Rocío de la Vega

mHealth: A Strategic Field without a Solid Scientific Soul. A Systematic Review of Pain-Related Apps

Background Mobile health (mHealth) has undergone exponential growth in recent years. Patients and healthcare professionals are increasingly using health-related applications, at the same time as concerns about ethical issues, bias, conflicts of interest and privacy are emerging. The general aim of this paper is to provide an overview of the current state of development of mHealth. Methods and Findings To exemplify the issues, we made a systematic review of the pain-related apps available in scientific databases (Medline, Web of Science, Gale, Psycinfo, etc.) and the main application shops (App Store, Blackberry App World, Google Play, Nokia Store and Windows Phone Store). Only applications (designed for both patients and clinicians) focused on pain education, assessment and treatment were included. Of the 47 papers published on 34 apps in scientific databases, none were available in the app shops. A total of 283 pain-related apps were found in the five shops searched, but no articles have been published on these apps. The main limitation of this review is that we did not look at all stores in all countries. Conclusions There is a huge gap between the scientific and commercial faces of mHealth. Specific efforts are needed to facilitate knowledge translation and regulate commercial health-related apps.

The Pittsburgh Sleep Quality Index: Validity and factor structure in young people.

The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure of sleep quality in adolescents, but information regarding its psychometric strengths and weaknesses in this population is limited. In particular, questions remain regarding whether it measures one or two sleep quality domains. The aims of the present study were to (a) adapt the PSQI for use in adolescents and young adults, and (b) evaluate the psychometric properties of the adapted measure in this population. The PSQI was slightly modified to make it more appropriate for use in youth populations and was translated into Spanish for administration to the sample population available to the study investigators. It was then administered with validity criterion measures to a community-based sample of Spanish adolescents and young adults (AYA) between 14 and 24 years old (N = 216). The results indicated that the questionnaire (AYA-PSQI-S) assesses a single factor. The total score evidenced good convergent and divergent validity and moderate reliability (Cronbachs alpha = .72). The AYA-PSQI-S demonstrates adequate psychometric properties for use in clinical trials involving adolescents and young adults. Additional research to further evaluate the reliability and validity of the measure for use in clinical settings is warranted.

Sex differences in psychological response to pain in patients with fibromyalgia syndrome.

Objectives:To examine whether men and women with fibromyalgia syndrome (FMS) differ with respect to pain severity and functioning, pain-related beliefs, or pain-related coping. We hypothesized no significant sex differences in measures of pain and functioning, but that we would observe differences between men and women in how they view and how they cope with FMS-related pain. Methods:A total of 747 women and 48 men with FMS who attended a multidisciplinary treatment program completed the study measures. Analyses of covariance were used to examine sex differences in the study measures, with a P-value of ⩽0.01 and at least a moderate effect size (Cohen d≥0.5) required for a difference to be deemed statistically significant. Results:Men and women did not differ on demographic measures except for their age, with the men in our sample being significantly younger than the women. Consistent with the study hypothesis, the results revealed no sex differences in the measures of pain and functioning. For pain-related beliefs, men were more likely to view pain as reflecting harm, and they were also more likely than women to use activity avoidance as a pain-coping strategy. Discussion:The study findings suggest that women and men with FMS may think about and cope with pain somewhat differently, and may therefore benefit from different types of psychosocial pain intervention.

Assessment of Pain Intensity in Clinical Trials: Individual Ratings vs Composite Scores

OBJECTIVES To evaluate the reliability of findings suggesting that composite scores made up of just two ratings of recalled pain may be adequately reliable and valid for assessing outcome in pain clinical trials. DESIGN Secondary analyses of data from a study where the responsivity of the outcome measures was a critical concern; that is, a study with few subjects testing the effects of a treatment that had only modest effects. Ten adults with spinal cord injury rated four domains of pain intensity (current pain and 24-hour recalled worst, least, and average pain) on four occasions before and after 12 sessions of neurofeedback treatment. We evaluated the reliability and validity of four single ratings and 16 different composite scores. RESULTS None of the single-item scales performed adequately. However, composite scores made up of two items or more yielded consistent effect size estimates. CONCLUSIONS The findings provide additional evidence that two-item composite scores may be adequate for assessing the primary outcome of pain intensity in chronic pain clinical trials. Additional research is needed to further establish the generalizability of these findings.

