Pain Assessment–Can it be Done with a Computerised System? A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Questions
2.2. Inclusion and Exclusion Criteria
2.3. Search Strategy
2.4. Extraction of Study Characteristics
2.5. Quality Assessment
2.6. Risk of Bias Assessment
2.7. Mathematical Analysis
2.7.1. Statistical Data Fusion
2.7.2. Qualitative Analysis
2.7.3. Considerations for the Analysis
3. Results
3.1. Mobile Systems
3.2. Web-Based Systems
3.3. Meta-Analysis
4. Discussion
5. Conclusions
Limitations
Acknowledgments
Author Contributions
Conflicts of Interest
Abbreviations
CBT | Cognitive-behavioural Therapy |
CG | Control Group |
ED | Electronic pain diaries |
EMA | Ecological Momentary Assessment |
IdT | Internet-delivery treatment |
IG | Intervention Group |
PD | Paper pain diaries |
PHR | Personal Health Record |
RCT | Randomised controlled trial |
SD | Standard Deviation |
Appendix A1
Study/Year | Population Participants (Mean Age, SD) | Patient Home | Data | Quality | ||
---|---|---|---|---|---|---|
As a Complement to the System | Collected through the Use of System | Transmission | ||||
Mobile systems | ||||||
Allen [84,85], 2009 | 157 (61.7 ± 10.6) | Yes | Pre: CSQ | Pain intensity (VAS), immediately after waking, then approximately every 2 h throughout the day (in order to complete at least 7 pain ratings per day) and immediately before going to sleep (to recall the average pain during the day) | NR | L |
Anatchkova [86], 2009 | 100 | No | Pain intensity (NRS), computer adaptive dynamic assessment of The Chronic Pain Impact Item Bank [87], and SF-12, in the medical appointment | NR | L | |
Axen [69,70], 2011 | 262 (44) | Yes | Pre: Pain intensity (NRS), location, duration and frequency, self-rated general health (5-point Likert scale). EuroQoL 5 (EQ5D) Post: EQ5D and self-rated general health (6-months follow up) | Pain intensity (NRS), once a week using SMS | Instant | L |
Badr [88], 2010 | 54 patients (49.4 ± 10.8) 48 partners (51.3 ± 11.5) | Yes | Patients: pain intensity (NRS), mood, medication taken and pain relief, 6 times per day between 9 a.m. and 9 p.m. Perceptions of relationship functioning in the last assessment of the day. Partners: patients’ pain, own mood and perceptions of relationship functioning, at similar time points | Instant | L | |
Baron-Mahn [89,90], 2009 | 2094 painful radiculopathy (59.4 ± 14.4) 1623 painful diabetic neuropathy (61.9 ± 13.0) 498 postherpetic neuralgia (60.6 ± 15.4) | No | MOS-SS, PHQ, PD-Q and pain location (pinpointed in 3D mannequin) in the medical appointment | Delayed | L | |
Broderick-Schneider [50,91,92], 2008 | 83 (56.2 ± 11.1) | Yes | Treatment: 10 random recalls pain assessment via phone interview (interactive voice recording was used) Post: Pain Intensity (VAS) | SF-36, BPI, BFI, MPQ, 7 times per day during the patients’ waking hours | Delayed | L |
Clauw [34], 2008 | 399 IG 100 mg/day (49.5 ± 10.9) 396 IG 200 mg/day (50.4 ± 10.6) 401 CG (50.7 ± 10.4) | Yes | Pre: FIQ, MASQ, MOS-SS, MDHAQ, MFI, BDI, and ASEX Treatment: 3, 7, 11 and 15 week visit: PGIC, SF-36, FIQ, MASQ, MOS-SS, MDHAQ, MFI. BDI and ASEX only at week 15 | Diary: pain intensity (VAS), 5 times per day (morning, 3 during day and evening) Weekly: pain, fatigue, influence of pain in self-care (VAS) | Instant | H |
Connelly [93], 2010 | 9 (12.3 ± 3.4) | Yes | Children: pain intensity (VAS), PANAS-C, CALQ, 3 times per day (morning, afternoon, and evening) Parents: PANAS, ARCS at the same time points, using a separate PDA | Delayed | L | |
Gaertner [94], 2004 | 24 (49.9 ± 15.1) Crossover randomized between IG and CG | Yes | Pain intensity (NRS), once a day and symptom assessment (fatigue, nausea, dyspnea, weakness…), once a week | Delayed | L | |
Ghinea [95], 2008 | 45 (46.1) | Yes | Pain intensity (VAS) and location (pinpointed in 3D mannequin), 3 times a day | Instant | L | |
Giske [72], 2010 | 50 (50.0 ± 11.0) | Yes | Pre: HSCL-25, FIQ Post: Pain intensity (VAS) and pain location | Pain intensity (NRS), 5 times a day between 9 a.m. and 9 p.m., using SMS | Instant | L |
Heiberg [96], 2007 | 38 (58.4 ± 12.9) | Yes | Diary: pain intensity (VAS), fatigue, and patient global evaluation of their disease, RADAI, 4 times per day Weekly: MHAQ, SF-36 | Instant | H | |
Jamison [28], 2001 | 20 IG (42.1 ± 5.0) 16 CG (43.3 ± 9.2) | Yes | Pre: CPEQ, SCL-90 Treatment: MPQ-SF (once a month). Pain reported weekly by phone interview Post: SCL-90 | Pain intensity (VAS) and pain ratings of the previous 16 waking hours, once a day (bedtime) | Delayed | H |
Jamison [97], 2002 | 24 (34.4) | No | Pain intensity (VAS) | Delayed | L | |
Jamison [98], 2006 | 21 (42.0 ± 4.9) | Yes | Pre: CPEQ, SF-36, MPQ-SF, SCL-90 Treatment: Pain reported weekly by phone interview | Pain intensity (VAS), at least once a day | Delayed | H |
Jamison-Wasan [26,27], 2010 | 21 IG ED + CBT (47.0 ± 7.8) 21 CG #1 ED (46.6 ± 6.8) 20 CG #2 ED (49.6 ± 6.8) | Yes | Pre and Post: ABC, BPI, COMM, HADS, MINI, PDI, SOAPP-R Post: PDUQ | BPI, pain location once a month at clinic visit Wasan’s study, also includes four questions to assess craving for prescription opioids over the past 24 h (14 days ED at patients' home) CBT: Group educational sessions (e.g., opioid addiction risks and medication compliance, making lifestyle changes...) and individual motivational counseling (review of medication adherence, support for patients’ efforts, education on pain management and drug misuse...) | Delayed | H |
Jespersen [71], 2012 | 188 (44.4 ± 9.0) | Yes | Pre: AMS | AMS, IPAQ, once a week using SMS | Instant | H |
Koroschetz [99], 2011 | 1623 painful diabetic neuropathy (61.9 ± 13.0) 1434 fibromyalgia (51.9 ± 10.8) | No | MOS-SS, PHQ, PD-Q and pain location (pinpointed in 3D mannequin) in the medical appointment | Delayed | L | |
Kvien [100], 2005 | 30 (61.6) | No | Pain intensity (VAS), fatigue, and patient global evaluation of their disease, RADAI, MHAQ, SF-36, at 2 medical appointments | Instant | L | |
Lewandowski [101], 2010 | 39 chronic pain (15.3 ± 1.5) 58 healthy participants (14.7 ± 1.8) | Yes | Pre: CES-D | Sleep quality (NRS) in the morning and pain intensity (NRS) in the evening. Integrated with wrist actigraphy to monitorize the sleep | Delayed | L |
Levin [102], 2006 | 24 | Yes | Pain intensity (NRS), location, duration reported via automated speech telephony delivery (a.k.a automated speech recognition) | Instant | L | |
Li [103], 2010 | 60 (69.0 ± 10.0) | Yes | Pre and Post: MPQ-SF | MPQ-SF, 8 times per day (hourly between 2 and 9 p.m.) | Delayed | H |
Lind [104], 2008 | 12 (67.5 ± 7.8) | Yes | Pain intensity (VAS), 3 times a day (8 a.m., 1 p.m., 8 p.m.) | Instant | L | |
