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Abstracts (923) The difficulties of analyzing children’s pain at home M Huth, D Van Kuiken, L Lin; Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Tonsillectomy is a common childhood surgery that most often occurs in an ambulatory setting. Children experience moderate to severe pain in days after tonsillectomy surgery and primarily rely on family caregivers for pain management. Research to explore the pain management of children in the home is needed. One method of gathering home data is through pain diaries. A secondary analysis was completed on diary data collected in a previously reported RCT on the effect of guided imagery on postoperative pain. This diary data was not included in previous analyses. This presentation will describe the challenges and the steps taken to determine the best means of analyzing and interpreting diary data completed in the first 24 hours after ambulatory tonsillectomy surgery. The diary included level of pain as measured with Oucher and Facial Affective Scale (FAS) instruments, and the amount of analgesics used. The data was unbalanced with each diary having a different number of entries at varying intervals. Also the issue of construct validity of cause needed to be considered due to the use of analgesics. This was complicated by four different analgesics being administered in the home. MANCOVA, repeated measure MANCOVA, and Hierarchical Linear Modeling (HLM) were compared for strengths and limitations with the data. In spite of finding no significant differences between groups using all methods, HLM was better able to address the difficulties with this data. HLM provided a means to analyze this unbalanced data and control for oral analgesics taken just prior to each pain measure. By entering group membership in the second level of the model, differences between groups were analyzed. In planning research that measures pain in children at home, issues of control must be addressed. HLM can address issues of incomplete data and confounder variables in repeated measures studies.
G. Diagnosis, Assessment and Reviews G01 - Assessment in Nonverbal Populations (Infants, Mentally Impaired, etc.) (924) A comparison of two behavioral pain scales with intubated intensive care unit patients A Purdum, Y D’Arcy; Suburban Hospital, Bethesda, MD Pain assessment in critically ill, intubated patients presents a challenge related to the acuity of the patient’s illness as well as the need for sedation. Since intubated patients cannot self-report their pain, the use of a behavioral assessment tool is one way to provide pain assessment. During a turn in bed, 30 intubated ICU patients had their pain assessed by two nurses using two behavioral pain scales, one using five behavioral criteria (Campbell), and one using similar criteria but adding a scale for tolerance to intubation (Payen). The patients were divided into 3 groups based on a Ramsey Scale sedation rating, mild, moderate, or heavy. The pain stimulus was a turn in bed which had been identified in the Thunder II data as being equal to a 5/10 pain using the 0 to 10 pain intensity scale. The primary medications being used for pain were fentanyl and morphine, sedation was achieved with propofol. Since the Payen Behavioral Scale uses a 12 point scale, the pain ratings with this scale were normalized to a 10 point format. Of the three groups the averaged pain assessment scores which most closely matched the pain stimulus were the Payen normalized scores of mild 5.3, moderate 6.2, heavy sedation 4.8. The Campbell pain scale had the best match for pain assessment in the moderate sedation group at 5.4. Using SPSS 10.2 statistical analysis package there was no significance for difference between the two pain scales. Surprisingly, 8 patients in the group had no sedation or pain medication prior to turning. Clinically it would appear that both the behavioral scales being studied provide a method for assessing pain in this group of patients, but overall, for all 3 groups the Payen normalized scale most accurately reflected the expected pain rating from the pain stimulus.
