Pain disability assessment tools

The FDI was originally created for children ages 8—18 years with chronic abdominal pain 33 , 34 but has been used extensively in research with other pediatric pain conditions including JFM. An FDI parent-report version also is available. The FDI assesses difficulty with completing activities in a number of domains including home, school, recreational, and social settings.

The child or adolescent rates the degree of difficulty completing each activity e. It can be administered by paper format or in interview format for younger children. The instrument can be completed in person, by mail, or by phone. The FDI was developed to monitor patient progress providing follow-up assessment via phone interview. A parent-report version of the measure also is available.

The total FDI score can be easily hand scored and does not require computer scoring. FDI total scores range from 0—60 with higher scores indicating greater functional disability. However, the FDI may take longer for younger children with reading difficulties. The interview format can be administered as needed. The FDI has a Flesch reading ease of Special training is unnecessary to administer or score the FDI. The FDI is available in English and 32 other languages see website above for a full list.

The FDI is an established measure with strong evidence for reliability and validity. Selected items underwent pilot testing with children and their parents in a pediatric outpatient clinic, following which items were removed and other items reworded 34 to reach the final set of items. Clinic-based studies reveal that youth with chronic pain generally endorse scores in the moderate range of disability 13—29 Community studies indicated that healthy school-aged children report overall FDI scores in the range of 3—8 The FDI has no known floor or ceiling effects, as individuals rarely score either 0 or The mean interim correlation is.

Concurrent validity was assessed by calculating correlation on the FDI with school absences, a common proxy for child disability Discriminant validity was assessed by examining whether the FDI could discriminate between diagnostic groups i. Post hoc analyses indicated significantly higher FDI scores for adolescents with abdominal pain conditions when compared to healthy controls Construct validity has been assessed by comparing the association between the FDI and other measures of child well-being.

Predictive validity was examined in an abdominal pain population by correlating FDI scores and illness-related school absences over the course of 3 months following their initial clinic appointment.

Currently, no studies examine criterion validity explicitly in juvenile FM. Treatment studies examining the efficacy of non-pharmacological interventions in juvenile fibromyalgia consistently find significant decreases in FDI scores from pre- to post-treatment.

Sil and colleagues 44 published a study in which the Reliable Change Index of 7. This RCI distinguished treatment responders from non-responders in the context of a clinical trial of cognitive-behavioral therapy for JFM. The FDI is generalizable across many chronic pain conditions including chronic abdominal pain, 33 recurrent pain, 35 and headache.

The FDI has been used in a number of clinical trials examining the efficacy of non-pharmacological interventions in juvenile fibromyalgia consistently find significant decreases in FDI scores from pre- to post-treatment.

The FDI is a well-established measure widely used to assess functional impairment in school-age children and adolescents with chronic pain. Items on the FDI tend to focus more on difficulties with physical function.

Social and emotional areas of functioning that may be impacted by pain are not as well-captured by this measure.

The FDI is a reliable, valid measure for assessing functional impairment in children and adolescents with juvenile fibromyalgia in a clinic setting. It is an efficient and user-friendly tool for tracking patient outcomes throughout treatment and successfully has been integrated into an outpatient clinic setting.

The PedsQL 3. There are different versions of this measure for children and adolescents, and a parent-proxy report version is also available. The daily activities subscale assesses the extent to which pain has interfered with tasks such as writing or drawing with pencils and turning door handles. The Rheumatology Module contains 22 items and five subscales: pain and hurt 4 items , daily activities 5 items , treatment 7 items , worry 3 items , and communication 3 items.

Respondents are asked how much of a problem each item has been within the last month. The PedsQL is free to use for certain types of non-funded academic research. An annual license fee is required for funded academic research, large non-commercial organization research, and commercial use. See www. James W. The measure is a self-report measure for children ages 8—12 years , adolescents ages 13—18 and a proxy-report version for their caregivers.

Subscale scores are computed by summing items and dividing by the total number of items answered. Scores on each of the subscales range from 0—, with higher scores indicating better disease-related QOL in a respective domain. Several studies suggest that youth with JFM report worse QOL across all domains relative to youth with rheumatic diseases 48 — The measure takes approximately 10 minutes for youth and caregivers to complete. The entire Rheumatology Module can be administered in approximately 10 minutes.