Agreement between verbal and electronic versions of the numerical rating scale (NRS-11) when used to assess pain intensity in adolescents.

Objectives:Electronic pain measures are becoming common tools in the assessment of pediatric pain intensity. The aims of this study were (1) to examine the agreement between the verbal and the electronic versions of the 11-point Numerical Rating Scale (NRS-11) (vNRS-11 and eNRS-11, respectively) when used to assess pain intensity in adolescents; and (2) to report participants’ preferences for each of the 2 alternatives. Materials and Methods:A total of 191 school children enrolled in grades 7 to 11 (mean age, 14.61; range, 12 to 18) participated. They were asked to report the highest intensity of the most frequent pain that they had experienced during the last 3 months using both the vNRS-11 and the eNRS-11. Agreement analyses were carried out using: (1) the Bland-Altman method, with confidence intervals (CI) of both 95% and 80%, and a maximum limit of agreement of ±1; and (2) weighted intrarater &kgr;-coefficients between the ratings for each participant on the vNRS-11 and eNRS-11. Results:The limits of agreement at 95% fell outside the limit established a priori (scores ranged from −1.42 to 1.69), except for participants in grade 11 (−0.80, 0.88). Meanwhile, the limits of agreement at 80% CI fell inside the maximum limit established a priori (scores ranged from −0.88 to 0.94), except for participants in grade 8 (Supplemental Digital Content 2, http://links.lww.com/CJP/A97) (−0.88, 1.16). The &kgr;-coefficients ranged from 0.786 to 0.912, indicating “almost perfect” agreement. A total of 83% of participants preferred the eNRS-11. Discussion:Pain intensity ratings on the vNRS-11 and eNRS-11 seem to be comparable, at least for the 80% CI.

What Determines Whether a Pain is Rated as Mild, Moderate, or Severe? The Importance of Pain Beliefs and Pain Interference

Summary Reliable and valid measures of pain intensity are needed to accurately evaluate the efficacy of pain treatments. Perhaps with the exception of faces pain intensity scales, which are thought to reflect both pain intensity and pain affect, the other most commonly used pain intensity scales—Numerical Rating Scales (NRSs), Visual Analog Scales, and Verbal Rating Scales (VRSs)—are all thought to reflect primarily pain intensity or the magnitude of felt pain. However, to our knowledge, this assumption has not been directly tested for VRSs. Methods We evaluated whether VRS pain severity ratings are influenced by pain beliefs, catastrophizing, or pain interference over and above any effects of pain intensity, as measured by a NRS, in 4 samples of individuals with physical disabilities and chronic pain. Results As hypothesized, and while controlling for pain intensity as measured by a NRS, higher scores on factors representing pain interference with function, pain catastrophizing, and a number of pain-related beliefs were all associated with a tendency for the study participants to rate their pain as more severe on a VRS. Discussion These findings indicate VRSs of pain severity cannot necessarily be assumed to measure only pain intensity; they may also reflect patient perceptions about pain interference and beliefs about their pain. Clinicians and researchers should take these findings into account when selecting measures and when interpreting the results of studies using VRSs as outcome measures.

