The interpretation of change score of the pain disability index after vocational rehabilitation is baseline dependent

• Published in: Health and quality of life outcomes Vol. 16; no. 1; p. 182
• Main Authors: Beemster, T, van Bennekom, C, van Velzen, J, Reneman, M, Frings-Dresen, M
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.09.2018; BioMed Central; BMC
• Subjects: Adolescent; Adult; Aged; Analysis; Area Under Curve; Back pain; Change detection; Chronic pain; Chronic Pain - diagnosis; Chronic Pain - rehabilitation; Clinical relevance; Disability; Disability Evaluation; Female; Follow-Up Studies; Humans; Interpretation of change; Male; Mental health; Middle Aged; Minimal important difference; Musculoskeletal Pain - diagnosis; Musculoskeletal Pain - rehabilitation; Occupational rehabilitation; Pain; Pain disability index; Pain Measurement - methods; Patients; Quality of Life; Rehabilitation; Rehabilitation, Vocational; Retrospective Studies; ROC Curve; Social services; Treatment Outcome; Vocational rehabilitation; Young Adult; Netherlands; Pain disability index; Occupational rehabilitation; Clinical relevance; Minimal important difference; Chronic pain; Interpretation of change
• ISSN: 1477-7525; 1477-7525
• DOI: 10.1186/s12955-018-1000-1

The Pain Disability Index (PDI) is a widely-used instrument to measure pain-related disability. The aim of this study was to assess the responsiveness and interpretation of change score of the PDI in patients with chronic musculoskeletal pain (CMP) at discharge of vocational rehabilitation. Retrospective data of patients with CMP who attended vocational rehabilitation between 2014 and 2017 was used. The anchor-based method was used to assess the responsiveness of the total sample and of PDI baseline quartile groups. A receiver operating characteristic curve was performed, including Area Under the Curve (AUC) and Minimal Important Change (MIC). The PDI showed responsive to detect clinically relevant changes in pain-related disability at discharge of vocational rehabilitation (AUC 0.79). A PDI change score of 13 points (MIC 12.5) can be considered as a real change in pain-related disability for the total study sample, and a PDI change score of 7-20 points can be considered as a real change in pain-related disability for PDI lowest and highest baseline quartile scores. The PDI is responsive in patients with CMP at discharge of vocational rehabilitation. The interpretation of change score depends on PDI baseline score. Patients with a PDI baseline score of ≤27 should decrease minimal 7 points, patients with a baseline score between 28 and 42 should decrease minimal 15 points, and patients with a baseline score ≥ 43 should decrease minimal 20 points.