Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy


Health and Rehabilitation Sciences


Walton, David M.


Numerous self-report questionnaires have been used in pain research to explore patients' experiences. However, these questionnaires often employ negatively worded items that can potentially worsen patients' distress. In response to the emergence of positive psychology, this thesis aimed to develop a new questionnaire that adopts a positive and strengths-focused approach, incorporating resilience, to replace the negative items found in existing tools such as the Pain Catastrophizing Scale (PCS). First, the effectiveness of the Connor-Davidson Resilience Scale (CD-RISC) in measuring resilience following trauma was assessed through a systematic review using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The review revealed that the CD-RISC may not adequately capture resilience in the context of trauma. Consequently, a new tool called the Post-traumatic Resilience Scale was theorized and developed to address these limitations. In line with the potential benefits of positive psychological factors such as optimism in mitigating the effects of trauma, the 2nd and 3rd studies of this thesis aimed to explore these factors within the framework of Post-traumatic Resilience and Optimism (PTRO). In developing the initial items for the prototype Pain Resilience and Optimism Scale (PROS), researchers reversed the polarity of 13 items from the widely used PCS, transforming them into positively worded items. Feedback from three patients with chronic pain contributed to the creation of the 13-item test version of the PROS. Validation of the PROS involved a sample of Canadian military veterans with chronic pain. The refined version of the scale consisted of eight items categorized into two subfactors: Pain Optimism (5 items) and Pain Resilience (3 items). The reduction in items aligns with previous findings that a shorter version of the PCS adequately measures pain catastrophizing. In conclusion, this thesis proposes the PROS as a new measurement tool for research and clinical use. The validation analyses demonstrate promising psychometric properties, although further research is needed for replication. Incorporating advanced measurement models such as Item Response Theory may enhance the reliability and validity of the PROS in evaluating pain resilience and optimism.

Summary for Lay Audience

Pain is a widespread issue that affects many people, and researchers use questionnaires to understand how people experience and cope with pain. However, most of these questionnaires ask questions in a negative way, which can make people recall and relive their painful experiences, causing more distress. This thesis aimed to develop a new questionnaire that focuses on positive aspects and strengths, such as resilience, to replace the negative questions found in existing tools such as the Pain Catastrophizing Scale (PCS). The Connor-Davidson Resilience Scale (CD-RISC) is commonly used to measure resilience, but it may not be effective in capturing resilience after a traumatic event. Thus, a systematic review was conducted to assess the CD-RISC's ability to measure resilience in post-trauma situations. The review found that the CD-RISC has limitations in this context, which led to the development of a new tool called the Post-traumatic Resilience Scale. Optimism has the potential to lessen the impact of traumatic events. The new questionnaire, called the Pain Resilience and Optimism Scale (PROS), was developed based on the idea that resilience and optimism can influence how people experience pain. To create the PROS, researchers transformed negative questions from the PCS into positive ones. We also gathered feedback from people living with chronic pain to ensure the questionnaire was relevant and meaningful. The PROS was then tested with a group of Canadian military veterans to validate its effectiveness. The results showed that the PROS is a reliable tool to assess pain resilience and optimism. In summary, this thesis reveals the limitations of the CD-RISC in measuring resilience after MSK trauma and introduces the PROS as a better alternative. The development and validation of the PROS offer a new way to understand how people cope with pain. By focusing on positive aspects such as resilience and optimism, this questionnaire provides valuable insights into the experiences of people dealing with pain and trauma.