Axon David Rhys, Bhattacharjee Sandipan, Warholak Terri L, Slack Marion K
Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, 1295 N Martin Avenue, Tucson, AZ 85721, USA.
Pain Res Manag. 2018 Dec 12;2018:2530286. doi: 10.1155/2018/2530286. eCollection 2018.
To assess the validity of an exposure score obtained from the Xm tool for all pharmacological and nonpharmacological strategies used by individuals to manage chronic pain.
Using data from individuals with chronic pain, eposure ultiodal (Xm) scores were calculated by assigning one point for every 100 mg of morphine equivalent used (opioid medications); 25% of the maximum recommended exposure used (nonopioid medications); and any use of another strategy then summed. Content, criterion, construct, and convergent validity were assessed.
The sample of 149 individuals used a mean of 12.6 (SD = 4.6) strategies to manage pain and had a mean Xm score of 16.8 (SD = 9.1). Content validity was established by demonstrating that the pain management strategies identified were also reported in the literature. Criterion validity was established by the positive association of exposure scores with the following: interference with work (odds ratio (OR) = 2.23, 95% confidence interval (CI) = 1.14-4.36), daily activities (OR = 2.10, CI = 1.07-4.13), relationships (OR = 1.98, CI = 1.01-3.88), and leisure activities (OR = 2.31, CI = 1.18-4.50); workdays missed (OR = 5.10, CI = 1.92-13.58); emergency department visits (OR = 3.40, CI = 1.17-9.91); hospitalizations (OR = 4.18, CI = 0.86-20.37); and by a negative association with satisfaction (OR = 0.40, CI = 0.18-0.88). Construct validity was established by the positive association of exposure with baseline pain intensity ( < 0.01) and odds of experiencing an adverse event (OR = 2.31, CI = 1.18-4.52). Convergent validity was established through correlations of pain intensity from the Xm score and existing quantitative analgesic questionnaire (QAQ) score.
Xm scores represent a valid estimate of total exposure to multimodal strategies used and provide clinically relevant information for deciding what strategies to use at what level.
评估通过Xm工具获得的暴露分数对于个体用于管理慢性疼痛的所有药物和非药物策略的有效性。
利用慢性疼痛患者的数据，通过对每使用100毫克吗啡当量（阿片类药物）计1分；使用最大推荐暴露量的25%（非阿片类药物）；以及任何其他策略的使用情况进行计分，然后求和来计算暴露累积（Xm）分数。评估内容效度、标准效度、结构效度和收敛效度。
149名个体的样本平均使用12.6种（标准差 = 4.6）策略来管理疼痛，Xm分数的平均值为16.8（标准差 = 9.1）。通过证明所确定的疼痛管理策略在文献中也有报道来确立内容效度。通过暴露分数与以下各项的正相关来确立标准效度：对工作的干扰（优势比（OR） = 2.23，95%置信区间（CI） = 1.14 - 4.36）、日常活动（OR = 2.10，CI = 1.07 - 4.13）、人际关系（OR = 1.98，CI = 1.01 - 3.88）和休闲活动（OR = 2.31，CI = 1.18 - 4.50）；错过的工作日（OR = 5.10，CI = 1.92 - 13.58）；急诊就诊（OR = 3.40，CI = 1.17 - 9.91）；住院（OR = 4.18，CI = 0.86 - 20.37）；以及与满意度的负相关（OR = 0.40，CI = 0.18 - 0.88）。通过暴露与基线疼痛强度（<0.01）和发生不良事件的几率（OR = 2.31，CI = 1.18 - 4.52）的正相关来确立结构效度。通过Xm分数的疼痛强度与现有的定量镇痛问卷（QAQ）分数的相关性来确立收敛效度。
Xm分数代表了对所使用的多模式策略总暴露的有效估计，并为决定在何种水平使用何种策略提供了临床相关信息。
