct pain domains(constant pain and pain that comes and goes)(126).
Reliability.Regarding content validity,Cronbach’s?was0.93(28)for100individuals with hip and knee OA. Test–retest reliability in76individuals with hip and knee OA,age?40years,demonstrated an intraclass correlation coef?cient of0.85(95%con?dence interval0.76–0.91) (122).
Validity.Content and face validity were determined through focus groups used to develop the ICOAP.For construct validity,descriptive analyses of items demon-strated good distribution of response options across all items(28).Total and subscale ICOAP scores are signi?-cantly correlated with scores on the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) pain scale,the Knee Injury and OA Outcome Score (KOOS)symptoms scale,and self-rated effect of hip/knee problems on quality of life,with Spearman’s correlation coef?cients ranging in magnitude from0.60(KOOS symp-toms)to0.81(WOMAC pain scale)(28).
Ability to detect change.The ICOAP has been found to be responsive to changes in OA pain in response to phar-macologic interventions(128)and joint replacement sur-gery(129).For the knee,standard response means(SRMs) ranged from0.49–0.57for the ICOAP intermittent,con-stant,and total scores comparable to that for the WOMAC
Pain Measures for Adults S247
pain(SRM0.54).For the hip,SRMs ranged from0.11–0.19,again comparable to that for the WOMAC(SRM0.15) (128).The ICOAP detected large improvements in pain resulting from joint replacement surgery with SRMs(0.84–1.02for knee replacement and1.50–2.29for hip replace-ment)(129).
Critical Appraisal of Overall Value to the Rheumatology Community
Strengths/caveats and cautions/clinical and research usability.The ICOAP is a valid and reliable measure that is unique in that it is intended to evaluate the multi-dimensional pain experience in OA,distinct from the impact of pain on physical functioning.Prior experience with the WOMAC,the most commonly used OA measure, has shown high correlations between the pain and physi-cal function subscales.As a result,evaluation of OA pain using the WOMAC is confounded by physical disability. The ICOAP is intended for use together with a measure of OA disability.Although the ICOAP has been trans-lated from English into a number of languages,only a few have been evaluated for validity,reliability,and responsiveness.
DISCUSSION
There are multiple measures available to assess pain in adult rheumatology populations.Each measure has its own strengths and weaknesses.Both the Visual Analog Scale for Pain and the Numeric Rating Scale(NRS)for Pain are unidimensional single-item scales that provide an es-timate of patients’pain intensity.They are easy to admin-ister,complete,and score.Of the2,the pain NRS may be preferred at point of patient care due to simpler scoring.In research,the pain NRS may similarly be preferred due to its ability to be administered both verbally and in writing. However,neither measure provides a comprehensive eval-uation of pain in patients with rheumatic disease.To eval-uate the multiple dimensions of acute and chronic pain,a number of valid and reliable questionnaires are available. The McGill Pain Questionnaire(MPQ)is a generic pain measure useful largely for research purposes to describe not only the quantity(intensity),but also the quality of the patients’pain.The Chronic Pain Grade Scale(CPGS)is similarly a generic pain measure useful for research pur-poses to describe,evaluate and compare chronic pain se-verity(its intensity and impact)across groups and in re-sponse to treatment effects.The third generic multidimensional pain measure,the Short Form-36Bodily Pain Scale(SF-36BPS),is useful in evaluating pain in the context of overall health status,and therefore most suit-able for use in making comparisons across populations and between subgroups within populations.Unlike the MPQ and CPGS,the SF-36BPS is simple enough for use at point of care.Finally,the Measure of Intermittent and Constant Osteoarthritis Pain is an osteoarthritis-speci?c pain measure that is recommended for descriptive and evaluative purposes in both clinical practice and research to provide a comprehensive evaluation of the pain expe-rience in osteoarthritis,including the impact of pain on mood,sleep and quality of life,separate and distinct from the impact of pain on functioning.Due to the variability in purpose,content,method of administration,respondent and administrative burden,and evidence to support the psychometric properties of each measure,no one pain measure can be recommended for use in all situations.We encourage clinicians and researchers to use this informa-tion presented in this chapter to help guide the selection of the questionnaire that is most appropriate for their speci?c purpose.