Litt [44], 2009 | 32 IG 22 CG Overall (41.0 ± 11.9) | Yes | Pre and Post: MPI, CES-D | Pan location, unpleasantness experienced, perceived control over pain, catastrophization and coping, 4 times per day (from 8 a.m. to 10 p.m.). Interactive voice recording was used CBT: relaxation training, cognitive restructuring and stress management | Instant | H |
Luckmann [76], 2010 | 4 | Yes | Pain intensity (NRS), location, activity and treatment completed each 2–4 waking hours. Acute pain registered when happens. Sleep report in the morning and end of day report before sleep. Data integration with PHR | Instant | L | |
Marceau [105], 2010 | 67 IG (48.5 ± 11.6) 67 CG (50.5 ± 11.0) | No | BPI at each monthly clinic visit. Pre and post-treatment and 5-month follow up: BPI, PCS, ODI, CES-D | Instant | H | |
McClellan [29], 2009 | 9 IG 10 CG Overall (13.4 ± 2.9) | Yes | Pain intensity at morning and evening (10-point Likert scale), pain location, sleep quality, and functional limitations once a day CBT: coping skills program, once a day. Parents presence is allowed | Instant | H | |
Oerlemans [38], 2011 | 37 IG (35.9 ± 11.7) 39 CG (40.6 ± 15.5) | Yes | Pre and Post (upon treatment and 3-month follow up): Pain intensity (5-point Likert scale), CFSBD, IBS-QoL, PCS | Pain intensity (5-point Likert scale) 3 times per day (morning, afternoon and evening). Sleep quality and intended activities for the day. (morning), accomplished activities, cognitions, and feelings (afternoon), and satisfaction with activity level and achievements of that day (evening) CBT: situational feedback on their diaries from a psychologist | Instant | H |
Okifuji [106], 2011 | 81 (28.8 ± 6.2) | Yes | Overall pain (7-point Likert scale), fatigue, head pain, emotional distress, abdominal pain, sense of relaxation, muscle pain, and sense of swelling, 3 times per day (morning, early afternoon, late afternoon) | Delayed | L | |
Page [107], 2010 | 14 (65.1) | No | Pre: PDQ-39, BDI-II, UPDRS | MPQ, in the medical appointment | Delayed | L |
Palermo [33], 2004 | 30 IG (12.3 ± 2.4) 30 CG (12.3 ± 3.0) | Yes | Pre: CALI | Pain intensity (Faces pain scale [108]), pain symptoms (occurrence, location, duration, and emotional upset), CSI, and CALI, once a day | Delayed | H |
Peters [109], 2000 | 80 (40.6 ± 6.7) | Yes | Pre: MPI, SF-36, BSI Post: CSQ (6 months follow up) | Pain intensity (7-point scale) and signal controlled diary (items: pain cognition, pain coping, sleep quality...), 4 times per day between 8 a.m. and 9:30 p.m. | Delayed | H |
Roelofs [110], 2004 | 40 (46.4 ± 9.9) | Yes | Pre: TSK, QBPDS | Pain intensity (PVAQ), TSK, 8 times per day between 8 a.m. (weekend 9 a.m.) and 10 p.m. | Delayed | L |
Schurman [35], 2010 | 10 IG 10 CG Overall (12.2 ± 2.8) | Yes | Pre and Post: BASC, PedsQL, completed by children and parents | Pain intensity (Faces pain scale Revised), once per day (bedtime) CBT: relaxation sessions, such as abdominal breathing, progressive muscle relaxation, imagery, and autogenic hand-warming. Multimedia content for home practice | Delayed | H |
Sorbi [111], 2007 | 5 | Yes | Pain intensity (VAS). 1st test run: 4–5 times per day. 2nd test run: 2–3 times per day CBT: migraine headache, medication use, attack precursors, self relaxation and other preventive behaviour | Instant | L | |
