Nogueira Suzana Curcino, Fernandes Ana Mércia, Lussani Rafael, da Silva Valquiria Aparecida, Galhardoni Ricardo, Barbour Julio, Hirata Rogério Pessoto, Kubota Gabriel Taricani, Teixeira Manoel Jacobsen, de Andrade Daniel Ciampi
Department of Neurology, LIM-62, Pain Center, University of São Paulo, São Paulo, Brazil.
Institute of Health Sciences, Paulista University, São Paulo, Brazil.
Eur J Pain. 2025 Oct;29(9):e70108. doi: 10.1002/ejp.70108.
Computerised adaptive testing (CAT) and equalisation are statistical approaches that mitigate questionnaire response burden by selecting individually tailored items according to previous response patterns; they facilitate comparing results across distinct instruments by providing conversion functions between their scores, respectively. However, they have seldom been specifically applied to the general chronic pain population. This study aimed at developing CAT and equalisation approaches for widely used sleep quality and quality of life (QoL) assessment instruments.
This prospective cross-sectional study included adult participants with chronic pain treated at specialised tertiary-care clinics. Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used for investigating sleep quality construct; and the 12-Item Short Form Health Survey, WHOQoL-BREF and 5 dimensions 3 levels EuroQol for QoL. CATs were developed for these two constructs based on graded model item response theory. Equalisation utilised equipercentile methodology.
Three-hundred participants (54.4 ± 13.8 years-old, female = 54.7%) with different chronic pain diagnoses, 77.3% of whom were neuropathic, were enrolled. CATs were developed for both constructs, with adequate model fit. A 5000-response simulation demonstrated average reductions of 80.6% and 76.8% in items required to be answered for evaluating sleep quality and QoL, respectively, when compared to the total original questionnaire items. Equalisation functions were described for score conversions between WHOQoL-BREF and 12-Item Short-Form Health Survey, and between PSQI and ISI.
This initial study demonstrated the feasibility of CATs for assessing sleep quality and QoL in chronic pain populations; and provided equalisation functions between instruments widely used for these purposes. Future replication and validation are necessary to establish the generalisability of these findings.
The high response burden inherent to the use of multiple validated instruments to assess quality of life (QoL) and of sleep undermines their systematic application in the assessment of chronic pain, both in daily practice and research settings. To address this gap, this initial study demonstrated the feasibility of employing computerised adaptive testing for this purpose within a population with diverse chronic pain conditions; and provided equalisation functions that allow for crosstalk between widely used QoL and sleep assessment tools.
计算机自适应测试（CAT）和等值化是通过根据先前的回答模式选择个性化定制项目来减轻问卷回答负担的统计方法；它们分别通过提供分数之间的转换函数，便于比较不同工具的结果。然而，它们很少专门应用于一般慢性疼痛人群。本研究旨在为广泛使用的睡眠质量和生活质量（QoL）评估工具开发CAT和等值化方法。
这项前瞻性横断面研究纳入了在专科三级护理诊所接受治疗的成年慢性疼痛患者。匹兹堡睡眠质量指数（PSQI）和失眠严重程度指数（ISI）用于调查睡眠质量结构；12项简短健康调查、世界卫生组织生活质量简表（WHOQoL-BREF）和5维度3水平欧洲生活质量量表用于评估生活质量。基于分级模型项目反应理论为这两个结构开发了CAT。等值化采用等百分位方法。
招募了300名参与者（年龄54.4±13.8岁，女性占54.7%），他们患有不同的慢性疼痛诊断，其中77.3%为神经性疼痛。为这两个结构都开发了CAT，模型拟合良好。一项5000次回答的模拟表明，与原始问卷项目总数相比，评估睡眠质量和生活质量所需回答的项目平均减少了80.6%和76.8%。描述了WHOQoL-BREF与12项简短健康调查之间以及PSQI与ISI之间分数转换的等值化函数。
这项初步研究证明了CAT在评估慢性疼痛人群睡眠质量和生活质量方面的可行性；并提供了广泛用于这些目的的工具之间的等值化函数。未来需要进行重复和验证以确定这些发现的普遍性。
使用多种经过验证的工具来评估生活质量（QoL）和睡眠时固有的高回答负担，在日常实践和研究环境中都削弱了它们在慢性疼痛评估中的系统应用。为了弥补这一差距，这项初步研究证明了在具有多种慢性疼痛状况的人群中为此目的采用计算机自适应测试的可行性；并提供了等值化函数，允许广泛使用的生活质量和睡眠评估工具之间进行相互比较。
