Validity, internal consistency and self-rated change of the patient enablement instrument in patients with chronic musculoskeletal pain
Paul Enthoven, Anneli Peolsson, Maria Landén Ludvigsson, Johanna Wibault, Gunnel Peterson, Birgitta Öberg
Department of Medical and Health Sciences , Division of Physiotherapy, Linköping University, SE-581 83 Linköping, Sweden. E-mail: firstname.lastname@example.org
Objective: Patient enablement reflects patient’s understanding of and coping with illness. The aim of this study was to investigate the content validity, construct validity, internal consistency and self-rated change (SRC) of the Patient Enablement Instrument (PEI) in patients with whiplash-associated disorders, cervical radiculopathy and mixed chronic pain treated in different settings.
Design: Psychometric analyses.
Participants: Patients with disabling non-malignant chronic musculoskeletal pain.
Methods: Participants answered questionnaires on disability (Neck Disability Index (NDI) or Functional Rating Index (FRI)), anxiety/depression (Hospital Anxiety and Depression Scale; HADS) and general health (EuroQol; EQ-5D). Content validity, construct validity (confirmatory factor analysis), internal consistency and cut-off for SRC were investigated for the PEI after treatment. The SRC value was the receiver operating characteristic (ROC) curve optimal cut-off point.
Results: After treatment all items were completed by 516 patients (mean standard deviation (SD) age 45.1 years (SD 10.1), women 75% (n = 385)). The 1-factor PEI model had approximate fit to the data. The internal consistency Cronbach’s alpha was between 0.878 and 0.929 for the 3 groups. Correlations between the PEI and the NDI/FRI, HADS and EQ-5D were fair to good. The SRCROC for whiplash-associated disorders, cervical radiculopathy and mixed chronic pain groups was 5, 6 and 4 points in the PEI, respectively.
Conclusion: The PEI showed fair content validity, construct validity and internal consistency. However, the scale needs further development to improve measurement of change.
Patient enablement reflects patients understanding of and coping with illness. This study investigated measurement properties and minimal important change in the Patient Enablement Instrument (PEI) in patients with whiplash-associated disorders, cervical radiculopathy and mixed chronic pain treated in different care settings. After treatment, all items were completed by 516 patients (mean age 45.1 years (standard deviation 10.1), women 75% (= 385)). Fair measurement properties were found for the PEI for the included groups of patients, indicating that the PEI is suitable for use in patients with chronic musculoskeletal pain. The minimal important change in the PEI for whiplash-associated disorders, cervical radiculopathy and mixed chronic pain groups was 5, 6 and 4 points, respectively, indicating that a study-specific minimal important change should be applied. However, the cale needs further development to improve measurement of changes.
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