A comparison of pain-assessment tools for use with elderly long-term-care residents. Comparing the psychometric properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) instruments. Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. Psychometric properties of a generic health measure in patients with neck pain The Bournemouth Questionnaire: a short-form comprehensive outcome measure. II. Psychometric properties in neck pain patients. Using the "TOPS," an outcomes instrument for multidisciplinary outpatient pain treatment. Implementing a pain management program in a long-term care facility using a quality improvement approach. A Controlled Trial of Methods for Managing Pain in Primary Care Patients With or Without Co-Occurring Psychosocial Problems Evaluation of changes in occupational performance among patients in a pain management program. Comparative reliability and validity of chronic pain intensity measures Improving assessment and treatment of pain in the critically ill. Implementation and preliminary effectiveness of a real‐time pain management smartphone app for adolescents with cancer: A multicenter pilot clinical study Treatment outcome of chronic non-malignant pain patients managed in a Danish multidisciplinary pain centre compared to general practice: a randomised controlled trial The use of a responder analysis to identify differences in patient outcomes following a self-care intervention to improve cancer pain management Addressing methodological challenges in implementing the nursing home pain management algorithm randomized controlled trial A randomized controlled evaluation of an online chronic pain self management program Accurately measuring the quality and effectiveness of cervical spine surgery in registry efforts: determining the most valid and responsive instruments.
The purpose of this study was to examine the psychometric properties ( test-retest and interrater reliability , criterion concurrent validity ) of 3 verbal pain- assessment tools ( Faces Pain Scale , Numerical Rating Scale , Present Pain Intensity Scale )  and a behavioural pain- assessment scale for use with an elderly population . The study used a repeated- measures design to examine the reliability and validity of the tools across 4 groups of participants with varying levels of cognitive impairment using a non-r and om stratified sample of 130 elderly long-term-care residents . The findings support the test-retest and interrater reliability of the  behavioural pain- assessment tool  across all levels of cognitive impairment , whereas the same measures of reliability for the verbal-report tools decreased with increasing cognitive impairment ; however , the majority of elderly with mild to moderate cognitive impairment were able to complete at least 1 of these tools . The findings are discussed in relation to their clinical and research implication OBJECTIVE To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia . DESIGN In a cross-sectional descriptive study nursing home ( NH ) residents  were videotaped at rest and during a structured movement procedure . Following one training session and one practice session , two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools . SETTING Fourteen NHs in Western Washington State participating in a r and omized controlled trial of an intervention to enhance pain assessment and management .  PARTICIPANTS Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment . MEASURES  Checklist of Nonverbal Pain Indicators ( CNPI ) and the Pain Assessment in Advanced Dementia ( PAINAD ) , demographic and pain-related data ( Minimum Data Set ) , nursing assistant reports of participants ' usual pain intensity , and Pittsburgh Agitation Scale . RESULTS Internal consistency for both tools was good except for the CNPI at rest for one rater . Inter-rater reliability for pain presence was fair ( K = 0.25 for CNPI with movement ; K = 0.31 for PAINAD at rest ) to moderate ( K = 0.43 for CNPI at rest ; K = 0.54 for PAINAD with movement ) . There were significant differences in mean CNPI and PAINAD scores at rest and during movement , providing support for construct validity . However , both tools demonstrated marked floor effects , particularly when participants were at rest . CONCLUSIONS Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD , findings from the current study indicate that these measures warrant further study with clinical users , should be used cautiously both in research and clinical setting s and only as part of a comprehensive approach to pain assessment This study constituted the first step in the psychometric development of a self-report screening instrument for risk of opioid medication misuse among chronic pain patients . A 26-item instrument , the Pain Medication Question naire ( PMQ ) , was constructed based on suspected behavioral correlates of opioid medication misuse , which heretofore have received limited empirical investigation . The PMQ  was administered to 184 patients at an interdisciplinary pain treatment center .  