Development and psychometric analysis of the PROMIS pain behavior item bank (original) (raw)
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Pain Medicine, 2007
Objectives. To describe the development and evaluation of the Pain Impact Questionnaire (PIQ-6 TM), a six-item measure of pain severity and impact on health-related quality of life (HRQOL) domains. Participants. Two general US population samples (N = 829 and N = 7,025) and one chronic pain patient sample (N = 350) were included. Methods. The PIQ-6 TM was developed using conventional and item response theory (IRT) methods in four steps: 1) initial selection and development of items based on results from a previously developed Bodily Pain item bank; 2) final item selection based on new data and investigations of unidimensionality, differential item functioning (DIF), and IRT modeling; 3) development of scoring algorithms, population norms, and cross-calibrations; and 4) psychometric evaluation. Results. Six items on pain intensity and impact satisfied requirements of unidimensionality and lack of DIF and could be scored using IRT methods. The PIQ-6 showed good internal consistency reliability (coefficient alpha = 0.94) and good construct validity. Convergent validity was supported by strong correlations with pain severity scales (visual analog and numerical rating scales; r = 0.81-0.84); discriminant validity was suggested by correlations with the SF-8™ Health Survey Physical and Mental Component Summary measures (r = − 0.77; r = − 0.32, respectively), significant mean score differences between chronic pain patients and the general population, and between patients differing in self-reported medical conditions (P < 0.001). Conclusion. The PIQ-6 is a brief, precise questionnaire available in a paper-and-pencil version and a computerized version that includes scoring and feedback software. It may facilitate large-scale, inexpensive, precise, and norm-based pain assessment and monitoring in a wide variety of settings (e.g., homes, clinics, offices).
Quality of Life Research, 2013
Purpose-In order to test the difference between group means, the construct measured must have the same meaning for all groups under investigation. This study examined the measurement invariance of responses to the patient-reported outcomes measurement information system (PROMIS) pain behavior (PB) item bank in two samples: the PROMIS calibration sample (Wave 1, N = 426) and a sample recruited from the American Chronic Pain Association (ACPA, N = 750). The ACPA data were collected to increase the number of participants with higher levels of pain. Methods-Multi-group confirmatory factor analysis (MG-CFA) and two item response theory (IRT)-based differential item functioning (DIF) approaches were employed to evaluate the existence of measurement invariance. Results-MG-CFA results supported metric invariance of the PROMIS-PB, indicating unstandardized factor loadings with equal across samples. DIF analyses revealed that impact of 6 DIF items was negligible.
Development and validation of a new self-report measure of pain behaviors
Pain, 2013
Pain behaviors that are maintained beyond the acute stage post-injury can contribute to subsequent psychosocial and physical disability. Critical to the study of pain behaviors is the availability of psychometrically sound pain behavior measures. In this study we developed a self-report measure of pain behaviors, the Pain Behaviors Self Report (PaB-SR). PaB-SR scores were developed using item response theory and evaluated using a rigorous, multiple-witness approach to validity testing. Participants included: a) 661 survey participants with chronic pain and with multiple sclerosis (MS), back pain, or arthritis; b) 618 survey participants who were significant others of a chronic pain participant; and c) 86 participants in a videotaped pain behavior observation protocol. Scores on the PaB-SR were found to be measurement invariant with respect to clinical condition. PaB-SR scores, observer-reports, and the video-taped protocol yielded distinct, but convergent views of pain behavior, supporting the validity of the new measure. The PaB-SR is expected to be of substantial utility to researchers wishing to explore the relationship between pain behaviors and constructs such as pain intensity, pain interference, and disability.
