Are treatment benefits in neuropathic pain reflected in the self assessment of treatment questionnaire?

Abstract

Background/objectiveThe Self Assessment of Treatment (SAT) questionnaire was developed to reflect key patient reported outcomes of Neuropathic Pain (NP) treatments. This study aimed to understand how patients perceived the relevance and ease of understanding of the questions in the SAT and to recommend modifications based on patient and clinician interviews.MethodsSemi-structured interviews were conducted with clinicians and NP patients to provide information regarding treatment attributes and the impact of pain. Patients were debriefed on the SAT, a 5-item scale evaluating pain, activity level, quality of life (QoL) and satisfaction with treatment (recommend treatment and undergo treatment again). The SAT has a recall period reflecting back to the start of treatment. The qualitative analysis software ATLAS.ti 5.0 was used to analyze patient transcripts. Changes to the SAT were integrated into the questionnaire for a second round of debriefing interviews.ResultsThree NP clinicians and 44 patients (20 painful diabetic neuropathy, 16 HIV-associated neuropathy and 8 post herpetic neuralgia) with a mean age of 60.3 (12.3) years and an even gender distribution were interviewed. Patient treatment experience included anticonvulsants (73%), antidepressants (34%), opioids (25%), and topical medications (41%). Pain descriptors and treatment attributes were similar across the three NP groups. Pain relief was judged the most important treatment attribute, followed by ability to undertake activities. Sleep improvement was another important attribute. Activity limitations and QOL were perceived as too broad and non-specific, and were split into 3 concepts each (activity limitations was split into self care, daily and physical activities and QOL was split into sleep, emotions, and social function). A 7-day recall period was introduced. The item stem and response options were made consistent, and a baseline and follow-up questionnaires were developed (except for the satisfaction items) to enable monitoring onset of treatment benefit and change over time.ConclusionsThe content validity of the revised SAT was improved by the qualitative research, and NP treatment benefits are reflected in a more consistent fashion by the changes. Baseline and follow-up versions make it possible to perform assessments of change over time.

Quality of Life and Self-Reported Lower Extremity Function in Adults With HIV-Related Distal Sensory Polyneuropathy

“…Our findings align with previous reports that QOL and function may be impaired in people with HIV disease. 7,21 The participants with DSP in the present study had greater functional loss than we anticipated, with scores on the respective lower extremity functional scales reflecting less than 50% of normal or full function. Even participants without DSP had functional loss, but not as much as those with DSP.…”

Evaluating the Measurement Properties of the Self-Assessment of Treatment Version II, Follow-Up Version, in Patients with Painful Diabetic Peripheral Neuropathy

“…The need for a new version of the questionnaire was identified through qualitative research, which showed that the original questionnaire was lacking in content validity for the activity and QoL items. The modified SAT II measure was developed to address these concerns [ 11 ]. There are two versions of the SAT II, one to be administered at baseline and the other at follow-up visits.…”

“…Furthermore, in a sample of patients with postoperative pain given the American Pain Society Satisfaction Survey, satisfaction was influenced by effectiveness of the medication independent of the level of pain intensity [ 10 ]. The five-item Self-Assessment of Treatment (SAT) questionnaire was developed based on the IMMPACT recommendations for assessing patient ratings of improvement and satisfaction [ 11 , 12 ]. Items assess patient ratings of treatment benefit relating to pain, activity level, and QoL.…”

“…Despite strong evidence of the measurement properties of the SAT items [ 12 ], concerns were expressed about the lack of a recall period and about that the activity and QoL items covering too broad a construct for single items. Qualitative interviews were conducted with clinical experts and with patients diagnosed with NP [ 11 ]. Three clinicians provided their perspective on the most relevant symptoms and impacts of NP, as well as on the key benefits and harms associated with treatment.…”

Burden of HIV-Related Neuropathic Pain in the United States

“…This is important in light of a recent analysis of a selfassessment of treatment questionnaire in patients with NeP, including HIV-NeP, showing that the activity level and quality of life sections were better assessed when they were divided into 3 concepts each rather than assessed as 1 overarching concept. 30 Because patients in the aforementioned analysis felt ''activity level'' was ''too broad and unspecific,'' it was divided into self-care, daily activities, and physical activities. Similarly, changes in quality of life were interpreted as unspecific by patients, and the question was divided into sleep, emotions, and social function.…”