Reliability coefficients for the PMQ were found to be of moderate but acceptable strength . Construct and concurrent validity were examined through correlation of PMQ scores to measures of substance abuse , physical and psychological functioning , and physicians ' risk assessment s. To explore high and low cutoff points for misuse risk , subgroups were formed according to the upper and lower thirds of PMQ scores and compared on validity measures . Higher PMQ scores were associated with history of substance abuse , higher levels of psychosocial distress , and poorer functioning . Future psychometric analyses will consider predictive validity and examine shortened versions of the instrument Objective : To examine the reliability , validity and responsiveness of the generic Current Perceived Health 42 ( CPH42 ) Profile in Chinese patients with neck pain in Hong Kong . Design : A prospect i ve observational study . Setting : Physiotherapy outpatient departments . Subjects : Two sample s with 472 consecutive adult patients with neck pain from seven physiotherapy outpatient departments in Hong Kong . Methods : Subjects were requested to complete the CPH42 Profile , and their pain intensity was measured using the 11-point numerical rating scale ( NRS ) . They were observed and measured at the beginning of physiotherapy , at seven days , at week 3 and at week 6 after treatment began . Results : The CPH42 Profile had very good test – retest reliability and internal consistency ( intraclass correlation coefficient 0.91 , Cronbach 's alpha 0.90 ) . Validity was confirmed by a moderate correlation with the NRS at the beginning of treatment and week 6 ( rank correlation 0.41–0.53 ) . Moreover , a significant difference in scores was found between those who had sought medical consultation and /or had taken medication because of neck pain than those who did not . The responsiveness measured from the beginning of treatment to week 3 and week 6 ( st and ard response means of 0.33 and 0.36 ) was comparable to the respective changes in pain intensity . Conclusion : The CPH42 Profile has been shown to demonstrate good reliability and validity , and it is sensitive to changes in severity over time . It is suitable for use as an outcome measure for evaluation of patients with neck pain OBJECTIVE To modify an existing outcome measure ( Bournemouth Question naire [ BQ ] ) for use in patients with nonspecific neck pain and test its psychometric properties . DESIGN Prospect i ve longitudinal study in which the question naire was administered on 3 occasions ( pretreatment , retest , and posttreatment ) . SETTING Anglo-European College of Chiropractic outpatient clinic and 8 field chiropractic practice s. METHOD Seven core items relating to the biopsychosocial model of pain were included in the original question naire ( back BQ ) . The wording of one of these items ( disability in activities of daily living ) was modified to include activities likely to be affected by neck pain . Testing of the neck BQ was carried out in 102 patients with nonspecific neck pain . RESULTS The instrument demonstrated high internal consistency on 3 administrations ( Cronbach 's alpha = 0.87 , 0.91 , 0.92 ) . All 7 items were retained on the basis that they each significantly contributed to the total score ( item-corrected total score correlations > 0.43 ) and to the instrument 's responsiveness to clinical change ( item change-corrected total change score correlations > 0.42 ) . The instrument was reliable in test-retest administrations in stable subjects ( ICC = 0.65 ) . The instrument demonstrated acceptable construct validity and longitudinal construct validity with established external measures . The treatment effect size of the instrument was found to be high ( 1.67 ) . CONCLUSION The neck BQ covers the salient dimensions of the biopsychosocial model of pain , is quick and easy to complete , and has been shown to be reliable , valid , and responsive to clinical ly significant change in patients with nonspecific neck pain . Its use as an outcome measure in clinical trials and outcomes research is recommended OBJECTIVE To assess the reliability of an augmented SF-36 instrument , the Treatment Outcomes in Pain Survey  ( "  TOPS  " ) , in patients treated in two pain management programs , and present norms for initial values and treatment-related improvements . DESIGN Prospect i ve case series at two sites with longitudinal follow-up . SETTING Multidisciplinary , comprehensive outpatient pain treatment centers in university hospitals in Salt Lake City and Boston . PATIENTS Nine hundred and forty seven adult out patients with a range of socioeconomic , demographic , and ethnic characteristics , all referred for evaluation and treatment of chronic pain . INTERVENTIONS Usual practice multidisciplinary pain treatment . OUTCOMES MEASURES TOPS prior to pain treatment and 5-week nominal follow-up . Means and st and ard deviations of baseline and follow-up results . Psychometric results for reliability ( Cronbach alpha ) , validity ( item discriminant validity , validity coefficients ) , and related statistical precision measures for group and individual design s. RESULTS Several measures were precise enough to permit following individual patients in st and ard clinic treatment , of which the Total Pain Experience dimension was the most powerful . Similar psychometrics were observed in the Boston and Salt Lake City sites . The Pain Symptom , Objective Family/Social Disability , Objective Work Disability , and Upper Body Functional Limitations scales were vali date d. DISCUSSION The TOPS was design ed to satisfy several models of clinical pain treatment . It successfully monitored treatment based on those models . Not all patients improve with treatment , but most do . The TOPS can be administered in a variety of ways , but we found paper and pencil administration with computer scanning of results quick and efficient for making the data available to clinicians as part of treatment . CONCLUSIONS The accuracy of the TOPS is sufficient to monitor the response of individual patients during multidisciplinary treatment of chronic pain . The TOPS provides needed documentation ( e.g. , to third-party payors ) of the aggregate value of multidisciplinary outpatient treatment of chronic pain as well as its benefit for individual patients BACKGROUND Pain constitutes a constant challenge facing staff and residents of skilled nursing facilities ( SNF ) and nursing homes ( NH ) . Many SNF and NH have not adopted a uniform plan to assess and treat pain for their residents despite published literature that demonstrates that the implementation of scales improves detection and treatment of pain . The objective of this study was to analyze the baseline pain level in the institutionalized elderly , and then implement a st and ard pain scale for its assessment and evaluation , while simultaneously identifying challenges in adopting this st and ardized method . METHODS As part of a Quality Improvement Project ( QI ) , a total of 40 patients were chosen at r and om in 2 of the major skilled care and dementia units at a Columbia area nursing home , 20 patients from each . A chart review was conducted to document the presence or absence of pain syndromes , pain medications used , and use of st and ardized tools for the evaluation of pain . Documentation regarding diagnosis of depression and behavioral problems were also noted as potential markers for the manifestation of pain . Verbal and nonverbal pain scales were introduced and approved by the medical and nursing staff . Training sessions for the administration of such tools were implemented . A baseline evaluation of pain level was obtained applying these newly adopted tools . One cycle using the PDSA ( Plan-Do- Study and Act ) model for QI was followed . RESULTS Our evaluation showed that 84.2 % ( 32/38 ) of our study population were females , and the mean age was 91.4 years . Fifty percent ( 19/38 ) of patients had mild to moderate pain .  Because of nonst and ardized approaches to analgesia , some regimens rendered clear potential for toxicity : ie , receiving more than 3 grams per day of acetaminophen . Most patients with cognitive deficits had lower levels of moderate pain ( 9.5 % [ 2/21 ] ) but higher levels of mild pain ( 33.3 % [ 7/21 ] ) when compared with patients with normal cognition or mild cognitive deficits ( 35.3 % [ 6/17 ] and 17.6 % [ 3/17 ] , respectively ) . Nursing staff adopted successfully the chosen pain tools and gave positive feedback after the trial period , indicating that they were helpful tools to identify pain and treat it promptly . Active participation of nursing staff through the process of decision making , tailoring of the pain assessment scales , and feedback during the period of implementation of pain assessment tools was perceived to facilitate better results . New cycles of pain evaluation and improvement were scheduled . CONCLUSIONS Pain evaluation and management is of paramount importance because of its high prevalence and demonstrated deleterious effects on both quality of life and long-term survival . Tools for verbal and nonverbal evaluation of pain are necessary in both NH and SCF . Also , regular cognitive and behavioral assessment may help evaluate pain by providing additional information to physicians , nurses , and other caregivers when treatment becomes more challenging and complex . The use of st and ard st and ing orders can easily help decrease the potential of toxicity related to the use of analgesics PURPOSE Pain , a common reason for visits to primary care physicians , is often not well managed . The objective of this study was to determine the effectiveness of  pain management interventions  suitable for primary care physicians . METHODS Patients from 14 rural primary care practice s ( 47 physicians ) who reported diverse pain problems with ( n = 644 ) or without ( n = 693 ) psychosocial problems were r and omized to usual-care or intervention groups . All patients in the intervention group received information tailored to their problems and concerns ( INFO ) . These patients ’ physicians received feedback about their patients ’ problems and concerns ( FEED ) . A nurse-educator ( NE ) telephoned patients with pain and psychosocial problems to teach