title: Clinical utility and validity of the Functional Disability Inventory among a multicenter sample of youth with chronic pain.
abstract: The Functional Disability Inventory (FDI) is a well-established and commonly used measure of physical functioning and disability in youth with chronic pain. Further validation of the measure has been called for, in particular, examination of the clinical utility and factor structure of the measure. To address this need, we utilized a large multicenter dataset of pediatric patients with chronic pain who had completed the FDI and other measures assessing pain and emotional functioning. Clinical reference points to allow for interpretation of raw scores were developed to enhance clinical utility of the measure, and exploratory factor analysis was performed to examine its factor structure. Participants included 1300 youth ages 8 to 18 years (mean=14.2 years; 76% female) with chronic pain. Examination of the distribution of FDI scores and validation with measures of depressive symptoms and pain intensity yielded 3 distinct categories of disability: No/Minimal Disability, Moderate Disability, and Severe Disability. Factor analysis of FDI scores revealed a 2-factor solution representing vigorous Physical Activities and non-physically strenuous Daily Activities. The 3-level classification system and factor structure were further explored via comparison across the 4 most commonly encountered pain conditions in clinical settings (head, back, abdominal, and widespread pain). Our findings provide important new information regarding the clinical utility and validity of the FDI. This will greatly enhance the interpretability of scores for research and clinical use in a wide range of pediatric pain conditions. In particular, these findings will facilitate use of the FDI as an outcome measure in future clinical trials.
authors: Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, and Department of Psychiatry, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, PA, USA Departments of Anesthesiology, Pediatrics, and Psychiatry, University of Washington School of Medicine, Seattle, WA, USA Departments of Pediatrics, Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA.
authors: Susmita
authors: S
authors: Kashikar-Zuck
authors: Stacy R
authors: SR
authors: Flowers
authors: Robyn Lewis
authors: RL
authors: Claar
authors: Jessica W
authors: JW
authors: Guite
authors: Deirdre E
authors: DE
authors: Logan
authors: Anne M
authors: AM
authors: Lynch-Jordan
authors: Tonya M
authors: TM
authors: Palermo
authors: Anna C
authors: AC
authors: Wilson
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000209:etiology*; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000150:complications* / Q000175:diagnosis*; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires