Development of a pictorial scale for assessing functional interference with chronic pain: the Pictorial Pain Interference Questionnaire

Andrew J Cook,1 David A Roberts,2 Karen C Nelson,3 Brian R Clark,4 B Eugene Parker Jr4 1Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center College of Medicine, Temple, TX, USA; 2Epiceutical Labs, Charlottesville, VA, USA; 3Southcentral Foundation, Anchorage, AK, USA; 4Barron Associates, Inc., Charlottesville, VA, USA Background: Assessment of function and functional interference is an important component of chronic pain assessment and treatment and is commonly based on self-report questionnaires. Existing questionnaires for assessing functional interference are language dependent, which can limit their utility for patients across cultures with literacy, fluency, or cognitive restrictions. Objective: The objectives of this study were to create a tool with minimal language dependence and literacy requirement for measuring functional interference due to chronic pain and evaluate the psychometric properties and usability of this new assessment scale, the Pictorial Pain Interference Questionnaire (PPIQ), in a clinical sample of participants with chronic pain. Design: The study employed a prospective, cross-sectional design in a clinical chronic pain setting. Participants and methods: A total of 113 participants with chronic non-cancer pain were recruited from a private chronic pain clinic. A pictorial scale was developed and tested via psychometric procedures, including comparisons with validated measures of functional interference and related chronic pain constructs. Results: Excellent internal consistency reliability (a=0.91), good construct validity (total score: r=0.72–0.81), and adequate-to-good convergent and discriminant validities were demonstrated through comparative analyses with existing self-report questionnaires. A scoring metric for classifying low, moderate, and high levels of interference was found to have good construct validity. Evaluation of satisfaction revealed adequate understanding of the PPIQ among most users. Conclusion: Initial support for the PPIQ as an alternative to language-based questionnaires for assessing functional interference from chronic pain was found. Subsequent research will help to clarify psychometric properties of the PPIQ and user response among various chronic pain subgroups. Keywords: chronic pain, assessment, function, functional interference, impairment, disability, patient-reported outcomes, health literac