problem-solving strategies and basic pain management skills . Outcomes were assessed with the Medical Outcomes Study 36-Item Short-Form and the Functional Interference Estimate at baseline , 6 months , and 12 months . RESULTS Patients with pain and psychosocial problems r and omized to INFOFEED+NE significantly improved on the bodily pain ( P = .011 ) , role physical ( P = .025 ) , vitality ( P < .001 ) , role emotional ( P = .048 ) , and the Functional Interference Estimate ( P = .027 ) scales compared with usual-care patients at 6 months . These improvements were maintained at the 12-month assessment even though these patients had received , on average , only 3 telephone calls . Compared with usual-care patients , at 6 months patients who received INFOFEED alone experienced minimal improvements that were not sustained at the 12-month assessment . CONCLUSIONS For patients with pain and psychosocial problems , telephone-based assistance result ed in significant , sustained benefit in pain and psychosocial problems OBJECTIVES The aims of this study were to evaluate changes in occupational performance among chronic pain patients after a pain management program  and to explore relationships between these changes and demographic and clinical factors , psychosocial functioning and psychological well-being . SUBJECTS 188 consecutive patients were included . METHODS Changes were registered by using Canadian Occupational Performance Measure , Multidimensional Pain Inventory and Psychological General Well-Being Index . RESULTS There were statistically significant positive changes in occupational performance .  Patients with sickness compensation had significantly higher changes in occupational performance than those without sickness compensation . The patients with a profile group as interpersonally distressed had statistically significant higher change scores on occupational performance than the adaptive coper group . Furthermore , increases in changes on general activity level , general health , and vitality and decreases in pain severity were associated with positive changes on perceived occupational performance and performance satisfaction . CONCLUSION Changes in occupational performance , psychological well-being and psychosocial functioning seem all to be of relevance in the evaluation of pain management programs . Psychosocial profiles and sickness compensation has relevance for directions on changes in occupational performance , whereas other demographic and clinical factors do not Reliable and valid measures of pain are essential for conducting research on chronic pain . The purpose of this longitudinal study was to compare the reliability and validity of several measures of pain intensity .  One hundred twenty-three patients with chronic pain were administered telephone interview versions of 0 - 10 scales of current , worst , least and average pain , immediately prior to beginning a multidisciplinary treatment program . The measures were administered again to these subjects 2 weeks ( n=108 ) , 1 month ( n=106 ) and 2 months ( n=105 ) after the end of treatment . The validity ( defined as ability to detect changes in pain intensity over the course of treatment up to the 2-month follow-up assessment ) and reliability ( defined as stability over time in the 2 months after treatment ) of these four measures and of composite combinations of these measures were examined . Contrary to prediction , the composite measures did not show a statistically significant superiority to the individual ratings in terms of their ability to detect change in pain intensity from pre-treatment to various points after treatment . The composite scores did , however , show greater stability than did the individual ratings after treatment . The practical conclusions of this study are ; ( 1 ) , individual 0 - 10 pain intensity ratings have sufficient psychometric strengths to be used in chronic pain research , especially research that involves group comparison design s with relatively large sample sizes , but , ( 2 ) , composites of 0 - 10 ratings may be more useful when maximal reliability is necessary , ( e.g. in studies with relatively small sample sizes , or in clinical setting s where monitoring of changes in pain intensity in individuals is needed ) OBJECTIVE Efforts to improve  pain assessment and treatment in critically ill patients are poorly studied and represent an opportunity to improve quality of care . We sought to improve  pain assessment and treatment in patients in a surgical intensive care unit at an academic medical center . DESIGN We performed a prospect i ve study of pain assessment and treatment in two surgical intensive care units in 2001 . We measured  pain assessment as the percentage of 4-h intervals where the patient 's pain was measured using a visual analog scale . We measured pain treatment as the percentage of 4-h intervals where the patient 's pain score on the scale was < or =3 . We then implemented four separate " plan-do- study -act " cycles to improve pain assessment and treatment . MAIN OUTCOME MEASURES We evaluated the percentage of 4-h