Cognitive Fusion and Pain Experience in Young People

Objectives:Acceptance and Commitment Therapy (ACT) has been shown to be an effective treatment for chronic pain in young people. Cognitive fusion is a key concept of ACT that is hypothesized to contribute to distress and suffering. In this study, we sought to: (1) test hypothesized associations between cognitive fusion and pain intensity, disability, and catastrophizing; and (2) examine the function of cognitive fusion as a possible mediator between catastrophizing and disability. Methods:A community sample of 281 young people (11 to 20 y) completed measures assessing cognitive fusion, pain intensity, disability, and pain catastrophizing. Results:Cognitive fusion was positively related to pain intensity (r=0.24, P<0.01), disability (r=0.32, P<0.001), and pain catastrophizing (r=0.47, P<0.001). Moreover, cognitive fusion was found to mediate the association between pain catastrophizing and disability (&bgr;=0.01, 95% confidence interval=0.002-0.024, 5000 bootstrap resamples). Discussion:The findings indicate that cognitive fusion is moderately to strongly associated with pain-related outcomes, which support the need for further research to (1) better understand the relationship between cognitive fusion and adjustment to chronic pain, and (2) determine whether the benefits of treatments such as ACT are mediated, at least in part, by reductions in cognitive fusion.

The Number of Ratings Needed for Valid Pain Assessment in Clinical Trials: Replication and Extension

OBJECTIVES To provide additional empirical findings regarding the number of pain ratings needed to obtain valid measures for assessing outcomes in pain clinical trials. DESIGN Secondary analyses of data from a clinical study examining the effects of psychological treatments on pain. Eleven adults with multiple sclerosis and chronic pain reported on four domains of pain intensity (current pain and 24-hour recalled worst, least, and average pain) on four occasions before and after receiving 16 sessions of psychological pain treatments. We evaluated the reliability and validity of four single ratings and 16 different composite scores. RESULTS Many of the single pain ratings were inadequately reliable while almost all of the composite scores, including the scores created from two ratings, evidenced adequate to excellent reliability. There was a noticeable increase in validity (ability to detect treatment effects) as the number of ratings used increased from one to two. However, there was little change in the validity as the number of items used to create composite scores increased from 2 to 3 or more. The findings also indicated that the scores assessing recalled worst pain were more valid than the scores assessing any of the other pain intensity domains. CONCLUSIONS Composite pain intensity scores created from two individual ratings of recalled pain appear to be adequately valid for detecting treatment effects. Moreover, the findings indicate that the selection of the pain intensity domain to use as a primary outcome variable may play a more important role than increasing reliability by obtaining more assessments; specifically, ratings of recalled worst pain may be more valid for detecting treatment effects than ratings of average pain.

AN APP for the Assessment of Pain Intensity: Validity Properties and Agreement of Pain Reports When Used with Young People

OBJECTIVE Painometer is a mobile application that includes four pain intensity scales: the Numerical Rating Scale, the Faces Pain Scale-Revised, the mechanical visual analogue scale and the Colored Analogue Scale. The aim of this study was to analyze the validity and agreement of the intensity reports provided by these scales and their traditional counterparts. METHODS Participants were 180 young people (mean age = 14.88; SD= 1.64; age range: 12-19). They were asked to report the maximum intensity of their most frequent pain in the previous three months using traditional and electronic versions of the scales. They also reported their level of fatigue and pain catastrophizing. Construct validity was evaluated by confirmatory factor analysis (CFA) and by convergent and discriminant validity. Criterion validity was assessed as concurrent validity. Agreement was calculated using the Bland and Altman method. Analyses were conducted for two confidence intervals (CI): 95% and 80%. RESULTS CFA demonstrated that the four electronic versions of the scales measure a single factor. All the scales showed a) moderate to high convergent validity, b) adequate discriminant validity with fatigue ratings, and c) adequate concurrent validity with pain catastrophizing ratings. Results also show that traditional and electronic versions of the four scales are in agreement, at least at the 80% CI. CONCLUSIONS Our results demonstrate that pain intensity scores reported with the scales in Painometer are valid, and concordant with their traditional counterparts.

Fibroline: A mobile app for improving the quality of life of young people with fibromyalgia

Fibroline is a mobile application with a self-administered cognitive behavioral treatment for young people with fibromyalgia or chronic widespread pain, designed to reduce pain and other common negative symptoms and improve quality of life. Our aims are to report on the usability and feasibility protocols used to assess the app. Two usability cycles were implemented. A group of patients followed the cognitive behavioral treatment intervention to test its feasibility. Qualitative data were collected and content analyses were conducted. The results demonstrated that the app is error-free, easy to use, liked by the users, and acceptable.