G02 - Assessment of Disability(839) Development and psychometric evaluation of the Bath

Adolescent Pain questionnaire (BAPQ)A. Jordan, C. Eccleston, L. McCracken, M. Sleed, H. Connell, J. Clinch, C.Sourbut; Pain Management Unit, University of Bath & Royal National Hospitalfor Rheumatic Diseases, Bath, UK, Bath, UKThere are no appropriate multidimensional inventories which provide areliable and valid assessment of the impact of adolescent chronic pain.This study reports on the second stage of the development and psycho-metric evaluation of an assessment tool designed specifically for usewith adolescents who experience chronic pain. A sample of 222 adoles-cents (11-18 years) experiencing chronic pain completed the 109 itemdraft inventory. Participants were recruited from two UK tertiary centreclinic sites. All participants responded to items using a 5 point frequencyscale. Psychometric evaluation of the data resulted in a reduced inven-tory length of 61 items. Internal consistency of all 7 questionnaire sub-scales was established using Cronbach’s alpha. Comparative validity wasundertaken by comparison of all individual subscales with existing vali-dated measures (SCAS, CDI-S, FDI, Brief FAM. PCS and CASAFS). Thetemporal reliability of each inventory subscale was established using asub-sample of 30 adolescent participants over a 17 day period. Psycho-metric evaluation of the data suggest the inventory to be both a reliableand valid tool for assessing the impact of chronic pain on the lives ofadolescents.

(840) Adolescent chronic pain: A systematic review of mea-surement instruments

A. Jordan, C. Eccleston, G. Crombez; Pain Management Unit, University of Bath& Royal National Hospital for Rheumatic Diseases, Bath, UK, Bath, UKChronic pain has widespread detrimental effect on adolescent daily life,affecting physical, social, emotional and family functioning. Measure-ment of these effects is the important clinical and scientific startingpoint. We reviewed the use of instruments to assess the impact of ado-lescent chronic pain, focusing on their development, the domains cov-ered, their psychometric properties, and their use in studies of adoles-cent chronic pain. Systematic literature searching recovered 706 articles,yielding a total of 116 relevant articles, employing a total of 43 separatemeasurement instruments. All 43 identified instruments were subjectedto detailed content analysis. The majority of instruments were found tobe in the psychological domain (n�22), with a self-report format (n�36).Thirty instruments were specifically developed for adolescent popula-tions whilst only 12 instruments had undergone psychometric evalua-tion with adolescent chronic pain patients. The median use of any oneinstrument in published studies was 2. Clinically relevant psychometricdata were missing for many instruments. The findings of this reviewdemonstrated a diversity of instrumentation with some pockets ofdepth of use, but some domains of chronic pain experience with noroutine assessment. Further development of the knowledge base ofmeasurement of the impact of chronic adolescent pain is required.

(841) Race differences in diagnosis and surgery for occupa-tional low back injuries

J. Chibnall, R. Tait; Saint Louis University School of Medicine, St. Louis, MOWhile recent research has documented treatment and outcome differ-ences between African Americans and Caucasians with occupational lowback injuries, race differences specific to diagnosis and surgery have notbeen examined. These relationships are important, in part because di-agnostic specificity and surgery are strong predictors of disability ratingsand settlement awards for occupational low back injuries. The currentstudy was a population-based telephone survey in Missouri of AfricanAmerican (n � 580) and Caucasian (n � 892) Workers’ Compensationclaimants with low back injuries whose claims were settled in 2001-2002.Logistic regression was used to predict diagnosis (herniated disc vs. re-gional backache) from clinical findings, legal representation, demo-graphics (age, gender, socioeconomic status), and race. For the subset ofclaimants with a herniated disc, similar analyses were used to predictsurgery. Nonparametric tests were used to identify differences in med-ical expenditures, disability ratings, and settlement awards associatedwith diagnosis and surgery. Race significantly predicted diagnosis: Cau-casians were nearly two times more likely than African Americans toreceive a diagnosis of herniated disc. For the subset of claimants with aherniated disc, race was the strongest predictor of surgery: lumbar sur-gery occurred over three times more often in Caucasians than AfricanAmericans. Medical expenditures, disability ratings, and settlementawards were significantly higher for claimants with a herniated discdiagnosis and surgery. The results suggest that African Americans wereunderdiagnosed and undertreated relative to Caucasians, which in turnpredicted lower disability ratings and awards at case settlement.

(842) Expansion of the Headache Impact Test (HIT TM) itempool & initial evaluation in a primary care setting

D. Turner-Bowker, J. Bjorner, M. DeRosa, M. Kosinski, R. Cady, M. Diamond, J.Ware; QualityMetric Incorporated, Lincoln, RIThe DYNHA Headache Impact Test (HIT)™ uses computerized adaptivetesting (CAT) to provide practical and precise measurement at the indi-vidual patient level, building on a large bank of headache impact items.This study documents expansion of the HIT™ item pool (from k�47 tok�75 items); and presents results from an initial pilot test of the im-proved tool, the HEADACHE-CAT™. The HIT item pool covers domains ofpain, role functioning, social functioning, fatigue, cognition, and men-tal health. Modifications were made to existing items in the pool (e.g.,revised item stem and response option text), and existing item contentwas evaluated for redundancy. Expert panels were convened to identifynew items with potential clinical relevance. The expanded item pool wasfielded through an Internet-based survey of 1,103 headache sufferers.Items were analyzed using factor analytic methods for categorical dataand item response models. Analyses of item thresholds and informationfunctions indicated that the new items covered the same range as pre-vious items; however, total test information and measurement precisionwere increased, with the most notable improvements occurring at thehigh and low end of the scale. A field study was then conducted withpatients (N�50) in two primary care clinics. Measurement coverage,precision and response burden of a dynamically-administered HEAD-ACHE-CAT versus a static fixed-form version were compared. Patients’acceptance and experiences with the items and a subsequent reportproduced by the tool were also assessed. Results from the first site(n�25) indicate that the HEADACHE-CAT is very precise, reduces respon-dent burden, and is well accepted by patients.

S68 Abstracts