title: Assessment of pain and activity using an electronic pain diary and actigraphy device in a randomized, placebo-controlled crossover trial of celecoxib in osteoarthritis of the knee. Accuracy of the Pain Numeric Rating Scale as a Screening Test in Primary Care Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale Patient-Reported Outcomes Measurement Information System (PROMIS) instruments among individuals with symptomatic knee osteoarthritis: a cross-sectional study of floor/ceiling effects and construct validity Validity, reliability, and responsiveness of a digital version of the visual analog scale. Performance of a Patient Reported Outcomes Measurement Information System (PROMIS) Short Form in Older Adults with Chronic Musculoskeletal Pain. Ability of early response to predict discharge outcomes with physical therapy for chronic low back pain. Responsiveness of the 24-, 18- and 11-item versions of the Roland Morris Disability Questionnaire Preliminary validation of the Defense and Veterans Pain Rating Scale (DVPRS) in a military population. Outcome measures in chronic low back pain Minimal Clinically Important Change for Pain Intensity, Functional Status, and General Health Status in Patients With Nonspecific Low Back Pain Lost productive time and cost due to common pain conditions in the US workforce. Comparative Responsiveness of Pain Outcome Measures Among Primary Care Patients With Musculoskeletal Pain Accurately measuring the quality and effectiveness of cervical spine surgery in registry efforts: determining the most valid and responsive instruments. Reliability and Construct Validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) Instruments in Women with Fibromyalgia Comparative Responsiveness of the PROMIS Pain Interference Short Forms, Brief Pain Inventory, PEG, and SF-36 Bodily Pain Subscale Reliability and Validity of 6 Measures of Pain, Function, and Disability for Ankle Arthroplasty and Arthrodesis
abstract: OBJECTIVE The primary goal was to determine whether a composite measure of pain and activity is a more responsive assessment of analgesic effect than pain alone or activity alone in patients with osteoarthritis ( OA ) of the knee . DESIGN We conducted a r and omized , double-blind , placebo-controlled , 2-period , crossover study of celecoxib vs. placebo in subjects with chronic pain due to knee OA . Patients with knee OA and baseline pain intensity score ≥4 on a 0 - 10 numerical rating scale ( NRS ) before each period were r and omized . Pain endpoints included in-clinic pain score ( 24-hour and 1-week recall ) , daily paper diary pain score , current pain on an electronic pain diary ( each on NRS ) , and WOMAC pain subscale . Activity measures included WOMAC function subscale and actigraphy using a device . Three composite pain-activity measures were prespecified . RESULTS Sixty-three patients were r and omized and 47 completed the study . The WOMAC pain subscale was the most responsive of all five pain measures . Pain-activity composites result ed in a statistically significant difference between celecoxib and placebo but were not more responsive than pain measures alone . However , a composite responder defined as having 20 % improvement in pain or 10 % improvement in activity yielded much larger differences between celecoxib and placebo than with pain scores alone . Actigraphy was more responsive than the WOMAC function scale , possibly due to lower placebo responsiveness . CONCLUSION We have identified composite pain-activity measures that are similarly or more responsive than pain-alone measures in patients with OA . Further research is warranted to determine the optimal method for computing these composites BACKGROUND Universal pain screening with a 0–10 pain intensity numeric rating scale ( NRS ) has been widely implemented in primary care . OBJECTIVE To evaluate the accuracy of the NRS as a screening test to identify primary care patients with clinical ly important pain . DESIGN Prospect i ve diagnostic accuracy study PARTICIPANTS 275 adult clinic patients were enrolled from September 2005 to March 2006 . MEASUREMENTS We operationalized clinical ly important pain using two alternate definitions : ( 1 ) pain that interferes with functioning ( Brief Pain Inventory interference scale ≥ 5 ) and ( 2 ) pain that motivates a physician visit ( patient-reported reason for the visit ) . RESULTS 22 % of patients reported a