School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main St. W, IAHS 441, Hamilton, ON, L8S 1C7, Canada.
Physical Therapy and Surgery, Western University, London, ON, Canada.
Clin Rheumatol. 2022 Oct;41(10):3159-3168. doi: 10.1007/s10067-022-06248-2. Epub 2022 Jun 27.
INTRODUCTION/OBJECTIVE: Central sensitization (CS) is a known contributor to chronic pain in people with knee osteoarthritis (KOA) and is commonly measured by psychophysical testing or patient-reported methods such as the Central Sensitization Inventory (CSI). However, previous studies have shown a weak association between the two. We therefore sought to evaluate the validity of the CSI through Rasch analysis in patients with KOA.
We performed a secondary analysis of a multicenter cohort study with patients with KOA consulting orthopedic surgeons. Rasch analysis was conducted considering person factors of age, sex, BMI, pain intensity, pain catastrophizing, and quantitative sensory test findings using pressure pain thresholds and temporal summation to assess how the CSI fits to the Rasch model (supporting validity). We used RUMM2030 software to model fit estimates, making adjustments as required to achieve model fit (P > 0.05).
Data from 293 patients were included (58.7% female, mean age 63.6 years, 49.1% obese) Initial evaluation with Rasch modelling indicated misfit. Eleven of 25 items on the CSI displayed disordered thresholds which were rescored by collapsing response categories until the thresholds demonstrated sequential progression. Reanalysis demonstrated persistent model misfit so a subtest was developed to address local dependency of 6 items. Thereafter, model fit was achieved (P = 0.071, indicating not differing from Rasch model) and acceptable unidimensionality (P = 0.068 with 95% CI 0.043-0.093).
The CSI was able to be fit to the Rasch model after rescoring while retaining all 25 items. The unidimensionality validates CS as measured by the CSI as a singular construct. Key Points • The Central Sensitization Inventory (CSI) was able to be fit to the Rasch model after rescoring while retaining all 25 items. • The unidimensionality of the CSI validates CS as a singular construct. • Our results suggest rescoring of the CSI for people with KOA, but it should be confirmed and replicated in larger samples prior to clinical use.
简介/目的：中枢敏化（CS）是导致膝骨关节炎（KOA）患者慢性疼痛的已知因素，通常通过心理物理测试或患者报告的方法（如中枢敏化量表（CSI））进行测量。然而，先前的研究表明两者之间的相关性较弱。因此，我们试图通过 KOA 患者的 Rasch 分析评估 CSI 的有效性。
我们对 KOA 咨询矫形外科医生的多中心队列研究进行了二次分析。Rasch 分析考虑了人的因素，包括年龄、性别、BMI、疼痛强度、疼痛灾难化和定量感觉测试结果，使用压力疼痛阈值和时间总和来评估 CSI 如何适应 Rasch 模型（支持有效性）。我们使用 RUMM2030 软件进行模型拟合估计，并根据需要进行调整以达到模型拟合（P>0.05）。
共纳入 293 例患者的数据（58.7%为女性，平均年龄 63.6 岁，49.1%为肥胖）。初始 Rasch 建模评估显示拟合不良。CSI 上的 25 个项目中有 11 个显示出阈值紊乱，通过合并反应类别进行重新评分，直到阈值显示出连续进展。重新分析显示模型拟合仍然不良，因此开发了一个子测试来解决 6 个项目的局部依赖性。此后，模型拟合得到了满足（P=0.071，表明与 Rasch 模型无差异），并且具有可接受的单维性（P=0.068，95%CI 为 0.043-0.093）。
CSI 在重新评分后能够适应 Rasch 模型，同时保留所有 25 个项目。单维性验证了 CSI 作为测量 CS 的单一结构。要点 • CSI 在重新评分后能够适应 Rasch 模型，同时保留所有 25 个项目。• CSI 的单维性验证了 CS 作为一个单一结构。• 我们的结果表明，需要对 KOA 患者的 CSI 进行重新评分，但在临床应用之前，应在更大的样本中进行确认和复制。
