Rationale, design, and baseline findings from a randomized trial of collaborative care for chronic musculoskeletal pain in primary care. Individually tailored treatment targeting activity, motor behavior, and cognition reduces pain-related disability: a randomized controlled trial in patients with musculoskeletal pain. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Patient utilities in chronic musculoskeletal pain: how useful is the standard gamble method? Prediction of function in daily life following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain; a prospective study Postsurgical pain outcome assessment Comparing the psychometric properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) instruments. Addressing methodological challenges in implementing the nursing home pain management algorithm randomized controlled trial Accurately measuring the quality and effectiveness of cervical spine surgery in registry efforts: determining the most valid and responsive instruments. Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management Comparative Responsiveness of Pain Outcome Measures Among Primary Care Patients With Musculoskeletal Pain Idiographic outcome analyses of the clinical significance of two interventions for patients with musculoskeletal pain. Concurrent Comparison of Responsiveness in Pain and Functional Status Measurements Used for Patients With Low Back Pain Multidisciplinary rehabilitation for chronic back pain in an outpatient setting: a controlled randomized trial. The effects of a novel psychological attribution and emotional awareness and expression therapy for chronic musculoskeletal pain: A preliminary, uncontrolled trial. Translation and Validation Study of the Iranian Versions of the Neck Disability Index and the Neck Pain and Disability Scale The CONECSI trial: Results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury
OBJECTIVE This article describes the rationale , design , and baseline findings from an ongoing study of collaborative care for chronic musculoskeletal pain and comorbid depression . DESIGN Cluster r and omized clinical trial . PARTICIPANTS AND SETTING Forty-two clinicians and 401 patients from five Veterans Affairs primary care clinics . INTERVENTION The intervention was based on the chronic care model , and included patient and provider activation and education , patient assessment , outcomes monitoring , and feedback to providers over 12 months . The intervention team consisted of a full-time psychologist care manager and a part-time physician internist . Approaches included goal setting emphasizing function , patient activation and educating about fear avoidance , and care management . OUTCOME MEASURES Main outcomes are Rol and -Morris Disability Question naire ( RMDQ ) score , depression severity ( Patient Health Question naire-9 ) , and pain severity ( Chronic Pain Grade Severity subscale ) at 6 and 12 months . BASELINE RESULTS Fifteen percent of primary care patients mailed a study advertisement letter requested screening for the study . The mean age of enrolled patients was 62 . Back and neck or joint pain diagnoses were present in 67 % and 65 % of patients , respectively . Mean pain duration was 15 years , and mean RMDQ score ( range 0 - 24 ) was 14.7 ( st and ard deviation = 4.4 ) . Sixty-five percent of patients were receiving disability . Eighteen percent of patients met criteria for major depression , 17 % for posttraumatic stress disorder , and 9 % for alcohol misuse . Thirty-nine percent of patients felt strongly that experiencing pain was a sign of damage , and 60 % reported strong avoidance of painful activities . CONCLUSIONS These baseline data support the rationale to develop a multifaceted approach to treat chronic pain in primary care that includes detection and treatment of psychiatric comorbidity UNLABELLED This study compares the outcomes of an individually tailored behavioral medicine intervention ( experimental ) with physical exercise therapy ( control ) . The experimental intervention was systematic ally individualized according to each participant 's behavioral treatment goals and functional behavioral analyses . One hundred twenty-two patients seeking care at 3 primary health care clinics because of musculoskeletal pain were r and omized . Ninety-seven completed the trial . Data were collected at baseline , immediately after treatment , and at a 3-month follow-up . Analyses of data from completers , as well as intention-to-treat analyses , showed that the experimental group experienced lower levels of disability ( P = .01 ) , lower maximum pain intensity ( P = .02 ) , higher levels of pain control ( P = .001 ) , and lower fear of movement ( P = .022 ) as a result of treatment condition . Self-efficacy ( P = .0001 ) and physical performance ( P = .0001 ) increased over time for both groups . Participants in the experimental group generally reported more positive effects after treatment . Treatment fidelity was maintained during the course of the study . Activity