Center for muscle and joint health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
Spine (Phila Pa 1976). 2022 Sep 15;47(18):1314-1320. doi: 10.1097/BRS.0000000000004391. Epub 2022 Jul 1.
A prospective cohort study.
To investigate construct validity by examining the convergent and discriminative validity of the Patient-Reported Outcomes Measurement Information System Physical Function 4a (PROMIS-PF4) questionnaire in low back pain (LBP) patients seeking care from Danish chiropractors.
The Roland-Morris Disability Questionnaire (RMDQ) is often used to assess physical functioning in LBP. However, it consists of 24 items, which is time consuming to complete in clinical practice. The PROMIS-PF4 questionnaire has only four items and may be more applicable for clinical use.
Patients with LBP seeking care from chiropractors in Denmark completed the PROMIS-PF4, RMDQ, Subgroups for Targeted Treatment (STarT) Back screening tool, and Numeric Pain Rating Scale (NPRS) in advance of their first appointment with the chiropractor. Convergent validity was assessed using Spearman correlation coefficients between the PROMIS-PF4 and RMDQ and NPRS, respectively. Discriminative validity of the PROMIS-PF4 was assessed by calculating the area under the receiver operating characteristic curve (AUC) when plotting the PROMIS-PF4 t score against a reference case for RMDQ; NPRS; and high and low risk groups using the STarT Back screening tool.
Among 356 patients the PROMIS-PF4 questionnaire had strong convergent validity with the RMDQ ( r =-0.76) and moderate convergent validity with the NPRS ( r =-0.42). The PROMIS-PF4 had good and acceptable discriminative validity for disability (AUC=0.88) and high risk of persisting disability (AUC=0.72), and poor or no discriminative validity for pain intensity (AUC=0.66) and low-risk of persisting disability (AUC=0.26), respectively.
As hypothesized, for convergent validity the PROMIS-PF4 has stronger correlation with the RMDQ than the NPRS and good discriminative validity for identifying patients with pain-related disability and at high risk of persisting disability but not for identifying pain intensity or low-risk of persisting disability. Consequently, the PROMIS-PF4 has adequate construct validity for measuring pain-related disability in an LBP population in chiropractic care.
前瞻性队列研究。
通过考察丹麦脊医就诊的慢性腰痛患者中患者报告结局测量信息系统物理功能 4a（PROMIS-PF4）问卷的聚合效度和区分效度，来探讨其结构效度。
罗伦兹-莫里斯残疾问卷（RMDQ）常用于评估腰痛患者的躯体功能，但它包含 24 个项目，在临床实践中完成这些项目耗时较长。PROMIS-PF4 问卷只有 4 个项目，可能更适用于临床应用。
在丹麦接受脊医治疗的腰痛患者在首次就诊前完成了 PROMIS-PF4、RMDQ、靶向治疗亚组（STarT）背部筛查工具和数字疼痛评分量表（NPRS）。聚合效度分别通过 PROMIS-PF4 与 RMDQ 和 NPRS 的斯皮尔曼相关系数来评估。通过绘制 PROMIS-PF4 得分相对于 RMDQ、NPRS 和 STarT 背部筛查工具的高风险和低风险组的参考病例的受试者工作特征曲线（ROC）下面积（AUC），来评估 PROMIS-PF4 的区分效度。
在 356 例患者中，PROMIS-PF4 问卷与 RMDQ 具有很强的聚合效度（r=-0.76），与 NPRS 具有中等聚合效度（r=-0.42）。PROMIS-PF4 对残疾（AUC=0.88）和高持续性残疾风险（AUC=0.72）具有良好和可接受的区分效度，而对疼痛强度（AUC=0.66）和低持续性残疾风险（AUC=0.26）的区分效度较差或无区分效度。
与假设一致，对于聚合效度，PROMIS-PF4 与 RMDQ 的相关性强于 NPRS，对于识别与疼痛相关的残疾和高持续性残疾风险的患者具有良好的区分效度，但对于识别疼痛强度或低持续性残疾风险的患者则没有。因此，PROMIS-PF4 在评估脊医治疗的腰痛人群中与疼痛相关的残疾方面具有足够的结构效度。
