Abstract
BackgroundChanges of health and quality-of-life in chronic conditions are mostly small and require specific and sensitive instruments. The aim of this study was to determine and compare responsiveness, i.e. the sensitivity to change of five outcome instruments for effect measurement in chronic pain.MethodsIn a prospective cohort study, 273 chronic pain patients were assessed on the Numeric Rating Scale (NRS) for pain, the Short Form 36 (SF-36), the Multidimensional Pain Inventory (MPI), the Hospital Anxiety and Depression Scale (HADS), and the Coping Strategies Questionnaire (CSQ). Responsiveness was quantified by effect size (ES) and standardized response mean (SRM) before and after a four week in-patient interdisciplinary pain program and compared by the modified Jacknife test.ResultsThe MPI measured pain more responsively than the SF-36 (ES: 0.85 vs 0.72, p = 0.053; SRM: 0.72 vs 0.60, p = 0.027) and the pain NRS (ES: 0.85 vs 0.62, p < 0.001; SRM: 0.72 vs 0.57, p = 0.001). Similar results were found for the dimensions of role and social interference with pain. Comparison in function was limited due to divergent constructs. The responsiveness of the MPI and the SF-36 was equal for affective health but both were better than the HADS (e.g. MPI vs HADS depression: ES: 0.61 vs 0.43, p = 0.001; SF-36 vs HADS depression: ES: 0.54 vs 0.43, p = 0.004). In the "ability to control pain" coping dimension, the MPI was more responsive than the CSQ (ES: 0.46 vs 0.30, p = 0.011).ConclusionThe MPI was most responsive in all comparable domains followed by the SF-36. The pain-specific MPI and the generic SF-36 can be recommended for comprehensive and specific bio-psycho-social effect measurement of health and quality-of-life in chronic pain.
Highlights
Changes of health and quality-of-life in chronic conditions are mostly small and require specific and sensitive instruments
Responsiveness is, besides reliability and other aspects of validity, one of the most important properties of an outcome measure [8]. It is the basis on which the 'discrimination' criteria were established by the quality classification process of the Outcome Measures in Rheumatology Clinical Trials (OMERACT) carried out by the World Health Organization (WHO), the American College of Rheumatology (ACR), and the European League Against Rheumatism (EULAR) [9]
Patients The subjects included in the study were all participants of the "Zurzach Interdisciplinary Pain Program" (ZISP) who were suffering either from chronic non-specific back pain, or fibromyalgia according to the definition of the American College of Rheumatology (ACR), or chronic widespread pain, i.e. generalized musculoskeletal pain syndrome which did not meet the definition criteria of fibromyalgia [21]
Summary
Changes of health and quality-of-life in chronic conditions are mostly small and require specific and sensitive instruments. The aim of this study was to determine and compare responsiveness, i.e. the sensitivity to change of five outcome instruments for effect measurement in chronic pain. Responsiveness is, besides reliability and other aspects of validity, one of the most important properties of an outcome measure [8]. It is the basis on which the 'discrimination' criteria were established by the quality classification process of the Outcome Measures in Rheumatology Clinical Trials (OMERACT) carried out by the World Health Organization (WHO), the American College of Rheumatology (ACR), and the European League Against Rheumatism (EULAR) [9]
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