Model validation and structural equation modeling: a reply to Ward and Thorn.
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Avoidance Learning↗
Biomedical subjects
Andrew J Cook
Publications and source records attributed to Andrew J Cook.
The fear-avoidance model of chronic pain: validation and age analysis using structural equation modeling.
The cognitive-behavioral, fear-avoidance (FA) model of chronic pain (Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995a;62:363-72) has found broad empirical support, but its multivariate, predictive relationships have not been uniformly validated. Applicability of the model across age groups of chronic pain patients has also not been tested. Goals of this study were to validate the predictive relationships of the multivariate FA model using structural equation modeling and to evaluate the factor structure of the Tampa Scale of Kinesiophobia (TSK), levels of pain-related fear, and fit of the FA model across three age groups: young (< or =40), middle-aged (41-54), and older (> or =55) adults. A heterogeneous sample of 469 chronic pain patients provided ratings of catastrophizing, pain-related fear, depression, perceived disability, and pain severity. Using a confirmatory approach, a 2-factor, 13-item structure of the TSK provided the best fit and was invariant across age groups. Older participants were found to have lower TSK fear scores than middle-aged participants for both factors (FA, Harm). A modified version of the Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H (Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995a;62:363-72.) FA model provided a close fit to the data (chi(2)(29)=42.0, p>0.05, GFI=0.98, AGFI=0.97, CFI=0.99, RMSEA=0.031 (90% CI 0.000-0.050), p close fit=0.95). Multigroup analyses revealed significant differences in structural weights for older vs. middle-aged participants. For older chronic pain patients, a stronger mediating role for pain-related fear was supported. Results are consistent with a FA model of chronic pain, while indicating some important age group differences in this model and in levels of pain-related fear. Longitudinal testing of the multivariate model is recommended.
Adolescent↗
The cognitive risk profile for pain: development of a self-report inventory for identifying beliefs and attitudes that interfere with pain management.
OBJECTIVES: An extensive body of research suggests that maladaptive beliefs about chronic pain can have a negative impact on patient adherence and treatment response. A series of studies to develop and validate a clinically-based, self-report instrument for pain beliefs, the Cognitive Risk Profile for Pain (CRPP), was undertaken. We sought to expand the existing body of knowledge for pain beliefs by development of an instrument with a somewhat different content and format than prior pain belief measures, and a primary focus on clinical risk assessment for treatment planning. METHODS: Test development and evaluation procedures were applied in the initial stages of CRPP development. We report here on a series of studies to evaluate and refine the structure and content of the CRPP, and to establish its internal reliability, concurrent, and criterion validities. A 68-item version of the CRPP was evaluated, including a total risk score and 9 scale scores: philosophic beliefs about pain (PB), denial that mood affects pain (MP), denial that pain affects mood (PM), perception of blame (BL), inadequate support (IS), disability entitlement (DE), desire for medical breakthrough (MB), skepticism of multidisciplinary approach (SM), and conviction of hopelessness (CH). The CRPP was administered to two large samples of chronic pain outpatients (n=499; 125) in conjunction with other self-report scales for pain and associated beliefs, behaviors, and psychopathology. In a final study, treatment outcome measures were obtained for a subsample of chronic pain patients (n=91) to evaluate criterion validity. RESULTS: Confirmatory factor analyses showed improved fit for the CRPP scale structure after elimination of 15 items. The resulting 53-item CRPP was found to have good internal consistency for the full score (alpha=0.82) and 7 of 9 scales, with moderate consistency for scales BL and MB. Low to moderate scale intercorrelations were found. Correlations with pain and psychosocial measures suggested good construct validity for the majority of individual scales and total score. Results were inconsistent for scale MP. Multivariate analyses of variances (MANOVAs) based on tertile split of total risk scores showed significant main effects across pain, mood, productivity, and sleep ratings at 3 and 6-month treatment follow-ups. Analyses of clinically significant treatment changes (ie, 2 points on a 11-point Numerical Rating Scales) showed significantly higher prevalence of treatment "failures" at 6 months among CRPP high-risk patients, but no significant differences at 3 months. DISCUSSION: Results provide initial support for the CRPP as a reliable, valid, and useful measure of general cognitive risk for pain management. Results were supportive of the content and reliabilities of the majority of scale scores. Scales for denial of mood impact on pain, perception of blame, and desire for medical breakthrough will require further evaluation. Data indicate an association of CRPP total risk with multidimensional outcome from medical treatment of chronic pain, supporting relevance to treatment planning. The unique content and format of the CRPP may be useful in some clinical pain settings. Possible applications of the CRPP for risk assessment and treatment planning for chronic pain are discussed.