patient-nursing intervals that were scored numerically pre- and post-intervention . We evaluated the percentage of 4-h patient-nursing intervals where the patients had a pain score of < or =3 pre- and post-intervention . In addition , we monitored  naloxone  use as a measure of adverse events related to pain treatment . RESULTS Our baseline assessment of pain was 42 % and the baseline treatment was 59 % . After 5 weeks , pain assessment improved to 71 % and pain management improved to 97 % . CONCLUSION Our interventions were associated with significant improvements in pain assessment and treatment without an increase in adverse events related to pain therapy . Our interventions were relatively simple and may be implemented broadly . Our interventions provide insights into the application of complexity theory in improvement efforts BACKGROUND Pain in adolescents with cancer ( 12 - 18 years ) is common and negatively impacts health-related quality of life ( HRQL ) . The Pain Squad+ smartphone app , which provides adolescents with real-time pain self-management support , was developed to address this issue . This study evaluated the implementation of the app to inform a future r and omized controlled trial ( RCT ) and obtain treatment effect estimates for pain intensity , pain interference , HRQL , and self-efficacy . PROCEDURE A one-group baseline/post study design with 40 adolescents recruited from two pediatric tertiary care centers was used . Baseline question naires were completed and adolescents used the app at least twice daily for 28 days , receiving algorithm-informed self-management advice depending on their reported pain . A nurse received alerts in response to sustained pain and contacted adolescents to assist in pain care . Post study question naires were completed . Descriptive analyses , with exploratory inferential testing conducted on health outcome data , were used to address study aims . RESULTS Most ( 40/52 ; 77 % ) eligible adolescents participated . Two participants withdrew participation . Intervention fidelity was impacted by technical difficulties ( occurring for 15 % of participants ) and a prolonged time for nurse contact in the event of sustained pain . Adherence to pain reporting was 68.8 ± 38.1 % . Outcome measure completion rates were high and the intervention was acceptable to participants . Trends in improvements in pain intensity , pain interference , and HRQL were significant , with effect sizes of 0.23 - 0.67 . CONCLUSIONS Implementation of Pain Squad+ is feasible and the app appears to improve pain-related outcomes for adolescents with cancer . A multicenter RCT will be undertaken to examine app effectiveness Abstract This r and omised controlled study investigated the effect of outpatient multidisciplinary pain centre treatment ( MPT ) compared with treatment by a general practitioner after initial supervision by a pain specialist ( GP‐group )  and with a group of patients waiting for 6 months before treatment was initiated ( WL‐group ) . One‐hundred‐ and ‐eighty‐nine chronic non‐malignant pain patients were studied . At referral , and after 3 and 6 months patients filled in question naires evaluating pain intensity , health related quality of life ( HRQL ) and use of analgesics . HRQL was evaluated using the Medical Outcome Study ‐Short Form ( SF‐36 ) , the Hospital Anxiety and Depression scale ( HAD ) and the Psychological General Well‐being Scale ( PGWB ) . After 6 months patients allocated to MPT ( n=63 ) reported statistically significant reduction in pain intensity ( VAS‐score , P<0.001 ) , improvement in psychological well‐being ( PGWB , P<0.001 ) , quality of sleep ( P<0.05 ) and physical functioning ( SF‐36‐Phycical Functioning , P<0.05 ) . No improvements were seen in the GP‐group ( n=63 ) . In the WL‐group ( n=63 ) a statistically significant deterioration was observed in PGWB‐scores , HAD‐scores and in 6 of 8 SF‐36‐subscores ( P ≤ 0.05 ) . A reduction in use of opioids administered on dem and was obtained in the group receiving MPT ( P<0.001 ) . In the MPT‐ and GP‐groups a decrease in the use of short acting opioids was observed ( P<0.01 ) . No change in use of analgesics was seen in the WL‐group . The study showed that ( i ) in the MPT‐group there was a significant reduction in pain intensity and improvement of HRQL compared to the WL‐group , and ( ii ) the mere establishment of a pain diagnosis and a pain management plan by a pain specialist was not sufficient to enable the referring GP to manage severely chronic pain patients Abstract Previously , we demonstrated , in a r and omized clinical trial , the effectiveness of a psychoeducational intervention to decrease pain intensity scores and increase patients ’ knowledge of cancer pain management with a sample of oncology patients with pain from bone metastasis . In the present study , we evaluated for changes in mood states ( measured using the Profile of Mood States ) , quality of life ( QOL ; measured using the Medical Outcomes Study Short Form‐36 ( SF‐36 ) ) , and pain ’s level of interference with function ( measured using the Brief Pain Inventory ( BPI ) ) from baseline to the end of the intervention first between the  intervention and the st and ard care groups and then within the intervention group based on the patients ’ level of response to the intervention ( i.e. , patients were classified as non‐responders , partial responders , or responders ) . No differences were found in any of these outcome measures between patients in the st and ard care and intervention groups . However , when patients in the intervention group were categorized using a responder analysis approach , significant differences in the various outcome measures were found among the three respondent groups . Differences in the physical and mental component summary scores on the SF‐36 and the interference items on the BPI , among the three respondent groups , were not only statistically significant but also clinical ly significant . The use of responder analysis in analgesic trials may help to identify unique subgroups of patients and lead to the development of more effective psychoeducational interventions Background Unrelieved pain among nursing home ( NH ) residents is a well-documented problem . Attempts have been made to enhance pain management for older adults , including those in NHs . Several evidence -based clinical guidelines have been published to assist providers in assessing and managing acute and chronic pain in older adults . Despite the proliferation and dissemination of these practice guidelines , research has shown that intensive systems-level implementation strategies are necessary to change clinical practice and patient outcomes within a health-care setting . One promising approach is the embedding of guidelines into explicit protocol s and algorithms to enhance decision making . Purpose The goal of the article is to describe several issues that arose in the design and conduct of a study that compared the effectiveness of pain management algorithms coupled with a comprehensive adoption program versus the effectiveness of education alone in improving evidence -based pain assessment and management practice s , decreasing pain and depressive symptoms , and enhancing mobility among NH residents . Methods The study used a cluster-r and omized controlled trial ( RCT ) design in which the individual NH was the unit of r and omization . The Roger ’s Diffusion of Innovations theory provided the framework for the intervention . Outcome measures were surrogate-reported usual pain , self-reported usual and worst pain , and self-reported pain-related interference with activities , depression , and mobility . Results The final sample consisted of 485 NH residents from 27 NHs . The investigators were able to use a staggered enrollment strategy to recruit and retain facilities . The adaptive r and omization procedures were successful in balancing intervention and control sites on key NH characteristics . Several strategies were successfully implemented to enhance the adoption of the algorithm . Limitations /Lessons The investigators encountered several method ological challenges that were inherent to both the design and implementation of the study . The most problematic issue concerned the measurement of outcomes in persons with moderate to severe cognitive impairment . It was difficult to identify valid , reliable , and sensitive outcome measures that could be applied to all NH residents regardless of the ability to self-report . Another challenge was the inability to incorporate advances in implementation science into the ongoing study Conclusions Method ological challenges are inevitable in the conduct of an RCT . The need to optimize internal validity by adhering to the study protocol is compromised by the emergent logistical issues that arise during the course of the study Summary Use of the Chronic Pain Management Program was associated with significant decreases in pain‐related , functional , and mental health outcomes and an increase in pain knowledge . Abstract Internet‐based educational and therapeutic programs ( e‐health applications ) are becoming increasingly popular for a variety of psychological and physical disorders . We tested the efficacy of an online Chronic Pain Management Program , a comprehensive , fully self‐directed and self‐paced system that integrates social networking features and self‐management tools into an interactive learning environment . Of 305 adult participants ( 196 women , 109 men ) , a total of 162 individuals with chronic pain were r and omly assigned unsupervised access to the program  for approximately 6 weeks ; 143 were assigned to the wait‐listed control group with treatment as usual .  