AUTHOR CONTRIBUTIONS
All authors were involved in drafting the article or revising it critically for important intellectual content,and all authors ap-proved the?nal version to be published.
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S250Hawker et al
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?1m i n u t e N o t r a i n i n g r e q u i r e d A b i l i t y t o u s e a r u l e r t o m e a s u r e d i s t a n c e t o s c o r e V A S r e q u i r e d H i g h e r s c o r e s i n d i c a t e g r e a t e r p a i n i n t e n s i t y G o o d ;T e s t –r e t e s t r e l i a b i l i t y h i g h e r a m o n g l i t e r a t e t h a n i l l i t e r a t e r h e u m a t o l o g y o u t p a t i e n t s (r ?0.94a n d r ?0.71,r e s p e c t i v e l y )G o o d ;V A S s c o r e s s h o w n t o b e h i g h l y c o r r e l a t e d w i t h o t h e r p a i n m e a s u r e s c o r e s R a n g e r ?0.62–0.91E x c e l l e n t ;S e n s i t i v e t o m e a s u r i n g c h a n g e s i n p a i n a s s o c i a t e d w i t h t r e a t m e n t o r t i m e .(M C I D o f 1.37c m o n 10-c m p a i n V A S ;c h a n g e o f 1.1p o i n t s o n 11-p o i n t s c a l e )A c c e p t a b l e /v a l i d /r e l i a b l e m e a s u r e o f p a i n i n t e n s i t y M a y n o t b e a p p r o p r i a t e f o r u s e i n o l d e r a n d /o r i l l i t e r a t e p o p u l a t i o n
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A m u l t i d i m e n s i o n a l m e a s u r e o f s e n s o r y ,a f f e c t i v e a n d e v a l u a t i v e a s p e c t s o f p a i n a n d p a i n i n t e n s i t y C o m p r i s e d o f 78p a i n d e s c r i p t o r i t e m s a n d o n e -i t e m p a i n i n t e n s i t y s c a l e
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P e n c i l /p a p e r ?20m i n u t e s N o t r a i n i n g r e q u i r e d t o s c o r e (2–5m i n u t e s t o s c o r e )I n t e r v i e w e r m u s t h a v e a b i l i t y t o d e s c r i b e e a c h p a i n d e s c r i p t o r H i g h e r s c o r e s o n M P Q i n d i c a t e w o r s e p a i n N o e s t a b l i s h e d c u t p o i n t s G o o d ;T e s t –r e t e s t r e l i a b i l i t y i n r h e u m a t o l o g y p o p u l a t i o n s i s a d e q u a t e (r ??0.70)G o o d ;C o n s t r u c t v a l i d i t y :M P Q w o r d s p o s i t i v e l y
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I n t e r v i e w e r -a d m i n i s t e r e d
P e n c i l /p a p e r 2–5m i n u t e s N o t r a i n i n g r e q u i r e d t o s c o r e (1m i n u t e t o s c o r e )I n t e r v i e w e r m u s t h a v e a b i l i t y t o d e s c r i b e e a c h p a i n d e s c r i p t o r H i g h e r s c o r e s o n S F -M P Q i n d i c a t e w o r s e p a i n N o e s t a b l i s h e d c u t p o i n t s G o o d ;I n t e r n a l c o n s i s t e n c y :C r o n b a c h ’s a l p h a i n r h e u m a t o l o g y p o p u l a t i o n r a n g e d f r o m 0.73t o 0.89.T e s t –r e t e s t r e l i a b i l i t y r a n g e d f r o m 0.45t o 0.73a t 1-a n d 3-m o n t h i n t e r v a l s .F o r 1–3d a y i n t e r v a l s ,t e s t –r e t e s t w a s h i g h (r a n g e :0.79–0.93).I C C w a s h i g h f o r e a c h S F -M P Q s u b s c a l e ,V A S a v e r a g e p a