Scoring also takes approximately 10 minutes and requires minimal training. All scales on the Rheumatology Module demonstrate high internal consistencies among youth with rheumatologic diseases Correlations between parent-proxy and child reports on the Rheumatology Module are moderate Spearman r range 0. Medical experts, patients, and families of patients were included in the development of the PedsQL. Similarly, the VAS showed only small, non-significant correlations with all of the Rheumatology Module scales except the pain and hurt scale.

The PedsQL Rheumatology Module has been shown to be responsive to change, showing improvements after treatment see use in clinical trials below. However, improvements seem to reflect generic improvements in well-being that may not be specific to type of treatment.

Currently, there are no available data on the Rheumatology Module that provide information about minimally important differences in JFM treatment. The PedsQL Rheumatology Module appears to be generalizable for use in most pediatric rheumatic diseases but several of the scales do not appear to be clearly applicable in JFM.

However, there were no main or group interaction effects for time for the daily activities scale. The subscales discriminate between groups of youth with various rheumatologic conditions, and four of the five scales demonstrate sensitivity to change.

The items on the daily activities subscale likely do not specifically capture the functional limitations of youth with JFM e.

Researchers have recommended using an alternative measure, such as the FDI discussed previously, in order to capture impairment in daily functioning among patients with JFM. The measure and its subscales are simple to administer and score, though the clinical utility of the measure has not been examined. The Rheumatology Module demonstrates strong psychometric properties for use in pediatric rheumatology populations.

It likely is best suited for use as a supplemental measure of disease-related QOL as it provides useful information about specific difficulties experienced by youth and their families e.

The present review summarizes recent and important developments that have enhanced evidence-based assessment among youth with JFM. The PSAT, which has demonstrated initial evidence for its sensitivity and specificity, shows promise as an instrument for classifying children and adolescents with JFM, characterizing the severity of their symptoms, and differentiating these youth from those with more localized pain conditions. Finally, the FDI continues to be a gold-standard measure in outcomes research, as it demonstrates excellent reliability, validity, and responsiveness to change among youth with JFM.

National Center for Biotechnology Information , U. Arthritis Care Res Hoboken. Author manuscript; available in PMC Oct 1.

Morgan Daffin , Psy. Gibler , M. Robert C. Author information Copyright and License information Disclaimer. Correspondence concerning this article should be addressed to: Susmita Kashikar-Zuck, Ph. Copyright notice. The publisher's final edited version of this article is available at Arthritis Care Res Hoboken. Abstract Juvenile fibromyalgia JFM is a chronic and debilitating noninflammatory musculoskeletal pain syndrome that is typically diagnosed in adolescence.

Introduction Juvenile fibromyalgia JFM is a chronic and debilitating noninflammatory musculoskeletal pain condition that is typically diagnosed in adolescence. Number of items. Recall period for items. Cost to use. The PSAT can be accessed and used for no charge. How to obtain. Copies can be obtained directly from Dr. Practical application Method of administration.

Moreover, the intervals between different adjectives describing pain may not be equal which may reduce the assessment data level to ordinal data level. The different terms used to describe pain may further be interpreted differently by respondents. Thus, the interpretation of a VRS does not allways allow to draw conclusions on the magnitude of a change in pain intensity between two assessments as for example pre- and postoperative and inter-respondent comparison is problematic.

In pain drawing, the patient is asked to mark the areas of pain on an outline of a human figure. According to some protocols, the subjects are just asked to shade those body areas where they feel pain. Others ask the patients to indicate different types of pain e. Pain drawings have also been suggested for assessment of the psychological involvement in the pain experience.

Other authors however, did not find a reliable discrimination between patients with and without psychological involvement with their pain condition [ 2 ]. Furthermore, some authors postulated pain drawings to be predictive for surgical outcome of back pain [ 77 ]. Recently Hagg et al. There was no association found between any of the four methods analysing the pain drawing and the Oswestry or the GFS.

Therefore, the authors concluded that this method of pain assessment was not able to predict the outcome of surgical or non-surgical treatment of chronic low-back pain. In general, the same techniques used for assessing the pain intensity may be used to assess the pain affect , e. In the VRS, the adjectives describe increasing unpleasantness caused by pain.

