Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

MacDermid, Joy C.

Abstract

Introduction: Comprehensive pain assessment depends on the use of psychometrically valid patient-reported outcome measures (PROMs). The Brief Pain Inventory-Short Form (BPI-SF) and Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) are general-use multidimensional pain assessment tools commonly used in musculoskeletal conditions. Understanding all relevant measurement properties supports stronger decisions about PROMs.

Thesis Objectives: The overarching objective of this thesis was to determine the sufficiency of measurement evidence backing the use of the BPI-SF and SF-MPQ-2 in musculoskeletal conditions. Specifically, a systematic review was conducted to locate, summarize and compare the quality and content of psychometric evidence backing the BPI-SF and SF-MPQ-2 in musculoskeletal conditions. Based on this review, the gap in evidence regarding the reliability and agreement properties (reproducibility) of SF-MPQ-2 was examined among patients with musculoskeletal shoulder pain.

Methods: For the systematic review, we searched four databases to identify relevant citations. Two reviewers independently screened, extracted and appraised (using MacDermid and COSMIN guidelines) all psychometric reports on both tools in musculoskeletal conditions. To determine the SF-MPQ-2 reproducibility, a convenience sample of adults diagnosed with musculoskeletal shoulder pain (baseline, n=195; test-retest, n=48) completed the SF-MPQ-2 twice. Cronbach alpha (α), intraclass correlations coefficient (ICC2,1), agreement parameters (SEM, MDC) and Bland-Altman plots were assessed.

Results: High quality evidence indicated both tools have high internal consistency (α = 0.83-0.96); and that they are moderately related (r = 0.3-0.69) to other health-related outcome measures. More studies of better quality have evaluated the BPI-SF responsiveness (n=5), retest reliability (n=3), known group validity (n=2) and structural validity (n=3), compared to the SF-MPQ-2. Our analysis of the SF-MPQ-2 reproducibility established internal consistency as satisfactory (α, 0.83-0.95), relative reliability as good (neuropathic, intermittent, and affective subscales: 1CC2,1= 0.78 - 0.88) to excellent (total and continuous subscale scores: 1CC2,1= 0.92 - 0.95). Agreement was within acceptable limits and there was no evidence of systematic bias.

Conclusion: A greater volume of evidence of better quality currently supports the BPI-SF although emerging evidence suggest the SF-MPQ-2 has excellent reliability and agreement properties when used to assess adults with musculoskeletal shoulder pain. Direct comparisons of the two scales in different contexts are needed.

Keywords: Brief Pain Inventory; Musculoskeletal Conditions; McGill Pain Questionnaire; Reliability; Psychometric Properties; Reproducibility; Systematic Review

Summary for Lay Audience

What is the problem? Musculoskeletal (MSK) refers to anything related to our muscles, tendons, joints and connective tissue. Pain that comes from any of these tissues is called MSK pain. MSK pain is one of the most common reasons people seek treatment from a doctor or therapist, so the better we understand this pain, the better decisions we can make about treatment. An important way of measuring MSK pain is by asking the person to give ratings for different aspects of their pain using tools called patient-reported outcome measures (or PROMS for short). Health care providers use PROMs for pain assessment because they are simple and affordable. But more important, they give accurate scores that help monitor treatment progress from the person’s own view. Researchers and health care providers need to know which tools are best for MSK pain, especially when they are used to assess more than one condition, like fractures and tendonitis.

Study question: The key question in my thesis work was: is there enough good evidence that researchers and health care providers can feel confident using the Brief Pain Inventory Short-Form (BPI-SF) and Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) for measuring MSK pain?

How did we study the problem? We did a careful search of online libraries of health science research to find every study we could that told us about both tools. We recorded all the key information about how well they measured MSK pain. Then, we assessed and compared the quality of these studies, so we knew what information was best. In our second study, we checked if the SF-MPQ-2 gave us the same (reliable) scores when it was used by patients coming to see a doctor because of shoulder pain at two different times.

What did we learn? After all these studies, we concluded that the BPI-SF currently has more good quality evidence backing its use in MSK condition than the SF-MPQ-2. We are also confident that SF-MPQ-2 will probably be a good tool for measuring MSK shoulder pain since it yields consistent scores from our evaluation.

What do we still not know? Researchers and health care providers who want to use these tools should be aware that they are not yet the ‘gold standard’. More research is needed to confirm some of their measurement properties in different kinds of MSK pain problems.

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