The interpretation of change score of the pain disability index after vocational rehabilitation is baseline dependent

Abstract

Background: The Pain Disability Index (PDI) is a widely-used instrument to measure pain-related disability. The aim of this study was to assess the responsiveness and interpretation of change score of the PDI in patients with chronic musculoskeletal pain (CMP) at discharge of vocational rehabilitation.

Methods: Retrospective data of patients with CMP who attended vocational rehabilitation between 2014 and 2017 was used. The anchor-based method was used to assess the responsiveness of the total sample and of PDI baseline quartile groups. A receiver operating characteristic curve was performed, including Area Under the Curve (AUC) and Minimal Important Change (MIC).

Results: The PDI showed responsive to detect clinically relevant changes in pain-related disability at discharge of vocational rehabilitation (AUC 0.79). A PDI change score of 13 points (MIC 12.5) can be considered as a real change in pain-related disability for the total study sample, and a PDI change score of 7-20 points can be considered as a real change in pain-related disability for PDI lowest and highest baseline quartile scores.

Conclusion: The PDI is responsive in patients with CMP at discharge of vocational rehabilitation. The interpretation of change score depends on PDI baseline score. Patients with a PDI baseline score of ≤27 should decrease minimal 7 points, patients with a baseline score between 28 and 42 should decrease minimal 15 points, and patients with a baseline score ≥ 43 should decrease minimal 20 points.

Keywords: Chronic pain; Clinical relevance; Interpretation of change; Minimal important difference; Occupational rehabilitation; Pain disability index.

Fig. 1

Interpretation of PDI change scores. MIC, Minimal Important Change; SDC, Smallest Detectable Change. Figure obtained from Terwee et al. [10]

Fig. 2

ROC curves of the PDI total sample and baseline quartiles. ROC, receiver operating characteristic; PDI, Pain Disability Index; Q, quartile; AUC, area under the curve. a ROC-curve of total study sample (n = 341). b ROC-curve of the sample with PDI baseline quartile 1 score (n = 89). c ROC-curve of the sample with PDI baseline quartile 12 score (n = 81). d ROC-curve of the sample with PDI baseline quartile 13 score (n = 83). e ROC-curve of the sample with PDI baseline quartile 14 score (n = 88)