i n a n d t o t a l s c o r e s (I C C ?0.89)G o o d ;C o n t e n t v a l i d i t y :T h e m e a n i n t e n s i t y s c o r e s f o r e a c h S F -M P Q w o r d s r a n g e d f r o m 1.57t o 2.60i n r h e u m a t o l o g y p a t i e n t s .I n O A p a t i e n t s ,S F -M P Q i s m o d e r a t e l y c o r r e l a t e d w i t h b o t h W O M A C a n d S F -26b o d i l y p a i n s c a l e s (r ?0.36a n d r ??0.36,r e s p e c t i v e l y )G o o d ;I n M S K p a t i e n t s ,S R M v a l u e s f o r N o r w e g i a n S F -M P Q w e r e ?0.80.C l i n i c a l l y i m p o r t a n t c h a n g e :m e a n i m p r o v e m e n t i n t o t a l s c o r e s ?5o n t h e 0–45N S F -M P Q s c a l e M i n i m u m d e t e c t a b l e c h a n g e f o r t o t a l ,s e n s o r y ,a f f e c t i v e ,a v e r a g e a n d c u r r e n t p a i n a r e 5.2,4.5,2.8,1.4,1.4c m A c c e p t a b l e /v a l i d /r e l i a b l e s h o r t -f o r m v e r s i o n o f t h e M P Q E a s i e r t o u s e ,m o r e u n d e r s t a n d a b l e ,a n d t a k e s l e s s t i m e t o a d m i n i s t e r a n d c o m p l e t e t h a n t h e l o n g e r f o r m
S u p e r v i s i o n d u r i n g c o m p l e t i o n r e q u i r e d f o r n e w u s e r s C P G S
A m u l t i d i m e n s i o n a l p a i n m e a s u r e t h a t a s s e s s e s 2d i m e n s i o n s o f o v e r a l l c h r o n i c p a i n s e v e r i t y :p a i n i n t e n s i t y a n d p a i n -r e l a t e d d i s a b i l i t y S u b s c a l e s c o r e s f o r p a i n i n t e n s i t y a n d d i s a b i l i t y a r e c o m b i n e d t o c a l c u l a t e a c h r o n i c p a i n g r a d e a n d c l a s s i f y c h r o n i c p a i n p a t i e n t s i n t o 5h i e r a r c h i c a l c a t e g o r i e s :g r a d e s 0(n o p a i n )t o I V (h i g h d i s a b i l i t y -s e v e r e l y l i m i t i n g )
S e l f -a d m i n i s t e r e d o r i n t e r v i e w e r -a d m i n i s t e r e d
?10m i n u t e s N o t r a i n i n g r e q u i r e d E a s y t o a d m i n i s t e r b u t s c o r i n g i s c o m p l e x 3s u b s c a l e s c o r e s a r e u s e d t o c l a s s i f y s u b j e c t s i n t o 1o f 5p a i n s e v e r i t y c a t e g o r i e s G o o d ;I n t e r n a l c o n s i s t e n c y :C r o n b a c h ’s ??0.74i n l o w b a c k p a i n p a t i e n t s .I n c h r o n i c M S K p a i n p a t i e n t s ,C r o n b a c h ’s ?r a n g e d f r o m 0.81–0.89f o r a n I t a l i a n C P G S T e s t –r e t e s t r e l i a b i l i t y w a s h i g h a f t e r 2-w e e k i n t e r v a l i n U K g e n e r a l p r a c t i c e p a t i e n t s (w e i g h t e d ??0.8195%C I 0.65–0.98)
G o o d ;C o n s t r u c t v a l i d i t y :S p e a r m a n ’s c o r r e l a t i o n c o e f ?c i e n t s f o r C P G S a n d S F -36w e r e h i g h f o r t h e p a i n d i m e n s i o n (r ??0.71t o ?0.84)a n d l o w f o r t h e m e n t a l h e a l t h d i m e n s i o n (r ??0.28t o ?0.38)G o o d ;E f f e c t s i z e s f o r C P G S i n t e n s i t y a n d d i s a b i l i t y s u b s c a l e s i n c h r o n i c M S K p a t i e n t s w e r e 0.41a n d 0.43,r e s p e c t i v e l y .I n c h r o n i c k n e e o r h i p p a i n ,e f f e c t s i z e w a s 0.32A c c e p t a b l e ,v a l i d a n d r e l i a b l e m e a s u r e o f c h r o n i c M S K p a i n .C P G S a l l o w s f o r t h e g r a d i n g o f g l o b a l s e v e r i t y o f c h r o n i c p a i n a n d q u a l i t a t i v e c h a n g e s i n c h r o n i c p a i n o v e r t i m e
