Abstract
BackgroundA comprehensive and accurate assessment of pain is critical for successful pain management. However, there is a lack of reliable and valid assessment tools for exploring multidimensional aspects of the chronic pain experience in culturally and linguistically diverse communities. This study investigates the reliability and validity of the Pictorial Representation of Illness and Self Measure + (PRISM+) for evaluating pain-related suffering and the sociocultural context of chronic pain within culturally and linguistically diverse patient cohorts.MethodThree prospective validation studies are reported for three culturally and linguistically diverse communities. Two hundred and fifty-one patients with chronic pain who self-identified as Assyrian (n = 85), Arabic (n = 83) or Vietnamese (n = 83) completed a PRISM+ assessment, alongside a battery of standardised pain assessments. To evaluate construct validity, the position of the ‘pain’ disk placement was correlated with the Brief Pain Inventory (BPI), Depression Anxiety and Stress Scale (DASS), and the Short-Form 36 Health Survey (SF-36). For content validity, thematic analysis of patient narratives accompanying each disk placement was conducted. Test-retest reliability of repeated ‘pain’ and five additional disks (PRISM+) values was analysed using intra-class correlation coefficients.ResultsThe PRISM pain assessment demonstrated moderate to good test-retest reliability for Arabic (ICC 0.76; 95% CI 0.65–0.84), Assyrian (ICC 0.65; 95% CI 0.50–0.76) and Vietnamese (ICC 0.82; 95% CI 0.73–0.88) patients. Moderate correlations between the PRISM ‘pain’ disk and sub-scores for the BPI, DASS and SF-36 were found (p < 0.001). Patient interpretations of the ‘pain’ disk aligned with accepted definitions of suffering, supporting content validity for PRISM. For the additional disks (PRISM+), moderate to good test-retest reliability (ICC 0.67–0.88) was observed and qualitative analysis highlighted each disk reflected social and cultural values.ConclusionThe PRISM demonstrates acceptable psychometric properties for measuring pain-related suffering for participants with chronic pain across three culturally and linguistically diverse communities. The use of additional disks (PRISM+) presents a reliable and valid option for exploring social and cultural dimensions of chronic pain in clinical encounters.
Highlights
Contemporary chronic pain assessments seek to holistically appraise biomedical, psychosocial and behavioural contributors to the pain and disability experience, often with patient-reported measures [1]
Consecutive consenting adults (> 18 years of age) from those referred for physiotherapy or pain clinic treatment for a neuromusculoskeletal chronic pain condition were invited to participate if they identified as a first-generation member of Assyrian, Arabic speaking or Vietnamese communities
Symptoms were constant for 81% of the sample and intermittent for the remaining 19%
Summary
Contemporary chronic pain assessments seek to holistically appraise biomedical, psychosocial and behavioural contributors to the pain and disability experience, often with patient-reported measures [1]. The PRISM quantitatively measures the subjective position of the patient’s illness in relation to self, while the therapist simultaneously elicits a narrative of how illness influences a patient’s identity [8, 9] This is achieved by the patient placing a coloured disk representing ‘illness’ on a ‘life’ board, in a position that symbolises the effect of illness on the integrity of the person, and their sense of self. There is a lack of reliable and valid assessment tools for exploring multidimensional aspects of the chronic pain experience in culturally and linguistically diverse communities. This study investigates the reliability and validity of the Pictorial Representation of Illness and Self Measure + (PRISM+) for evaluating pain-related suffering and the sociocultural context of chronic pain within culturally and linguistically diverse patient cohorts
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