Stinson [112], 2008 | Study 1 76 (13.4 ± 2.5) Study 2 36 (12.6 ± 2.4) | Yes | Post: PedsQL, PCQ | Pain intensity, pain unpleasantness, pain’s interference with aspects of quality of life and other symptoms (e.g., stiffness and fatigue) (VAS), 3 times per day (upon waking, after school, and before bed) | Instant | H |
Stinson [113], 2012 | 24 children (5.9 ± 0.9) 77 youth (13.5 ± 3.1) | No | Pain intensity: faces pain scale (children), NRS (youth), in the medical appointment | Instant | H | |
Stone [31], 2003 | 40 IG (43.0 ± 9.0) 40 CG (48.0 ± 10.8) | Yes | Pre: MPQ-SF | BPI, PD-IIP, HAQ, 3 times per day (10 p.m., 4 a.m., 8 a.m.) | Delayed | H |
Stone-Kelly [30,32], 2003 | 22 IG 3 prompts/day (49.0 ± 10.7) 22 IG 6 prompts/day (53.5 ± 10.4) 24 IG 12 prompts/day (50.3 ± 10.3) 23 CG (49.8 ± 12.5) | Yes | Pre: Questionnaire to assess anxiety, stress, pain, health, and quality of life Pre/Treatment: Questionnaire, once a week, to assess pain and mood, the momentary and the occurred over the last 7 days Treatment: Questionnaire once a week to assess interference of ED with participants' daily routines | Pain intensity (VAS), and other questions related to sensory, affective and physical aspects, 3, 6 or 12 times a day. Kelly’s study includes all the IGs | Delayed | H |
Turner [47], 2005 | 61 IG (39.3 ± 11.1) 65 CG (35.4 ± 10.5) | Yes | Pre: GCPS | Pain intensity (NRS), pain-related activity interference, jaw use limitations, and several questions adapted from CSQ, SOPA, PCS, and DCI, 3 times per day (morning, afternoon, and evening) CBT: At each session activity goals were recommended (correct jaw posture, progressive relaxation practice, breathing exercises, physical exercise...) | Delayed | H |
Wallasch [114], 2012 | 545 (43.1 ± 12.9) | Yes | MIDAS, GCPS, HADS, SF-12 | Delayed | L | |
Weering [115], 2012 | 16 (40.7 ± 13.8). | Yes | Pre: RMDQ, SoC | Pain intensity (VAS), 3 times a day (noon, 4 p.m., 8 p.m.). Integration with Body Area Network (BAN) | Instant | L |
Younger [116], 2009 | 10 (46.5 ± 10.3) | Yes | Treatment: FIQ every 2 weeks | Fibromyalgia severity, average pain intensity, highest pain, and other symptoms (fatigue, sadness, stress, sleep quality, ability to think and remember…), once a day (night) | NR | L |
Web-based systems | ||||||
Berman [41], 2009 | 41 IG (64.3) 37 CG (67.5) | Pre and Post: BPI, PSEQ, CED-S, STAI, PAQ, HDM | Pain intensity (BPI), after logon and before logoff in the site CBT: abdominal breathing, relaxation, writing about experiences (positives or negatives), creative visual expression and positive thinking. Audio, visual and textual content related to pain | H | ||
Buhrman [36], 2004 | 22 IG (43.5 ± 10.3) 29 CG (45.0 ± 10.7) | Pre: HADS | Pain intensity (VAS), 3 times per day (morning, noon and evening). PAIRS, MPI, CSQ and HADS once a week CBT: several modules (pain, stress, physical activities, problem solving...) and slideshows and sound files for download | H | ||
Devineni [42], 2005 | 39 IG (43.6 ± 12.0) 47 CG (41.0 ± 11.8) | Frequency, duration, and severity of pain, once a day Pre/Post/Follow up: HSQ, CES-D, STAI, HDI CBT: muscle relaxation program, and stress coping therapy | H | |||
Hicks [43], 2006 | 25 IG (12.1 ± 2.0) 22 CG (11.3 ± 2.2) | Pre: PedsQL Post: PedsQL (1-month and 3-month follow up) | Pain intensity (NRS), 4 times per day CBT: relaxation techniques, lifestyle (diet, exercise), information related to pain | H | ||
