title: Performance of the Angle Labor Pain Questionnaire During Initiation of Epidural Analgesia in Early Active Labor.
abstract: The Angle Labor Pain Questionnaire (A-LPQ) is a new, 22-item multidimensional psychometric questionnaire that measures the 5 most important dimensions of women's childbirth pain experiences using 5 subscales: The Enormity of the Pain, Fear/Anxiety, Uterine Contraction Pain, Birthing Pain, and Back Pain/Long Haul. Previous work showed that the A-LPQ has overall good psychometric properties and performance during early active labor in women without pain relief. The current study assessed the tool's sensitivity to change during initiation of labor epidural analgesia with the standardized response mean (SRM, primary outcome).
  
  
  
  Two versions of the A-LPQ were administered once, in each of 2 test sessions, by the same trained interviewer during early active labor. The sequence of administration was randomized (ie, standard question order version [Test 1] followed by mixed version [Test 2] or vice versa). Test 1 was completed before epidural insertion; Test 2 commenced 20 to 30 minutes after the test dose. Providers assessed/treated pain independently of the study. Sensitivity to change was assessed using SRMs, Cohen's d, and paired t tests. Overall pain intensity was concurrently examined using Numeric Rating Scale and the Verbal Rating Scale (VRS); coping was assessed with the Pain Mastery Scale. Changes in pain were measured with the Patient Global Impression of Change Scale. Internal consistency was assessed with Cronbach's α. Concurrent validity with other tools was assessed using Spearman's rank correlation coefficient.
  
  
  
  A total of 51 complete datasets were analyzed. Most women reported moderate (63%, 32/51) or severe (18%, 9/51) baseline pain on VRS scores during Test 1; 29% (15/51) reported mild pain, and 6% (3/51) reported moderate pain during Test 2. Approximately 90% (46/51) of women reported much or very much improved pain at the end of testing. Cronbach's α for A-LPQ summary scores was excellent (0.94) and ranged from 0.78 (acceptable) to 0.92 (excellent) for subscales (Test 1). Large SRMs were found for A-LPQ summary scores (1.6, 95% CI: 1.2, 2.1) and all subscales except the Birthing Pain subscale (moderate, 0.60, 95% CI: 0.23, 0.97). Significant (P < .001) differences were found between A-LPQ summary scores and between all subscales on paired t tests. Correlations between A-LPQ summary and Numeric Rating Scale scores (overall pain intensity) were strong (ρ > 0.73), correlations were moderate (ρ > 0.5) with VRS scores and coping scores (ρ > 0.67).
  
  
  
  Findings support A-LPQ use for measurement of women's childbirth pain experiences during initiation of labor epidural analgesia during early active labor. Combined with our previous work, they also support the use of the A-LPQ in late labor and at delivery.
authors.affiliation: From the *Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; †Division of Obstetrical Anesthesia, Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ‡Clinical Epidemiology, Institute for Health Management and Evaluation, University of Toronto, Toronto, ON, Canada; §University of British Columbia, Vancouver, BC, Canada; ‖Evidence-Based Health Programme, Kellogg College, Oxford University, Oxford, UK; ¶Obstetrical Anesthesia Research Unit, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; #School of Nursing, Faculty of Health, York University, Toronto, ON, Canada; **Obstetrical Anesthesia Research Unit, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ††Women and Babies, Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ‡‡Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and §§Research Design and Biostatistics, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Angle
authors.forename: Christine
authors.initials: C
authors.lastname: Kurtz Landy
authors.forename: Jasmine
authors.initials: J
authors.lastname: Djordjevic
authors.forename: Jon
authors.initials: J
authors.lastname: Barrett
authors.forename: Alanna
authors.initials: A
authors.lastname: Kibbe
authors.forename: Saiena
authors.initials: S
authors.lastname: Sriparamananthan
authors.forename: Yuna
authors.initials: Y
authors.lastname: Lee
authors.forename: Lydia
authors.initials: L
authors.lastname: Hamata
authors.forename: Pearl
authors.initials: P
authors.lastname: Zaki
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D001416:Back Pain / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D036861:Delivery, Obstetric; D005239:Fear; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D009864:Ontario; D010147:Pain Measurement / Q000379:methods*; D036801:Parturition; D011237:Predictive Value of Tests; D011247:Pregnancy; D011594:Psychometrics; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014590:Uterine Contraction