Dataset Information

Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain.

ABSTRACT: Low back pain (LBP) is the most common cause of chronic pain. Numerous clinical scales are available for evaluating pain, but their objective criteria in the management of LBP patients remain unclear. This study aimed to determine an objective cutoff value for a change in the Pain Intensity Numerical Rating Scale (?PI-NRS) three months after LBP treatment. Its utility was compared with changes in six commonly used clinical scales in LBP patients: Pain Disability Assessment Scale (PDAS), Pain Self-Efficacy Questionnaire (PSEC), Pain Catastrophizing Scale (PCS), Athens Insomnia Scale (AIS), EuroQoL 5 Dimension (EQ5D), and Locomo 25. We included 161 LBP patients treated in two representative pain management centers. Patients were partitioned into two groups based on patient's global impression of change (PGIC) three months after treatment: satisfied (PGIC = 1, 2) and unsatisfied (3-7). Multivariate logistic regression analysis was performed to explore relevant scales in distinguishing the two groups. We found ?PI-NRS to be most closely associated with PGIC status regardless of pre-treatment pain intensity, followed by ?EQ5D, ?PDAS, ?PSEC, and ?PCS. The ?PI-NRS cutoff value for distinguishing the PGIC status was determined by ROC analysis to be 1.3-1.8 depending on pre-treatment PI-NRS, which was rounded up to ?PI-NRS = 2 for general use. Spearman's correlation coefficient revealed close relationships between ?PI-NRS and the six other clinical scales. Therefore, we determined cutoff values of these scales in distinguishing the status of ?PI-NRS?2 vs. ?PI-NRS<2 to be as follows: ?PDAS, 6.71; ?PSEC, 6.48; ?PCS, 6.48; ?AIS, 1.91; ?EQ5D, 0.08; and ?Locomo 25, 9.31. These can be used as definitive indicator of therapeutic outcome in the management of chronic LBP patients.

SUBMITTER: Suzuki H

PROVIDER: S-EPMC7053735 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain.

Suzuki Hidenori H Aono Shuichi S Inoue Shinsuke S Imajo Yasuaki Y Nishida Norihiro N Funaba Masahiro M Harada Hidenori H Mori Aki A Matsumoto Mishiya M Higuchi Fumihiro F Nakagawa Shin S Tahara Shu S Ikeda Satoshi S Izumi Hironori H Taguchi Toshihiko T Ushida Takahiro T Sakai Takashi T

PloS one 20200303 3

Low back pain (LBP) is the most common cause of chronic pain. Numerous clinical scales are available for evaluating pain, but their objective criteria in the management of LBP patients remain unclear. This study aimed to determine an objective cutoff value for a change in the Pain Intensity Numerical Rating Scale (ΔPI-NRS) three months after LBP treatment. Its utility was compared with changes in six commonly used clinical scales in LBP patients: Pain Disability Assessment Scale (PDAS), Pain Sel ...[more]

PMID: 32126108

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Project description:Pain intensity and patients' impression of global improvement are widely used patient-reported outcome measures (PROMs) in clinical practice and research. They are commonly assessed using the Numerical Pain Rating Scale (NPRS) and Global Rating of Change (GROC) questionnaires. The GROC is essential as an anchor for evaluating the psychometric properties of PROMs. Both of these PROMs are translated to many languages and have shown excellent psychometric properties. Their availability in Nepali would facilitate pain research and cross-cultural comparison of research findings. Therefore, the objectives of this study were to translate and cross-culturally adapt the NPRS and GROC into Nepali and to assess the psychometric properties of the Nepali version of the NPRS (NPRS-NP).After translating and cross-culturally adapting the NPRS and GROC into Nepali using recommended guidelines, NPRS-NP was administered to 104 individuals with musculoskeletal pain twice. The Nepali version of the GROC (GROC-NP) was administered at the follow-up for anchor-based assessment. (1) Test-retest reliability and minimum detectable change (MDC) among the stable group, (2) construct validity (by single sample t-test within the improved group and independent sample t-test between groups), and (3) concurrent validity were assessed. Receiver operating characteristic (ROC) curves were plotted to determine the responsiveness of the NPRS-NP using the area under the curve (AUC), and minimum important changes (MIC) for small, medium and large improvements.Significant cultural adaptations were required to obtain relevant Nepali versions of both the NPRS and GROC. The NPRS-NP showed excellent test-retest reliability and a MDC of 1.13 points. NPRS-NP demonstrated a good construct validity by significant within-group difference in mean of NPRS score- t(63)= 7.57, P?<?0.001 and statistically significant difference of mean score- t(98)= -4.24, P?<?.001 between the stable and improved groups. It demonstrated moderate concurrent correlation with the GROC-NP; r?=?0.43, P?<?0.01. Responsiveness of the NPRS-NP was shown at three levels with AUC?=?0.68-0.82, and MIC?=?1.17-1.33.The NPRS and GROC were successfully translated and culturally adapted into Nepali. The NPRS-NP demonstrated good reliability, validity and responsiveness in assessing musculoskeletal pain intensity in a Nepali population.

Project description:ObjectiveTo develop clinically meaningful improvement thresholds in both the 17-item and the 6-item Hamilton Rating Scale for Depression (HRSD) total scores in depressed outpatients.MethodsThe post-hoc analysis included all adult outpatients with non-psychotic major depressive disorder in the STAR*D trial who entered and exited the first treatment step (up to 14 weeks of citalopram) with a complete set of study measures at baseline and exit and at least one post-baseline measure. Within-patient change and linear regression anchor-based analyses were conducted to define meaningful and substantial changes in the HRSD17 and HRSD6 using three patient-reported outcomes [Work and Social Adjustment Scale (WSAS), Quality of Life Enjoyment and Satisfaction-Short Form (Q-LES-Q-SF); Mini-Q-LES-Q] obtained at baseline and exit from the first treatment step in STAR*D.ResultsLinear regression analyses identified a meaningful change threshold for the HRSD17 as 3.9 [3.7-4.1] [lower, upper 95% CI] and a substantial change as 7.8 [7.4-8.3] with the WSAS. Analogous thresholds based on the Q-LES-Q-SF were 5.8 [5.5-6.1] and 11.6 [11.0-12.2], respectively, and 4.9 [4.7-5.2] and 9.9 [9.3-10.4] for the Mini-QLES-Q, respectively. For the HRSD6, linear regression analyses with the WSAS identified a meaningful change as 2.2 [2.1-2.4], while a substantial change was 4.5 [4.2-4.7]. Analogous figures based on the Q-LES-Q-SF were 3.2 [3.0-3.4] and 6.4 [6.1-6.8]. Similarly, based on the Mini-QLESQ, results were 2.8 [2.6-2.9] and 5.6 [5.3-5.9]. For both the HRSD17 and the HRSD6, within-patient analyses produced less precise estimates of the same change thresholds with substantial overlap between groups. Based on the WSAS, a clinically meaningful change in the HRSD17 total score was 9.6 (SD = 6.5), while a substantial change was 15.0 (SD = 6.7). Analogous change thresholds based on the Q-LESQ-SF were 12.9 (SD = 6.2) and 16.8 (SD = 6.4), respectively. For the Mini-Q-LES-Q, thresholds were 10.9 (SD = 6.5) and 16.1 (SD = 6.2).ConclusionA 4-6 point change in the HRSD17 is clinically meaningful; a 7-12 point change is clinically substantial. For the HRSD6, analogous estimates were 2-3 and 4-7 point changes, respectively.

Dataset Information

Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain.

Publications

Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain.

Similar Datasets

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