The aforementioned drawbacks of these tools are also valid when using it for the assessment of pain affect. Furthermore, the evidence for the validity of VRS in assessing the pain affect is not as clear as it is for pain intensity.

It has been recognised that it may fail to distinguish between pain affect and pain intensity [ 18 ]. However, some overlap of these two issues exist making the distinction between pain affect and pain intensity difficult.

Advantages and disadvantages of the pain-affect measurement by VAS are similar to pain intensity assessment. In several investigations, VAS for assessing pain affect have shown to be valid and sensitive to treatment effects and to have ratio scales qualities [ 45 ]. Besides these methods, some more sophisticated tools are available to assess the pain affect.

They are described in the following. This tool consists of a mechanical VAS and two lists of terms describing the pain affect [ 25 ]. Each of these terms has an associated intensity value ranging from one to five. The respondents must decide, which of the 11 possible words best describe their pain. Then the associated intensity values are summed together to build the Pain-O-Meter-affective scale. This scale has been shown to be reliable and sensitive in different settings such as analgesic treatment or differentiation between chest pain caused by myocardial infarction and other chest pain [ 25 , 26 ].

However, more research on validity and reliability in different settings should be performed to further understand this tool. The McGill Pain Questionnaire MPQ consists of three major measures—pain-rating index, the number of words chosen to describe pain and the present pain intensity based on a 1—5 intensity scale [ 55 ]. The pain-rating index is built by a numerical grading of words describing sensory, affective and evaluative aspects of pain. The affective subscale consists of five sets of words describing the pain affect.

The MPQ is the most extensive tool to measure pain affection. It has been used in many studies and has recently been reviewed extensively [ 56 ]. Nowadays, it is accepted that pain perception is influenced by far more parameters than only pain intensity.

Different coping strategies have found to influence significantly the development and perception of pain either directly [ 57 ] or indirectly [ 83 ]. Mercado et al. That is, patients who gave responsibility for pain management to an outside source or allowed other areas of life to be adversely affected by pain were at a significantly higher risk of developing disabling pain compared to those exhibiting an active coping behaviour.

On the other hand, Oron and Reichenberg [ 63 ] found young extroverted men at a higher risk for self-referring to a general practitioner and reporting pain than less-extroverted ones.

This finding however is controversially discussed as other studies failed to demonstrate similar results [ 53 , 81 ]. Other authors showed that patients with a pattern of catastrophic thinking had more difficulty in disengaging from pain compared to those with less or without catastrophic thinking [ 15 ].

Several tools were developed to assess different coping strategies [ 9 , 23 , 37 , 69 ]. Truchon and Cote [ 80 ] showed that some of the subscales of the Chronic Pain Coping Inventory [ 37 ] and the Coping Strategies Questionnaire [ 69 ] were able to predict different outcome variables in conservatively treated patients with subacute low-back pain.

The acceptance of chronic pain has been found to be associated with reports of less pain, psychological distress and physical and psychological disability [ 50 , 52 , 76 ]. On the other extreme, high psychological and medical risk factors according to a pre-surgical psychological screening were highly correlated to a poor surgical outcome for chronic back pain [ 6 ].

Pain-related fear was found to be predictive of back-pain intensity in a recent study by van den Hout et al. Consequently, several instruments such as the Chronic Pain Acceptance Questionnaire [ 27 ], the Pain Anxiety Symptoms Scale [ 51 ] and the Fear Avoidance Beliefs Questionnaire [ 82 ] have been developed to assess these aspects.

Pain tolerance as the individual expectancy of how much pain would be bearable to work with has recently found to be predictive for work disability and future chronification of back pain [ 61 ]. Besides pain intensity, pain tolerance was found to be the most important predictor for the development of chronic low-back pain.

Based on the preliminary results, the Heidelberger Questionnaire HKF-R 10 ten items on pain intensity, pain tolerance, education, effect of massage, depression, catastrophic thinking, helplessness, duration of back pain and gender was developed. This simple tool currently available only in German was able to correctly predict the course of pain development in Besides the aforementioned parameters, a thorough assessment of pain history may be very helpful in evaluating better the back-pain patients.

Smedley et al. On the other hand, low-back pain of acute onset at work was strongly correlated with exposure to specific patient-handling tasks where no such association was found for gradual onset.

