Evaluating the Structural and Construct Validity of the Pain Understanding and Confidence Questionnaire for Assessing Physical Therapists' Pain Management Competence: A Cross-Sectional Study.

Abstract

Background The Pain Understanding and Confidence Questionnaire (PUnCQ) comprises two parts: the first assesses clinical judgments based on contemporary pain knowledge, and the second consists of items querying confidence in pain management for the presented vignette. In contrast to existing measures, PUnCQ can evaluate a therapist's capacity to make appropriate clinical decisions within a specific vignette. Thus, PUnCQ may be a promising measure to assess the clinical competence of physical therapists in pain management. This study evaluated the structural and construct validity of PUnCQ. Methodology Eligible participants were two cohorts of physical therapists managing patients with pain. PUnCQ and Knowledge and Attitudes of Pain (KNAP) data were collected using an anonymous survey. Confirmatory factor analysis was conducted for both parts of the PUnCQ, and an exploratory factor analysis was conducted when multidimensionality was suspected. Construct validity was assessed with the hypothesis that Pearson's r values to KNAP scores, indicating knowledge about modern pain science and biopsychosocial attitudes toward pain, were expected to be 0.3-0.5 in part one and >0.5 in part two. Results Data from 112 participants were analyzed. PUnCQ part one fully satisfied the predetermined criteria for unidimensionality, but part two did not. Exploratory factor analysis for part two revealed a two-factor structure: a 14-item Factor 1 labeled "pain management" and a seven-item Factor 2 labeled "medication guidance and pain mechanism," while Cronbach's alpha was 0.98 across all items. Statistically significant correlations were detected with the KNAP in each part of the PUnCQ (r = 0.26 in part one and r = 0.41 in part two). Conclusion PUnCQ has structural validity and an aspect of construct validity.