Clinical Rheumatology

, Volume 25, Issue 5, pp 619–631

Reliability and validity of the Italian version of the Chronic Pain Grade questionnaire in patients with musculoskeletal disorders

Original Article

Abstract

The aim of this study is to analyse the psychometric properties of the Italian version of the Chronic Pain Grade (CPG) questionnaire within a population of chronic musculoskeletal pain patients. The CPG questionnaire was adapted following the translation and back-translation methodologies. There were 576 patients with chronic musculoskeletal pain. Internal consistency was checked by the Cronbach’s alpha coefficient. Construct validity was analysed by performing principal component factor analysis and by comparing CPG dimensions and subscales with the SF-36 questionnaire. Discriminant validity was assessed by comparing the CPG and SF-36 dimensions in patients with and without other health conditions. Factor analysis yielded two factors which accounted for 76.4% of the variance of the questionnaire. Both subscales of the CPG showed satisfying to good internal consistency. Cronbach’s alpha was 0.89 for the first factor ‘Disability Score’ (58.72% of the explained variance) and 0.81 for the second factor ‘Characteristic Pain Intensity’ (17.70% of the explained variance). Item–total correlations for the subscales were moderate up to high (from 0.500 to 0.771). In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Discriminant validity, assessed by comparing the CPG dimensions in patients with and without other health conditions, showed that the CPG shows moderate association with the presence of co-morbidities. Furthermore, the CPG Disability Score was inversely correlated (p=0.01) to years of formal education. In conclusion, the Italian version of the CPG questionnaire has shown to be valid and reliable for evaluating the severity of chronic musculoskeletal pain, with metric properties in agreement with the original, widely used version.

Keywords

Chronic pain grade questionnaire Musculoskeletal disorders Physical functioning Quality of life Rheumatic diseases Validation 