can be resumed and pain might be managed by the patients themselves if treatment incorporates the biopsychosocial explanatory model of pain and strategies are tailored according to individual 's priorities of everyday life activities and empirically derived determinants of pain-related disability . PERSPECTIVE This study shows that the biomedical and the psychosocial perspectives of the experiences and consequences of pain complement rather than contradict each other . Primary health care patients with persistent musculoskeletal pain benefit more from a systematic tailoring of treatments according to biopsychosocial factors than from a physically based exercise intervention OBJECTIVE To examine the test-retest reliability , validity , and responsiveness of several outcome measures in the treatment of patellofemoral pain . DESIGN Evaluation of the clinimetric properties of individual outcome measures for patellofemoral pain treatment , using data collected from a previously published r and omized controlled trial ( RCT ) . SETTING General community and private practice . PARTICIPANTS The data from 71 persons enrolled in an RCT of a conservative intervention for patellofemoral pain were used to evaluate the measures ' validity and responsiveness . A subset of this cohort ( n=20 ) was used to assess reliability . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Three  10-cm visual analog scales ( VASs ) for usual pain ( VAS-U ) , worst pain ( VAS-W ) , and pain on 6 aggravating activities ( walking , running , squatting , sitting , ascending and descending stairs ) ( VAS-activity ) ; the Functional Index Question naire ( FIQ ) ; the Anterior Knee Pain Scale ( AKPS ) ; and the global rating of change . RESULTS The test-retest reliability ranged from poor ( intraclass correlation coefficient [ICC]=.49 ) to good ( ICC=.83 ) , and the measures correlated moderately with each other ( r range,.56-.72 ) . Median change scores differed significantly between improved and unimproved persons for all measures . The effect sizes for VAS-U ( .79 ) , VAS-W ( .88 ) , and the AKPS ( .98 ) were large , indicating greater responsiveness than the FIQ ( .37 ) and VAS-activity ( .66 ) . Similarly , the AKPS and VAS-W were the most efficient measures for detecting a treatment effect when compared with a reference measure ( VAS-U , which was assigned a value of 1 ) . The minimal difference that patients or clinicians consider clinical ly important for the AKPS is 10 ( out of 100 ) points and for the VAS it is 2 cm ( out of 10 cm ) . CONCLUSIONS The AKPS and VAS for usual or worst pain are reliable , valid , and responsive and are therefore recommended for future clinical trials or clinical practice in assessing treatment outcome in persons with patellofemoral pain The main goal of current pain management approaches is to increase the patients ' quality of life by improving pain coping skills and by reducing the levels of disability in daily life , often despite persistent pain . Direct measurement of quality of life is of crucial importance in economic evaluation research , in which not only is the estimation of financial costs and benefits included , but so is the evaluation of costs and benefits in terms of changes in health states . The purpose of this study is to compare the psychometric qualities of two instruments for assessing patients ' utilities , the  rating scale ( RS )  and the st and ard gamble ( SG ) . Such instruments are design ed for their application in economic evaluation research , but have seldomly been used in chronic pain trials . Both methods provide a single measure between 0 and 1 . The relationship between these utility measures and descriptive and domain-specific quality of life measures was examined in 133 fibromyalgia patients and 148 patients with chronic non-specific low back pain .  Mean utility score at baseline was 0.43 with the RS and 0.78 for the SG . The correlation between both methods was found to be poor ( r = 0.21 ) . Both measures appeared to be fairly stable in a 2-week test-retest period ( intra class correlation coefficient ( ICC ) = 0.74 and 0.77 ) . Scores on the description of patient 's own health on six domains , global assessment of change and domain specific measures correlated moderately with the RS scores and low with the SG . Multiple regression analyses demonstrated that 32 % of the variance in RS values and only 13 % of the variance in SG utilities could be explained by domain-specific measures . These results suggest an acceptable construct validity for the RS but insufficient construct validity for the SG . Valuations of ones own health appear only partially to be related to the assessment of the pain-specific measures and measures of distress . It can be concluded that the RS and domain-specific measures assess partly different , but nevertheless complementary aspects of health-related quality of life . It is therefore recommended to include in economic evaluation studies both domain-specific measures and valuation