Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA.
J Pain Symptom Manage. 2013 Sep;46(3):413-21. doi: 10.1016/j.jpainsymman.2012.08.006. Epub 2012 Nov 15.
Pain is a common and complex experience for individuals who live with multiple sclerosis (MS) and it interferes with physical, psychological, and social function. A valid and reliable tool for quantifying observed pain behaviors in MS is critical to understand how pain behaviors contribute to pain-related disability in this clinical population.
To evaluate the reliability and validity of a pain behavioral observation protocol in individuals who have MS.
Community-dwelling volunteers with MS (N=30), back pain (N=5), or arthritis (N=8) were recruited based on clinician referrals, advertisements, fliers, web postings, and participation in previous research. Participants completed the measures of pain severity, pain interference, and self-reported pain behaviors and were videotaped doing typical activities (e.g., walking and sitting). Two coders independently recorded frequencies of pain behaviors by category (e.g., guarding and bracing) and interrater reliability statistics were calculated. Naïve observers reviewed videotapes of individuals with MS and rated their pain. The Spearman's correlations were calculated between pain behavior frequencies and self-reported pain and pain ratings by naïve observers.
Interrater reliability estimates indicated the reliability of pain codes in the MS sample. Kappa coefficients ranged from moderate (sighing=0.40) to substantial agreements (guarding=0.83). These values were comparable with those obtained in the combined back pain and arthritis sample. Concurrent validity was supported by correlations with self-reported pain (0.46-0.53) and with self-reports of pain behaviors (0.58). Construct validity was supported by a finding of 0.87 correlation between total pain behaviors observed by coders and mean pain ratings by naïve observers.
Results support the use of the pain behavior observation protocol for assessing pain behaviors of individuals with MS. Valid assessments of pain behaviors of individuals with MS could lead to creative interventions in the management of chronic pain in this population.
疼痛是多发性硬化症（MS）患者常见且复杂的体验，它会干扰身体、心理和社会功能。对于了解疼痛行为如何导致该临床人群的疼痛相关残疾，量化 MS 患者观察到的疼痛行为的有效且可靠的工具至关重要。
评估一种用于评估多发性硬化症患者疼痛行为的观察协议的可靠性和有效性。
根据临床医生的推荐、广告、传单、网络发布以及参与先前研究，招募了 30 名居住在社区的多发性硬化症志愿者、5 名背痛患者和 8 名关节炎患者。参与者完成了疼痛严重程度、疼痛干扰和自我报告的疼痛行为的测量，并进行了典型活动（例如行走和坐姿）的录像。两位编码员独立记录了疼痛行为的发生频率，计算了类目间的信度统计数据。无经验的观察者观看多发性硬化症患者的录像带并对其疼痛进行评分。计算了疼痛行为频率与自我报告的疼痛和无经验观察者的疼痛评分之间的 Spearman 相关系数。
多发性硬化症样本中的疼痛代码的可靠性估计表明了信度可靠。kappa 系数范围从中等（叹气=0.40）到显著一致（保护=0.83）。这些值与背痛和关节炎联合样本中的值相当。与自我报告的疼痛（0.46-0.53）和自我报告的疼痛行为（0.58）的相关性支持了同时效度。观察者编码的总疼痛行为与无经验观察者的平均疼痛评分之间的 0.87 相关性支持了结构效度。
结果支持使用疼痛行为观察协议评估多发性硬化症患者的疼痛行为。对多发性硬化症患者疼痛行为的有效评估可能会导致对该人群慢性疼痛管理的创造性干预。