References

  1. 1.
    Woolf AD, Zeidler H, Haglund U, Carr AJ, Chaussade S, Cucinotta D et al (2004) Musculoskeletal pain in Europe: its impact and a comparison of population and medical perceptions of treatment in eight European countries. Ann Rheum Dis 63:342–347PubMedCrossRefGoogle Scholar
  2. 2.
    Bingefors K, Isacson D (2004) Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain—a gender perspective. Eur J Pain 8:435–450PubMedCrossRefGoogle Scholar
  3. 3.
    Leardini G, Salaffi F, Caporali R, Rovati L, Canesi B, Montanelli R, and the Italian Group for Study of the Costs of Arthritis (GISCA) (2004) Direct and indirect costs of osteoarthritis of the knee. Clin Exp Rheumatol 22:699–706PubMedGoogle Scholar
  4. 4.
    Leardini G, Salaffi F, Montanelli M, Gertzeli S, Canesi B (2002) A multicenter cost-of-illness study on rheumatoid arthritis in Italy. Clin Exp Rheumatol 20:505–515PubMedGoogle Scholar
  5. 5.
    Smith BH, Elliott AM, Chambers WA, Smith WC, Hannaford PC, Penny K (2001) The impact of chronic pain in the community. Fam Pract 18:292–299PubMedCrossRefGoogle Scholar
  6. 6.
    Lamé IE, Peters ML, Vlaeyen JWS, Kleef MV, Patijn J (2005) Quality of life in chronic pain is more associated with beliefs about pain, than pain intensity. Eur J Pain 9:15–24PubMedCrossRefGoogle Scholar
  7. 7.
    Franchignoni F, Salaffi F (2004) Generic and specific measures for outcome assessment in orthopaedic and rheumatologic rehabilitation. In: Barat M, Franchignoni F (eds) Assessment in physical medicine and rehabilitation—advances in rehabilitation, vol 16. pp 45–77Google Scholar
  8. 8.
    Keystone EC, Shiff MH, Kremer JM, Kafka S, Lovy M, De Vries T et al (2004) Once-weekly administration of 50 mg etanercept in patients with active rheumatoid arthritis. Arthritis Rheum 50:353–363PubMedCrossRefGoogle Scholar
  9. 9.
    Brandt J, Listing J, Haibel H, Sorensen H, Schwebig A, Rudwaleit M et al (2005) Long-term efficacy and safety of etanercept after readministration in patients with active ankylosing spondylitis. Rheumatology (Oxford) 44(3):342–348CrossRefGoogle Scholar
  10. 10.
    Mease PJ, Kivitz AJ, Burch FX, Siegel EL, Cohen SB, Ory P et al (2004) Etanercept treatment of psoriatic arthritis. Arthritis Rheum 50:2264–2272PubMedCrossRefGoogle Scholar
  11. 11.
    Pope JE, Prashker M, Anderson J (2004) The efficacy and cost effectiveness of N of 1 studies with diclofenac compared to standard treatment with nonsteroidal antiinflammatory drugs in osteoarthritis. J Rheumatol 31(1):140–149PubMedGoogle Scholar
  12. 12.
    Gowans SE, Dehueck A, Voss S, Silaj A, Abbey SE (2004) Six-month and one-year followup of 23 weeks of aerobic exercise for individuals with fibromyalgia. Arthritis Rheum 51(6):890–898PubMedCrossRefGoogle Scholar
  13. 13.
    Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB et al (2003) Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain 106:337–345PubMedCrossRefGoogle Scholar
  14. 14.
    Von Korff M, Ormel J, Keefe F, Dworkin SF (1992) Grading the severity of chronic pain. Pain 50:133–149CrossRefGoogle Scholar
  15. 15.
    Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J et al (1997) The Chronic Pain Grade questionnaire: validation and reliability in postal research. Pain 71:141–147PubMedCrossRefGoogle Scholar
  16. 16.
    Elliott AM, Smith BH, Smith WC, Chambers WA (2000) Changes in chronic pain severity over time: the Chronic Pain Grade as a valid measure. Pain 88:303–308PubMedCrossRefGoogle Scholar
  17. 17.
    Elliott A, Smith BH, Hannaford PC, Smith WC, Chambers WA (2002) Assessing change in chronic pain severity: the Chronic Pain Grade compared with retrospective perceptions. Br J Gen Pract 52:269–274PubMedGoogle Scholar
  18. 18.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRefGoogle Scholar
  19. 19.
    Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25(11):1271–1277PubMedCrossRefGoogle Scholar
  20. 20.
    Subcommittee for Scleroderma Criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee (1980) Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 23:581–590CrossRefGoogle Scholar
  21. 21.
    Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A et al (1991) The European spondylarthropathy study group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227PubMedCrossRefGoogle Scholar
  22. 22.
    Vitali C, Bombardieri S, Moutsopoulos HM, Balestrieri G, Bencivelli W, Berstein RM et al (1993) Preliminary criteria for the classification of Sjögren’s syndrome: results of a prospective concerted action supported by the European Community. Arthritis Rheum 36:340–347PubMedCrossRefGoogle Scholar
  23. 23.
    Moll JMH, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3:55–78PubMedCrossRefGoogle Scholar
  24. 24.
    Bird HA, Esselinckx W, Dixon AS, Mowat AG, Wood PH (1979) An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis 38:434–439PubMedCrossRefGoogle Scholar
  25. 25.
    McCarty DJ (1993) Calcium pyrophosphate dihydrate crystal deposition disease. In: Schumacher HR Jr (ed) Primer on the rheumatic diseases, 10th edn. Arthritis Foundation, Atlanta, pp 219–222Google Scholar
  26. 26.
    Sieper J, Rudwaleit M, Braun J, van der Heijde D (2002) Diagnosing reactive arthritis. Role of clinical setting in the value of serologic and microbiologic assay. Arthritis Rheum 46:319–327PubMedCrossRefGoogle Scholar