Adolescent↗
Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis?
UNLABELLED: The differential diagnosis of headache is often challenging, with significant clinical and socioeconomic consequences of incomplete or inaccurate diagnosis. Overlapping symptoms contribute to the diagnostic challenge. Four female patients, ages 26 to 69 with standing diagnoses of migraine, were evaluated and treated for complaints of chronic, severe headaches. All had obtained limited relief from migraine therapies. On physical examination, all had occipital nerve tenderness or positive Tinel sign over the occipital nerve. All responded well to occipital nerve blocks with local anesthetic, achieving complete or substantial pain relief lasting up to 2 months. We conclude that accurate diagnosis of occipital neuralgia or cervicogenic headache as contributing factors can lead to substantial headache relief through occipital nerve blocks in patients with coexisting or misdiagnosed migraine. PERSPECTIVE: The pathophysiology of many types of chronic headaches is not well understood. Mixed mechanisms such as neurovascular, neuropathic, myofascial, and cervicogenic may all contribute. Our four patients with chronic headaches responded well to occipital nerve blocks. The neuroanatomical relationship between the trigeminocervical nucleus and occipital nerve may serve as the basis of efficacy for these blocks.
Adult↗
Application of the pressure-state-response framework to perceptions reporting of the state of the New Zealand environment.
The Pressure-State-Response framework for environmental reporting was used as a basis to develop a long-term study of people's perceptions of the state of the New Zealand environment. A postal survey of 2000 people, randomly drawn from the New Zealand electoral roll was used to gather data--an effective response rate of 48% was achieved. A range of different resource sectors was examined. We report on New Zealand's air, native animals and plants, and marine fisheries, as well as New Zealand compared to other developed countries. Respondents generally considered that in terms of pressures, states and responses, New Zealand was performing better than other developed countries and that for the resources examined here overall performance was in the adequate to good range, except for marine fisheries. The survey appears to be a useful tool for linking perceptions data into State of the Environment reporting. It also helps identify policy issues where perceptions do not match other scientific evidence or management initiatives. Such findings can be important for the successful implementation of policy measures.
Animals↗
Electronic pain questionnaires: a randomized, crossover comparison with paper questionnaires for chronic pain assessment.
Electronic questionnaires for pain assessment are becoming increasingly popular. There have been no published reports to establish the equivalence or psychometric properties of common pain questionnaires administered via desktop computers. This study compared responses to paper (P) and touch screen electronic (E) versions of the Short-Form McGill Pain Questionnaire (SF-MPQ) and Pain Disability Index (PDI), while examining the role of computer anxiety and experience, and evaluating patient acceptance. In a randomized, crossover design 189 chronic pain patients completed P and E versions of the SF-MPQ and PDI, and self-ratings of anxiety, experience, relative ease and preference. Psychometric properties were highly similar for P and E questionnaires. For the SF-MPQ, 60% or more of subjects gave equivalent responses on individual descriptors and PPI scale, with 80% rating within +/-1 point for an 11-point VAS. Correlations for the SF-MPQ scales ranged from 0.68 to 0.84. For the PDI, 60% or more of subjects responded within +/-1 point on individual questions, and the total score correlation was 0.67. Comparison of mean difference scores revealed no significant differences between modes for any of the questionnaire items or scores. Anxiety and experience scores showed no significant associations through correlations and high/low comparisons. Although nearly half of subjects reported no computer training, anxiety ratings were low, and considerably more subjects rated the E questionnaires as easier and preferred. Findings are consistent with test-retest reliability data, and support the validity and acceptance of electronic versions of the SF-MPQ and PDI.
Adolescent↗