A review of general pain measurement tools and instruments for consideration of use in COPD clinical practice

Figures & data

Table 1 Quality criteria for pain measurement tools

Property	Definitiona	Rating	Quality criteriab
Reliability
Internal consistency	The degree of interrelatedness among items	+	Unidimensional (sub)scale AND Cronbach’s alpha between 0.70 and 0.95
		?	Dimensionality unknown OR Cronbach’s alpha not determined
		−	Unidimensional (sub)scale OR Cronbach’s alpha(s) <0.70 or >0.95
Reliability	The degree in which measurement is free from measurement error	+	ICC weighted kappa >0.70
		?	Time interval not indicated or described
		−	ICC OR weighted kappa <0.70
Validity
Content validity	Degree HR-PRO instrument reflects the construct to be measured	+	All questionnaires in target relevant AND complete questionnaire
		?	No target population involvement
		−	Target population considers items in questionnaire irrelevant OR considers questionnaire incomplete OR design method flaw
Criterion validity	Degree HR-PRO instrument reflects “gold standard”	+	Gold standard is true “gold standard” AND correlation with gold standard ≥0.70
		?	Gold standard not the “gold standard” OR uncertain design or method
		−	Correlation with gold standard >0.70
Responsiveness
Responsiveness	Ability of HR-PRO instrument to detect change over time in measured construct	+	Related constructs is higher than unrelated constructs
		?	Correlations determined only with unrelated constructs
		−	Related constructs is lower than unrelated constructs

Notes:

a Definitions of properties and

b quality criteria reprinted from J Clin Epidemiol, 63(7), Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes, 737–745, Copyright (2010), with permission from Elsevier.¹⁶

Abbreviations: HR-PRO, health related-patient reported outcomes; ICC, intraclass correlation coefficients.

Table 2 Overall quality rating assessment of general pain measurement

Level	Criteria
Strong	Consistently good OR contains 1 or more excellent score
Moderate	Consistently fair OR contains 1 excellent or good score
Low	Consistently fair
Unknown	Consistently poor

Note: Data from National Health and Medical Research Council.²⁶

Table 3 Overall quality level of rating from Terwee’s assessment scale for clinimetric properties

Level	Rating
Strong	+++ OR −−−
Moderate	++ OR −−
Low	+ OR −
Unknown	?

Note: Reprinted from J Clin Epidemiol, 60(1), Terwee CB, Bot SDM, de Boer MR, et al, Quality criteria were proposed for measurement properties of health status questionnaires, 34–42, Copyright (2007), with permission from Elsevier.²³

Figure 1 Pain measurement tool search diagram.

Note: Reproduced from Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med. 2009;6(7):e1000097.²⁹

Table 4 Summary of methodological quality assessment of measurement tool using COSMIN checklist

Measure	Internal consistency	Reliability	Content validity	Criterion validity	Responsiveness without gold standard	Responsiveness with gold standard	Interpretability	Design score total (D + G)	Statistical score total (S)	Total (D + G + S)
Pain Catastrophizing Scale^Citation24	D=3	D=3	D=1	G=1	D=3		G=5	16		18
	S=1	S=0			S=1				2
Pain Sensitivity Questionnaire^Citation18	D=5	D=5	D=4	G=4	D=7		G=5	30		33
	S=1	S=1			S=1				3
Defense and Veterans Pain Rating Scale^Citation22	D=3	D=1	D=4	G=4		D=4	G=2	18		21
	S=1	S=1				S=1			3
Pain Evaluation Scale^Citation27	D=1	D=1	D=2	G=2	D=1		G=1	8		9
	S=0	S=0			S=1				1
Geriatric Pain Measure^Citation19	D=5	D=5	D=4	G=4		D=5	G=4	27		29
	S=1	S=1				S=0			2
Painmatcher^Citation20	D=0	D=3	D=0	G=0		D=4	G=1	8		9
	S=0	S=0				S=1			1
Chronic Pain-cat^Citation28	D=4	D=3	D=0	G=0	D=3		G=3	13		13
	S=0	S=0			S=0				0
Profile of Chronic Pain: Screen^Citation21	D=5	D=7	D=0	G=0	D=2		G=4	18		18
	S=0	S=0			S=0				0

Abbreviations: COSMIN, consensus-based standards for the selection of health measurement instruments; D, Design requirement; G, General requirement; S, Statistical methods.

Table 5 Overall score for quality assessment of pain assessment tools using COSMIN 4-point checklist

Measure	Internal consistency	Reliability	Content validity	Criterion validity	Responsiveness	Overall result
Pain Catastrophizing Scale	Poor	Poor	Poor	Fair	Poor	Unknown
Pain Sensitivity Questionnaire	Excellent	Good	Excellent	Fair	Excellent	Strong
Defense and Veterans Pain Rating Scale	Fair	Poor	Excellent	Fair	Poor	Moderate
Pain Evaluation Scale	Poor	Poor	Poor	Fair	Poor	Unknown
Geriatric Pain Measure	Excellent	Poor	Good	Excellent	Poor	Strong
Painmatcher	Poor	Excellent	Poor	Fair	Poor	Low
Chronic Pain-cat	Poor	Poor	Poor	Fair	Poor	Unknown
Profile of Chronic Pain: Screen	Excellent	Good	Poor	Excellent	Excellent	Strong

Abbreviation: COSMIN, consensus-based standards for the selection of health measurement instruments.

Table 6 Quality criteria for pain measurement tools from Terwee’s assessment scale for clinimetric properties

Measure	Internal consistency	Reliabilitya	Content validity	Criterion validityb	Responsiveness	Overall
Pain Catastrophizing Scale	+	?	?	?	NA	+
Pain Sensitivity Questionnaire	+	+	+	?	NA	+++
Defense and Veterans Pain Rating Scale	+	+	+	?	NA	+++
Pain Evaluation Scale	?	?	+	?	NA	+
Geriatric Pain Measure	+	+	+	?	NA	+++
Painmatcher	?	?	?	?	NA	?
Chronic Pain-cat	?	?	?	?	NA	?
Profile of Chronic Pain: Screen	?	?	?	?	NA	?

Notes:

a Individual kappa scores ranged between 0.52 and 0.82 with a majority of kappa scores <0.70.

b No pain tools demonstrated correlation statistics. Strong: +++; Moderate: ++; Low: +; Unknown: ?. Reprinted from J Clin Epidemiol, 60(1), Terwee CB, Bot SDM, de Boer MR, et al, Quality criteria were proposed for measurement properties of health status questionnaires, 34–42, Copyright (2007), with permission from Elsevier.²³

Abbreviation: NA, not applicable.

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