pain symptom as the main reason for the visit . The most common pain locations were lower extremity ( 21 % ) and back/neck ( 18 % ) . The area under the receiver operator characteristic curve for the NRS as a test for pain that interferes with functioning was 0.76 , indicating fair accuracy . A pain screening NRS score of 1 was 69 % sensitive ( 95 % CI 60–78 ) for pain that interferes with functioning . Multilevel likelihood ratios for scores of 0 , 1–3 , 4–6 , and 7–10 were 0.39 ( 0.29–0.53 ) , 0.99 ( 0.38–2.60 ) , 2.67 ( 1.56–4.57 ) , and 5.60 ( 3.06–10.26 ) , respectively . Results were similar when NRS scores were evaluated against the alternate definition of clinical ly important pain ( pain that motivates a physician visit ) . CONCLUSIONS The most commonly used measure for pain screening may have only modest accuracy for identifying patients with clinical ly important pain in primary care . Further research is needed to evaluate whether pain screening improves patient outcomes in primary care & NA ;  Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo‐controlled clinical trials of pregabalin in diabetic neuropathy , postherpetic neuralgia , chronic low back pain , fibromyalgia , and osteoarthritis were used . The studies had similar design s and measurement instruments , including the PI‐NRS , collected in a daily diary , and the st and ard seven‐point patient global impression of change ( PGIC ) , collected at the endpoint . The changes in the PI‐NRS from baseline to the endpoint were compared to the PGIC for each subject . Categories of ‘ much improved ’ and ‘ very much improved ’ were used as determinants of a clinical ly important difference and the relationship to the PI‐NRS was explored using graphs , box plots , and sensitivity/specificity analyses . A consistent relationship between the change in PI‐NRS and the PGIC was demonstrated regardless of study , disease type , age , sex , study result , or treatment group . On average , a reduction of approximately two points or a reduction of approximately 30 % in the PI‐NRS represented a clinical ly important difference . The relationship between percent change and the PGIC was also consistent regardless of baseline pain , while higher baseline scores required larger raw changes to represent a clinical ly important difference . The application of these results to future studies may provide a st and ard definition of clinical ly important improvement in clinical trials of chronic pain therapies . Use of a st and ard outcome across chronic pain studies would greatly enhance the comparability , validity , and clinical applicability of these studies Background The psychometric properties of Patient Reported Outcomes Measurement Information System ( PROMIS ) instruments have been explored in a number of general and clinical sample s. No study , however , has evaluated the psychometric function of these measures in individuals with symptomatic knee osteoarthritis ( KOA ) . The aim of this project was to evaluate the construct ( structural ) validity and floor/ceiling effects of four PROMIS measures in this population . Methods We conducted a secondary analysis of baseline data from a r and omized trial comparing Tai Chi and physical therapy . Participants completed four PROMIS static short-form instruments ( i.e. , Anxiety , Depression , Physical Function , and Pain Interference ) as well as six well-vali date d ( legacy ) measures that assess pain , function , and psychological health . We calculated descriptive statistics and percentages of participants scoring the minimum ( floor ) and maximum ( ceiling ) possible scores for PROMIS and legacy measures . We also estimated the association between PROMIS scores and scores on legacy measures using Spearman ’s rank correlations coefficients . Results Data from 204 participants were analyzed . Mean age of the sample was 60 years ; 70 % were female .  