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Transcultural validation of a French–European version of the Prescription Opioid Misuse Index Scale (POMI-5F)

Validation transculturelle d’une version franco-européenne de l'échelle de mésusage des prescriptions d'opioïdes (POMI-5F)

Abstract

Purpose

The Prescription Opioid Misuse Index scale (POMI) is a brief questionnaire used to assess opioid prescription misuse. In view of the increase in the prescription of opioid analgesics for chronic noncancer pain (CNCP), this tool is particularly useful during medical consultations to screen opioid misuse in patients using opioids. We sought to generate and validate a French–European translation of the POMI.

Methods

We conducted an observational, longitudinal, and multicenter psychometric study with crosscultural validation. All adult CNCP patients who were treated with opioids for at least three months, were followed in pain clinics, and spoke French were eligible. From September 2015 to November 2017, we included 163 patients and analyzed 154. We performed a pretest on a sample of representative patients to evaluate acceptability and understanding of translation. Study patients completed the POMI scale at a pain clinic (test phase), and we assessed test–retest reliability after two to four weeks by a second completion of the POMI scale at home by patients (retest phase). We subsequently explored psychometric properties of the POMI (acceptability, internal consistency, reproducibility, and external validity).

Results

Due to poor internal consistency and reproducibility, items 4, 7, and 8 of the original POMI scale were removed, and we proposed a five-question French–European version (POMI-5F). The internal consistency of POMI-5F was good (Cronbach’s α = 0.71), as was test–retest reliability (r = 0.65 [0.55–0.67]). The external validity of POMI-5F, compared with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was moderate but significant (r = 0.45; P < 0.001). The optimal POMI-5F cut-off score to indicate misuse was 2/5 (sensitivity = 0.95 and specificity = 0.54).

Conclusion

We generated and validated a French–European translation of the POMI scale, POMI-5F, for use by French researchers and physicians to identify opioid misuse in CNCP patients.

Résumé

Objectif

L'échelle Prescription Opioid Misuse Index (POMI) est un questionnaire court utilisé pour évaluer le mésusage de la prescription d'opioïdes. Face à l'augmentation de la prescription d'antalgiques opioïdes pour les douleurs chroniques non cancéreuses (DCNC), cet outil est particulièrement utile lors des consultations médicales pour dépister le mésusage chez les patients utilisateurs d'opioïdes. Nous avons cherché à générer et à valider une traduction franco-européenne de la POMI.

Méthodes

Nous avons mené une étude psychométrique observationnelle, longitudinale et multicentrique avec une validation transculturelle. Tous les patients souffrant de DCNC, traités par opioïdes depuis au moins trois mois, suivis en structures douleur chronique et parlant le Français étaient éligibles. De septembre 2015 à novembre 2017, 163 patients ont été inclus et 154 analysés. Un pré-test a été réalisé sur un échantillon de patients représentatifs pour évaluer l'acceptabilité et la compréhension de la traduction. Les patients de l'étude ont rempli l'échelle POMI (phase TEST) au sein du centre investigateur et la fiabilité du test–retest a été évaluée après deux à quatre semaines par un second remplissage de l'échelle POMI à domicile par les patients (phase RETEST). Ensuite, les propriétés psychométriques de l'échelle POMI ont été explorées (acceptabilité, cohérence interne, reproductibilité et validité externe).

Résultats

En raison d’une faible cohérence interne et reproductibilité, les items 4, 7 et 8 de l'échelle POMI originale ont été supprimés, et nous avons proposé une version française (Europe) à cinq questions (POMI-5F). La cohérence interne de l'échelle POMI-5F était bonne (α de Cronbach = 0,71), tout comme la fiabilité test–retest (r = 0,65 [0,55–0,67]). La validité externe du POMI-5F, comparée à la cinquième édition du Manuel diagnostique et statistique des troubles mentaux (DSM-5), était modérée mais significative (r = 0,45; P < 0,001). Le score seuil optimal du POMI-5F pour indiquer un mésusage était de 2/5 (sensibilité = 0,95 et spécificité = 0,54).

Conclusion

Nous avons généré et validé une traduction franco-européenne de l'échelle POMI, POMI-5F, pour une utilisation par les chercheurs et les médecins français afin d’identifier le mésusage des opioïdes chez les patients souffrant de DCNC.

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Author contributions

Noémie Delage, Catherine Laporte, Anne Roussin, and Nicolas Authier contributed to the design of the clinical study. Noémie Delage, Catherine Laporte, Pascale Picard, Anne Roussin, Jessica Delorme, and Nicolas Authier created the original tool, checked the validity of the back-translation, and contributed to the design of the French version of the questionnaire. Noémie Delage and Nathalie Cantagrel contributed to data acquisition. Bruno Pereira, Jessica Delorme, Noémie Delage, Nicolas Kerckhove, and Nicolas Authier contributed to data analysis. Christian Dualé proofread the article and gave relevant methodological advice. Noémie Delage, Jessica Delorme, Celian Bertin, Chouki Chenaf, Nicolas Kerckhove, and Nicolas Authier contributed to the interpretation of data and drafting the manuscript.

Acknowledgements

The authors wish to mention and thank the sponsor of the study. The study was part of the Prescription Opioids Misuse Assessment (POMA) in chronic pain patients project, which has received the financial support of the French National Agency for Medicines and Health Products Safety (ANSM: Agence Nationale de Sécurité du Médicament et des Produits de Santé—Grant number 20145013). We thank Mr. Keith Hudson of Accent Europe (Ecully, France) for the proofreading.

Disclosures

None.

Funding statement

This study was part of the POMA project (Prescription Opioids Misuse Assessment in chronic pain patients) and funded by the French National Agency for Medicine and Health Product Safety (ANSM: Agence Nationale de Sécurité du Médicament et des Produits de Santé – Grant number 20145013). The financial sponsor of this work played no role in the design and conduct of the study, nor in the collection, management, analysis, or interpretation of the data. The sponsor also had no role in either the preparation or review of the manuscript or the decision to submit the article for publication.

Editorial responsibility

This submission was handled by Dr. Philippe Richebé, French Language Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Delage, N., Cantagrel, N., Delorme, J. et al. Transcultural validation of a French–European version of the Prescription Opioid Misuse Index Scale (POMI-5F). Can J Anesth/J Can Anesth (2022). https://doi.org/10.1007/s12630-022-02210-7

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  • DOI: https://doi.org/10.1007/s12630-022-02210-7

Keywords

  • opioid use disorder
  • chronic pain
  • transcultural validation
  • POMI scale