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Development of a pictorial scale for assessing functional interference with chronic pain: the Pictorial Pain Interference Questionnaire

Authors Cook AJ, Roberts DA, Nelson KC, Clark BR, Parker BE Jr

Received 25 December 2017

Accepted for publication 18 April 2018

Published 19 July 2018 Volume 2018:11 Pages 1343—1354

DOI https://doi.org/10.2147/JPR.S160801

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 4

Editor who approved publication: Dr E Alfonso Romero-Sandoval


Andrew J Cook,1 David A Roberts,2 Karen C Nelson,3 Brian R Clark,4 B Eugene Parker Jr4

1Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center College of Medicine, Temple, TX, USA; 2Epiceutical Labs, Charlottesville, VA, USA; 3Southcentral Foundation, Anchorage, AK, USA; 4Barron Associates, Inc., Charlottesville, VA, USA

Background: Assessment of function and functional interference is an important component of chronic pain assessment and treatment and is commonly based on self-report questionnaires. Existing questionnaires for assessing functional interference are language dependent, which can limit their utility for patients across cultures with literacy, fluency, or cognitive restrictions.
Objective: The objectives of this study were to create a tool with minimal language dependence and literacy requirement for measuring functional interference due to chronic pain and evaluate the psychometric properties and usability of this new assessment scale, the Pictorial Pain Interference Questionnaire (PPIQ), in a clinical sample of participants with chronic pain.
Design: The study employed a prospective, cross-sectional design in a clinical chronic pain setting.
Participants and methods: A total of 113 participants with chronic non-cancer pain were recruited from a private chronic pain clinic. A pictorial scale was developed and tested via psychometric procedures, including comparisons with validated measures of functional interference and related chronic pain constructs.
Results: Excellent internal consistency reliability (a=0.91), good construct validity (total score: r=0.72–0.81), and adequate-to-good convergent and discriminant validities were demonstrated through comparative analyses with existing self-report questionnaires. A scoring metric for classifying low, moderate, and high levels of interference was found to have good construct validity. Evaluation of satisfaction revealed adequate understanding of the PPIQ among most users.
Conclusion: Initial support for the PPIQ as an alternative to language-based questionnaires for assessing functional interference from chronic pain was found. Subsequent research will help to clarify psychometric properties of the PPIQ and user response among various chronic pain subgroups.

Keywords: chronic pain, assessment, function, functional interference, impairment, disability, patient-reported outcomes, health literacy

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