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G02 - Assessment of Disability (925) Multidimensional Pain Inventory: Can it replace a comprehensive test battery? P Davidson, M Davidson, D Tripp, L Fabrigar; Queen’s University, Kingston, ON The Multidimensional Pain Inventory (MPI) is a self-report measure used to assess important aspects of the chronic pain experience (e.g., pain severity, disability and activity, depression, anxiety, and support). It is brief, and measures many pain dimensions that our clinic assesses with other instruments, but with fewer items and in less time. However, the MPI is a revision of an earlier instrument and has never been adequately validated. Psychometric studies have raised questions about the structure and validity of MPI scales. This study assesses psychometric qualities of the MPI, and examines the extent to which it can replace a more comprehensive battery. Factor structure, reliability, and validity of the MPI were examined. Participants (129 chronic pain patients aged 16 to 91 years (M ⫽ 50.38)) completed the MPI and 8 criterion scales (McGill Pain Questionnaire-SF, Pain Disability Index, Beck Depression Inventory, Beck Hopelessness Scale, Beck Anxiety Inventory, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Chronic Pain Coping Inventory). Exploratory factor analysis of the MPI yielded 4 mathematically plausible solutions but none of these were interpretable and none replicated either of the factor structures in the literature. Internal consistency estimates of MPI scales produced varied results. Internal consistency was acceptable for 10 of 12 scales, however, 2 scales demonstrated poor internal consistency (alpha ⬍ .70 : activities away from home and social activities). Correlation of MPI scales with criterion scales revealed that only two MPI scales correlated well (rs ⬎ .69) with criterion scales (interference and affective distress). The MPI negative affect and interference scales measure similar constructs to the Beck Depression Inventory, and Pain Disability Index, respectively. The remaining 10 MPI scales appear to measure different constructs than the criterion scales. These issues with its factor structure and validity indicate that the MPI cannot completely replace a comprehensive assessment battery.
(926) Screening performance of the DASS and the HADS for symptoms of depression and anxiety in back pain patients referred for physiotherapy G Pron, S Tervit; Trillium Health Centre, Toronto, ON The objectives of this study were to a) compare two screening measures for anxiety and depression – the Hospital Anxiety Depression Scales (HADS) and the Depression Anxiety Stress Scale (DASS) and b) evaluate the relationship between screening scores, patient’s perception of their symptoms and their desire for supportive interventions. The study involves a prospective survey of patients with back pain referred for physiotherapy in a multi-disciplinary outpatient based spine institute. Patients completed a battery of instruments including the Depression, Anxiety, Stress Scale (DASS), Hospital Anxiety Depression Scales (HADS), Coping Strategies Questionnaire (CSQ) and the Oswestry Disability Scale (ODI). Patients were subsequently followed up with a structured telephone interview to determine their perception of their emotional distress, coping and desire for supportive intervention. In the two month study period, 61 (31F, 30M) patients were referred for physiotherapy. Completed instruments were available for 81% (n⫽ 52) of the patients. Of the 24 patients (15F, 9M) interviewed so far, 6 (25%), all female, expressed a desire for supportive interventions. Patient average age was 58.5 years (range 51-69 years), all had back pain for more than one year and only a few (n⫽2) were taking prescription medication for pain. In patients requesting support - with the HADS, no cases were identified as abnormal for symptoms of depression and with the DASS, 3 cases were identified with symptoms of moderate or severe depression. For anxiety, 1 case (also by the DASS) was identified as abnormal by the HADS and 4 cases were identified with symptoms of moderate or severe anxiety with the DASS. Among back pain patients referred for physiotherapy, female patients were more likely to report a desire for supportive interventions for symptoms of depression and/or anxiety. Agreement between HADS and DASS scoring for symptoms of depression and anxiety in back pain patients was low.
G. Diagnosis, Assessment and Reviews G01 - Assessment in Nonverbal Populations (Infants, Mentally Impaired, etc.) (924) A comparison of two behavioral pain scales with intubated intensive care unit patients A Purdum, Y D’Arcy; Suburban Hospital, Bethesda, MD Pain assessment in critically ill, intubated patients presents a challenge related to the acuity of the patient’s illness as well as the need for sedation. Since intubated patients cannot self-report their pain, the use of a behavioral assessment tool is one way to provide pain assessment. During a turn in bed, 30 intubated ICU patients had their pain assessed by two nurses using two behavioral pain scales, one using five behavioral criteria (Campbell), and one using similar criteria but adding a scale for tolerance to intubation (Payen). The patients were divided into 3 groups based on a Ramsey Scale sedation rating, mild, moderate, or heavy. The pain stimulus was a turn in bed which had been identified in the Thunder II data as being equal to a 5/10 pain using the 0 to 10 pain intensity scale. The primary medications being used for pain were fentanyl and morphine, sedation was achieved with propofol. Since the Payen Behavioral Scale uses a 12 point scale, the pain ratings with this scale were normalized to a 10 point format. Of the three groups the averaged pain assessment scores which most closely matched the pain stimulus were the Payen normalized scores of mild 5.3, moderate 6.2, heavy sedation 4.8. The Campbell pain scale had the best match for pain assessment in the moderate sedation group at 5.4. Using SPSS 10.2 statistical analysis package there was no significance for difference between the two pain scales. Surprisingly, 8 patients in the group had no sedation or pain medication prior to turning. Clinically it would appear that both the behavioral scales being studied provide a method for assessing pain in this group of patients, but overall, for all 3 groups the Payen normalized scale most accurately reflected the expected pain rating from the pain stimulus.
