Development and validation of the Treatment Expectations in Chronic Pain Scale

Abstract

Objectives To develop and examine the psychometric properties of the Treatment Expectations in Chronic Pain (TEC) scale, a brief measure of treatment expectations of chronic non‐cancer pain treatment. Design A cross‐sectional study design was used. Methods After conducting a literature review and expert discussions, a preliminary version of the TEC scale was developed. Cognitive interviews with 10 clinicians and 14 patients were conducted to examine the scale's face validity and item wording. Last, two hundred and five patients on the waitlist for a multidisciplinary pain treatment centre completed a battery of self‐report questionnaires to examine the TEC scale's reliability and construct validity. Mokken scale analysis was conducted to select the final items. Reliability (Cronbach's alpha and Guttman's lambda2) and construct validity (Pearson correlations) were assessed. Results The final scale was composed of nine items that each measured ideal and predicted expectations about process and outcome of treatment. Mokken scale analysis showed the presence of two subscales: ideal and predicted expectations. The TEC scale had good internal consistency (α = 0.876–0.869) and adequate discriminant validity as assessed by its low correlation with measures of depression, anxiety, and quality of life (r = −.038 to .114). The scale had however low correlation with a theoretically related measure of optimism (r = .240). Conclusion The TEC scale is a reliable scale measuring pain treatment expectation. Further evaluation of its psychometric properties is needed. The scale has the potential to deepen our understanding of the role treatment expectations play in chronic non‐cancer pain treatment response. What is already known on this subject? Expectations play a role in pain perception and the response to pain treatment Patients' expectations about pain and its management are associated with treatment satisfaction The absence of a validated tool to measure treatment expectations in chronic non‐cancer pain prevents further exploration and understanding of the role of expectations in the context of multidisciplinary pain treatment . What does this study add? A new, reliable 9‐item scale measuring treatment expectations among chronic non‐cancer pain patients attending specialized multidisciplinary pain clinics .

The Treatment Expectation Questionnaire (TEX-Q): Validation of a generic multidimensional scale measuring patients’ treatment expectations

“…The TEX-Q has several advantages over previous treatment expectation measures. In contrast to treatment-specific scales [e.g., 18 ], it is fully generic, and–like the IPQ [ 31 ]–can be adapted to specific treatment settings. In contrast to other generic scales [e.g., 28 , 30 , 41 , 42 ], it has a theory-derived multidimensional structure that allows for the comparison of the relative impact of different expectation constructs on outcome.…”

“…Out of 197 studies, 56% use single items or non-validated ad-hoc measures, which might result in unreliable data. Disease- or treatment-specific expectation measures, such as the Treatment Expectations in Chronic Pain Scale [ 18 ], are relevant for assessing unique aspects of a given disease or treatment. However, they impede the generalizability and integration of evidence across different treatments and conditions [ 1 , 17 , 19 ].…”

Recovery expectations can be assessed with single-item measures: findings of a systematic review and meta-analysis on the role of recovery expectations on return-to-work outcomes after musculoskeletal pain conditions

“… 15 , 29 , 55 Researchers have stated that heterogeneity of tools to measure expectations prevents further exploration and understanding of the role of expectations in the context of multidisciplinary pain treatment. 80 In this review, the measurement of recovery expectations varied considerably across studies. Two issues are noteworthy: first, most of the studies included in this review used single-item measures of recovery expectations without evaluating the reliability of the single-item measure.…”

Commitment to activities and quality of life and associated factors in patients with chronic pain

“…As with chronic pain, the goal is to increase the quality of life and alleviate suffering; contrary to the logic of pain cure, the patient's expectations that may change and differ from the expectations created by the health team throughout the process. 29 The findings of our study showed that patients with chronic pain when evaluated by the SF-36 demonstrated a quality of life well below, when compared with the average of the Brazilian population, in all domains; the ones with the worst scores were physical and emotional aspects. 30 The work-related limitations for the individual suffering from chronic pain are very severe.…”