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Validation of the Surgical Pain Scales in Women Undergoing Pelvic Reconstructive Surgery

Barber, Matthew D. MD, MHS*; Janz, Nancy PhD; Kenton, Kim MD, MS; Hsu, Yvonne MD§; Greer, W. Jerod MD; Dyer, Keisha MD, MPH; White, Amanda MD#; Meikle, Susan MD, MSPH**; Ye, Wen PhD

Female Pelvic Medicine & Reconstructive Surgery:
doi: 10.1097/SPV.0b013e31825d65aa
Original Articles
Journal Club
Abstract

Objective: Surgical pain scales (SPS) consist of 4 items that measure pain at rest, during normal activities, and during work/exercise and quantify unpleasantness of worst pain, which are valid and responsive in men undergoing hernia repair. Our objective was to evaluate the psychometric properties of SPS in women undergoing vaginal surgery for pelvic organ prolapse and stress urinary incontinence.

Methods: We modified SPS by converting original response scales from a visual analog scale to numerical rating scales. Numerical rating scales have lower error rates and higher validity than visual analog scale. The sample included 169 women with stage II to IV pelvic organ prolapse and stress urinary incontinence in a randomized trial comparing sacrospinous ligament fixation to uterosacral vault suspension with and without pelvic floor muscle training. Participants completed SPS and SF-36 at baseline, and 2 weeks and 6 months after surgery. Construct validity and responsiveness were examined in cross-sectional and longitudinal data using Pearson correlation and analysis of variance.

Results: Pain at rest, during normal activities, and during work/exercise worsened at 2 weeks (P < 0.05); and all measures of pain improved from baseline to 6 months (P < 0.0001). Construct validity was demonstrated by correlations of 0.51 to 0.74 between SPS and the SF-36 Bodily Pain Scale (P < 0.0001). Pain worsened on SF-36 between baseline and 2 weeks in 63% of the participants, and this group demonstrated a mean (SD) increase in pain of 1.9 (2.8) on the SPS (effect size, 0.99), confirming responsiveness of the scale.

Conclusions: The modified SPS are valid and responsive in women after pelvic reconstructive surgery.

In Brief

The modified Surgical Pain Scales are valid and responsive in women after pelvic reconstructive surgery.

Author Information

From the *Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, OH; †Data Coordinating Center, University of Michigan, Ann Arbor MI; ‡Departments of Obstetrics and Gynecology, and Urology, Loyola University, Chicago, IL; §Department of Obstetrics and Gynecology, University of Utah Medical Center, Salt Lake City, UT; ∥Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, AL; ¶Department of Reproductive Medicine, University of California-San Diego, San Diego, CA; #Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; and **The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.

Reprints: Matthew D. Barber, MD, MHS, Cleveland Clinic, 9500 Euclid Ave, Desk A81, Cleveland, OH 44195. E-mail: barberm2@ccf.org.

This work was supported by grants from The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH Office of Research on Women’s Health (U01 HD41249, U10 HD41250, U10 HD41261, U10 HD41267, U10 HD54136, U10 HD54214, U10 HD54215, and U10 HD54241).

This trial is registered at clinicaltrials.gov under Registration # NCT00597935.

Reprints will not be available.

The authors declare that they have nothing to disclose.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins