Cook Karon F, Kallen Michael A, Buckenmaier Chester, Flynn Diane M, Hanling Steven R, Collins Teresa S, Joltes Kristin, Kwon Kyung, Medina-Torne Sheila, Nahavandi Parisa, Suen Joshua, Gershon Richard
Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, 625 North Michigan Avenue, Suite 2700, Chicago, IL 60611.
Defense and Veterans Center for Integrative Pain Management, Department of Military Emergency Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda MD 20814.
Mil Med. 2017 Jul;182(7):e1851-e1861. doi: 10.7205/MILMED-D-16-00285.
In 2009, the Army Pain Management Task Force was chartered. On the basis of their findings, the Department of Defense recommended a comprehensive pain management strategy that included development of a standardized pain assessment system that would collect patient-reported outcomes data to inform the patient-provider clinical encounter. The result was the Pain Assessment Screening Tool and Outcomes Registry (PASTOR). The purpose of this study was to assess the validity and response burden of the patient-reported outcome measures in PASTOR.
Data for analyses were collected from 681 individuals who completed PASTOR at baseline and follow-up as part of their routine clinical care. The survey tool included self-report measures of pain severity and pain interference (measured using the National Institutes of Health Patient-Reported Outcome Measurement Information System [PROMIS] and the Defense and Veterans Pain Rating scale). PROMIS measures of pain correlates also were administered. Validation analyses included estimation of score associations among measures, comparison of scores of known groups, responsiveness, ceiling and floor effects, and response burden.
Results of psychometric testing provided substantial evidence for the validity of PASTOR self-report measures in this population. Expected associations among scores largely supported the concurrent validity of the measures. Scores effectively distinguished among respondents on the basis of their self-reported impressions of general health. PROMIS measures were administered using computer adaptive testing and each, on average, required less than 1 minute to administer. Statistical and graphical analyses demonstrated the responsiveness of PASTOR measures over time.
2009年，陆军疼痛管理特别工作组成立。根据其调查结果，国防部推荐了一项全面的疼痛管理策略，其中包括开发一个标准化疼痛评估系统，该系统将收集患者报告的结果数据，以为患者与医疗服务提供者之间的临床诊疗提供参考。结果就是疼痛评估筛查工具与结果登记系统（PASTOR）。本研究的目的是评估PASTOR中患者报告的结果测量指标的有效性和应答负担。
分析数据收集自681名在基线和随访时完成PASTOR的个体，这是他们常规临床护理的一部分。调查工具包括疼痛严重程度和疼痛干扰的自我报告测量指标（使用美国国立卫生研究院患者报告结果测量信息系统 [PROMIS] 和国防与退伍军人疼痛评定量表进行测量）。还实施了PROMIS疼痛相关测量指标。验证分析包括测量指标之间得分关联的估计、已知组得分的比较、反应性、天花板效应和地板效应以及应答负担。
心理测量测试结果为PASTOR自我报告测量指标在该人群中的有效性提供了大量证据。得分之间的预期关联在很大程度上支持了这些测量指标的同时效度。得分根据受访者对总体健康的自我报告印象有效地区分了受访者。PROMIS测量指标采用计算机自适应测试进行，平均每个指标的施测时间不到1分钟。统计和图形分析证明了PASTOR测量指标随时间的反应性。