Item response theory evaluation of the biomedical scale of the Pain Attitudes and Beliefs Scale
PLOS ONE, 2018
The assessment of health care professionals' attitudes and beliefs towards musculoskeletal pain is essential because they are key determinants of their clinical practice behaviour. The Pain Attitudes and Beliefs Scale (PABS) biomedical scale evaluates the degree of health professionals' biomedical orientation towards musculoskeletal pain and was never assessed using item response theory (IRT). This study aimed at assessing the psychometric performance of the 10-item biomedical scale of the PABS scale using IRT. Methods Two cross-sectional samples (BeBack, n = 1016; DABS; n = 958) of health care professionals working in the UK were analysed. Mokken scale analysis (nonparametric IRT) and common factor analysis were used to assess dimensionality of the instrument. Parametric IRT was used to assess model fit, item parameters, and local reliability (measurement precision). Results Results were largely similar in the two samples and the scale was found to be unidimensional. The graded response model showed adequate fit, covering a broad range of the measured construct in terms of item difficulty. Item 3 showed some misfit but only in the DABS sample. Some items (i.e. 7, 8 and 9) displayed remarkably higher discrimination parameters than others (4, 5 and 10). The scale showed satisfactory measurement precision (reliability > 0.70) between theta values-2 and +3.
The pain behavior check list (PBCL): Factor structure and psychometric properties
Journal of Behavioral Medicine, 1991
The construct of “pain behaviors” as observable and measurable manifestations of pain occupies a central role in Fordyce's operant model of pain. The present study was designed to evaluate the multidimensional nature of the construct and to explore the psychometric properties of a newly developed self-report instrument called the Pain Behavior Check List (PBCL). Subjects were 126 chronic pain patients who completed an initial version of the PBCL and other standardized questionnaires as part of their evaluation by the West Haven VAMC. Factor analysis identified four factors labeled Distorted Ambulation, Affective Distress, Facial/Audible Expressions, and Seeking Help. Substantial reliability and stability estimates for the total PBCL and the subscales support the potential clinical and theoretical utility of the instrument.
An Item Response Theory-Based Pain Item Bank Can Enhance Measurement Precision
Journal of Pain and Symptom Management, 2005
Cancer-related pain is often under-recognized and undertreated. This is partly due to the lack of appropriate assessments, which need to be comprehensive and precise yet easily integrated into clinics. Computerized adaptive testing (CAT) can enable precise-yet-brief assessments by only selecting the most informative items from a calibrated item bank. The purpose of this study was to create such a bank. The sample included 400 cancer patients who were asked to complete 61 pain-related items. Data were analyzed using factor analysis and the Rasch model. The final bank consisted of 43 items which satisfied the measurement requirement of factor analysis and the Rasch model, demonstrated high internal consistency and reasonable item-total correlations, and discriminated patients with differing degrees of pain. We conclude that this bank demonstrates good psychometric properties, is sensitive to pain reported by patients, and can be used as the foundation for a CAT pain-testing platform for use in clinical practice. J Pain Symptom Manage 2005;30:278-288. Ć 2005 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
The use of multiple-item scales for pain intensity measurement in chronic pain patients
Pain, 1996
This studyexaminedthe relativepredictivevaliditiesof severalmeasuresof pain intensity.Forty chronic pain patients completed6-14 days worth of hourly pain ratings, which were averagedto obtain a measure of actual averagepain intensity.These patients then made ratings, on 101-pointnumericalrating scales,of worst, least, and usual pain during the previous2 wks, and of their current pain. A seriesof correlation coefficientswere computed and regressionanalyseswere performed to determinethe individualor compositemeasuresthat best predicted actual averagepain intensity.Consistentwith previous research, the best singlepredictor of actual average pain intensity was patient rating of least pain in the previous2 wks. Of all possiblecompositesof usual, least, worst, and current pain ratings, the arithmetic mean of least and usual pain had the strongestrelationshipto actual average pain. The inclusionof ratings of most pain or current pain in any compositescore actuallyweakenedthe relationshipbetween the compositescore and actual averagepain intensity.These resultssuggestthat, when cliniciansor researcherswish to assessaveragepain among chronic pain patients, but cannot obtain multiplemeasuresof pain over time, the most valid measure would be the arithmetic mean of patient-recalledleast and usual pain.
Dimensionality and Reliability Assessment of the Pain Patient Profile Questionnaire
European Journal of Psychological Assessment, 2008
Objective: To factor analyze the Pain Patient Profile questionnaire (P3; Tollison & Langley, 1995), a self-report measure of emotional distress in respondents with chronic pain. Method: An unweighted least squares factor analysis with oblique rotation was conducted on the P3 scores of 160 pain patients to look for evidence of three distinct factors (i.e., Depression, Anxiety, and Somatization). Results: Fit indices suggested that three distinct factors, accounting for 32.1%, 7.0%, and 5.5% of the shared variance, provided an adequate representation of the data. However, inspection of item groupings revealed that this structure did not map onto the Depression, Anxiety, and Somatization division purportedly represented by the P3. Further, when the analysis was rerun , eliminating items that failed to meet salience criteria, a two-factor solution emerged, with Factor 1 representing a mixture of Depression and Anxiety items and Factor 2 denoting Somatization. Each of these factors correlated significantly with a subsample's assessment of pain intensity. Conclusion: Results were not congruent with the P3's suggested tripartite model of pain experience and indicate that modifications to the scale may be required.
Pain, 2019
Recent research has highlighted a need for the psychometric evaluation of instruments targeting core domains of the pain experience in chronic pain populations. In this study, the measurement properties of Short Form-36 Health Survey (SF-36),EuroQol 5-dimensions (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) were analyzed within the item response-theory framework based on data from 35,908 patients. To assess the structural validity of these instruments, the empirical representations of several conceptually substantiated latent structures were compared in a cross-validation procedure. The most structurally sound representations were selected from each questionnaire and their internal consistency reliability computed as a summary of their precision. Finally, questionnaire scores were correlated with each other to evaluate their convergent and discriminant validity. Our results supported that SF-36 is an acceptable measure of 2 independent constructs of physical and mental health. By contrast, although the approach to summarize the health-related quality of life construct of EQ-5D as a unidimensional score was valid, its low reliability rendered practical model implementation of doubtful utility. Finally, rather than being separated into 2 subscales of anxiety and depression, HADS was a valid and reliable measure of overall emotional distress. In support of convergent and discriminant validity, correlations between questionnaires showed that theoretically similar traits were highly associated, whereas unrelated traits were not. Our models can be applied to score SF-36 and HADS in chronic pain patients, but we recommend against using the EQ-5D model due to its low reliability. These results are useful for researchers and clinicians involved in chronic pain populations because questionnaires' properties determine their discriminating ability in patient status assessment.
Linking Pain Items from Two Studies Onto a Common Scale Using Item Response Theory
Journal of Pain and Symptom Management, 2009
This study examined two approaches to linking items from two pain surveys to form a single item bank with a common measurement scale. Secondary analysis of two independent surveys: Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials Survey with Main Survey (959 chronic pain patients; 42 pain items) and Pain Module (n ¼ 148; 36 pain items), and Center on Outcomes, Research and Education Survey (400 cancer patients; 43 pain items). There were common items included among the three data sets. In the first approach, all items were calibrated to an item response theory (IRT) model simultaneously, and in the second approach, items were calibrated separately and then the scales were transformed to a common metric. The two approaches produced similar linking results across the two sets of pain interference items because there was sufficient number of common items and large enough sample size. For pain intensity, simultaneous calibration yielded more stable results. Separated calibration yielded an unsatisfactory linking result for pain intensity because of a single common item with small sample size. The results suggested that a simultaneous IRT calibration method produces the more stable item parameters across independent samples, and hence, should be recommended for developing comprehensive item banks. Patient-reported health outcome surveys are often limited in sample sizes and the number of items owing to the difficulty of recruitment and the burden to the patients. As a result, the surveys either lack statistical power or are limited in scope. Using IRT methodology, survey data can be pooled to lend strength to each other to expand the scope and to increase the sample sizes.