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Photographs of Daily Activities–Youth English: validating a targeted assessment of worry and anticipated pain

Simons, Laura E.a,*; Pielech, Melissab; McAvoy, Shannonc; Conroy, Caitlinc; Hogan, Melindad; Verbunt, Jeanine A.e; Goossens, Marielle E.e,f

doi: 10.1097/j.pain.0000000000000855
Research Paper

PHODA is an electronic measure that individualizes and guides treatment for individuals with chronic pain. Implicit in its design is recognition that pain-related fear is a driving force that impedes treatment progress. With this tool, patients visually rate their expectations about the harmful consequences of specific movements. This study aimed to (1) develop and validate PHODA-Youth English (PHODA-YE) and (2) evaluate the potential impact of PHODA-YE assessment on treatment outcomes. Participants were 195 youth, age 8 to 20 years, who presented to an outpatient pain clinic for evaluation (n = 99), or enrolled at the Pediatric Pain Rehabilitation Center (PPRC) intensive program (PPRC; n = 96). All patients completed the PHODA-YE along with measures of emotional functioning and disability. Patients in the PPRC completed the measure at both admission and discharge. After eliminating infrequently endorsed and poorly loading items, factor analytic procedures yielded a 4-subscale, 50-item measure with strong internal consistency (from 0.92 to 0.97 across subscales). Fear, avoidance, and functional disability were strongly associated with PHODA-YE scores, supporting construct validity. Within the PPRC sample, PHODA-YE was sensitive to changes over time in relation to functional improvements. Across the PPRC sample, patients found it helpful to complete the PHODA and target feared activities. Altogether, the PHODA-YE is a valid and concrete assessment tool that rapidly identifies specific activities and movements that elicit fearful responses from patients.

The PHODA-YE is a highly engaging electronic assessment tool that yields individually tailored treatment targets with results sensitive to change in response to pain treatment.

aDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

bDepartment of Psychology, University of New Mexico, Albuquerque, NM, USA

cDepartment of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA

dDepartment of Physical and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA

eDepartment of Rehabilitation-Medicine, Maastricht University, Maastricht, the Netherlands

fDepartment of Clinical Psychological Sciences, Maastricht University, Maastricht, the Netherlands

Correspondence author. Address: Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304, USA. Tel.: (650) 723-6412. E-mail address: (L. Simons).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received June 14, 2016

Received in revised form January 02, 2017

Accepted January 12, 2017

© 2017 International Association for the Study of Pain
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