A comprehensive assessment was administered before the study and approximately 7 and 14 weeks thereafter . All recruitment , data collection , and participant involvement took place online . Participation was fully self‐paced , permitting the evaluation of program effectiveness under real‐world conditions . Intent‐to‐treat analysis that used linear growth models was used as the primary analytic tool . Results indicated that program utilization was associated with significant decreases in pain severity , pain‐related interference and emotional burden , perceived disability , catastrophizing , and pain‐induced fear . Further , program use led to significant declines in depression , anxiety , and stress . Finally , as compared to the wait‐listed control group , the experimental group displayed a significant increase in knowledge about the principles of chronic pain and its management . Study limitations are considered , including the recognition that not all persons with chronic pain are necessarily good c and i date s for self‐initiated , self‐paced , interactive learning BACKGROUND CONTEXT There is a growing dem and to measure the real-world effectiveness and value of care across all specialties and disease states . Prospect i ve registries have emerged as a feasible way to capture real-world care across large patient population s. However , the proven validity of more robust and cumbersome patient-reported outcome instruments ( PROi ) must be balanced with what is feasible to apply in large-scale registry efforts . Hence , commercial registry efforts that measure quality and effectiveness of care in an attempt to guide quality improvement , pay for performance , or value-based purchasing should incorporate measures that most accurately represent patient-centered improvement . PURPOSE We set out to establish the relative validity and responsiveness of common PROi in accurately determining effectiveness of cervical surgery for neck and arm pain in registry efforts . STUDY DESIGN Prospect i ve cohort study . PATIENT SAMPLE Eighty-eight patients undergoing primary anterior cervical discectomy and fusion ( ACDF ) for neck and arm pain . OUTCOME MEASURES Patient-reported outcome measures for pain ( numeric rating scale for neck pain [ NRS-NP ] and arm pain [ NRS-AP ] ) , disability ( neck disability index [ NDI ] ) , general health ( short-form 12-item survey physical component summary [ SF-12 PCS ] and mental component summary [ SF-12 MCS ] ) , and quality of life ( Euro-Qol-5D [ EQ-5D ] ) were assessed . METHODS Eighty-eight patients undergoing primary ACDF for neck and arm pain were entered into a Web-based prospect i ve registry . Baseline and 12-month patient-reported outcomes ( NRS-NP , NRS-AP , NDI , SF-12 PCS , SF-12 MCS , and EQ-5D ) were assessed . Patients were also asked whether they experienced a level of improvement after ACDF that met their expectation ( meaningful improvement ) . To assess the validity of NRS-NP , NRS-AP , and NDI ( measures of pain and disability ) to discriminate between meaningful and nonmeaningful improvement and the validity of SF-12 PCS , SF-12 MCS , and EQ-5D ( measures of general health and quality of life ) to discriminate between meaningful and nonmeaningful improvement , receiver-operating characteristic curves were generated for each outcome instrument . The greater the area under the curve ( AUC ) , the more valid the discriminator . The difference between st and ardized response means ( SRMs ) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each outcome instrument to changes in  pain and QOL after surgery . RESULTS For pain and disability , both NDI ( AUC=0.75 ) and NRS-AP ( AUC=0.74 ) were valid discriminators of meaningful improvement . Numeric rating scale for neck pain ( AUC=0.69 ) was a poor discriminator . Neck disability index was also most responsive to postoperative improvement ( SRM difference 0.78 ) , followed by NRS-AP ( SRM difference 0.59 ) and NRS-NP ( SRM difference 0.46 ) . For general health and quality of life , SF-12 PCS ( AUC=0.79 ) was the only valid discriminator of meaningful improvement . Euro-Qol-5D ( AUC=0.68 ) and SF-12 MCS ( AUC=0.44 ) were poor discriminators . Short-form 12 physical component summary ( SRM difference 1.08 ) was also most responsive compared with EQ-5D ( SRM difference 0.89 ) and SF-12 MCS ( SRM difference 0.01 ) . CONCLUSIONS For pain and disability , NDI is the most valid and responsive measure of improvement after surgery for neck and arm pain . Numeric rating scale for neck pain and NRS-AP are poor substitutes for NDI when measuring effectiveness of care in registry efforts . For health-related quality of life , only SF-12 PCS could accurately discriminate meaningful improvement after cervical surgery and was found to be most valid and responsive . Large-scale registry efforts aim ed at measuring effectiveness of cervical spine surgery should use NDI and SF-12 to accurately assess improvements in pain , disability , and quality of life
Conclusion : Systemic changes to academic and funding structures could better support eHealth tool availability and may reduce potential for research waste .
Abstract Introduction : Numerous eHealth tools for pain assessment and management have been developed and evaluated with promising results regarding psychometric properties , efficacy , and effectiveness .
Although considerable re sources are spent on developing and evaluating these tools with the aim of increasing access to care , current evidence suggests they are not made available to end users , reducing their impact and creating potential research waste .