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Exploring the prevalence and construct validity of high-impact chronic pain across chronic low-back pain study samples.

ABSTRACT: BACKGROUND CONTEXT:The US National Pain Strategy focused attention on high-impact chronic pain and its restrictions. Although many interventions have been studied for chronic low-back pain, results are typically reported for heterogeneous samples. To better understand chronic pain and target interventions to those who most need care, more granular classifications recognizing chronic pain's impact are needed. PURPOSE:To test whether chronic pain impact levels can be identified in chronic low-back pain clinical trial samples, examine the baseline patient mix across studies, and evaluate the construct validity of high-impact chronic pain. STUDY DESIGN/SETTING:Descriptive analyses using 12 large study datasets. PATIENT SAMPLES:Chronic low-back pain patients in nonsurgical, nonpharmacologic trials in the US, Canada, and UK. OUTCOME MEASURES:Preference-based health utilities from the SF-6D and EQ-5D, employment status and absenteeism. METHODS:We used two logistic regression models to predict whether patients had high-impact chronic pain and whether the remainder had low- or moderate-impact chronic pain. We developed these models using two datasets. Models with the best predictive power were used to impute impact levels for six other datasets. Stratified by these estimated chronic pain impact levels, we characterized the case mix of patients at baseline in each dataset, and summarized their health-utilities and work productivity. This study was funded by a National Center for Complementary and Integrative Medicine grant. The authors have no potential conflicts of interest. RESULTS:The logistic models had excellent predictive power to identify those with high-impact chronic pain. Although studies were all of chronic low-back pain patients, the baseline mix of patients varied widely. Across all datasets, utilities, and productivity were similar for those with high-impact chronic pain and worsened as chronic pain impact increased. CONCLUSIONS:There is a need to better categorize chronic pain patients to allow the targeting of optimal interventions for those with each level of chronic pain impact.

SUBMITTER: Herman PM

PROVIDER: S-EPMC6760858 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Exploring the prevalence and construct validity of high-impact chronic pain across chronic low-back pain study samples.

Herman Patricia M PM Broten Nicholas N Lavelle Tara A TA Sorbero Melony E ME Coulter Ian D ID

The spine journal : official journal of the North American Spine Society 20190315 8

<h4>Background context</h4>The US National Pain Strategy focused attention on high-impact chronic pain and its restrictions. Although many interventions have been studied for chronic low-back pain, results are typically reported for heterogeneous samples. To better understand chronic pain and target interventions to those who most need care, more granular classifications recognizing chronic pain's impact are needed.<h4>Purpose</h4>To test whether chronic pain impact levels can be identified in c ...[more]

PMID: 30885677

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Project description:BackgroundCurrently, there are no outcome measures assessing the ability of people with non-specific low back pain to self-manage their illness. Inspired by the 'Patient Enablement Instrument', we developed the Patient Enablement Instrument for Back Pain (PEI-BP). The aim of this study was to describe the development of the Patient Enablement Instrument for Back Pain (PEI-BP) and investigate content validity, construct validity, internal consistency, test-retest reliability, measurement error, responsiveness and floor and ceiling effects.MethodsThe PEI-BP consists of 6 items that are rated on a 0-10 Numeric Rating Scale. Measurement properties were evaluated using the COSMIN taxonomy and were based on three cohorts from primary care with low back pain: The content validity cohort (N = 14) which participated in semi-structured interviews, the GLA:D® Back cohort (N = 272) and the test-retest cohort (N = 37) which both completed self-reported questionnaires. For construct validity and responsiveness, enablement was compared to disability (Oswestry Disability Index), back pain beliefs (Brief Illness Perception Questionnaire), fear avoidance (Fear-Avoidance Beliefs Questionnaire-physical activity), mental health (SF-36), educational level and number of previous episodes of low back pain.ResultsThe PEI-BP was found to have acceptable content validity, construct validity, reliability (internal consistency, test-retest reliability and measurement error) and responsiveness. The Smallest Detectable Change was 10.1 points illustrating that a patient would have to change more than 1/6 of the scale range for it to be a true change. A skewed distribution towards the high scores were found at baseline indicating a potentially problematic ceiling effect in the current population.ConclusionsThe PEI-BP can be considered a valid and reliable tool to measure enablement on people seeking care for non-specific LBP. Further testing of the PEI-BP in populations with more severe LBP is recommended.Trial registrationNot applicable.

Project description:BackgroundChronic low back pain (cLBP) is a complex condition that is physically and psychologically debilitating, with vulnerable populations experiencing more severe outcomes. Physical therapy (PT) includes evidence-based treatments that can reduce disability, however the experience of PT can vary amongst different populations. Empirical evidence is largely based on majority samples that are predominantly white with high educational attainment. Little is known regarding how people from vulnerable groups (e.g. low income and racial minority) experience physical therapy treatment for low back pain.ObjectiveTo describe the experience of physical therapy in a predominantly low-income and minority population with cLBP.MethodsThis qualitative study was embedded within a randomized controlled trial for patients with cLBP in urban, underserved communities. We used a convenience sample to interview 12 participants from the 102 who participated in the PT arm of the trial and then performed thematic analysis to describe their experience.ResultsThree major themes emerged: 1) Empowerment through education and exercise; 2) Interconnectedness to providers and other patients; and 3) Improvements in pain, body mechanics, and mood. Divergent cases were few however centered around a lack of improvement in pain or an absence of connection with the therapist. Within the first theme a prevailing sub-theme emerged that aligned with Bandura's theory of self-efficacy: 1) Mastery of experience; 2) Verbal persuasion; 3) Vicarious experience; and 4) Physiological state.ConclusionsOur participants' insight highlighted the value of cognitive-emotional and interpersonal dimensions of PT. These may be particularly important components of PT in populations that have experienced systemic distrust in providers and disparities in services. Future work could use Bandura's model of self-efficacy to build a PT intervention comprised of fear-based movement exercises, interconnectedness, a strong therapeutic alliance, and mindfulness techniques.

Dataset Information

Exploring the prevalence and construct validity of high-impact chronic pain across chronic low-back pain study samples.

Publications

Exploring the prevalence and construct validity of high-impact chronic pain across chronic low-back pain study samples.

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