measures . Finally , in chronic musculoskeletal pain patients , RS scores were found to be more responsive in detecting significant changes in preferences than SG scores . For use in patients with chronic musculoskeletal pain , the RS is preferred to the SG for establishing accurate decisions about the impact of new interventions on their health outcomes Background The prevalence of chronic musculoskeletal pain is high , with widespread negative economic , psychological , and social consequences for the individual . It is therefore important to find ways to predict the outcome of rehabilitation programmes in terms of function in daily life . The aims of this study were to investigate the improvements over time from multidisciplinary rehabilitation in terms of pain and function , and analyse the relative impact of individual and psychosocial factors as predictors of function in daily life in individuals with chronic musculoskeletal pain . Methods A prospect i ve study was conducted among one hundred and forty three ( N = 143 ) musculoskeletal pain patients .  Measures of pain , function , and functional health status were obtained at baseline , after 5 weeks of intensive training , at the end of the 57-week rehabilitation programme , and at a 1 year follow-up , using vali date d self-administrated measures . Linear regression analysis was applied to investigate the relative impact of musculoskeletal pain , individual- , and psychosocial factors in function . Results The participants studied showed a significant increase in function during the 57 weeks rehabilitation period . There was also a significant increase in function from the end of the rehabilitation period ( 57th week ) to the one year follow-up measures . Pain intensity associated significantly with pain experience over all measurement periods . High levels of pain intensity ( β = .42 * * ) and pain experience ( β = .37 * ) , and poor psychological capacity ( β = -.68 * ) at baseline , as well as poor physiological capacity ( β = -.44 * * ) and high levels of anxiety ( β = .48 * * ) and depression ( β = .58 * * * ) at the end of the rehabilitation program were the most important prognostic factors of variance in functioning over the 4 measurement periods . Conclusion The data suggest that physical capacity , emotional distress and coping skills should be priority areas in rehabilitation programmes to improve functioning in daily life & NA ; Reliable and valid measures of pain are essential for conducting clinical trials of pain treatments . Perhaps the most important aspect of a pain measure 's validity is its sensitivity , or ability to detect changes in pain over time and due to treatment . Several factors may affect a measure 's sensitivity , including the complexity of the rating task for the measure , the number of pain intensity levels assessed by the measure , the dimension of pain assessed ( e.g. pain intensity vs. pain relief ) , and the number of individual ratings ( e.g. single rating vs. composite score ) used to create the measure . The purpose of this study was to compare the relative sensitivity of three measures of outcome and a composite made up of all three measures for detecting analgesic effects in two sample s of persons participating in a r and omized controlled trial . One hundred and twenty‐three patients who had undergone knee surgery and 124 women who had undergone a laparotomy were given one of three medications in the day after their surgery : morphine , ketorolac , or placebo . Two measures of pain intensity ( a visual analog scale ( VAS ) and a 4‐point verbal rating scale ( VRS ) ) were administered at baseline , and these measures plus a 5‐point VRS of pain relief were administered at 16 additional time points up to 24 h following surgery . As predicted , we found variability in the sensitivity of the outcome measures used in these studies , with the 4‐point VRS showing less sensitivity than the VAS or relief ratings . However , contrary to our prediction , a composite measure of outcome made up of all three measures was not consistently superior to the individual measures for detecting treatment effects . Finally , we found that pain relief ratings were related to , but also distinct from , change in pain intensity as measured by changes in pain intensity ratings from baseline to each postmedication assessment point . These findings have important implication s for the assessment of pain in clinical trials 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 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 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 Chronic low back pain ( CLBP ) is associated with persistent or recurrent disability which results in high costs for society . Cognitive behavioral treatments produce clinical ly relevant benefits for patients with CLBP . Nevertheless , no clear evidence for the most appropriate intervention is yet available . The purpose of this study is to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management