Unpacking the impact of chronic pain as measured by the impact stratification score

Anthony Rodriguez, Maria Orlando Edelen, Patricia M Herman, Ron D Hays, Anthony Rodriguez, Maria Orlando Edelen, Patricia M Herman, Ron D Hays

Abstract

Background: In 2014, the National Institute of Health Pain Consortium's research task force on research standards for chronic low back pain (CLBP) proposed a measure that could be used to stratify patients by the impact CLBP has on their lives, namely the Impact Stratification Score (ISS). This study examines the dimensionality of the ISS and support for its single total score, and evaluates its overall psychometric properties.

Methods: The sample included 1677 chiropractic patients being treated for CLBP and chronic neck pain, had an average age of 49, 71% female, and 90% White. Study participants completed the PROMIS-29 v2.1 profile survey that contains the 9 ISS items. The ISS was evaluated using item-total correlations, Cronbach's alpha, factor analysis (i.e., correlated factors and bifactor models), and item response theory (IRT). Reliability indices and item properties were evaluated from bifactor and IRT models, respectively.

Results: Item-total correlations were high (0.64-0.84) with a Cronbach's alpha of 0.93. Eigenvalues suggested the possibility of two factors corresponding to physical function and pain interference/intensity. Bifactor model results indicated that data were essentially unidimensional, primarily reflecting one general construct (i.e., impact) and that after accounting for 'impact' very little reliable variance remained in the two group factors. General impact scores were reliable (omegaH = .73). IRT models showed that items were strong indicators of impact and provided information across a wide range of the impact continuum and offer the possibility of a shorter 8-item ISS. Finally, it appears that different aspects of pain interference occur prior to losses in physical function.

Conclusions: This study presents evidence that the ISS is sufficiently unidimensional, covers a range of chronic pain impact and is a reliable measure. Insights are obtained into the sequence of chronic pain impacts on patients' lives.

Keywords: Bifactor; Chronic low back pain; Impact stratification; PROMIS®; Patient-reported outcomes; Reliability.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Bifactor measurement model demonstrating one general factor (g) underlying all items and two group factors consisting of four pain interference and one pain intensity item (F1) and four physical function items (F2)
Fig. 2
Fig. 2
Item ranking from lowest to highest based on average location parameter. Physical function items are denoted PF and pain interference as PI. Vertical lines between shaded segments reflect threshold parameters (b1-b4). Superimposed boxes display the average location parameter for each item

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