The PROMIS Anxiety and Depression had floor effects with 17 and 24 % of participants scoring the minimum , respectively . PROMIS Anxiety and Depression scores had strongest associations with general mental health , including stress ( Perceived Stress Scale , r ≥ 0.65 ) and depression ( Beck Depression Index-II , r = 0.70 ) . PROMIS Pain Interference scores correlated most strongly with measures of whole body pain ( Short-Form 36 Bodily Pain , r = −0.73 ) and physical health ( Short-Form 36 Physical-Component Summary , r = −0.73 ) ; their correlations were lower with other legacy measures , including with the WOMAC knee-specific pain ( r = 0.47 ) . PROMIS Physical Function scores had stronger associations with scores on the Short-Form 36 Physical Function ( r = 0.79 ) than with scores on other legacy measures . Conclusion The four PROMIS static-short forms performed well among individuals with symptomatic knee osteoarthritis as evidence d in correlations with legacy measures . PROMIS Anxiety and Depression target general mental health ( e.g. , stress , depression ) , and PROMIS Pain Interference and Physical Function static-short forms target whole-body outcomes among participants with symptomatic knee osteoarthritis . Floor effects in the PROMIS Anxiety and Depression scores should be considered if needing to distinguish among patients with very low levels of these outcomes .Trial registration Clinical trials.gov NCT01258985 . Registered 10 December UNLABELLED The design used in this study was a prospect i ve cohort . Pain intensity levels recorded by the digital version of the visual analog scale ( VAS-D ) are easy to both score and share with other health care professionals . The purpose of the study was to examine the test-retest reliability , concurrent validity , and responsiveness of the VAS-D.  Thirty-three people with upper extremity injuries reported pain intensity levels before and after performing four maximal grip contractions ( pre- and postgripping ) . Our version of the VAS-D had high test-retest reliability ( r=0.96 ) and good concurrent validity ( r=0.84 - 0.97 ) with both the paper version of the VAS ( VAS-P ) and the verbal numerical rating scale ( NRS-V ) . Responsiveness of the VAS-D was indicated by a significant increase in pain levels from pre- to postgripping . Similar responsiveness to that of the VAS-P and NRS-V was indicated by similar effect size coefficients and analysis of variance of pain change scores . In conclusion , the VAS-D is a reliable , valid , and responsive measure of pain intensity for people with upper extremity injuries . However , differences in accuracy ( resolution ) among the VAS-D , VAS-P , or NRS-V may render the three pain scales not fully compatible . LEVEL OF EVIDENCE Not applicable OBJECTIVE To assess reliability , validity , and responsiveness of a 29-item short-form version of the Patient Reported Outcomes Measurement Information System ( PROMIS ) and a novel “ impact score ” calculated from those measures . DESIGN Prospect i ve cohort study . SETTING Rural primary care practice s. SUBJECTS Adults aged ≥ 55 years with chronic musculoskeletal pain , not currently receiving prescription opioids . METHODS Subjects completed the PROMIS short form at baseline and after 3 months . Patient subsets were compared to assess reliability and responsiveness . Construct validity was tested by comparing baseline scores among patients who were or were not applying for Worker 's Compensation ; those with higher or lower catastrophizing scores ; and those with or without recent falls . Responsiveness was assessed with mean score changes , effect sizes , and st and ardized response means . RESULTS Internal consistency was good to excellent , with Cronbach 's alpha between 0.81 and 0.95 for all scales . Among patients who rated their pain as stable , test-retest scores at 3 months were around 0.70 for most scales . PROMIS scores were worse among patients seeking or receiving worker 's compensation , those with high catastrophizing scores , and those with recent falls . Among patients rating pain as “ much less ” at 3 months , absolute effect sizes for the various scales ranged from 0.24 ( Depression ) to 1.93 ( Pain Intensity ) . CONCLUSIONS Results indicate that the PROMIS short 29-item form may be useful for the study of patients with chronic musculoskeletal pain . Our findings also support use of the novel “ impact score ” recommended by the National Institutes of Health ( NIH ) Task Force on Research St and ards for Chronic Low Back Pain OBJECTIVE To determine how well early responses to physical therapy for chronic low back pain predict outcomes at discharge . METHODS A prospect i ve single cohort study of chronic low back pain patients seen at a university spine physical therapy clinic . Self-reported pain severity on a 100-mm visual analog scale was measured before each physical therapy visit . The predictive variables