Smith Wally R, Qayyum Rehan, Ulbing Alexandra, Guy Margaret S, Sop Daniel M, Zhang Yue May
Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23219-0306, United States.
Department of Internal Medicine, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23501-1980, United States.
J Sick Cell Dis. 2025 Feb 19;2(1):yoaf006. doi: 10.1093/jscdis/yoaf006. eCollection 2025.
Readiness for discharge for a SCD vaso-occlusive crisis is dictated by factors far beyond pain control, including physical function/activity. We therefore designed and tested a functional status-based pain assessment questionnaire in SCD patients hospitalized with vaso-occlusive crises.
Sickle cell disease patients on a preselected nursing unit rated 10 draft Functional status-Based Pain Assessment items of activities of daily living on a five-point Likert scale (0-5) from "very easy" to "very difficult" daily on each day of their admission until discharge, at approximately the same time. Concurrently, they reported Numeric Rating Scale (0-10) pain intensity. For validation, we used exploratory factor analysis, confirmatory factor analysis, and item response theory analysis.
We analyzed 503 observations from 175 admissions of 88 patients. Half were female, the mean age was 32.1 ± 11.8 years, and the mean length of stay was 7.1 ± 6.9 days. The mean Numeric Rating Scale (6.8 ± 1.9) was inversely correlated with the mean Functional Status-based Pain Assessment (0-50) score (27 ± 8.0, = -0.4342, < .0001). Functional Status-based Pain Assessment item means ranged from 2.1 to 3.3. Cronbach's alpha was 0.91. Exploratory factor analysis showed that all Functional Status-based Pain Assessment items loaded on a single factor. Confirmatory factor analysis found adequate convergent and discriminant validity and showed strong fit of the model to the data. Item response theory analysis showed item discrimination ranging from 0.56 to 4.1, while difficulty ranged from -2.8 to 7.5.
The Functional Status-based Pain Assessment shows strong correlation with daily Numeric Rating Scale, is multidimensional, and demonstrates strong construct validity. It may improve assessment of SCD vaso-occlusive crisis pain and may enhance vaso-occlusive crisis discharge discussions.
镰状细胞贫血（SCD）血管闭塞性危象患者出院的准备情况取决于疼痛控制之外的诸多因素，包括身体功能/活动能力。因此，我们设计并测试了一种针对因血管闭塞性危象住院的SCD患者的基于功能状态的疼痛评估问卷。
在一个预先选定的护理单元中，镰状细胞病患者在入院直至出院的每一天，大约在同一时间，对10项基于功能状态的日常生活活动疼痛评估草案项目按照从“非常容易”到“非常困难”的五点李克特量表（0 - 5）进行评分。同时，他们报告数字评定量表（0 - 10）的疼痛强度。为进行验证，我们采用了探索性因素分析、验证性因素分析和项目反应理论分析。
我们分析了88例患者175次入院的503份观察资料。其中一半为女性，平均年龄为32.1±11.8岁，平均住院时间为7.1±6.9天。数字评定量表的平均分（6.8±1.9）与基于功能状态的疼痛评估（0 - 50）平均分（27±8.0）呈负相关（r = -0.4342，P <.0001）。基于功能状态的疼痛评估项目平均分在2.1至3.3之间。克朗巴哈系数为0.91。探索性因素分析表明，所有基于功能状态的疼痛评估项目均加载于一个单一因素上。验证性因素分析发现有足够的收敛效度和区分效度，并表明模型与数据拟合良好。项目反应理论分析表明项目区分度在0.56至4.1之间，而难度在 -2.8至7.5之间。
基于功能状态的疼痛评估与每日数字评定量表显示出强相关性，具有多维性，并表现出强结构效度。它可能会改善对SCD血管闭塞性危象疼痛的评估，并可能加强关于血管闭塞性危象出院的讨论。