S81
G02 - Assessment of Disability (925) Multidimensional Pain Inventory: Can it replace a comprehensive test battery? P Davidson, M Davidson, D Tripp, L Fabrigar; Queen’s University, Kingston, ON The Multidimensional Pain Inventory (MPI) is a self-report measure used to assess important aspects of the chronic pain experience (e.g., pain severity, disability and activity, depression, anxiety, and support). It is brief, and measures many pain dimensions that our clinic assesses with other instruments, but with fewer items and in less time. However, the MPI is a revision of an earlier instrument and has never been adequately validated. Psychometric studies have raised questions about the structure and validity of MPI scales. This study assesses psychometric qualities of the MPI, and examines the extent to which it can replace a more comprehensive battery. Factor structure, reliability, and validity of the MPI were examined. Participants (129 chronic pain patients aged 16 to 91 years (M ⫽ 50.38)) completed the MPI and 8 criterion scales (McGill Pain Questionnaire-SF, Pain Disability Index, Beck Depression Inventory, Beck Hopelessness Scale, Beck Anxiety Inventory, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Chronic Pain Coping Inventory). Exploratory factor analysis of the MPI yielded 4 mathematically plausible solutions but none of these were interpretable and none replicated either of the factor structures in the literature. Internal consistency estimates of MPI scales produced varied results. Internal consistency was acceptable for 10 of 12 scales, however, 2 scales demonstrated poor internal consistency (alpha ⬍ .70 : activities away from home and social activities). Correlation of MPI scales with criterion scales revealed that only two MPI scales correlated well (rs ⬎ .69) with criterion scales (interference and affective distress). The MPI negative affect and interference scales measure similar constructs to the Beck Depression Inventory, and Pain Disability Index, respectively. The remaining 10 MPI scales appear to measure different constructs than the criterion scales. These issues with its factor structure and validity indicate that the MPI cannot completely replace a comprehensive assessment battery.
(926) Screening performance of the DASS and the HADS for symptoms of depression and anxiety in back pain patients referred for physiotherapy G Pron, S Tervit; Trillium Health Centre, Toronto, ON The objectives of this study were to a) compare two screening measures for anxiety and depression – the Hospital Anxiety Depression Scales (HADS) and the Depression Anxiety Stress Scale (DASS) and b) evaluate the relationship between screening scores, patient’s perception of their symptoms and their desire for supportive interventions. The study involves a prospective survey of patients with back pain referred for physiotherapy in a multi-disciplinary outpatient based spine institute. Patients completed a battery of instruments including the Depression, Anxiety, Stress Scale (DASS), Hospital Anxiety Depression Scales (HADS), Coping Strategies Questionnaire (CSQ) and the Oswestry Disability Scale (ODI). Patients were subsequently followed up with a structured telephone interview to determine their perception of their emotional distress, coping and desire for supportive intervention. In the two month study period, 61 (31F, 30M) patients were referred for physiotherapy. Completed instruments were available for 81% (n⫽ 52) of the patients. Of the 24 patients (15F, 9M) interviewed so far, 6 (25%), all female, expressed a desire for supportive interventions. Patient average age was 58.5 years (range 51-69 years), all had back pain for more than one year and only a few (n⫽2) were taking prescription medication for pain. In patients requesting support - with the HADS, no cases were identified as abnormal for symptoms of depression and with the DASS, 3 cases were identified with symptoms of moderate or severe depression. For anxiety, 1 case (also by the DASS) was identified as abnormal by the HADS and 4 cases were identified with symptoms of moderate or severe anxiety with the DASS. Among back pain patients referred for physiotherapy, female patients were more likely to report a desire for supportive interventions for symptoms of depression and/or anxiety. Agreement between HADS and DASS scoring for symptoms of depression and anxiety in back pain patients was low.