were the change in pain score at the second , third , and fourth visits . The first outcome variable was discharge change in pain severity for a correlation analysis . The second outcome variable was a dichotomous variable of whether the subjects had achieved at least a 30 % reduction in pain severity at discharge for a discriminant analysis . RESULTS Spearman 's rank order correlation coefficient showed that early responses at the second ( r = 0.324 , P = 0.02 ) third ( r = 0.342 , P = 0.01 ) , and fourth visits ( r = 0.615 , P < 0.001 ) were all significantly correlated with discharge change in pain . The discriminant analysis showed that early responses from the second to fourth visits were able to correctly predict 80.4 % of the discharge outcomes ( P < 0.001 ) . CONCLUSIONS Early responses with physical therapy help predict discharge outcomes for chronic low back pain Several versions of the 24-item Rol and Morris Disability Question naire ( RMDQ ) have been proposed ; however , their responsiveness has not been extensively explored . The objective of this study was to compare the responsiveness of four versions of the RMDQ .  Perceived disability was measured using the 24-item , two 18-item and an 11-item RMDQ on 1,069 low back pain patients from six r and omised controlled trials .  Responsiveness was calculated using effect size , Guyatt ’s responsiveness index ( GRI ) and receiver operating characteristics ( ROC ) curves . Effect size analyses showed that both 18-item versions of the RMDQ were superior to the 24- and 11-item versions of the RMDQ . GRI showed that the 24- and 18-item versions of the RMDQ were similar but more responsive than the 11-item . ROC curves revealed that the 11-item was less responsive than the other three versions , which had similar responsiveness . The results of this study demonstrate that the 24-item and both 18-item versions of the RMDQ have similar responsiveness with all having superior responsiveness to the 11-item BACKGROUND The Army Surgeon General released the Pain Management Task Force final report in May 2010 . Among military providers , concerns were raised that the st and ard numeric rating scale ( NRS ) for pain was inconsistently administered and of question able clinical value . In response , the Defense and Veterans Pain Rating Scale ( DVPRS ) was developed . METHODS The instrument design integrates pain rating scale features to improve interpretability of incremental pain intensity levels , and to improve communication and documentation across all transitions of care . A convenience sample of 350 inpatient and outpatient active duty or retired military service members participated in the study at Walter Reed Army Medical Center . Participants completed the five-item DVPRS-one pain intensity NRS with and without word descriptors presented in r and om order and four supplemental items measuring general activity , sleep , mood , and  level of stress and the Brief Pain Inventory seven interference items . Using systematic sampling , a r and om sample was selected for a word descriptor validation procedure matching word phases to corresponding pain intensity on the NRS . RESULTS Parallel forms reliability and concurrent validity testing demonstrated a robust correlation . When the DVPRS was presented with the word descriptors first , the correlation between the two ratings was slightly higher , r = 0.929 ( N = 171 ; P < 0.001 ) , than ordering first without the descriptors , r = 0.882 ( N = 177 ; P < 0.001 ) . Intraclass correlation coefficient was 0.943 showing excellent alignment of word descriptors by respondents ( N = 42 ) , matching them correctly with pain level . CONCLUSIONS The DVPRS tool demonstrated acceptable psychometric properties in a military population The purpose of this prospect i ve , single site cohort quasi-experimental study was to determine the responsiveness of the numerical rating scale ( NRS ) , Rol and –Morris disability question naire ( RMDQ ) , Oswestry disability index ( ODI ) , pain self-efficacy question naire ( PSEQ ) and the patient-specific functional scale ( PSFS ) in order to determine which would best measure clinical ly meaningful change in a chronic low back pain ( LBP ) population . Several patient-based outcome instruments are currently used to measure treatment effect in the chronic LBP population . However , there is a lack of consensus on what constitutes a “ successful ” outcome , how an important improvement/deterioration has been defined and which outcome measure(s ) best captures the effectiveness of therapeutic interventions for the chronic LBP population . Sixty-three consecutive patients with chronic LBP referred to a back exercise and education class participated in this study ; 48 of the 63 patients had complete data . Five question naires were administered initially and after the 5-week back class intervention . Also at 5 weeks , patients completed a global impression of change as a reflection of meaningful change in patient status . Score changes in the five different question naires were subjected to both distribution- and anchor-based methods : st and ard error of measurement ( SEM ) and receiver operating characteristic ( ROC ) curves to define clinical improvement . From these methods , the minimal clinical ly important difference ( MCID ) defined as the smallest difference that patients and clinicians perceive to be worthwhile is presented for each instrument . Based on the SEM , a point score change of 2.4 in the NRS , 5 in the RMDQ , 17 in the ODI , 11 on the PSEQ , and 1.4 on the PSFS corresponded to the MCID . Based on ROC curve analysis , a point score change of 4 points for both the NRS and RMDQ , 8 points for the ODI , 9 points for the PSEQ and 2 points for the PSFS corresponded to the MCID . The ROC analysis demonstrated that both the PSEQ and PSFS are responsive to clinical ly important change over time . The NRS was found to be least responsive . The exact value of the MCID is not a fixed value and is dependent on the assessment method used to calculate the score change . Based on ROC curve analysis the PSFS and PSEQ were more responsive than the other scales in measuring change in patients with chronic LBP following participation in a back class programme . However , due to the small sample size , the lack of observed worsening of symptoms over time , the single centre and intervention studied these results which need to be interpreted with caution Study Design . Cohort study . Objectives . To estimate the Minimal Clinical ly Important Change ( MCIC ) of the pain intensity numerical rating scale ( PI-NRS ) , the Quebec Back Pain Disability Scale ( QBPDS ) , and the Euroqol ( EQ ) in patients with low back pain . Summary of Background Data . MCIC can provide valuable information for research ers , healthcare providers , and policymakers . Methods . Data from a r and omized controlled trial with 442 patients with low back pain were used . The MCIC was estimated over a 12-week period , and three different methods were used : 1 ) mean change scores , 2 ) minimal detectable change , and 3 ) optimal cutoff point in receiver operant curves . The global perceived effect scale ( GPE ) was used as an external criterion . The effect of initial scores on the MCIC was also assessed . Results . The  MCIC of the PI-NRS ranged from 3.5 to 4.7 points in (sub)acute patients and 2.5 to 4.5 points in chronic patients with low back pain . The  MCIC of the QBPDS was estimated between 17.5 to 32.9 points and 8.5 to 24.6 points for (sub)acute and chronic patients with low back pain . The  MCIC for the EQ ranged from 0.07 to 0.58 in (sub)acute patients and 0.09 to 0.28 in patients with chronic low back pain . Conclusion . Reporting the percentage of patients who have made a MCIC adds to the interpretability of study results . We present a range of MCIC values and advocate the choice of a single MCIC value according to the specific context CONTEXT Common pain conditions appear to have an adverse effect on work , but no comprehensive estimates exist on the amount of productive time lost in the US workforce due to pain . OBJECTIVE To measure lost productive time ( absence and reduced performance due to common pain conditions ) during a 2-week period . DESIGN AND SETTING Cross-sectional study using survey data from the American Productivity Audit ( a telephone survey that uses the Work and Health Interview ) of working adults between August 1 , 2001 , and July 30 , 2002 . PARTICIPANTS R and om sample of 28 902 working adults in the United States . MAIN OUTCOME MEASURES Lost productive time due to common pain conditions ( arthritis , back , headache , and other musculoskeletal ) expressed in hours per worker per week and calculated in US dollars . RESULTS Thirteen percent of the total workforce experienced a loss in