title: Validity of an observation method for assessing pain behavior in individuals with multiple sclerosis.
abstract: BACKGROUND
  Pain is a common and complex experience for individuals who live with multiple sclerosis (MS) and it interferes with physical, psychological, and social function. A valid and reliable tool for quantifying observed pain behaviors in MS is critical to understand how pain behaviors contribute to pain-related disability in this clinical population.
  
  
  OBJECTIVE
  To evaluate the reliability and validity of a pain behavioral observation protocol in individuals who have MS.
  
  
  METHODS
  Community-dwelling volunteers with MS (N=30), back pain (N=5), or arthritis (N=8) were recruited based on clinician referrals, advertisements, fliers, web postings, and participation in previous research. Participants completed the measures of pain severity, pain interference, and self-reported pain behaviors and were videotaped doing typical activities (e.g., walking and sitting). Two coders independently recorded frequencies of pain behaviors by category (e.g., guarding and bracing) and interrater reliability statistics were calculated. Naïve observers reviewed videotapes of individuals with MS and rated their pain. The Spearman's correlations were calculated between pain behavior frequencies and self-reported pain and pain ratings by naïve observers.
  
  
  RESULTS
  Interrater reliability estimates indicated the reliability of pain codes in the MS sample. Kappa coefficients ranged from moderate (sighing=0.40) to substantial agreements (guarding=0.83). These values were comparable with those obtained in the combined back pain and arthritis sample. Concurrent validity was supported by correlations with self-reported pain (0.46-0.53) and with self-reports of pain behaviors (0.58). Construct validity was supported by a finding of 0.87 correlation between total pain behaviors observed by coders and mean pain ratings by naïve observers.
  
  
  CONCLUSIONS
  Results support the use of the pain behavior observation protocol for assessing pain behaviors of individuals with MS. Valid assessments of pain behaviors of individuals with MS could lead to creative interventions in the management of chronic pain in this population.
authors.affiliation: Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA. karon.cook@northwestern.edu
authors.forename: Karon F
authors.initials: KF
authors.lastname: Cook
authors.forename: Toni S
authors.initials: TS
authors.lastname: Roddey
authors.forename: Alyssa M
authors.initials: AM
authors.lastname: Bamer
authors.forename: Dagmar
authors.initials: D
authors.lastname: Amtmann
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
mesh_terms: D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000453:epidemiology*; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology*; D010147:Pain Measurement / Q000379:methods*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology