title: Development, psychometric evaluation and validation of a brief measure of emotional preoperative stress (B-MEPS) to predict moderate to intense postoperative acute pain.
abstract: BACKGROUND
  Preoperative stress might influence postoperative pain, thereby, it is desirable to assess it more precisely. Thus, we developed and evaluated the psychometric properties of a brief measure of emotional preoperative stress (B-MEPS) index using Item Response Category Characteristic Curves. We validated and assessed whether the B-MEPS can predict moderate to intense acute postoperative pain (MIAPP).
  
  
  METHODS
  We included 863 adult patients who underwent elective surgeries (ASA I-III physical status). The B-MEPS was constructed based on items selected from instruments to assess anxiety, depression, future self-perception and minor psychiatric disorders. We identified 24 items with greatest discriminant power to identify patients who should undergo surgery to treat cancer with MIAPP. The reliability was maximized using the Cronbach's alpha indices. Fifteen items remained, which were adjusted by the Generalized Partial Credit Model. The convergent validity was assessed correlating the B-MEPS index with the pain catastrophizing (n = 100). Finally, the B-MEPS was applied in a prospective cohort of patients who underwent an abdominal hysterectomy (n = 150).
  
  
  RESULTS
  The Cronbach's alpha for selected items was 0.83. The correlation coefficient between B-MEPS index and catastrophizing was r = 0.37 (P < 0.01). A hierarchical regression model evidenced that the B-MEPS index was a factor independent to predict MIAPP after an abdominal hysterectomy [odds ratio (OR)=1.20, confidence interval (CI) 95% 1.05-1.43).
  
  
  CONCLUSIONS
  The B-MEPS index presents satisfactory psychometric evaluations based on its internal consistency, convergent, and discriminant validity. The B-MEPS is a propensity index to MIAPP, which might help the clinician to decide on the best therapeutic approaches for acute postoperative pain.
authors: Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) wcaumo@hcpa.edu.br.|Surgery Department, School of Medicine.|Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.|Laboratory of Pain and Neuromodulation at HCPA, Porto Alegre, Brazil.
authors: W
authors: W
authors: Caumo
authors: Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS).
authors: M
authors: M
authors: Nazare Furtado da Cunha
authors: Pharmacology Department, Instituto de Ciências Básicas da Saúde, UFRGS.
authors: S
authors: S
authors: Camey
authors: Pharmacology Department, Instituto de Ciências Básicas da Saúde, UFRGS.
authors: S
authors: S
authors: Maris de Jezus Castro
authors: Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS).|Pharmacology Department, Instituto de Ciências Básicas da Saúde, UFRGS.
authors: I L S
authors: IL
authors: Torres
authors: Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS).|Surgery Department, School of Medicine.|Anesthesia and Perioperative Pain Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.|Statistics Department at UFRGS, Porto Alegre, Brazil.
authors: L
authors: L
authors: Cadore Stefani
mesh_terms: D059787:Acute Pain / Q000175:diagnosis / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000523:psychology*; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011594:Psychometrics; D015203:Reproducibility of Results; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: anxiety; item response theory (IRT); postoperative pain; preoperative emotional stress; psychometrics; surgery