productive time during a 2-week period due to a common pain condition . Headache was the most common ( 5.4 % ) pain condition result ing in lost productive time . It was followed by back pain ( 3.2 % ) , arthritis pain ( 2.0 % ) , and other musculoskeletal pain ( 2.0 % ) . Workers who experienced lost productive time from a pain condition lost a mean ( SE ) of 4.6 ( 0.09 ) h/wk . Workers who had a headache had a mean ( SE ) loss in productive time of 3.5 ( 0.1 ) h/wk . Workers who reported arthritis or back pain had mean ( SE ) lost productive times of 5.2 ( 0.25 ) h/wk . Other common pain conditions result ed in a mean ( SE ) loss in productive time of 5.5 ( 0.22 ) h/wk . Lost productive time from common pain conditions among active workers costs an estimated 61.2 billion dollars per year . The majority ( 76.6 % ) of the lost productive time was explained by reduced performance while at work and not work absence . CONCLUSIONS Pain is an inordinately common and disabling condition in the US workforce . Most of the pain-related lost productive time occurs while employees are at work and is in the form of reduced performance Background : Comparative responsiveness data are needed to inform choices about pain outcome measures . Objectives : To compare responsiveness of pain intensity , pain-related function , and composite measures , using data from a r and omized trial and observational study . Research Design : Analysis of responsiveness . Subjects : A total of 427 adults with persistent back , hip , or knee pain were recruited from primary care . Methods : Participants completed  Brief Pain Inventory , Chronic Pain Grade ( CPG ) , Rol and disability ,  SF-36 bodily pain  , and pain global rating of change measures . We used the global rating as the anchor for st and ardized response mean and receiver operating characteristic curve analyses . We used the distribution-based st and ard error of measurement to estimate minimally important change . To assess responsiveness to the trial intervention , we evaluated st and ardized effect size statistics stratified by trial arm . Results : All measures were responsive to global improvement and all had fair-to-good accuracy in discriminating between participants with and without improvement . SF bodily pain was less responsive than other measures in several analyses . The 3-item PEG was similarly responsive to full Brief Pain Inventory scales . CPG and SF bodily pain were less responsive to the trial intervention and did not perform well among participants with hip/knee pain . Agreement between anchor and distribution-based methods was modest . Conclusions : If a brief measure is desired , the 3-item PEG is more responsive than the SF bodily pain scale . CPG and SF bodily pain scales may be relatively poor choices for trial outcome assessment . Both anchor and distribution-based methods should be considered when determining clinical ly important change BACKGROUND CONTEXT There is a growing dem and to measure the real-world effectiveness and value of care across all specialties and disease states . Prospect i ve registries have emerged as a feasible way to capture real-world care across large patient population s. However , the proven validity of more robust and cumbersome patient-reported outcome instruments ( PROi ) must be balanced with what is feasible to apply in large-scale registry efforts . Hence , commercial registry efforts that measure quality and effectiveness of care in an attempt to guide quality improvement , pay for performance , or value-based purchasing should incorporate measures that most accurately represent patient-centered improvement . PURPOSE We set out to establish the relative validity and responsiveness of common PROi in accurately determining effectiveness of cervical surgery for neck and arm pain in registry efforts . STUDY DESIGN Prospect i ve cohort study . PATIENT SAMPLE Eighty-eight patients undergoing primary anterior cervical discectomy and fusion ( ACDF ) for neck and arm pain . OUTCOME MEASURES Patient-reported outcome measures for pain ( numeric rating scale for neck pain [ NRS-NP ] and arm pain [ NRS-AP ] ) , disability ( neck disability index [ NDI ] ) , general health ( short-form 12-item survey physical component summary [ SF-12 PCS ] and mental component summary [ SF-12 MCS ] ) , and quality of life ( Euro-Qol-5D [ EQ-5D ] ) were assessed . METHODS Eighty-eight patients undergoing