A Study to Explore the Reliability of Pain Drawings Using a Novel Method to define Pain Extent and Pain Location

Leoni, Diego and Falla, Deborah and Egloff, Michele and Faccendini, Simone and Barbero, Marco (2013) A Study to Explore the Reliability of Pain Drawings Using a Novel Method to define Pain Extent and Pain Location. In: 3° Congresso Nazionale SIF, 24-25 Maggio 2013, Napoli.

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BACKGROUND AND AIM Pain drawings (PDs) are a common method to investigate pain extent and pain location. Several methods for shading and scoring PDs have been proposed resulting in different estimations of pain extent and pain location. Despite the large use of PDs in clinical and research settings, the test-retest reliability of PDs has never been investigated. The aim of this study was to investigate the test-retest reliability of PDs using a novel method for defining pain extent and pain location. MATERIALS AND METHODS Twenty-nine patients with chronic low back pain and twenty-three with chronic neck pain participated. Each patient shaded two consecutive PDs (PD1 and PD2) with an interval of one minute. PDs were shaded with a stylus pen on an iPad®. PDs’s pixels were counted and Bland-Altman plots were examined to provide a visual representation of size and range differences between two consecutive PDs from the same patient. The ICC and the Jaccard Similarity Coefficient were used to assess the reliability of documenting the pain extent and pain location respectively. RESULTS The mean extent was 5888±4564 pixels and 6261±5029 for PD1 and PD2 respectively. The ICC value was 0.96 (95% CI: 0.94-0.98). In the Bland-Altman plot the values for the mean difference was -372 pixel, and the 95% limits of agreement were -2710 to 1960 (Fig. 1). The mean Jaccard Similarity Coefficient between PD1 and PD2 was 0.62±0.18. Results for the whole sample and two subgroups (low back pain and neck pain patients) are reported in Table 1. DISCUSSION The test re-test reliability of pain extent between PD1 and PD2 was very high. Nevertheless the large variability of the pain extent between the subjects may determine an overestimation of the ICC. The Bland-Altman 95% interval of agreement was acceptable. Subjects shaded the pain extent approximately in the same location. CONCLUSIONS The results of this study suggest that PDs are a reliable tool to measure the pain extent and its location. However further research is needed to investigate the reliability of PDs in different patient populations with a larger sample size and an estimation of the potential confounding factors. KEYWORDS: Pain drawing, outcome measures, reliability ACKNOWLEDGEMENT Supported by a grant from the Thim van der Laan Foundation

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