Evaluation of content validity and feasibility of the eVISualisation of physical activity and pain (eVIS) intervention for patients with chronic pain participating in interdisciplinary pain rehabilitation programs

Abstract

Background: Chronic pain negatively influences most aspects of life, including aerobic capacity and physical function. The "eVISualisation of physical activity and pain" (eVIS) intervention was developed to facilitate individualized physical activity for treatment in interdisciplinary pain rehabilitation programs (IPRPs). The objective of this study was to evaluate the content validity and feasibility of the eVIS intervention prior to an effectiveness trial.

Methods: In order to determine pre-clinical content validity, experts (n = 10) (patients, caregivers, researchers) participated in three assessment rounds using a Likert-scale survey where relevance, simplicity, and safety were rated, whereafter the intervention was revised. Item-content validity index (I-CVI), average, and overall CVI were used to quantify ratings. To determine content validity and feasibility in the clinical context, experts (n = 8) (patients and physiotherapists) assessed eVIS after a 2-3-week test trial, with the feasibility aspects acceptability, demand, implementation, limited efficacy-testing, and practicality in focus. Additional expert interviews (with physiotherapists, physicians) were conducted on two incomplete areas.

Results: The intervention was iteratively revised and refined throughout the study. After three assessment and revision rounds, the I-CVI ratings for relevance, simplicity, and safety ranged between 0.88 and 1.00 (≥0.78) in most items, giving eVIS "excellent" content validity. In the IPRP context, the intervention emerged as valid and feasible. Additional interviews further contributed to its content validity and clinical feasibility.

Conclusions: The proposed domains and features of the eVIS intervention are deemed valid in its content and feasible in the IPRP context. The consecutive step-by-step evaluation process enabled careful intervention development with revisions to be made in close collaboration with stakeholders. Findings implicate a robust base ahead of the forthcoming effectiveness trial.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright: © 2023 Tseli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Figures

Fig 1. Development, content validity, and feasibility evaluation stages of the eVIS intervention according to the updated Framework for Developing and Evaluating Complex Interventions.

* [35] Broken lines illustrate the subsequent phases with effectiveness evaluation and potential implementation.

Fig 2. Schematic overview of the eVIS intervention’s elements.

Copied from study protocol by Sjöberg et al. [20]. Attribution CC BY-NC 4.0.

Fig 3. Evaluation of feasibility in a clinical context.

Ratings post IPRP by patients (n = 5). Domain-specific explications of grades 1: Not at all, 2: To some extent, 3: To a rather large extent, 4: To a large extent. Item P-F17 was rated as extent of agreement with a statement from 1: Strongly disagree to 4: Strongly agree. Ratings ≥ 3 = satisfactory feasibility. Abbreviations: IPRP = Interdisciplinary pain rehabilitation program, P = Practicality, I = Implementation, A = Acceptability, L = Limited Efficacy testing, D = Demand.

Fig 4. Evaluation of feasibility in a clinical context.

Ratings post IPRP by physiotherapists (n = 3). Domain-specific explications of grades 1: Not at all, 2: To some extent, 3: To a rather large extent, 4: To a large extent. Item PT-F23 was rated as extent of agreement with a statement from 1: Strongly disagree to 4: Strongly agree. Ratings ≥ 3 = satisfactory feasibility. Abbreviations: IPRP = Interdisciplinary pain rehabilitation program, P = Practicality, I = Implementation, A = Acceptability, L = Limited Efficacy testing, D = Demand. * PT-F15, one physiotherapist follow up was not possible, due to other non-related events.