Assessment of disability: Comparison of PRISM (pictorial representation of Illness and Self-measure) scores and the SF-36 quality of life questionnaire to assess suffering in chronic non-cancer pain patients

Abstract

The PRISM method of assessment of suffering, originally described by Buchi et al in 1998,is a fast visual quantitative method of measuring the intrusiveness of illness into a patient's life. Patients are asked to look at an A4-sized metal board and imagine it represents their life, with a yellow disc in the corner representing their concept of ‘self’.They are asked to place a magnetized red disc, representing their illness, on the board in such a way as to represent its intrusiveness into their concept of ‘self’. Ninety four patients attending a chronic pain clinic in a Toronto teaching hospital were asked to complete this test, imagining the red disc as their pain, as well as the SF 36 short form questionnaire, which is validated for measuring quality of life in physical and mental domains. Comparison of the distance between the centres of the yellow and red discs showed statistically significant correlation with the physical domain of the SF36. The SF36 takes ten to twenty minutes to complete and relies on literacy. The PRISM does not, and took less than 30 seconds to complete, and was also managed by two blind patients. It offers a rapid method of tracking progress at each visit, and allows patients to demonstrate, visually, their goals of treatment. It is likely to be more reflective of suffering than the pain scores so commonly in current use.