Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 6 Issue 7

The Interpretability of Change Scores of the Pain Disability Index and its Responsiveness in Chronic Musculoskeletal Pain Rehabilitation

Albère JA Köke1,2,3*, Laura WME Beckers1, Alexandra NTD Pulles1 and Rob JEM Smeets1,4

1Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
2Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
3Zuyd University for Applied Sciences, Faculty Health and Technology, Heerlen, The Netherlands
4CIR Revalidatie, location Eindhoven, The Netherlands

*Corresponding Author: Albère JA Köke, Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

Received: March 04, 2022; Published: June 09, 2022


Purpose: The Pain Disability Index (PDI) questionnaire assesses the reduction of disability, the main goal of chronic musculoskeletal pain (CMSP) rehabilitation. Moreover, the PDI is widely used and its clinimetric properties seem to be positive. This study aimed to provide reference values to interpret change scores of individuals on the PDI, for daily clinical practice, and to assess its responsiveness.

Methods: The smallest detectable change (SDC), and minimal clinically important change (MCIC) of the PDI were investigated in 374 patients with CMSP, participating in an interdisciplinary pain rehabilitation programme (IPRP). Two Global Perceived Effect (GPE) statements were used to investigate these properties and values.

Results: The hypotheses concerning correlations of the GPEs with the change scores on the PDI could not be confirmed. The SDC was evidently larger than the MCIC, independent of the GPE used.

Conclusion: The PDI appeared not to be able to distinguish clinically important change from measurement error in individual patients for a broad range of change scores. For now, the calculated SDC can be used as a cut-off score to be fairly certain of real improvement. Further research is necessary to enhance usability.

Keywords: Outcome; Disability; Chronic Pain; Clinically Relevant; Responsiveness


  1. McGlynn EA and EA Kerr. “Creating Safe Harbors for Quality Measurement Innovation and Improvement”. JAMA 2 (2016): 129-130.
  2. McGlynn EA., et al. “Reimagining quality measurement”. The New England Journal of Medicine 23 (2014): 2150-2153.
  3. Köke AJA., et al. “Dutch Dataset Pain Rehabilitation in daily practice: Content, patient characteristics and reference data”. European Journal of Pain3 (2017): 434-444.
  4. Köke AJA., et al. “Implemetatie en uitbreiding Nederlandse Dataset Pijnrevalidatie”. OPR, Editor (2012).
  5. Higginson IJ and AJ Carr. “Measuring quality of life: Using quality of life measures in the clinical setting”. BMJ7297 (2001): 1297-300.
  6. de Vet. “Henrica Measurement in Medicine: a practical guide”. Cambridge University Press (2011).
  7. Terwee CB., et al. “Linking measurement error to minimal important change of patient-reported outcomes”. Journal of Clinical Epidemiology10 (2009): 1062-1067.
  8. Mokkink LB., et al. “The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study”. Quality Life Research4 (2010): 539-549.
  9. Pulles ANTD., et al. “The responsiveness and interpretability of psychosocial patient-reported outcome measures in chronic musculoskeletal pain rehabilitation”. European Journal of Pain1 (2020): 134-144.
  10. Tait RC., et al. “The Pain Disability Index: psychometric and validity data”. Archives of Physical Medicine and Rehabilitation 7 (1987): 438-441.
  11. McKillop AB., et al. “Measuring participation in patients with chronic back pain-the 5-Item Pain Disability Index”. Spine Journal2 (2018): 307-313.
  12. Soer R., et al. “Extensive validation of the pain disability index in 3 groups of patients with musculoskeletal pain”. Spine (Phila Pa 1976)9 (2013): E562-568.
  13. Soer R., et al. “Responsiveness and minimal clinically important change of the Pain Disability Index in patients with chronic back pain”. Spine (Phila Pa 1976)8 (2012): 711-715.
  14. Beemster T., et al. “The interpretation of change score of the pain disability index after vocational rehabilitation is baseline dependent”. Health Quality and Life Outcomes1 (2018): 182.
  15. Chibnall JT and RC Tait. “The Pain Disability Index: factor structure and normative data”. Archives of Physical Medicine and Rehabilitation10 (1994) 1082-1086.
  16. Guyatt GH., et al. “A critical look at transition ratings”. Journal of Clinical Epidemiology9 (2002): 900-908.
  17. Dworkin RH., et al. “Core outcome measures for chronic pain clinical trials: IMMPACT recommendations”. Pain1-2 (2005): 9-19.
  18. Fischer D., et al. “Capturing the patient's view of change as a clinical outcome measure”. JAMA12 (1999): 1157-1162.
  19. de Vet HC., et al. “When to use agreement versus reliability measures”. Journal of Clinical Epidemiology10 (2006): 1033-1039.
  20. Andersson EI., et al. “Performance tests in people with chronic low back pain: responsiveness and minimal clinically important change”. Spine (Phila Pa 1976)26 (2010): E1559-1563.
  21. de Vet H., et al. “Three ways to quantify uncertainty in individually applied "minimally important change" values”. Journal of Clinical Epidemiology1 (2010): 37-45.
  22. Jaeschke R., et al. “Measurement of health status. Ascertaining the minimal clinically important difference”. Control Clinical Trials4 (1989): 407-415.
  23. Terwee CB., et al. “Quality criteria were proposed for measurement properties of health status questionnaires”. Journal of Clinical Epidemiology1 (2007): 34-42.
  24. Ostelo RW and HC de Vet. “Clinically important outcomes in low back pain”. Best Practice and Research: Clinical Rheumatology 4 (2005): 593-607.
  25. Beckers L and R Smeets. “Methodological and interpretive concerns about Beemster et al.'s article 'The interpretation of change score of the pain disability index after vocational rehabilitation is baseline dependent': a letter to the editor”. Health Quality Life Outcomes1 (2020): 301.
  26. Borghuis EMC., et al. “Assessing discrepancies in outcomes of pain rehabilitation: "these questionnaires don't measure results that are relevant to me". Disability and Rehabilitation16 (2020): 2374-2380.
  27. Deyo RA and WB Carter. “Strategies for improving and expanding the application of health status measures in clinical settings. A researcher-developer viewpoint”. Medical Care5 (1992): MS176-186; discussion MS196-209.
  28. Evans R., et al. “I know it's changed": a mixed-methods study of the meaning of Global Perceived Effect in chronic neck pain patients”. European Spine Journal4 (2014): 888-897.
  29. Grovle L., et al. “Patients' ratings of global perceived change during 2 years were strongly influenced by the current health status”. Journal of Clinical Epidemiology5 (2014): 508-515.
  30. Kamper SJ., et al. “Global Perceived Effect scales provided reliable assessments of health transition in people with musculoskeletal disorders, but ratings are strongly influenced by current status”. Journal of Clinical Epidemiology7 (2010): 760-766 e1.
  31. Schmitt J and RP Di Fabio. “The validity of prospective and retrospective global change criterion measures”. Archives of Physical Medicine and Rehabilitation12 (2005): 2270-2276.


Citation: Albère JA Köke., et al. “The Interpretability of Change Scores of the Pain Disability Index and its Responsiveness in Chronic Musculoskeletal Pain Rehabilitation”.Acta Scientific Medical Sciences 6.7 (2022): 78-85.


Copyright: © 2022 Albère JA Köke., 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.


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