Assessments of Pain VAS Relatively consistent pain –Very ACUTE pain –Short-term assessments with a rapid decrease in pain It is not a good measure: When used to recall average pain or previous pain or Of long-term outcomes for intermittent conditions Measure the distance from zero to mark by patient with a ruler and record in millimetres - Remember that when using VAS in the clinical situation repeated photocopying of the same VAS sheet can lead to increases in the length of the VAS line QVAS Good measure for Chronic pain Measures: CURRENT level of pain at time of visit ,AVERAGE pain over previous specified time e.g. since onset , WORST (maximum) pain level over specified tome and BEST (lowest) pain level. Each of the four levels of the QVAS is rated on a VAS and then totaled to a give score out of 40 - The final score is expressed as a percentage (total score divided by 40 multiplied by 100) - Categorized as “low intensity” (score” < 50%) or “ high intensity” (score > 50%) Numerical Pain Scale (NPS) The NPS or Numerical Rating Scale (NRS) contains 11 numbers (0-10) and the patient circles one to represent their pain level. - Generally found to be as reliable as VAS and is easier to complete and analyse. - A suggested disadvantage is that the patient may more easily remember their previous levels Pain Quality - McGill/Melzack Pain questionnaire (MPQ) Measures pain outcomes in terms of pain quality The original form contained 20 category scales of verbal descriptors of pain. A short form (SF) version consisting of 15 category scales has been validated and found reliable and is more commonly used Short Form McGill Pain Questionnaire The descriptors 1-11 represent the sensory dimension of pain while descriptors 12-15 represent the affective domain The MPQ is unique in that it can discriminate between the sensory and affective domains of pain experience The MPQ form also includes a standard VAS scale and a Present Pain Intensity (PPI) scale Each descriptor is ranked on an intensity scale – _0=none, 1=mild, 2=moderate, 3=severe A total score plus sub scores for the sensory and affective domains can be calculated Scores are also recorded for VAS and Present Pain Intensity (PPI) Pain Location Pain diagrams are often used for recording pain location and some measure of the quality e.g. ache, burning etc. They capture a pictorial representation of a patient’s verbal pain report They are mainly qualitative Pain Frequency and Duration Pain diaries Best document the frequency and duration of pain over a period depending on nature of pain – usually 2-4 weeks is sufficient A problem is bias from the patient and poor recording Frequency Usually reported as intermittent, occasional, frequent or constant Can be quantified to some degree in terms of percent of waking hours that pain is present using the following definitions of pain frequency: Percentage of waking hours that pain is present Intermittent < 25% Occasional 25-50% Frequent 50-75% Constant > 75% Duration Reported as but may vary as rely upon an arbitrary interval of time from onset : Acute (less than 30 days) Subacute ( 1 to 6 months) Chronic (> 6 months) “Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Oswestry Low Back Pain Disability Questionnaire Best for more chronic/severe cases Purpose: It provides a reliable and valid self-rated means to quantify the effect of low back pain on a person’s activities of daily living (ADLs) Design: Made up of ten categories relating to disability/function. Each category has six possible responses of which the patient choses one only in each category Each of the 10 sections is scored separately (0 to 5 points each) and then added up (max. total = 50) (Patient's score / No. of sections completed x 5) X 100 = % DISABILITY Note: If all 10 sections are completed, simply double the patient's score, If a section is omitted, divide the patient's total score by the number of sections completed times 5. (A change in score of 10% is normally needed to be considered of clinical importance beyond measurement error, score of 11% appropriate to consider discharge/return to work) Scoring system: 0-20% Minimal disability 40-60% Severe disability 20-40% Moderate disability 80-100% bedbound or exaggerating symptoms Roland-Morris disability questionnaire Derived from the much longer Sickness Impact Profile and provides a reliable and valid means to quantify the effect of back pain on a person’s daily living activities. Disability Rating: 0-5 Minimal disability 15-19 Crippling 6-10 Moderate 20-24 Bedbound or exaggerating 11-14 Severe Note: A change in score of 4 or more is needed to be clinically significant The Lower Extremity Functional Scale Maximum score is 80, The lower the score the greater the disability, % of maximal function = (LEFS score) / 80 * 100 Change in score of 9=clinical significance Neck Disability Index (NDI) Purpose: It provides a reliable and valid self-rated means to quantify the effect of neck pain on a person’s activities of daily living(ADLs) Design: Made up of ten categories relating to disability/function. Each category has six possible If all 10 sections are completed, simply double the patient's score –If a section is omitted, divide the patient's total score by the number of sections completed times 5 –Formula: (Patient's score / No. of sections completed x 5) X 100 = % DISABILITY Ratings include: 0-9% No disability 10-29% Mild 30-49% Moderate 50-69% Severe >70% Complete The Whiplash Disability Questionnaire (WDQ) A modified version of the Neck Disability Index to evaluate whiplash related disability Has been shown to have excellent validity, reliability and responsiveness when used to measure disability