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The CALI-9

A brief measure for assessing activity limitations in children and adolescents with chronic pain

Holley, Amy Lewandowskia,*; Zhou, Chuanb,f; Wilson, Anna C.a; Hainsworth, Keric,d; Palermo, Tonya M.e,f

doi: 10.1097/j.pain.0000000000001063
Research Paper
Global Year 2018

Pain-related functional limitations represent an important outcome domain to assess in children and adolescents with chronic pain. The aim of this study was to extend the empirical support of the 21-item Child Activity Limitations Interview (CALI-21), a well-validated measure of activity limitations, using a large, multisite sample and to develop a brief form of the measure with more interpretable scoring. A sample of 1616 youth and 1614 parents completed the CALI-21 at an initial appointment in 1 of 3 pain specialty clinics in the Midwest or Northwest United States, or as part of a research study after this initial visit. All youth also reported on usual pain intensity. The CALI-21 data from 1236 youth and parents were used in analyses. Results of the exploratory and confirmatory factor analyses supported a common 2-factor structure (Active and Routine factors) for both child- and parent-report versions. Using item reduction, the 9-item measure (CALI-9) was developed with both child and parent versions showing good internal consistency and high cross-informant reliability. Initial validity was shown by the ability of the CALI-9 to distinguish by level of pain intensity. Findings suggest that the CALI-9 is a promising brief tool for the evaluation of pain-related activity limitations in youth with chronic pain and for proxy report by parents. Advantages of the shortened scale include the revised 0 to 100-point scale, which increases interpretability, and further validation of the subscale scoring to assess specific limitations in Active and Routine physical functioning domains.

aDepartment of Pediatrics, Oregon Health & Science University, Portland, OR, USA

bDepartment of Pediatrics, University of Washington, Seattle, WA, USA

cChildren's Hospital of Wisconsin, Milwaukee, WI, USA

dDepartment of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA

eDepartment of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA

fSeattle Children's Research Institute, Seattle, WA, USA

Corresponding author. Address: 3181 SW Sam Jackson—CDRC, Portland, OR 97239, USA. E-mail address: (A. L. Holley).

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

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received March 01, 2017

Received in revised form August 30, 2017

Accepted September 05, 2017

© 2018 International Association for the Study of Pain
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