primary ACDF for neck and arm pain were entered into a Web-based prospect i ve registry . Baseline and 12-month patient-reported outcomes ( NRS-NP , NRS-AP , NDI , SF-12 PCS , SF-12 MCS , and EQ-5D ) were assessed . Patients were also asked whether they experienced a level of improvement after ACDF that met their expectation ( meaningful improvement ) . To assess the validity of NRS-NP , NRS-AP , and NDI ( measures of pain and disability ) to discriminate between meaningful and nonmeaningful improvement and the validity of SF-12 PCS , SF-12 MCS , and EQ-5D ( measures of general health and quality of life ) to discriminate between meaningful and nonmeaningful improvement , receiver-operating characteristic curves were generated for each outcome instrument . The greater the area under the curve ( AUC ) , the more valid the discriminator . The difference between st and ardized response means ( SRMs ) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each outcome instrument to changes in  pain and QOL after surgery . RESULTS For pain and disability , both NDI ( AUC=0.75 ) and NRS-AP ( AUC=0.74 ) were valid discriminators of meaningful improvement . Numeric rating scale for neck pain ( AUC=0.69 ) was a poor discriminator . Neck disability index was also most responsive to postoperative improvement ( SRM difference 0.78 ) , followed by NRS-AP ( SRM difference 0.59 ) and NRS-NP ( SRM difference 0.46 ) . For general health and quality of life , SF-12 PCS ( AUC=0.79 ) was the only valid discriminator of meaningful improvement . Euro-Qol-5D ( AUC=0.68 ) and SF-12 MCS ( AUC=0.44 ) were poor discriminators . Short-form 12 physical component summary ( SRM difference 1.08 ) was also most responsive compared with EQ-5D ( SRM difference 0.89 ) and SF-12 MCS ( SRM difference 0.01 ) . CONCLUSIONS For pain and disability , NDI is the most valid and responsive measure of improvement after surgery for neck and arm pain . Numeric rating scale for neck pain and NRS-AP are poor substitutes for NDI when measuring effectiveness of care in registry efforts . For health-related quality of life , only SF-12 PCS could accurately discriminate meaningful improvement after cervical surgery and was found to be most valid and responsive . Large-scale registry efforts aim ed at measuring effectiveness of cervical spine surgery should use NDI and SF-12 to accurately assess improvements in pain , disability , and quality of life Objective The Patient-Reported Outcomes Measurement Information System ( PROMIS ) was developed to st and ardize measurement of clinical ly relevant patient-reported outcomes . This study evaluated the reliability and construct validity of select PROMIS static short-form ( SF ) instruments in women with fibromyalgia . Design Analysis of baseline data from the Fibromyalgia Activity Study with TENS ( FAST ) , a r and omized controlled trial of the efficacy of transcutaneous electrical nerve stimulation . Setting Dual site , university-based outpatient clinics . Subjects Women aged 20 to 67 years diagnosed with fibromyalgia . Methods Participants completed the Revised Fibromyalgia Impact Question naire ( FIQR ) and 10 PROMIS static SF instruments . Internal consistency was calculated using Cronbach alpha . Convergent validity was examined against the FIQR using Pearson correlation and multiple regression analysis . Results PROMIS static SF instruments had fair to high internal consistency ( Cronbach α = 0.58 to 0.94 , P < 0.05 ) . PROMIS ' physical function ' domain score was highly correlated with FIQR ' function ' score ( r = -0.73 ) . The PROMIS ' total ' score was highly correlated with the FIQR total score ( r = -0.72 ) . Correlations with FIQR total score of each of the three PROMIS domain scores were r = -0.65 for ' physical function , ' r = -0.63 for ' global , ' and r = -0.57 for ' symptom ' domain . PROMIS ' physical function , ' ' global , ' and ' symptom ' scores explained 58 % of the FIQR total score variance . Conclusions Select PROMIS static SF instruments demonstrate convergent validity with the FIQR , a legacy measure of fibromyalgia disease severity . These results highlight the potential utility of select PROMIS static SFs for assessment and tracking of patient-reported outcomes in fibromyalgia Purpose : To compare the sensitivity to change and the responsiveness to intervention of the PROMIS Pain Interference short forms , Brief Pain Inventory ( BPI ) , 3-item PEG scale , and SF-36 Bodily Pain subscale in a sample of patients with persistent musculoskeletal pain of moderate severity . Methods : St and ardized response means , st and ardized effect sizes , and receiver operating curve analyses were used to assess change between baseline and 3-month assessment s in 250 participants who participated in a r and omized clinical effectiveness trial of collaborative telecare management for moderate to severe and persistent musculoskeletal pain . Results : The BPI , PEG , and SF-36 Bodily Pain measures were more sensitive to patient-reported global change than the PROMIS Pain Interference short forms , especially for the clinical ly improved group , for which the change detected by the PROMIS short forms was not statistically significant . The BPI was more responsive to the clinical intervention than the SF-36 Bodily Pain and PROMIS Pain Interference measures . Post hoc analyses exploring these findings did not suggest that differences in content or rating scale structure ( number of response options or anchoring language ) adequately explained the observed differences in the detection of change . Conclusions : In this clinical trial , the BPI and PEG measures were better able to detect change than the SF-36 Bodily Pain and PROMIS Pain Interference measures Background : Patient-reported outcome measures are increasingly used evaluating clinical care . Many measures used to assess operative hindfoot interventions vary in content , and some have not been psychometrically vali date d in this population . The purpose of this study was to compare measurement properties of  6 lower-extremity patient-reported outcome measures  , and to evaluate their reliability and validity in light of patients ’ preferences . Methods : Cross-sectional survey of 42 preoperative and 100 postoperative patients completed 6 lower-extremity outcome measures  on 2 occasions : Foot Function Index ( FFI ) , Ankle Osteoarthritis Scale ( AOS ) , patient-reported items of the  American  Orthopaedic Foot & Ankle Society Question naire ( AOFAS ) , Lower Extremity Functional Scale ( LEFS ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and the Short Musculoskeletal Function Assessment ( SMFA ) , as well as measures of preference , and symptoms . Results : Internal consistency was good to excellent for all scales and subscales ( α = .84-.97 ; ICC [ 2,1 ] = .81-.96 ) . Correlations between scales ranged from .50 ( WOMACStiffness and FFIActivity Limitations ) to .92 ( LEFS and SMFAOverall , WOMACPain and AOSOverall , FFIOverall and AOFASOverall ) . Higher correlations occurred within instruments ( r = .97 AOSPain and AOSOverall ) and between similar subscales from different instruments ( r = .91 WOMACPain and AOSPain ) . Construct validity showed moderate to high correlations to global ratings of Pain , Stiffness , and difficulty performing Daily Activities . The highest correlations ( r > .75 ) occurred between Pain and AOSOverall ( r = .84 ) , stiffness and WOMACStiffness ( r = .81 ) , and Daily Activities and AOSDisability ( r = .87 ) . Patients rated instruments by preference . FFI , WOMAC , LEFS , and SMFA rated favorably for length . FFI , WOMAC , LEFS , and AOFAS rated high for underst and ability . FFI was rated by postoperative patients as most likely to capture change due to surgery . SMFA rated the best overall . Conclusions : Direct comparison of instruments revealed similarity between scales in construct validity and reliability . Patient preferences supported the use of these scales . Foot-specific instruments offered no clear advantage over lower-extremity instruments . Level of Evidence : Level II , prospect i ve comparative study
target: Our primary outcome was the measure ’s minimal important difference ( MID ) .
  Conclusions In this focused evidence review , the most evidence on key psychometric properties in chronic musculoskeletal pain population s was found for the ODI , RMDQ , SF-36 BPS , NRS , and VAS .
background: Background Developing successful interventions for chronic musculoskeletal pain requires valid , responsive , and reliable outcome measures .
  The Minneapolis VA Evidence -based Synthesis Program completed a focused evidence review on key psychometric properties of 17 self-report measures of pain severity and pain-related functional impairment suitable for clinical research on chronic musculoskeletal pain .