New Information on the Use of the Pain Outcomes Profile

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New Information on the Use of the Pain Outcomes
Profile

• Alexandra Campbell, PhD
• American Academy of Pain Management
• Sonora, CA
• Michael Schatman, PhD
• Consulting Clinical Psychologist
• Redmond, WA

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Conflict of Interest/Financial Disclosure

• Alexandra Campbell, PhD
• Director, Pain Program Accreditation
• Outcomes Measurement
• American Academy of Pain Management
• Sonora, CA
• Dr. Campbell is employed by the American Academy
  of Pain Management, the publisher of the Pain
  Outcomes Profile

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Conflict of InterestFinancial Disclosure

• Michael Schatman, PhD
• Consulting Clinical Psychologist
• Redmond, Washington
• Dr. Schatman was the developer of the Accredited
  Pain Program at PinnacleHealth Rehab Options and
  is a Pain Program Accreditation Surveyor
  (Independent Contractor)

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Comprehensive Measures of Emotional and
Behavioral Sequelae of Chronic Pain

• Coping Strategies Questionnaire Rosentiel
  Keefe, 1983
• Multidimensional Pain Inventory Kerns, Turk
  Rudy, 1985
• Behavioral Assessment of Pain Questionnaire
  Tearnan Lewandowski, 1992
• Brief Pain Inventory Cleeland Ryan, 1994
• Chronic Pain Coping Inventory Jensen et al.,
  1995
• Pain Coping Inventory Eimer Allen, 1998
• Profile of Chronic Pain Screen Ruehlman et al,
  2005

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Profile of Chronic Pain Screen

• Strength Brevity (15-item screening tool)
• Limitations Designed as a screening tool for the
  general population, not normed on clinical
  populations

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The Origin of the Pain Outcomes Profile (POP)

• Brief, clinically useful self-report assessment
  tool
• Assesses pain, function and emotional response
• Suitable for multiple measurements across
  treatment
• Administration time 1-5 minutes
• 20 items total (see handout)

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The POP Questionnaire

• Pain Outcomes Profile (POP) Scales
• Pain Intensity Right Now (0-10)
• Pain on Average Past Week (0-10)
• Mobility (5 items, 0-10 items)
• Adls (4 items, 0-10)
• Negative Affect (5 items, 0-10)
• Vitality (3 items, 0-10)

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Scoring Instrument

• Template provided
• Scale scores calculated linear aggregation
• Scoring time minimal
• High scores indicate more impairment (see handout)

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Cumulative Patient Scoring Record

• Easily track POP scores across consecutive
  administrations for individual patients
• More objective estimate of self-reported pain and
  functional impairment
• Can be placed in chart for convenient tracking of
  progress across treatment
• Can be used in patient education to demonstrate
  functional improvement when pain relief may be
  less prominent

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Use of the POP in Clinical Practice

• Why use multiple measures (e.g. Visual Analogue
  or Numerical Pain Rating Scale, Oswestry, Beck
  Depression Inventory, Tampa Scale of
  Kinesophobia) when the POP will give you all of
  this information?

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Use of the POP in Clinical Practice

• Time is money
• Patients may become discouraged or frustrated by
  having to take multiple measures at initial
  assessment as well as at the completion of
  treatment
• Clinical experience suggests that patients are
  less defensive when taking the POP, although this
  needs to be empirically substantiated

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Use of the POP in Clinical Practice

• Increasing demand for outcomes measurement in
  order to receive third-party reimbursement

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Psychometric PropertiesVA Samples

• Equivalent core scales (mob, adl, vit, NA, fear)
  administered to gt1200 veterans with chronic pain
  (instrument named Pain Outcomes Questionnaire in
  VA system)
• Scales demonstrated reliability, stability,
  generalizability, convergent validity,
  discriminant and predictive validity, and
  sensitivity to change (Clark et al., 2003)

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Validation of the POPAAPMs Action Plan

• Administer POP to large sample(s) of non-VA
  chronic pain patients in different settings
• Assess reliability and validity by comparing POP
  scales with gold standard measures of pain and
  functional impairment
• Assess sensitivity of POP to treatment related
  change
• Collect normative data for publication
• Validate Spanish language version of POP

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PinnacleHealth Rehab OptionsValidation Sample 1

• Over 234 patients completed the POP as part of
  evaluation for participation in a comprehensive
  pain management program
• Patients who successfully finished program
  (currently n50) completed POP at discharge

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Correlations Between POP Scales (Pearsons r, n
234) Discriminant Validity

• Avg MOB ADL VIT NA
  Fear
• Curr .68 .39 .36 .11
  .30 .20
• Avg .32 .43 .09
  .34 .14
• MOB .53 .28 .42
  .33
• ADL .18 .52 .33
• VIT .31 .20
• NA .38
• p lt.01, p lt.05

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Correlations Between POP Negative Affect, Fear
and Vitality Scales and Other Affective Measures
(Spearmans rho, n 234) Concurrent Validity

• BDI-II BAI MPQ-a
  TSK-13
• NA .78 .69 .53 .38
• Fear .39 .33 .20 .59
• Vit .40 .25 .20 .08 ns
• All rs p lt.01

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Correlations Between POP Scales and MSPQ, MOPDQ
(Spearmans rho, n 234) Discriminant/Concurrent
Validity

• Curr Avg Mob Adl Vit NA
  Fear
• mspq .11 .26 .30 .29 .21 .49
  .20
• mopdq .40 .30 .53 .50 .33 .37
  .23
• plt.01 plt.05

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Rehab Options Treatment Components

• Physiatric Medical Management
• Individual Psychological Counseling (2-3X qw)
• Psycho Educational Groups (2X qw)
• Nursing Educational Groups
• Biofeedback/Relaxation Training
• Physical Therapy
• Occupational Therapy
• Aquatics
• Vocational Counseling
• Dietary Counseling

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POP Sensitivity to Change (MANOVA, n50)

• Intake Discharge
• F(1,49)
• Curr (1-10) 1.94 36.17
• Avg (1-10) 1.94 61.96
• Mob [phone]
• Adl (1-100) 7.09 8.81
• Vit (1-100) 17.85 56.26
• NA (1-100) 14.51 26.28
• Fear (1-100) 18.90 36.29
• plt.05

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Previously Presented POP Validity Data

• Campbell Schatman. Concurrent validity of the
  negative affect and fear scales of the Pain
  Outcomes Profile, Poster presented, American Pain
  Society Meeting, Boston, MA, March 30 April 2,
  2005.
• Schatman Campbell. Concurrent validity of the
  pain and physical interference scales of the Pain
  Outcomes Profile in chronic spinal pain patients,
  Paper presented, North American Spine Society,
  Philadelphia, PA, September 27 October 1, 2005.

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Previously Presented POP Validity Data

• Campbell, A. Schatman, M. (2005) Validation of
  the Pain Outcomes Profile, Lecture, 16th Annual
  Clinical Meeting, American Academy of Pain
  Management, San Diego, CA, September 23, 2005.
• Campbell, A. Linking Pain Practice Standards
  with Outcomes Measurement Improving Treatment
  Quality through Clinical Pain Research, Paper
  presented, Agency for Healthcare Research and
  Quality Conference Translating Research in
  Policy and Practice, Washington, DC, July 11,
  2006.

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PinnacleHealth Rehab OptionsValidation Sample
2Test-Retest Reliability

• 36 patients completed the POP as part of
  evaluation for participation in a comprehensive
  pain management program 27 cases selected for
  test-retest reliability analysis (outliers
  excluded)
• Patients completed the POP at initial evaluation
  and at admission to the program (mean time
  between POP admins 25.48 days SD 13.50)

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Sample Demographics (n27)

• Female 13 male 14
• Mean age 38 (range 18-58 years)
• Married 67
• Mean educ. 12 years
• Mean pain duration 50 months (4yrs)
• Mean avg. narc daily consum 93 mg morphine
  equivalent (range 0 683 mg, SD 164)

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Demographics, cont.

• Circumstances of Onset of Pain
• Work-related accident 37
• MVA 7
• Arthritis 4
• Other 52

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Demographics, cont.

• Anatomical Location of Pain
• Cervical 15
• Lumbar/Sacral 33
• Headache 4
• Lumbar/Sacral Lower Extremity 26
• Other 22

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Demographics, cont.

• Number of Surgical Procedures for Pain
• None 59
• One 11
• Two 11
• gt Two 19

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Demographics, cont.