programme . The programme provided by RealHealth-Netherl and s is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons . Main outcome parameters were daily functioning ( Rol and and Morris Disability Question naire and Oswestry Disability Question naire ) , self-efficacy ( Pain Self-Efficacy Question naire ) and quality of life ( Short Form 36 Physical Component Score ) . All parameters were measured at baseline , last day of residential programme and at 1 and 12 months follow-up . Repeated measures analysis was applied to examine changes over time . Clinical relevance was examined using minimal clinical important differences ( MCID ) estimates for main outcomes . To compare results with literature effect sizes ( Cohen ’s d ) and St and ardized Morbidity Ratios ( SMR ) were determined . 107 patients with CLBP participated in this programme .  Mean scores on outcome measures showed a similar pattern : improvement after residential programme and maintenance of results over time . Effect sizes were 0.9 for functioning , 0.8 for self-efficacy and 1.3 for physical functioning related quality of life . Clinical relevancy : 79 % reached MCID on functioning , 53 % on self-efficacy and 80 % on quality of life . Study results on functioning were found to be 36 % better and 2 % worse when related to previous research on , respectively , rehabilitation programmes and spinal surgery for similar conditions ( SMR 136 and 98 % , respectively ) . The participants of this evidence -based programme learned to manage CLBP , improved in daily functioning and quality of life . The study results are meaningful and comparable with results of spinal surgery and even better than results from less intensive rehabilitation programmes Background : Comparative responsiveness data are needed to inform choices about pain outcome measures . Objectives : To compare responsiveness of pain intensity , pain-related function , and composite measures , using data from a r and omized trial and observational study . Research Design : Analysis of responsiveness . Subjects : A total of 427 adults with persistent back , hip , or knee pain were recruited from primary care . Methods : Participants completed  Brief Pain Inventory , Chronic Pain Grade ( CPG ) , Rol and disability ,  SF-36 bodily pain  , and pain global rating of change measures . We used the global rating as the anchor for st and ardized response mean and receiver operating characteristic curve analyses . We used the distribution-based st and ard error of measurement to estimate minimally important change . To assess responsiveness to the trial intervention , we evaluated st and ardized effect size statistics stratified by trial arm . Results : All measures were responsive to global improvement and all had fair-to-good accuracy in discriminating between participants with and without improvement . SF bodily pain was less responsive than other measures in several analyses . The 3-item PEG was similarly responsive to full Brief Pain Inventory scales . CPG and SF bodily pain were less responsive to the trial intervention and did not perform well among participants with hip/knee pain . Agreement between anchor and distribution-based methods was modest . Conclusions : If a brief measure is desired , the 3-item PEG is more responsive than the SF bodily pain scale . CPG and SF bodily pain scales may be relatively poor choices for trial outcome assessment . Both anchor and distribution-based methods should be considered when determining clinical ly important change UNLABELLED This study adopted a perspective of the individual to define domains of everyday life for the analysis of clinical ly meaningful change . The purpose was to compare the clinical significance of two interventions for patients with musculoskeletal pain , applying an idiographic outcome measure , The Patient Goal Priority Question naire , in combination with the Jacobson and Truax methodology [ ( 1991 ) . CLINICAL SIGNIFICANCE A statistical approach to defining meaningful change in psychotherapy research . Journal of Consulting and Clinical Psychology , 67 ( 3 ) , 300 - 307 ] for determination of clinical significance . The concurrent validity of the outcome variables behavioral performance , satisfaction with behavioral performance , and fulfilled pre-treatment expectations was also studied . Eighty-two patients , r and omized to either individually tailored behavioral medicine treatment ( experimental group ) or physical exercise therapy ( control group )  were evaluated at baseline and 3 months post-treatment regarding behavioral treatment goals . The experimental intervention had high impact on participants ' performance of their highest ranked everyday life activities , and result ed in larger proportions of clinical ly significant outcomes compared with controls . The concurrent validity of the outcomes was high for those reporting clinical ly significant changes , but more generally , there was a moderate agreement across outcome categories . The individual should be the unit for analyses of clinical significance to enhance the ecological validity of the construct . Further development of idiographic outcome measures is necessary , as is the inclusion in pain intervention research Study Design . Prospect i ve study of two sample s of patients with acute and chronic low back pain , respectively . Objectives . To compare the responsiveness of four functional status question naires , Rol and Morris Disability Question naire ( RMDQ ) ,  Oswestry Disability Index ( ODI ) ,  Disability Rating Index ( DRI ) , and  Physical Functioning scale of the SF-36 ( PFSF-36 ) , and two  pain scales , a  Numerical Pain Rating Scale ( NRS ) and  Visual Analogue Scale ( VAS ) .  