Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.
Clin J Pain. 2013 Sep;29(9):791-9. doi: 10.1097/AJP.0b013e318278d4e2.
Persistent postoperative pain is an acknowledged entity that reduces daily activities. Evaluation of the post-thoracotomy pain syndrome (PTPS) is often measured using traditional pain scales without in-depth questions on pain impairment. Thus, the purpose was to create a procedure-specific questionnaire for assessment of functional impairment due to PTPS.
Activities were obtained from the literature supplemented by interviews with patients and surgeons. The questionnaire was validated using the Rasch model in order to describe an underlying pain impairment scale.
Four of 17 questions were redundant. The remaining 13 questions from low to intensive activity described functional impairment following persistent pain from thoracotomy and video-assisted thoracic surgery (VATS). No evidence for differential item functioning for gender, age or differences between open or VATS, were found. A generalized log-linear Rasch model including local dependence was constructed. Though local dependence influenced reliability, the test-retest reliability estimated under the log-linear Rasch model was high (0.88-0.96). Correlation with items from the Disability of the Arm, Shoulder and Hand (quick) questionnaire supported validity (γ = 0.46, P < 0.0001), and procedure specificity. The analysis also procured evidence that the pain impairment questionnaire measured 2 qualitatively different pain dimensions although highly correlated (γ = 0.76).
This study presents method, results and validation of a new unidimensional scale measuring procedure specific functional impairment due to PTPS following open surgery and VATS. Procedure specific tools such as this could provide important outcomes measures for future trials on persistent postsurgical pain states allowing better assessment of interventions (250).
持续性术后疼痛是一种公认的会降低日常活动能力的病症。胸科手术后疼痛综合征（PTPS）的评估通常使用传统的疼痛量表进行测量，而没有深入询问疼痛对功能的损害。因此，本研究的目的是创建一种专门针对 PTPS 评估的功能性损伤的问卷。
活动内容从文献中获取，并通过对患者和外科医生的访谈进行补充。使用 Rasch 模型对问卷进行验证，以描述潜在的疼痛损伤量表。
17 个问题中有 4 个是多余的。剩余的 13 个问题从低强度活动到高强度活动，描述了开胸手术和电视辅助胸腔镜手术（VATS）后持续性胸痛引起的功能障碍。未发现性别、年龄或开胸手术与 VATS 之间的差异对项目有差异作用的证据。构建了一个包含局部依赖的广义对数线性 Rasch 模型。尽管局部依赖会影响可靠性，但在对数线性 Rasch 模型下估计的测试-重测可靠性很高（0.88-0.96）。与手臂、肩部和手部残疾问卷（快速）的项目相关性支持了有效性（γ=0.46，P<0.0001）和程序特异性。该分析还提供了证据，证明疼痛损伤问卷测量了 2 种高度相关但性质不同的疼痛维度（γ=0.76）。
本研究介绍了一种新的、单一维度的量表的方法、结果和验证，该量表用于测量开胸手术和 VATS 后 PTPS 引起的手术特异性功能损伤。这种专门针对手术的工具可以为未来的持续性手术后疼痛状态的试验提供重要的结果测量指标，从而更好地评估干预措施（250）。