Furthermore, previous back-pain symptoms were significantly associated with a higher incidence of low-back pain during follow-up and the risk of new back pain increased with increasing duration of previous pain and decreasing interval since the last episode. However, low-back pain of sudden onset was associated with greater short-term disability and more sickness-absence from work.

Similarly, Burton et al. Recurrence of pain was associated with time since onset, whereas chronicity was related to distress and blaming police work. Not only pain onset but also duration of the first episode of the pain has some predictive potential. Patients remaining off work after 1—2 months, because of their back, exhibit a high risk of much longer-term disability [ 29 ]. Usually, pain is the major complaint of back-pain patients and thus, the evaluation of pain is one of the foundation pillars in the outcome assessment.

Pain-intensity assessment seems to be most reliable when asking for an average pain level during a short past period of time from 1 week to 6 months. Some restrictions have to be taken into account when using these tools in an elderly population.

Although being well understandable and easy to handle also in telephone interviews , they are not as appropriate to detect changes over time as are VAS and GRS.

The value of pain drawing is controversially discussed. Whereas some authors find it to be useful to assess psychological involvement in pain, others do not. Moreover, this method failed to predict the outcome after surgical or non-surgical treatment as shown in a recently published randomised trial. Several instruments that address pain affect exist and have proven their validity. Besides all these methods, a thorough assessment of the previous pain history may contribute important information to the pathomorphologic correlate causing pain and may be of substantial prognostic importance.

Finally, one should be aware of the influence of coping strategies, pain acceptance, pain tolerance, anxiety of pain and fear-avoidance behaviour when evaluating the pain situation of patients. These factors were found to be significantly associated with the outcome after treatment for chronic pain in several trials. A standard minimum pain assessment for back-pain patients should integrate pain intensity e.

Depending on more detailed research questions, more sophisticated questionnaires on pain affect e. MPQ , coping strategies and fear-avoidance behaviour should be used. This allows for a more comprehensive assessment of pain and factors influencing pain perception. National Center for Biotechnology Information , U.

Journal List Eur Spine J v. Eur Spine J. Published online Dec 1. Mathias Haefeli 1 and Achim Elfering 2. Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Received Oct 2; Accepted Oct This article has been cited by other articles in PMC. Abstract Pain usually is the major complaint of patients with problems of the back, thus making pain evaluation a fundamental requisite in the outcome assessment in spinal surgery.

Keywords: Pain-assessment instruments, Spinal surgery, Coping strategies in pain patients, Pain perception, Pain experience. Introduction General aspects Back pain is one of the most frequent reasons for spinal surgery and therefore, pain relieving is one of the major aims to be achieved while operating on spine patients. There are several aspects that define pain and its effects [ 45 ]: Pain severity.

Open in a separate window. Numerical Rating Scale In a Numerical Rating Scale NRS , patients are asked to circle the number between 0 and 10, 0 and 20 or 0 and that fits best to their pain intensity [ 1 ]. Pain drawing In pain drawing, the patient is asked to mark the areas of pain on an outline of a human figure.

Instruments to measure pain affect In general, the same techniques used for assessing the pain intensity may be used to assess the pain affect , e. McGill Pain Questionnaire The McGill Pain Questionnaire MPQ consists of three major measures—pain-rating index, the number of words chosen to describe pain and the present pain intensity based on a 1—5 intensity scale [ 55 ]. Other aspects of chronic pain perception: coping with pain, pain acceptance, pain tolerance and pain-related anxiety Nowadays, it is accepted that pain perception is influenced by far more parameters than only pain intensity.

Importance of pain history Besides the aforementioned parameters, a thorough assessment of pain history may be very helpful in evaluating better the back-pain patients. Summary Usually, pain is the major complaint of back-pain patients and thus, the evaluation of pain is one of the foundation pillars in the outcome assessment. Recommendation A standard minimum pain assessment for back-pain patients should integrate pain intensity e. References 1. Spine — Invalid use of pain drawings in psychological screening of back pain patients.

Beaton DE. Understanding the relevance of measured change through studies of responsiveness. There are numerous assessment tools available that are specific to conditions and populations. Here are just a few examples. Assessment Tools Pain assessment tools are in the public domain and are available to all health care providers to assist them in better understanding the impact of pain on a person.