Hunt [51], 2009 | 28 IG (39.0 ± 10.0) 26 CG (38.0 ± 12.0) | GSRS-IBS, IBS-QoL, ASI, GAD-Q and CPSQ, conducted at pre-and post-treatment and 3-month follow-up CBT: gastrointestinal symptoms and stress and on relaxation training, stress management, catastrophic thinking, exposure therapy and the social consequences of IBS | H | |||
Kristjansdottir [52], 2011 | 6 (36.3) | Pre and Post: CPAQ, PCS | Pain intensity, interference of pain, planned and achieved activities, feelings, pain-related fear, avoidance, catastrophizing and acceptance, 3 times per day (morning, evening and a time randomly chosen between 11:30 a.m. and 2 p.m.) CBT: feedback SMS with praise, encouragement messages, and exercises | L | ||
Ljótsson [45], 2010 | 42 IG (36.4 ± 10.1) 43 CG (32.8 ± 8.6) | Treatment: Gastrointestinal symptom diary | GSRS-IBS, IBS-QoL, VSI, MADRS-S and SDS conducted at pre-and post treatment. 3-month follow up: VSI, IBS-QoL and 2 weekly GSRS-IBS CBT: mindfulness exercises program, and lifestyle strategies (diet, exercise) | H | ||
Lorig [39], 2008 | 422 IG (52.2 ± 10.9) 433 CG (52.5 ± 12.2) | Pre and post treatment, and 6/12 months follow up: pain intensity and fatigue (NRS), distress, activities limitations, disabilities and HAQ CBT: tailored exercises programmes and medication diaries | H | |||
Palermo [37], 2009 | 26 IG (14.3 ± 2.1) 22 CG (15.3 ± 1.8) | Pre and Post: RCADS, ARCS | Pain intensity (NRS), CALI CBT: two separate websites, one for child access and one for parent access. The child access comprised eight treatment modules (education about chronic pain, recognizing stress and negative emotions, relaxation, distraction, cognitive skills, sleep hygiene and lifestyle, staying active, relapse prevention). Download of multimedia content. | H | ||
Ruehlman [46], 2012 | 162 IG (19~78) 143 CG (19~78) | CES-D, DASS, PCP-S and PCP-EA at pre-treatment, 7-weeks and 14-weeks follow-up CBT: several content such as interactive activity, relaxation sessions | H | |||
Strom [40], 2000 | 20 IG (41.5) 25 CG (39.2) | Pre: Pain intensity (VAS), duration, BDI, HDI, MLPC. Treatment: Number of times and the total time used for training relaxation. Post: Pain intensity (VAS) | CBT: several modules concerning relaxation | H | ||
Williams [48], 2010 | 59 IG (50.2 ± 12.3) 59 CG (50.8 ± 10.6) | Pre: MINI, PD-IIP | SF-36, BPI, MFI, MOS-SS, CES-D, STPI and PGIC at pre and post-treatment CBT: multimedia content following topics: educational lectures, symptom management and adaptive life style | H |
Appendix A2
Appendix A3
Study/Year | Sequence Generation | Allocation Concealment | Blinding of Participants, Personnel and Outcome Assessors | Incomplete Outcome Data | Free of Selective Outcome Reporting | Free of Other Sources of Bias |
---|---|---|---|---|---|---|
Berman [41], 2009 | Yes | No | No | Yes | Yes | No |
Buhrman [36], 2004 | Yes | Yes | No | Yes | Yes | Yes |
Devineni [42], 2005 | No | Yes | No | Yes | Yes | Yes |
Hicks [43], 2006 | Yes | Yes | No | No | Yes | Yes |
Hunt [51], 2009 | Yes | Yes | No | No | Yes | No |
Litt [44], 2009 | Yes | Yes | No | Unclear | Yes | Yes |
Ljótsson [45], 2010 | Yes | Yes | No | Unclear | Yes | Yes |
Lorig [39], 2008 | Yes | Yes | No | No | Yes | Yes |
Marceau [105], 2010 | Yes | Yes | No | No | Yes | Yes |
Oerlemans [38], 2011 | Yes | Yes | No | Unclear | Yes | No |
