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Chronifizierungsprozesse bei Rückenschmerzen (German Edition)

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The assessment is based on four dimensions "axes": A complex scoring system results in an additive index ranging from 4 to 12 points. Finally this score leads to one of three stages, which are assumed to represent different phases in the process of chronification: The MPSS is widely used in German pain clinic inpatients and has found some validation support [ 20 ], [ 21 ].

With increasing level of severity of the pain problem, as operationalized by the CPG, it can be assumed, that patients intensify their efforts in the use of and seeking for medical treatment. Internal consistency of the translated version of the CPG was assessed with Cronbach's alpha [ 22 ]. Factor structure was evaluated using factor analysis principal component, varimax rotation following on Patients.

The relationship between the Chronic Pain Grade and further staging and disability instruments were identified by correlational analyses Pearson's r and Spearman's Rho respectively in order to demonstrate validity of the German language CPG. In case of multiple testing Bonferroni's adjustment of the alpha-level was used.

Chronische Rückenschmerzen: Vom Symptom zur Krankheit

The sample characteristics sociodemographic data and medical history are summarized in Table 1 Tab. The mean pain intensity was 4. More than a half of the sample was assigned to CGP I For the Raspe Grading Scheme the corresponding values were Factor analysis was carried out to examine the factorial structure of the German version of the CPG. Whereas all other items were answered by a point numerical self rating scale, item 4 asks for the number of disability days "number of days", see Appendix A Fig.

This item demonstrated a skewed distribution: Therefore item 4 was excluded from principal component analysis. Items were accepted on the final factors if they had a loading of more than 0. The analysis revealed a two-factor solution eigenvalues 3. Both factors consisted of three items see Tab. The first factor "Disability Score DS" accounted for Subscales were calculated as proposed by Von Korff et al.

In spite of this moderate relation we chose to maintain two factors in view of the results of the factor analysis and textual considerations: Cronbach's alpha was 0. The lowest item-total correlation was.

Both subscales of the German language CPG showed satisfying to good internal consistency. Item-total correlations for the subscales were moderate up to high see Tab. The lowest item-total correlation to subscale "characteristic pain intensity" was. Exploring the hierarchical relationship between pain intensity and disability as proposed by Von Korff and colleagues [ 4 ], Figure 3 Fig.

Both grades consist of low disability less than 3 disability points. Considering the unequal distribution of gender in the presented study sample, Kruskal-Wallis tests and unpaired t-tests have been carried out to debar possible differences in the CPG and its subscales respectively. The results revealed no gender differences. The CPG showed significant correlations with its subscales.

Spearman's Rho coefficients were 0. In case of correlations between the total CPG and other measures Spearman's Rho for ordinal data was used. For other correlational analyses, Pearson's product-moment coefficients were conducted. As seen in Table 6 Tab. Finally, the CPG and its two subscales were correlated with behavioural measures, e. As shown in Table 7 Tab. However, this was not valid for the CPI. The present study was conducted to analyse the psychometric properties of the German version of the Chronic Pain Grade CPG [ 4 ] within a population of primary care back pain patients.

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In accordance with the results of Von Korff et al. However, in contrast to former studies [ 4 ], [ 5 ] the factor analysis of our data suggested a two-factor solution accounting for The first factor "Disability Score DS"; Both subscales revealed satisfying internal consistency. On the one hand, this intercorrelation is low enough to use both subscales as separate measures, as the results of factors analysis and eigenvalues suggested, but this correlation is also high enough to use the Chronic Pain Grade as an overall measure.

Up to now, several authors applied both, the CPI and the DS in their studies [ 5 ], [ 23 ]; yet Von Korff himself recommended the use of two subscale scores depending on the aims of study interests [ 4 ], [ 6 ] even though emphasizing the unidimensional structure of the CPG. Independently of the question of using an unidimensional or a two factor solution our data suggest that it is justified to apply both, the CPG as a categorical measure and also the two subscales CPI and DS.

In view of concurrent validity we found that the CPG and its subscales were significantly correlated with other clinical variables. This result was supported by a more detailed analyses of the results. These results may refer to a higher correspondence between the CPG and the PDI with regard to the concept of pain-related disability as restrictions in several activities of daily life.

In contrast, the FFbH-R mainly measures disability as a concept which is stronger related to concrete physical activities, such as sitting or walking. Furthermore, the relevant time span differs. Against our expectations, the results regarding the interrelation between the CPG and other measures of staging chronic pain were conflicting. This may be due to the fact, that besides a measure of pain intensity, which refers to actual pain, the FFbH is a central component of the RGS.

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A further aspect refers to the different meaning of the stages. In both instruments stage I refers to low pain intensity and low disability. Get fast, free shipping with Amazon Prime. Get to Know Us. English Choose a language for shopping. Explore the Home Gift Guide. Amazon Music Stream millions of songs. Amazon Advertising Find, attract, and engage customers. Amazon Drive Cloud storage from Amazon.

Alexa Actionable Analytics for the Web. AmazonGlobal Ship Orders Internationally. Amazon Inspire Digital Educational Resources. However, in contrast to former studies [ 4 ], [ 5 ] the factor analysis of our data suggested a two-factor solution accounting for The first factor "Disability Score DS"; Both subscales revealed satisfying internal consistency.

On the one hand, this intercorrelation is low enough to use both subscales as separate measures, as the results of factors analysis and eigenvalues suggested, but this correlation is also high enough to use the Chronic Pain Grade as an overall measure. Up to now, several authors applied both, the CPI and the DS in their studies [ 5 ], [ 23 ]; yet Von Korff himself recommended the use of two subscale scores depending on the aims of study interests [ 4 ], [ 6 ] even though emphasizing the unidimensional structure of the CPG.

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Independently of the question of using an unidimensional or a two factor solution our data suggest that it is justified to apply both, the CPG as a categorical measure and also the two subscales CPI and DS. In view of concurrent validity we found that the CPG and its subscales were significantly correlated with other clinical variables. This result was supported by a more detailed analyses of the results. These results may refer to a higher correspondence between the CPG and the PDI with regard to the concept of pain-related disability as restrictions in several activities of daily life.

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A further aspect refers to the different meaning of the stages. In both instruments stage I refers to low pain intensity and low disability. In contrast, stage II measures different aspects. As one consequence, these both grades could include patients with low or high pain intensity. This also can be explained by different underlying conceptions of the two measures: The results indicate that there is no homogenous concept of the severity of chronic pain.

As Von Korff et al. Further, the MPSS will realize a better differentiation within pain clinical inpatients, whereas the RGS may be especially valid for patients with short time pain of less than three months. These both groups, patients with short time pain as well as pain clinic patients were not represented within our sample. Further, comparative studies are required to answer the questions about the different purposes of different measures of chronification, chronic pain or the severity of chronic pain.

At this point is has to be retained that the German version of the CPG is a reliable and valid measure at least for samples similar to that of the present study. This is also supported by its independency of the duration of pain and its positive correlations with behavioural measures as frequency of doctor visits and use of pain medication which is consistent with the findings of earlier research [ 4 ], [ 5 ], [ 6 ], [ 8 ].

There are several limitations that have to be considered regarding the presented results.

We applied grading to a non-randomly ascertained primary care sample. It can be assumed that the motivation of the patient's voluntary taking part in a study differs in random population samples imputing randomly ascertained patients a tendency to aggravate self perceived severity. Furthermore, the results of our study are limited to patients with so called "unspecific" low back pain with none or minor organic findings lasting at least three months. A further limitation was due to age.

As this research was part of a larger psychosocial intervention study, which was conducted in patients between 18 and 65 years, especially older patients were not represented in the present sample. Furthermore, we have to ask about the CPG's ability to assess change over time in clinical trials considering the results of Elliott et al. We agree with Von Korff's appraisal that primary care patients probably will display a greater dynamic change in their pain status compared to pain clinic patients [ 4 ].

To answer these questions longitudinal studies on both samples are neccesary. Finally this study was part of a larger intervention study whose results will be published later. Nevertheless the reported findings implicate that the German version of the Chronic Pain Grade is a reliable, valid and useful instrument if a brief, simple method of grading the severity of chronic pain is needed. Furthermore it can be easily assessed and is able to facilitate the communication among English speaking and German speaking researchers.

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Journal List Psychosoc Med v. Dirk Hallner 1 Dept. Monika Hasenbring 1 Dept. Author information Copyright and License information Disclaimer. You are free to copy, distribute and transmit the work, provided the original author and source are credited. This article has been cited by other articles in PMC. Abstract Von Korff et al. Introduction Chronic low back pain is an important cause of personal suffering and disability with a number of aversive social consequences. Subjects and methods Subjects and study setting Data for this research were obtained as part of a longitudinal psychosocial intervention study of primary care back pain patients in the area of Bochum Ruhr-District , Germany.

Self report components Medical history The medical history contained detailed questions about pain e. Open in a separate window. Results Sample description The sample characteristics sociodemographic data and medical history are summarized in Table 1 Tab. Factor analysis Factor analysis was carried out to examine the factorial structure of the German version of the CPG.

Reliability Cronbach's alpha was 0. Validity Exploring the hierarchical relationship between pain intensity and disability as proposed by Von Korff and colleagues [ 4 ], Figure 3 Fig. By definition all patients with CPG I and II reported characteristic pain intensity less than 50 and greater than 50 respectively. Spearman's Rho Correlation coefficients for the correlation of the CPG, subscales and behavioural measures. Discussion The present study was conducted to analyse the psychometric properties of the German version of the Chronic Pain Grade CPG [ 4 ] within a population of primary care back pain patients.

Limitations of the present study There are several limitations that have to be considered regarding the presented results.