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The Diagnostic Accuracy of Brief Screening Questions for Psychosocial Risk Factors of Poor Outcome From an Episode of Pain: A Systematic Review

Mirkhil, Saeida BSc; Kent, Peter M. PhD

The Clinical Journal of Pain: May 2009 - Volume 25 - Issue 4 - p 340-348
doi: 10.1097/AJP.0b013e31819299e3
Review Article
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Objective To determine the diagnostic accuracy of brief screening questions for psychosocial risk factors predictive of poor outcome from an episode of pain.

Methods Six electronic databases were searched, content experts contacted, and reference and citation tracking performed. Studies were included that examined the diagnostic accuracy of 1-item screening or 2-item screening questions for depression, anxiety, fear-avoidance beliefs, social isolation, catastrophization, or somatization and were published in English. Studies were assessed for quality, and data extracted describing study characteristics and the diagnostic accuracy of brief screening questions.

Results Four cross-sectional studies met the inclusion criteria and all met 4 or more of our 6 method quality criteria. These studies examined the diagnostic accuracy of brief screening tools for depression (sensitivity=50.5% to 82.1%, specificity=71.0% to 90.6%, and overall accuracy=74.6% to 80.6%) and anxiety (sensitivity 63.0% to 94.0%, specificity=53.0% to 71.2%, and overall accuracy=60.0% to 68.1%). No studies were identified that examined the diagnostic accuracy of brief screening questions for fear-avoidance beliefs, social isolation, catastrophization, and somatization.

Discussion Data were only available on the accuracy of brief screening instruments for depression and anxiety, and there was variability in the results. Head-to-head studies are required to determine if this variability reflects differential question accuracy or population characteristics, and studies that determine the diagnostic accuracy of brief screening questions for other common psychosocial risk factors would be useful.

Department of Physiotherapy, Monash University, Melbourne, Australia

Reprints: Peter M. Kent, PhD, Monash Department of Clinical Epidemiology, Cabrini Hospital, Monash University, 183 Wattletree Road, Malvern, Victoria 3144, Australia (e-mail: peter.kent@med.monash.edu.au).

Received for publication January 30, 2008; revised July 28, 2008; accepted October 15, 2008

Conflict of interest: Neither of the review authors conducted any of the studies included in this review nor has any other conflict of interest.

© 2009 Lippincott Williams & Wilkins, Inc.