Utility of unidimensional and functional pain assessment tools in adult postoperative patients: a systematic review

Abstract

Background: In this systematic review we aimed to appraise the evidence relating to the measurement properties of unidimensional tools to quantify pain after surgery. Furthermore, we wished to identify the tools used to assess interference of pain with functional recovery. Methods: Four electronic sources (MEDLINE, Embase, CINAHL, PsycINFO) were searched in August 2020. Two reviewers independently screened articles and assessed risk of bias using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results: Thirty-one studies with a total of 12 498 participants were included. Most of the studies failed to meet the methodological quality standards required by COSMIN. Studies of unidimensional assessment tools were underpinned by low-quality evidence for reliability (five studies), and responsiveness (seven studies). Convergent validity was the most studied property (13 studies) with moderate to high correlation ranging from 0.5 to 0.9 between unidimensional tools. Interpretability results were available only for the visual analogue scale (seven studies) and numerical rating scale (four studies). Studies on functional assessment tools were scarce in which only one study included an 'Objective Pain Score;' a tool assessing pain interference with respiratory function and had low-quality for convergent validity. Conclusions: This systematic review challenges the validity and reliability of unidimensional tools in patients after surgery. We found no evidence that any one unidimensional tool has superior measurement properties in assessing postoperative pain. In addition, because promoting function is a crucial perioperative goal, psychometric validation studies of functional pain assessment tools are needed to improve pain assessment and management. Clinical trial registration: PROSPERO CRD42020213495.

Intracapsular tonsillectomy in the treatment of recurrent and chronic tonsillitis in adults: a protocol of a prospective, single-blinded, randomised study with a 5-year follow-up (the FINITE trial)

“…The definition of recovery time can vary. In addition to measuring pain, tools to assess interference of pain with functional recovery should be used 36. We defined the duration of the postoperative recovery to be dependent on three endpoints: pain at rest, pain on swallowing and the regular use of analgesics.…”

The effect of a quality improvement project on post-operative opioid use following outpatient spinal surgery

“…Future research should include disease-specific patient-reported outcome measures and focus on analgesia as it relates to function due to the limitations in, and risks of, unidimensional pain assessment tools such as the NRS. 26,27 This prospective cohort study is limited in its external validity as the intervention was only studied in a small subset of patients seen by spine surgeons. However, the results are comparable with a similar protocol in general surgery procedures, such as laparoscopic cholecystectomy and inguinal hernia repair, 22 and as such it is reasonable to assume it may be applicable to other relatively minor surgical procedures in other specialties.…”

“…Future research should include disease-specific patient-reported outcome measures and focus on analgesia as it relates to function due to the limitations in, and risks of, unidimensional pain assessment tools such as the NRS. 26 , 27 …”

Frequency of post-operative pain in thyroid surgery with or without use of ligasure.

“…4 Among the different assessment tools for pain perception, one is Visual Analogue Scale (VAS) for pain with 10 scores with 0=no pain and 10 worst intolerable pain. [5][6][7] The study is concerned with mean postoperative pain score assessment with use of conventional knot and tie with suture technique in comparison with Ligasure, while keeping analgesics common for both. We found significance of 3.6+1.2 with former and 2.4+1.6 for the later, while in another study, no significant difference was found in postoperative pain score in both surgical techniques, results were 2.1 with use of Ligasure and was 2.6 with conventional technique.…”