• Litigation Status
• Ongoing 26
• N/A 74
• Work Status
• Not working 74
• Working 26

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Number of Days Between Evaluation POP and
Admission POP Administrations (n27)

• Mean No. of Days Between POP administrations 25
• Range 3 49 days
• Standard Deviation 13.49 days

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Partial Correlations POP Scores at Evaluation
and Admission(Controlling for Days Between POPs,
n27)

• Current Pain .76 (p.00)
• Average Pain .64 (p.00)
• Mobility .86 (p.00)
• Adls .81 (p.00)
• Vitality .45 (p.01)
• Negative Affect .61 (p.00)
• Fear .76 (p.00)

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Interpretation of Sample 2 ResultsTest-Retest
Reliability

• Caveat The sample size is small these results
  are preliminary
• The mean length of time between test and retest
  is long, compared with the most commonly used
  periods in the literature (about 1-2 weeks)
• As more data is gathered this analysis will be
  redone with a shorter test-retest gap and a
  larger n
• The Vitality Scale of the POP seems to be the
  least reliable

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Number of Days Between Admission POP and
Discharge POP Administrations (n21)

• Mean No. of Days Between POP administrations 56
• Range 35 - 80 days
• Standard Deviation 13.08 days

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Partial Correlations POP Scores at Admission and
Discharge(Controlling for Days Between POPs,
n21)

• Current Pain .35 (p.07)
• Average Pain .11 (p.32)
• Mobility .50 (p.01)
• Adls .61 (p.002)
• Vitality .11 (p.31)
• Negative Affect .24 (p.16)
• Fear .61 (p.002)

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Conclusions and Next Steps

• The Pain Outcomes Profile shows promise as a
  brief, clinically useful, reliable and valid
  multidimensional pain outcomes measurement tool
• Psychometric analysis of the POP at the level of
  individual items will be performed and the tool
  will be revised as necessary
• Future studies will continue to examine
  test-retest reliability, validity and sensitivity
  to change in different pain populations

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The Future of Outcomes Measurement

• Use of similar scales across pain programs will
  allow for program comparability by clients and
  payors
• Use of online data collection will allow for
  instant benchmarking
• Clinical Quality Improvement methodology can be
  used to answer specific treatment questions at
  multiple sites

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Current Research Partnerships

• The Puerto Rico VA is currently in the process of
  proposing a project to validate the Spanish POP
• The US Naval Hospital in Bremerton, WA is using
  the POP in a residency training program for
  family practice physicians
• A researcher at Harvard Medical School has
  included the Spanish POP in a grant proposal
• The National Pain Institute will be examining the
  Spanish POP in a Cuban immigrant population

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Ongoing Research

• To participate in clinical research using the
  POP
• Contact Dr. Campbell at the Academy.
• Email your CV, a description of the clinical
  program, typical patients, program process,
  outcomes measures currently used, ideas for study
  design
• Depending on current needs a collaborative
  relationship may be established for data
  collection and analysis

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Selected References

• Campbell, A. Cole, B.E. (2006)
  Interdisciplinary Pain Management Programs The
  AAPM Model. In Weiners Pain Management A
  practical guide for clinicians, 7th Ed., Eds
  Mark Boswell and B. Eliot Cole. Taylor Francis,
  NY.
• Clark, M.E., Gironda, R.J., Young, R.W. Jr.
  (2003). Development and validation of the Pain
  Outcomes Questionnaire-VA Electronic version.
  Journal of Rehabilitation Research and
  Development, 40(5), 381.

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Selected References (cont.)

• Cohen, B., Clark, M.E. Gironda, R.W. (2003).
  Assessing fear of (re)injury among chronic pain
  patients Revision of the Tampa Scale of
  Kinesiophobia. Poster presented at the 22nd
  Annual Meeting of the American Pain Society,
  Chicago, IL.
• Kerns, R.D., Turk, D.C., Rudy, T.E. (1985). The
  West Haven-Yale Multidimensional Pain Inventory
  (WHYMPI). Pain, 23, 345-356.
• Melzack, R. (1975) The McGill Pain Questionnaire
  Major properties and scoring methods. Pain, 1,
  277-299.
• Ruehlman, L.S., Karoly, P., Newton, C., Aiken,
  L.S. (2005). The development and preliminary
  validation of a brief measure of chronic pain
  impact for use in the general population. Pain,
  113, 82-90.