associated with WAD As a disability measure for whiplash can be of assistance as focus on global functioning rather than just symptoms. Design: 13-item questionnaire Items address current pain levels, personal care, role performance (work/study/home duties), mobility (driving/public transport), sleep disturbances, tiredness, social and leisure (sporting and non-sporting) activity, emotional (sadness/depression, anger, anxiety) and concentration impairments Circle a No. on a 11 point scale (0-1), max score 130 A score of 13 or less is expected to be associated with a high level of functioning The Upper Extremity Functional Index Purpose: To evaluate the functional impairment of a patient with a disorder of one or both upper extremities. May be used as a measure of patients' initial function, ongoing progress and outcome, as well as to set functional goals. Design: Made up of 20 questions relating to the ability to perform everyday tasks(Max score 80) lower the score = greater the disability % of maximal function = (UEFS score) / 80 * 100 A change in score of 9 points or more is needed to be clinically significant Short Form 36 (SF-36)/RAND-36 Purpose: It is a reliable and valid measure to assess a patient’s general health status and quality of life/wellbeing at a given point in time for adults! Design: It assesses eight different elements of health • • • All questions are scored on a scale from 0 to 100 100 = highest level of functioning A recoded score is allotted for each response within each of the eight categories Validity: Refers to whether the test is measuring what it actually says it is measuring OR refers to the accuracy with which an instrument measures a variable Reliability: The ability of a test to be reproducible OR reliability is the consistency of the measurement obtained with repeated testing (when the measurement in fact has NOT changed) Intra-examiner reliability: Consistent results obtained for a given test when repeated by a given examiner Inter-examiner reliability: Consistent results obtained for a measure when repeated by different examiners Sensitivity: is the test’s ability to detect whether somebody HAS the condition being tested. Calculated as the proportion of patients who have the specific disorder being tested who have a positive test - ideally this would be 100%. the true positive rate of the test Specificity: is the ability of the test to detect those that do NOT have the condition being tested (the true negative rate of the test) Headache Disability Inventory (HDI) Purpose: A condition specific tool used for headache sufferers to assess the impact of headaches on daily living NOT PAIN LEVELs (if the headache is cervcogenic in origin then the NDI is usually also used) Design: Consists of 25 questions divided up into 13 emotional (E) and 12 functional (F) questions A maximum score of 100 is possible with maximum sub scores of 52 for the Emotional component and 48 for the Functional component Mild Moderate Severe 2-32 (total score) 33-59 60+ A minimum change of 29 in the total score is necessary to conclude positive treatment effects Arthritis Impact Measurement Scales- 2 (AIMS2) Objective: To measure changes in global health, pain, mobility and social function in patients with arthritis Disease: DJD, RA Revised Fibromyalgia Impact questionnaire (FIQR) Objective: A revised version of the original publication of the FIQ. “The FIQR has the same 3 domains as the FIQ (that is, function, overall impact and symptoms). It differs from the FIQ in having modified function questions and the inclusion of questions on memory, tenderness, balance and environmental sensitivity.” Disease: Fibromyalgia – a syndrome of chronic widespread pain Depression Anxiety Stress Scales (DASS) A set of three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. Each of the three DASS scales contains 14 items, divided into subscales of 2-5 items with similar content. Pain Self-Efficacy Questionnaire (PSEQ) The Pain Self-Efficacy Questionnaire (PSEQ) is a 10-item questionnaire. Covers a range of functions, including household chores, socialising, work, as well as achieving goals in life without pain & coping with pain without medication. It is an assessment of not just the chronic pain patient’s expectation that they could perform a particular behaviour or task, but also their confidence in being able to do it despite their pain. Higher scores indicate higher levels of self-efficacy. <20 = severe 20-30 = moderate 31-40 = mild >40 = minimal Pain Self Catastrophising Scale (PCS) 13-item instrument developed from definitions of catastrophizing as described in the literature Patients are asked to reflect on past painful experiences, and to indicate the degree to which they experienced each of the 13 thoughts or feelings when experiencing pain, on 5-point scales with (0) not at all and (4) all the time. Pain catastrophising is characterised by a tendency to magnify the threat of a pain stimulus and to fell helpless/immobilised whilst in pain plus an inability to prevent or inhibit pain-related thoughts in anticipation of during, or following a painful event. Severity : <20 = mild 20-30 = high >30 = severe Patient Health Questionnaire-4, PHQ-4 Ultra-brief self-report screening scale for anxiety & depression. Total score is determined by adding together the scores of each of the 4 items. Total scores are rated as normal (0-2), mild (3-5), moderate (6-8), and severe (9-12). Anxiety subscale = sum of items 1 and 2 Depression subscale = sum of items 3 and 4 Severity: None 0-2 Mild 3-5 Moderate 6-8 Severe 9-12 Modified Patient Specific needs: MYMOP is a patient-generated, or as defined by a patient outcome questionnaire.
