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Dimensionality and Reliability of the Central Sensitization Inventory in a Pooled Multicountry Sample

  • Antonio I. Cuesta-Vargas
    Correspondence
    Address reprint requests to Antonio I. Cuesta-Vargas, PhD, Faculty of Health Sciences, Universidad de Málaga, Av/ Arquitecto Peñalosa s/n (Teatinos Campus Expansion), 29009, Málaga, Spain.
    Affiliations
    Department of Physiotherapy of the Faculty of Health Science at the University of Malaga, IBIMA, Málaga, Spain

    Faculty of Health at the Queensland University of Technology, Brisbane, Australia
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  • Randy Neblett
    Affiliations
    PRIDE Research Foundation, Dallas, Texas
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  • Alessandro Chiarotto
    Affiliations
    Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands

    Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands

    Amsterdam Public Health, Amsterdam, The Netherlands
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  • Jeroen Kregel
    Affiliations
    Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Pain in Motion International Research Group, Brussels, Belgium
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  • Jo Nijs
    Affiliations
    Pain in Motion International Research Group, Brussels, Belgium

    Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium

    Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
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  • C. Paul van Wilgen
    Affiliations
    Pain in Motion International Research Group, Brussels, Belgium

    Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium

    Transcare; transdisciplinary pain center, The Netherlands
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  • Laurent Pitance
    Affiliations
    Neuro Musculo Skeletal Lab, Institute of clinical research (IREC), Université Catholique de Louvain, Brussels, Belgium

    Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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  • Aleksandar Knezevic
    Affiliations
    Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia

    Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia
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  • Robert J. Gatchel
    Affiliations
    Department of Psychology, College of Science, University of Texas at Arlington, Arlington, Texas
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  • Tom G. Mayer
    Affiliations
    Department of Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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  • Carlotta Viti
    Affiliations
    FACEit, Italian Association of Integrated Therapy for Cervico-Cranio-Facial Pain and Dysfunction, Italy

    Department of Biomedical Sciences, University of Padova, Padova, Italy

    Studio Fisioterapico Viti, Bologna, Italy
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  • Cristina Roldan-Jiménez
    Affiliations
    Department of Physiotherapy of the Faculty of Health Science at the University of Malaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
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  • Marco Testa
    Affiliations
    Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
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  • Wolnei Caumo
    Affiliations
    Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Anesthesiologist, Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre, Laboratory of Pain and Neuromodulation at UFRGS, Porto Alegre, Brazil

    Pain and Anesthesia in Surgery Department, School of Medicine, UFRGS, Porto Alegre, Brazil
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  • Milica Jeremic-Knezevic
    Affiliations
    Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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  • Juan V. Luciano
    Affiliations
    Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain

    Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain

    Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
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Published:November 30, 2017DOI:https://doi.org/10.1016/j.jpain.2017.11.006

      Highlights

      • Dimensionality and reliability of the Central Sensitization Inventory (CSI) was investigated.
      • After examining 1-factor and 4-factor solutions, a bifactor model was determined to be the best fit.
      • The general “CS-related symptoms“ factor was highly reliable.
      • The 4 specific CSI factors did not show enough reliability to be used as subscales.
      • It is recommended that only total CSI scores be used and reported.

      Abstract

      Central sensitization (CS) involves the amplification of neural signaling within the central nervous system, which evokes pain hypersensitivity. The Central Sensitization Inventory (CSI) assesses 25 overlapping health-related symptom dimensions that have been reported to be associated with CS-related disorders. Previous studies have reported satisfactory test-retest reliability and internal consistency, but factor analyses have exhibited conflicting results in different language versions. The purpose of this cross-sectional study was to thoroughly examine the dimensionality and reliability of the CSI, with pooled data from 1,987 individuals, collected in several countries. The principal component analysis suggested that 1 general factor of CS best described the structure. A subsequent confirmatory factor analysis revealed that a bifactor model, which accounted for the covariance among CSI items, with regard to 1 general factor and 4 orthogonal factors, fit the CSI structure better than the unidimensional and the 4-factor models. Additional analyses indicated substantial reliability for the general factor (ie, Cronbach α = .92; ω = .95; and ω hierarchical = .89). Reliability results for the 4 specific factors were considered too low to be used for subscales. The results of this study clearly suggest that only total CSI scores should be used and reported.

      Perspective

      As far as we know, this is the first study that has examined the factor structure and reliability of the CSI in a large multicountry sample. The CSI is currently considered the leading self-report measure of CS-related symptoms worldwide.

      Key words

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