title: Cross-cultural examination of the structure of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R).
abstract: This study investigated the cross-cultural factor stability and internal consistency of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R), a measure of the quality of postoperative pain management used internationally. We conducted exploratory factor analysis (EFA) of APS-POQ-R data from 2 point prevalence studies comprising 268 and 311 surveys of Danish and Australian medical-surgical patients, respectively. Parallel analysis indicated 4- and 3-factor solutions for Danish and Australian patients, respectively, which accounted for 58.1% and 52.9% of variance. Internal consistency was unsatisfactory among both Danish (Cronbach α = .54) and Australian (Cronbach α = .63) cohorts. There was a high degree of between-group similarity in item-factor loadings of variables coded as "pain experience," but not "pain management." This finding reflected cross-cultural differences in ratings of treatment satisfaction. For Danish patients, satisfaction was associated with the degree of pain severity and activity interference, whereas for Australian patients, satisfaction was associated with their perceived ability to participate in treatment. To facilitate further cross-cultural comparison, we compared our findings with past research conducted in the United States and Iceland. EFA supported the construct validity of the APS-POQ-R as a measure of "pain experience" but indicated that items measuring "pain management" may vary cross-culturally. Findings highlighted the need for further validation of the APS-POQ-R internationally.
  
  
  CONCLUSIONS
  This study revealed the APS-POQ-R as a valid measure of postoperative pain experience for Danish and Australian patients. Measures of patients' perception of pain management were not robust to group differences in treatment expectations and demonstrated cross-cultural instability. Results highlighted the difficulties in establishing stable cross-cultural, cross-population subscales for the APS-POQ-R.
authors.affiliation: Epworth/Deakin Centre for Clinical Nursing Research, Melbourne, Victoria, Australia.
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
authors.affiliation: Epworth/Deakin Centre for Clinical Nursing Research, Melbourne, Victoria, Australia. Electronic address: damien.khaw@epworth.org.au.
authors.forename: Damien
authors.initials: D
authors.lastname: Khaw
authors.affiliation: Department of Nursing Research, VIA University College, Holstebro, Denmark; Hospitalsenheden Vest, Region Midtjylland, Denmark.
authors.forename: Emmy Brandt
authors.initials: EB
authors.lastname: Jørgensen
authors.affiliation: School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Bodil
authors.initials: B
authors.lastname: Rasmussen
authors.affiliation: School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Hunter
authors.affiliation: Epworth/Deakin Centre for Clinical Nursing Research, Melbourne, Victoria, Australia.
authors.forename: Bernice
authors.initials: B
authors.lastname: Redley
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria; D016009:Chi-Square Distribution; D003431:Cross-Cultural Comparison; D003718:Denmark; D005163:Factor Analysis, Statistical; D005260:Female; D006306:Health Surveys; D006801:Humans; D007055:Iceland; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards; D059408:Pain Management; D010149:Postoperative Pain / Q000453:epidemiology / Q000628:therapy*; D012016:Reference Values; D015203:Reproducibility of Results; D012955:Societies, Medical / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States
keywords: Pain experience; construct validity; cross-cultural; patient participation; quality improvement