C o m p l e x i t y o f s c o r i n g l i m i t s i t s u s e f o r a s s e s s m e n t o f p a i n a t p o i n t o f c a r e (c o n t i n u e d )
Pain Measures for Adults
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S u m m a r y T a b l e (C o n t ’d )
S c a l e P u r p o s e /c o n t e n t
M e t h o d o f a d m i n i s t r a t i o n
R e s p o n d e n t b u r d e n A d m i n i s t r a t i v e b u r d e n S c o r e i n t e r p r e t a t i o n R e l i a b i l i t y e v i d e n c e V a l i d i t y e v i d e n c e A b i l i t y t o d e t e c t c h a n g e S t r e n g t h s C a u t i o n s
S F -36B P S A 2-i t e m b o d i l y p a i n s c a l e t h a t m e a s u r e s p a i n i n t e n s i t y a n d p a i n i n t e r f e r e n c e w i t h n o r m a l a c t i v i t i e s .T h e S F -36B P i s 1o f t h e 8S F -36s u b s c a l e s S e l f -a d m i n i s t e r e d ,c o m p u t e r -a d m i n i s t e r e d ,o r i n t e r v i e w e r -a d m i n i s t e r e d (i n -p e r s o n o r b y t e l e p h o n e )
?2m i n u t e s M i n i m a l t r a i n i n g r e q u i r e d t o a d m i n i s t e r ,a n d s c o r e .(U s e r ’s G u i d e a v a i l a b l e )H i g h e r s c o r e s i n d i c a t e l a c k o f b o d i l y p a i n E x c e l l e n t ;I n t e r n a l c o n s i s t e n c y :C r o n b a c h ’s ?i n h i p a n d k n e e O A p a t i e n t s w a s 0.72a n d 0.77,r e s p e c t i v e l y .U s i n g a C h i n e s e v e r s i o n ,C r o n b a c h ’s ?i n R A p a t i e n t s w a s 0.91.T e s t –r e t e s t r e l i a b i l i t y w a s 0.78i n g e n e r a l p r a c t i c e p a t i e n t s a n d 0.82i n C h i n e s e -s p e a k i n g R A p a t i e n t s o v e r a 2-w e e k p e r i o d G o o d ;C o n s t r u c t v a l i d i t y :p r o p o r t i o n o f p a t i e n t s r e p o r t i n g n o p a i n o n W O M A C a n d B P S w e r e 32.2%a n d 13.6%.C o r r e l a t i o n s b e t w e e n W O M A C p a i n s c a l e a n d S F -36B P S r a n g e d f r o m 0.6–0.7A c c e p t a b l e ;M C I D i n p a t i e n t s u n d e r g o i n g k n e e r e p l a c e m e n t s u r g e r y r a n g e d f r o m 16.86/100(S D 31.83)a t 6m o n t h s t o 6.69/100(S D 29.20)a t 2y e a r s .F o r h i p r e p l a c e m e n t ,M C I D r a n g e d f r o m 14.67/100(S D 26.46)t o 18.34/100(S D 27.06)a t 6m o n t h s a n d 2y e a r s r e s p e c t i v e l y .M D C r a n g e d f r o m 37.91/100t o 38.09/100a t 6m o n t h s f o r h i p a n d k n e e ,r e s p e c t i v e l y A c c e p t a b l e ,v a l i d a n d r e l i a b l e g e n e r i c m e a s u r e o f b o d i l y p a i n t h a t i s s i m p l e t o a d m i n i s t e r a n d u s e i n d i v e r s e p o p u l a t i o n s M a y n o t b e a u s e f u l m e a s u r e t o d i s c r i m i n a t e l e v e l s o f p a i n s e v e r i t y a n d t h u s r e s p o n s e t o t r e a t m e n t I C O A P
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t h a t c o m p r e h e n s i v e l y e v a l u a t e s t h e p a i n e x p e r i e n c e i n p e o p l e w i t h h i p o r k n e e O A ,i n d e p e n d e n t o f t h e e f f e c t o f p a i n o n p h y s i c a l f u n c t i o n A n 11-i t e m s c a l e e v a l u a t i n g 2p a i n d o m a i n s :c o n s t a n t p a i n a n d i n t e r m i t t e n t p a i n (p a i n t h a t c o m e s a n d g o e s )T w o s u p p l e m e n t a r y q u e s t i o n s c a n b e u s e d t o a s s e s s t h e p r e d i c t a b i l i t y o f i n t e r m i t t e n t p a i n ,w h e n p r e s e n t
I n t e r v i e w e r -a d m i n i s t e r e d (i n p e r s o n o r b y t e l e p h o n e )R e s p o n d e n t s s h o u l d c o m p l e t e b o t h s u b s c a l e s ?10m i n u t e s N o t r a i n i n g r e q u i r e d t o a d m i n i s t e r a n d s c o r e .(U s e r ’s G u i d e a v a i l a b l e )H i g h e r s c o r e s i n d i c a t e w o r s e p a i n e x p e r i e n c e E x c e l l e n t ;I n t e r n a l c o n s i s t e n c y :C r o n b a c h ’s ?w a s 0.93i n h i p a n d k n e e O A s u b j e c t s .T e s t –r e t e s t r e l i a b i l i t y w a s h i g h i n h i p a n d k n e e O A s u b j e c t s (I C C 0.85)G o o d ;C o n s t r u c t v a l i d i t y :S p e a r m a n ’s c o r r e l a t i o n c o e f ?c i e n t s f o r I C O A P s c o r e s r a n g e d f r o m 0.60t o 0.81f o r W O M A C a n d K O O S ,r e s p e c t i v e l y G o o d ;F o r k n e e O A ,S R M s r a n g e d f r o m 0.49–0.57f o r I C O A P s u b s c a l e s .F o r h i p O A ,S R M s r a n g e d f r o m 0.11–0.19.S R M s r a n g e d f r o m 0.84–1.02f o r k n e e r e p l a c e m e n t a n d 1.50–2.29f o r h i p r e p l a c e m e n t
A c c e p t a b l e /v a l i d /r e l i a b l e m e a s u r e o f t h e m u l t i -d i m e n s i o n a l p a i n e x p e r i e n c e i n O A ,d i s t i n c t f r o m t h e i m p a c t o f p a i n o n p h y s i c a l f u n c t i o n i n g O n l y a f e w t r a n s l a t e d v e r s i o n s o f t h e I C O A P h a v e b e e n a s s e s s e d f o r v a l i d i t y ,r e l i a b i l i t y ,a n d r e s p o n s i v e n e s s *V A S ?v i s u a l a n a l o g s c a l e ;M C I D ?m i n i m u m c l i n i c a l l y i m p o r t a n t d i f f e r e n c e ;N R S ?n u m e r i c r a t i n g s c a l e ;M P Q ?M c G i l l P a i n Q u e s t i o n n a i r e ;O A ?o s t e o a r t h r i t i s ;W O M A C ?W e s t e r n O n t a r i o a n d M c M a s t e r U n i v e r s i t i e s O s t e o a r t h r i t i s I n d e x ;E S ?e f f e c t s i z e ;S F -M P Q ?S h o r t F o r m M P Q ;I C C ?i n t r a c l a s s c o r r e l a t i o n c o e f ?c i e n t ;M S K ?m u s c u l o s k e l e t a l ;S R M ?s t a n d a r d i z e d r e s p o n s e m e a n ;N S F ?N o r w e g i a n S h o r t F o r m ;C P G S ?C h r o n i c P a i n G r a d e S c a l e ;95%C I ?95%c o n ?d e n c e i n t e r v a l ;S F -36
B P S ?S h o r t F o r m 36B o d i l y P a i n S c a l e ;R A ?r h e u m a t o i d a r t h r i t i s ;M D
C ?m i n i m a l d e t e c t a b l e c h a n g e ;I C O A P ?M e a s u r e o f I n t e r m i t t e n t a n d C o n s t a n t O s t e o a r t h r i t i s P a i n ;K O O S ?K n e e I n j u r y a n d O s t e o a r t h r i t i s O u t c o m e S c o r e .
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