Highlights
- •Psychometric properties were evaluated in primary care patients with musculoskeletal complaints.
- •All items fitted the item response theory model and no substantial differential item functioning was found.
- •Weaknesses with regard to unidimensionality and scalability were found.
Abstract
We studied the psychometric properties of the 39-item v1.1 Dutch-Flemish Patient-Reported
Outcomes Measurement Information System Pain Behavior item bank in a sample of 1,602
patients with musculoskeletal complaints. We evaluated the assumptions of the underlying
item response theory (IRT) model (unidimensionality and local dependency with confirmatory
factor analyses), and monotonicity with scalability coefficients). We studied the
IRT model fit of all items and estimated the item parameters of the IRT model. Differential
item functioning (DIF) was studied for age and gender, and DIF for language was studied
as a measure of cross-cultural validity. Confirmatory factor analyses showed suboptimal
fit of a unidimensional model, but a bifactor model showed low risk of bias when a
unidimensional model was assumed (Omega H = .92, explained common variance of .70).
Fifteen item pairs (2%) were locally dependent. Five items showed poor scalability.
All items fitted the IRT model; slope parameters ranged from .60 to 2.00, and threshold
parameters from –2.05 to 6.80. One item showed DIF for age, 1 item DIF for gender,
and 5 items showed DIF for language, but the impact on total scores was low. Our study
shows limitations of the Dutch-Flemish Patient-Reported Outcomes Measurement Information
System Pain Behavior item bank when used in a primary care population with musculoskeletal
complaints.
Perspective
We studied the psychometric properties of the Dutch-Flemish Patient-Reported Outcomes
Measurement Information System Pain Behavior item bank in a large primary care population
of patients with musculoskeletal complaints. It showed that the Pain Behavior item
bank has limitations when used in this population.
Key words
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Article info
Publication history
Published online: May 09, 2019
Accepted:
May 6,
2019
Received in revised form:
April 22,
2019
Received:
December 30,
2018
Footnotes
This study has been conducted as part of a larger research effort funded by the Dutch Association for Musculoskeletal Medicine.
Conflicts of interest: Caroline B. Terwee and Leo D. Roorda are members of the Dutch-Flemish Patient-Reported Outcomes Measurement Information System (PROMIS) group (http://www.dutchflemishpromis.nl/), and Caroline B. Terwee is president of the PROMIS Health Organization. Caroline B. Terwee previously received grants for work on the translation and validation of the PROMIS item banks. Wouter Schuller, Caroline B. Terwee, Leo D. Roorda and Henrica de Vet are members of the PROMIS health organization. Thomas Klausch, Daphne C. Rohrich, and Raymond W. Ostelo declare that they have no conflicts of interest.
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© 2019 by the American Pain Society