Summary of Background Data . Concurrent comparisons of different outcome measurements in back patients have been requested . Methods .  Norwegian versions of the scales and question naires  were completed by 54 patients with acute ( < 3weeks ) and 50 patients with chronic low back pain ( > 3 months ) . Clinical change was estimated on a global change index . An alternative external criterion was the expected clinical course in the two cohorts . Mean changes , st and ardized response mean ( SRM ) , and area under the receiver operating characteristic ( ROC ) curves with cutoff point for highest sensitivity and specificity were calculated . Results . At the follow-up , 63 % of the acute and 41 % of the chronic sample reported improvement on the global change index . Large SRMs ( 1.3–2.0 ) and areas under the ROC curves ( 0.84–0.93 ) were found for the measurements in the acute sample . In the chronic sample , the SRMs ( 0.4–1.1 ) and areas under the ROC curves ( 0.65–0.83 ) were lower , in particular for the PFSF-36 and the VAS . There was no statistically significant difference between the responsiveness in the measurements , except for higher responsiveness in the NRS compared with the VAS when using expected clinical course as the external criterion for change . Conclusion . The results suggest that all the outcome measures were appropriate for measuring changes in functional status and pain in patients with acute low back pain , whereas among chronic patients the RMDQ , ODI , DRI , and NRS were most appropriate Based on existing models for pain chronicity and effective treatment strategies for patients with chronic low back pain , a multidisciplinary rehabilitation programme for an outpatient group setting was developed . The main treatment components address the patient 's physical functional capacity ( functional restoring ) , cognitive and affective processes ( pain management strategies ) , and behavioural and ergonomical aspects ( back school elements ) . Short-term ( immediately after intervention ) and long-term effects ( at 6-months follow-up ) of the intervention were assessed in a r and omized controlled study . Dependent variables were pain measures , functional capacity , disability , muscular strength and endurance , pain and posture-related self-efficacy , attitudes , depression , well-being , behavioural habits and posture assessed by a st and ardized behavioural observation method . Immediately after the intervention , patients in the treatment group ( n=36 ) showed significant improvement over patients in the control group ( n=29 ) in all variables except depression and muscular strength and endurance . At 6-months follow-up , compared to pretreatment scores , patients continued to show beneficial effects in pain intensity and frequency , posture , posture-related self-efficacy and well-being . In contrast to post-treatment results , there were also significant improvements in strength and endurance . Overall results testify to the effectiveness of the intervention programme . Future studies ( with larger sample sizes ) should aim at a further improvement of functional capacity and disability perception , an analysis of differential treatment effects , and strategies for an improved long-term maintenance of the changes induced by the programme OBJECTIVE Current psychological and behavioral therapies for chronic musculoskeletal pain only modestly reduce pain , disability , and distress . These limited effects may be due to the failure of current therapies : a ) to help patients learn that their pain is influenced primarily by central nervous system psychological processes ; and b ) to enhance awareness and expression of emotions related to psychological trauma or conflict . METHODS We developed and conducted a preliminary , uncontrolled test of a novel psychological attribution and emotional awareness and expression therapy that involves an initial individual consultation followed by 4 group sessions . A series of 72 patients with chronic musculoskeletal pain had the intervention and were assessed at baseline , post-treatment , and 6-month follow-up . RESULTS Participation and satisfaction were high and attrition was low . Intent-to-treat analyses found significant improvements in hypothesized change processes : psychological attributions