Bernardes Sónia F, Matos Marta, Mourão Susana, Vauclair Christin-Melanie
Iscte-Instituto Universitário de Lisboa (Iscte-IUL), Centro de Investigação e Intervenção Social (CIS-Iscte), Lisbon, Portugal.
Scand J Pain. 2021 May 3;21(4):688-695. doi: 10.1515/sjpain-2021-0002. Print 2021 Oct 26.
Breakthrough cancer pain (BTcP) is a transient exacerbation of pain that occurs over persistent, stable, and adequately controlled cancer background pain. It is prevalent and bears severe consequences to patients' quality-of-life. The effective management of BTcP depends on fast and reliable (re)assessment. The Breakthrough pain Assessment Tool (BAT) is one of the most concise and reliable self-report instruments adapted to clinical contexts so far, showing good psychometric qualities in the United Kingdom, the Netherlands, and South Korea. As to promote the effective management of BTcP in Portuguese-speaking communities this study, first aimed to culturally adapt and validate the Portuguese version of the BAT (BAT-Pt). Second, and most importantly, it sought to provide novel evidence on its criterion validity by investigating its association with measures of psychological distress, which has not been yet investigated.
The BAT was translated into European Portuguese, using the back-translation method, and culturally adapted. Its psychometric properties (factor structure, internal consistency, construct and criterion validity) were analyzed in a cross-sectional multicenter study, with a sample of 65 cancer patients (49.2% women) recruited from eight hospitals in mainland Portugal ( power analysis determined a minimum sample of 50). Health professionals collected patients' clinical information, assessed their functional disability () and the adequacy of pain control. In addition to the Portuguese version of the BAT (BAT_Pt), patients completed the Portuguese versions of the , the , a and answered questions about the adequacy of pain control.
The BAT-Pt was very well accepted by experts and patients. As hypothesized, a Principal Axis Factor Analysis revealed two underlying factors accounting for 55.2% of the variance: (1) of BTcP and (2) Two items (on episode frequency and medication efficacy) were analyzed separately given their lower/cross loadings. The BAT-Pt showed good internal consistency overall (=0.79) and for each sub-scale, namely, of BTcP (n=5 items; =0.86) and (n2 items; r=0.62). The BAT-Pt showed good convergent validity, being moderately to strongly associated with overall pain severity and interference (0.46<r<0.77, p<0.001). It also showed good concurrent validity by being associated not only with physical outcomes - such as functional disability (r=0.40, p<0.001) and patient- and physician-determined adequacy of BTcP control (|0.25<r<0.63|, p <0.05) - but also, with distress (0.33<r<0.46, p <0.001), anxiety (0.28<r<0.44, p <0.05) and depression (r=0.47, p<0.001).
The BAT-Pt is a reliable and valid measure of breakthrough pain in Portuguese cancer patients and it is strongly associated to physical and psychological outcomes. This study confirms and extends the psychometric validation of the BAT to a new cultural context, promoting its diffusion and use by researchers and clinicians in Portuguese-speaking communities. The BAT-Pt may be an invaluable tool for daily clinical practice by tapping multiple aspects of BTcP experiences that are associated to patients' physical and psychological outcomes.
爆发性癌痛（BTcP）是在持续、稳定且得到充分控制的癌痛背景上出现的短暂疼痛加剧。它很常见，会给患者的生活质量带来严重后果。BTcP的有效管理依赖于快速且可靠的（再）评估。爆发性疼痛评估工具（BAT）是目前最简洁且可靠的适用于临床环境的自我报告工具之一，在英国、荷兰和韩国显示出良好的心理测量学特性。为了促进葡萄牙语社区对BTcP的有效管理，本研究首先旨在对BAT的葡萄牙语版本（BAT-Pt）进行文化调适和验证。其次，也是最重要的，通过调查其与心理困扰测量指标的关联，本研究试图为其效标效度提供新的证据，而这一点尚未得到研究。
采用回译法将BAT翻译成欧洲葡萄牙语，并进行文化调适。在一项横断面多中心研究中分析其心理测量学特性（因子结构、内部一致性、结构效度和效标效度），样本为从葡萄牙大陆八家医院招募的65名癌症患者（49.2%为女性）（功效分析确定最小样本量为50）。卫生专业人员收集患者的临床信息，评估其功能残疾情况以及疼痛控制的充分性。除了BAT的葡萄牙语版本（BAT_Pt），患者还完成了葡萄牙语版本的[具体量表名称未给出]、[具体量表名称未给出]、一份[具体问卷名称未给出]，并回答了关于疼痛控制充分性的问题。
BAT-Pt得到了专家和患者的高度认可。如假设的那样，主成分因子分析揭示了两个潜在因子，解释了55.2%的方差：（1）BTcP的[具体方面未明确]和（2）[具体方面未明确]。鉴于两个项目（关于发作频率和药物疗效）的载荷较低/交叉载荷，对其进行了单独分析。BAT-Pt总体显示出良好的内部一致性（=0.79），每个子量表也是如此，即BTcP的[具体方面未明确]（n = 5个项目；=0.86）和[具体方面未明确]（n = 2个项目；r = 0.62）。BAT-Pt显示出良好的收敛效度，与总体疼痛严重程度和干扰呈中度至高度相关（0.46 < r < 0.77，p < 0.001）。它还显示出良好的同时效度，不仅与身体结果相关——如功能残疾（r = 0.40，p < 0.001）以及患者和医生确定的BTcP控制充分性（|0.25 < r < 0.63|，p < 0.05）——而且与困扰（0.33 < r < 0.46，p < 0.001）、焦虑（0.28 < r < 0.44，p < 0.05）和抑郁（r = 0.47，p < 0.001）相关。
BAT-Pt是一种可靠且有效的测量葡萄牙癌症患者爆发性疼痛的工具，并且与身体和心理结果密切相关。本研究确认并将BAT的心理测量学验证扩展到了新的文化背景，促进了其在葡萄牙语社区的研究人员和临床医生中的传播和使用。BAT-Pt通过挖掘与患者身体和心理结果相关的BTcP体验的多个方面，可能成为日常临床实践中一个非常有价值的工具。