Palermo [37], 2009 | Yes | Yes | No | Yes | Yes | Yes |
Ruehlman [46], 2012 | Yes | Yes | No | Yes | Yes | No |
Schurman [35], 2010 | Yes | Yes | No | Yes | Yes | Yes |
Strom [40], 2000 | Yes | Yes | No | Yes | Yes | No |
Turner [47], 2005 | No | Yes | No | Yes | Yes | Yes |
Williams [48], 2010 | Yes | Yes | No | Unclear | Yes | Yes |
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Pain intensity | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Study | Variable | Technology | Pen and Paper | Technology | Pen and Paper | Favourable To | ||||
Pre Treatment | Post Treatment | Pre Treatment | Post Treatment | Aggregated Value | SD | Aggregated Value | SD | |||
Value (SD) | Value (SD) | Value (SD) | Value (SD) | |||||||
Berman [41] | BPI (mean) | 52 (19.40) | 45.60 (18.30) | 54.30 (17.40) | 47.30 (18.40) | 48.61 | 13.31 | 51 | 12.64 | Technology |
Buhrman [36] | Pain (mean) | 37.40 (18.20) | 34.30 (16.80) | 44.4 (14.20) | 39.6 (16.30) | 35.73 | 12.34 | 42.33 | 10.71 | Technology |
MP—pa in severity | 63.33 (31.67) | 40 (18.33) | 83.33 (28.33) | 53.33 (13.33) | 45.86 | 15.87 | 58.77 | 12.06 | Technology | |
Devineni [42] | Headache pain | 31.80 (17) | 18.60 (13) | 35.50 (15.50) | 30.60 (14.70) | 23.47 | 10.33 | 32.92 | 10.67 | Technology |
Hicks [43] | Pain (mean) | 48 (13) | 34 (24) | 43 (16) | 47 (22) | 44.82 | 11.43 | 44.38 | 12.94 | Pen-and-Paper |
Litt [44] | MPI (mean) | 43.83 (21) | 20.50 (16.33) | 35.17 (14.33) | 25 (22.67) | 29.29 | 12.89 | 32.26 | 12.11 | Technology |
Ljótsson [45] | Pain | 65 (42.50) | 35 (37.50) | 60 (37.50) | 60 (40) | 48.13 | 28.12 | 60 | 27.36 | Technology |
Lorig [39] | Pain | 65.30 (22.70) | 58.60 (24.40) | 63.70 (22.20) | 63.40 (23.10) | 62.19 | 16.62 | 63.56 | 16.01 | Technology |
Palermo [37] | Pain | 54.50 (22.50) | 35.40 (24.20) | 51.70 (16.50) | 47.60 (18.40) | 45.64 | 16.48 | 49.87 | 12.28 | Technology |
Retrospective pain | 66.30 (18.70) | 49.60 (21.80) | 61.60 (18.40) | 54.50 (20.40) | 59.22 | 14.19 | 58.42 | 13.66 | Pen-and-Paper | |
Ruehlman [46] | PCP-S—pain severity | 76.47 (9.72) | 71.10 (12.94) | 74.78 (10.91) | 71.66 (13.28) | 74.53 | 7.77 | 73.52 | 8.43 | Pen-and-Paper |
Turner [47] | Pain (mean) | 43 (22) | 39 (24) | 43 (19) | 40 (22) | 41.17 | 16.22 | 41.72 | 14.38 | Technology |
Williams [48] | BPI—pain severity | 51 (14) | 43 (16) | 49 (14) | 49 (15) | 47.53 | 10.54 | 49 | 10.23 | Technology |
Fusion | value | 55.90 (4.80) | 40.57 (5.08) | 52.65 (4.56) | 49.02 (4.94) | 48.67 | 3.49 | 50.98 | 3.35 | Equivalent |
alpha | 23.04 | 25.82 | 20.79 | 24.38 |
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Pombo, N.; Garcia, N.; Bousson, K.; Spinsante, S.; Chorbev, I. Pain Assessment–Can it be Done with a Computerised System? A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2016, 13, 415. https://doi.org/10.3390/ijerph13040415
Pombo N, Garcia N, Bousson K, Spinsante S, Chorbev I. Pain Assessment–Can it be Done with a Computerised System? A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2016; 13(4):415. https://doi.org/10.3390/ijerph13040415
Chicago/Turabian StylePombo, Nuno, Nuno Garcia, Kouamana Bousson, Susanna Spinsante, and Ivan Chorbev. 2016. "Pain Assessment–Can it be Done with a Computerised System? A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 13, no. 4: 415. https://doi.org/10.3390/ijerph13040415