  27. 27.
    Bodolay E, Csiki Z, Szekanecz Z, Ben T, Kiss E, Zeher M et al (2003) Five-year follow-up of 665 Hungarian patients with Undifferentiated Connective Tissue Disease (UCTD). Clin Exp Rheumatol 21:313–320PubMedGoogle Scholar
  28. 28.
    Altman RD, Asch E, Bloch DA, Bole G, Borenstein D, Brandt K et al (1986) Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 29:1039–1049PubMedCrossRefGoogle Scholar
  29. 29.
    Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K et al (1990) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 33:1601–1610PubMedCrossRefGoogle Scholar
  30. 30.
    Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K et al (1991) The American College of Rheumatology criteria for the classification of osteoarthritis of the hip. Arthritis Rheum 34:505–514PubMedCrossRefGoogle Scholar
  31. 31.
    Frank JW, Kerr MS, Brooker AS, DeMaio SE, Maetzel A, Shannon HS et al (1996) Disability resulting from occupational low back pain: I. What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine 21:2908–2917PubMedCrossRefGoogle Scholar
  32. 32.
    Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosèn I (1999) Prevalence of carpal tunnel syndrome in a general population. JAMA 281:153–158CrossRefGoogle Scholar
  33. 33.
    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33:160–172PubMedCrossRefGoogle Scholar
  34. 34.
    Ware J, Sherbourne CD (1992) The MOS 36-item short form health survey (SF-36). 1. Conceptual frame-work and item selection. Med Care 30:473–481PubMedCrossRefGoogle Scholar
  35. 35.
    Apolone G, Mosconi P (1998) The Italian SF-36 Health Survey: translation, validation and norming. J Clin Epidemiol 51:1025–1036PubMedCrossRefGoogle Scholar
  36. 36.
    Ware J, Kosinski M, Bayliss M, Rogers WH, Razec A (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the medical outcomes study. Med Care 4:AS264–AS279Google Scholar
  37. 37.
    Steiner GL, Norman DR (1996) Health measurement scales: a practical guide to their development and use, 2nd edn. Oxford University Press, OxfordGoogle Scholar
  38. 38.
    Klasen BW, Hallner D, Shaub C, Willburger R, Hasenbring M (2004) Validation and reliability of the German version of the Chronic Pain Grade questionnaire in primary care back pain patients. Psycho-Social-Medicine, 1:doc07. Available online at http://www.egms.de/en/journals/psm/2004–1/psm000007.shtml
  39. 39.
    Bergman S, Jacobsson LTH, Herrström P, Petersson I (2004) Health status as measured by SF-36 reflects changes and predicts outcome in chronic musculoskeletal pain: a 3-year follow up study in the general population. Pain 108:115–123PubMedCrossRefGoogle Scholar
  40. 40.
    Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA (1999) The epidemiology of chronic pain in the community. Lancet 354:1248–1252PubMedCrossRefGoogle Scholar
  41. 41.
    Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ (2001) Chronic pain in Australia: a prevalence study. Pain 89:127–134PubMedCrossRefGoogle Scholar
  42. 42.
    McBeth J, Macfarlane GJ, Hunt IM, Silman AJ (2001) Risk factors for persistent chronic widespread pain: a community-based study. Rheumatology 40:95–101PubMedCrossRefGoogle Scholar
  43. 43.
    Rustøen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C (2004) Prevalence and characteristics of chronic pain in the general Norwegian population. Eur J Pain 8:555–565PubMedCrossRefGoogle Scholar
  44. 44.
    Gagliese L, Melzack R (1997) Chronic pain in elderly people. Pain 70:3–14PubMedCrossRefGoogle Scholar
  45. 45.
    Callahan LF, Smith WJ, Pincus T (1989) Self-report questionnaires in five rheumatic diseases. Arthritis Care Res 2:122–131PubMedCrossRefGoogle Scholar
  46. 46.
    Goubert L, Crombez G, De Bourdeaudhuij I (2004) Low back pain, disability and back pain myths in a community sample: prevalence and interrelationships. Eur J Pain 8:385–394PubMedCrossRefGoogle Scholar
  47. 47.
    Von Korff M, Dworkin SF, Le Resche L (1990) Graded chronic pain status: an epidemiologic evaluation. Pain 40:279–291CrossRefGoogle Scholar
  48. 48.
    Salaffi F, Leardini G, Canesi B, Mannoni A, Fioravanti A, Caporali R, on behalf of Gonarthrosis and Quality Of Life Assessment (GOQOLA) Study Group (2003a) Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index in Italian patients with osteoarthritis of the knee. Osteoarthritis Cartilage 11:551–560PubMedCrossRefGoogle Scholar
  49. 49.
    Salaffi F, Piva S, Barreca C, Cacace E, Ciancio G, Leardini G, on behalf of Gonarthrosis and Quality of Life (GOQUOLA) Study Group (2000) Validation of an Italian version of the arthritis impact measurement scales 2 (ITALIAN-AIMS2) for patients with osteoarthritis of the knee. Rheumatology 39:720–726PubMedCrossRefGoogle Scholar
  50. 50.
    Bombardier C, Melfi CA, Paul J, Green R, Hawker G, Wright J et al (1995) Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery. Med Care 33:AS131–AS144PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2006

Authors and Affiliations

  • Fausto Salaffi
    • 1
  • Andrea Stancati
    • 1
  • Walter Grassi
    • 1
  1. 1.Dipartimento di Patologia Molecolare e Terapie InnovativeCattedra di Reumatologia-Università Politecnica delle MarcheJesi AnconaItaly

Personalised recommendations