Friday, July 20, 2018 From PTJ: Are Pain Measures Asking the Right Questions? In terms of measuring how a patient is impacted by chronic pain, there is a gap between what commonly used questionnaires ask and what patients care about most, say authors of a study in the July issue of PTJ (Physical Therapy). It's time, they write, to "embed patients' values and preferences" into the instruments providers use to evaluate the effects of chronic pain. In the first phase of an effort to develop a "patient-driven" instrument, researchers in the Netherlands conducted focus groups and developed an online survey to identify the attributes of pain that have the most impact on participants' daily lives. Survey respondents were asked to provide information about their diagnosis and level of pain, complete the Pain Disability Index, and select the 8 (from a total of 84) most important attributes of pain. Authors say that while many instruments measure areas such as pain sensation, psychological impact, functional disability, related symptoms, activities of daily living, social functioning, coping strategies, environmental factors, and financial burden, those aren't necessarily the factors that are most important to patients. In the end, the 8 most frequently chosen attributes of pain identified by the 949 survey respondents were fatigue, social life, cramped muscles, sleeping, housekeeping, concentration/focus, feelings of not being understood, and control over pain. Authors also broke down the results by gender, age group, diagnosis, and pain intensity. The only significant difference between men and women was the rating for "housekeeping" – ranked at 5 for women and 29 for men. Individuals with back pain rated "concentration" and "not being understood" much lower than did other diagnostic groups. Comparing the results against attributes measured in several widely used instruments and item banks, there was some overlap; however, many standard test items were not deemed important by survey respondents. Similarly, some items rated important to patients are absent from these instruments—for example, researchers note that fatigue was consistently identified as an important attribute in their survey, but it is not included in many instruments used for patients with chronic pain. Authors say that the results of the study are being used to develop a prototype pain survey, based on the 8 areas identified through the survey and focus groups, that will measure the impact of chronic pain on health-related quality of life (HRQoL). "A preference-based measuring method allows attributes to be weighted so that HRQoL can be calculated," they write, adding that "a substantial amount of information can be ascertained from these 8 attributes." "These attributes in [themselves] are not in fact new, but discovering which attributes are most important to people with chronic pain leads to new insights, which should be used to guide further development of a truly patient-centered, preference-based instrument," authors write. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.