for pain , emotional awareness , emotional approach coping , and alexithymia . Pain , interference , depression , and distress showed large effect size improvements at post-treatment , which were maintained or even enhanced at 6 months . Approximately two-thirds of the patients improved at least 30 % in pain and other outcomes , and one-third of the patients improved 70 % . Changes in attribution and emotional processes predicted outcomes . Higher baseline depressive symptoms predicted greater improvements , and outcomes were comparable for patients with widespread vs. localized pain . CONCLUSION This novel intervention may lead to greater benefits than available psychological interventions for patients with chronic musculoskeletal pain , but needs controlled testing Study Design . Cultural translation and psychometric testing . Objective . To translate and vali date the Iranian versions of the Neck Disability Index ( NDI-IR ) and the Neck Pain and Disability Scale ( NPDS-IR ) . Summary of Background Data . The widely used the NDI and the NPDS scales have not been translated and vali date d for Persian-speaking patients with neck pain . This was to provide a vali date d instrument to measure functional status in patients with neck pain in Iran . Methods . The translation and cultural adaptation of the original question naires were carried out in accordance with the published guidelines . One hundred and eighty-five patients with neck pain were participated in the study . Patients were asked to complete a question naire booklet including the NDI-IR , the NPDS-IR , the Iranian SF-36 , and a visual analog scale ( VAS ) of pain . To carry out the test-retest reliability , 30 r and omly selected patients with neck pain were asked to complete the question naire booklet 48 hours later for the second time . Results . Cronbach & agr ; coefficient for the NDI-IR was 0.88 and for the 4 subscales of the NPDS-IR was found to be satisfactory ( ranging from 0.74 to 0.94 ) . The NDI-IR and the NPDS-IR subscales showed excellent test-retest reliability ( intraclass correlation coefficient ranged from 0.90 to 0.97 ; P < 0.01 ) . The correlation between the NDI-IR and the NPDS-IR subscales and functional scales of the SF-36 showed desirable results , indicating a good convergent validity ( Pearson correlation coefficients ranged from −0.31 to −0.70 ) . The correlation between the NDI-IR and the VAS was 0.71 and between the NPDS-IR subscales and the VAS ranged from 0.63 to 0.79 ( P < 0.01 ) . Conclusion . The Iranian versions of the NDI and NPDS are reliable and valid instruments to measure functional status in Persian-speaking patients with neck pain in Iran . They are simple and easy to use and now can be applied in clinical setting s and future outcome studies in Iran and other Persian speaking communities Summary A multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic spinal cord injury pain . ABSTRACT Many people with spinal cord injury ( SCI ) rate chronic neuropathic pain as one of the most difficult problems to manage . The aim of the CONECSI ( COping with NEuropathiC Spinal cord Injury pain ) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI . The intervention consisted of educational , cognitive , and behavioral elements .  A total of 61 people were r and omized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers . Primary outcomes were pain intensity and pain‐related disability ( Chronic Pain Grade question naire ) , and secondary outcomes were mood ( Hospital Anxiety and Depression Scale ) , participation in activities ( Utrecht Activities List ) , and life satisfaction ( Life Satisfaction Question naire ) . Measurements were performed at baseline , and at 3 , and 6 months follow‐up . The primary statistical technique was r and om coefficient analysis . The analyses showed significant changes over time on both primary ( t1–t2 ) , and 2 out of 4 secondary outcomes ( both t1–t2 and t1–t3 ) . Significant intervention effects ( Time * Group interactions ) were found for anxiety and participation in activities , but not for the primary outcomes . Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group : decrease of pain intensity , pain‐related disability , anxiety , and increase of participation in activities . This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain
Our primary outcome was the measure ’s minimal important difference ( MID ) .
Conclusions In this focused evidence review , the most evidence on key psychometric properties in chronic musculoskeletal pain population s was found for the ODI , RMDQ , SF-36 BPS , NRS , and VAS .
Background Developing successful interventions for chronic musculoskeletal pain requires valid , responsive , and reliable outcome measures .
The Minneapolis VA Evidence -based Synthesis Program completed a focused evidence review on key psychometric properties of 17 self-report measures of pain severity and pain-related functional impairment suitable for clinical research on chronic musculoskeletal pain .