Validity of the Dutch modified painDETECT questionnaire (MPDQ-NL) for patients with hip or knee osteoarthritis

Wietske Rienstra, Tim Blikman, Baukje Dijkstra, Jos J. van Raay, Geranda Slager, Sjoerd K. Bulstra, Martin Stevens, I. van den Akker-Scheek

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    Purpose: The etiology of pain in osteoarthritis (OA) is complex and
    multifactorial. A growing number of studies suggest that modification
    of pain-transmission in the peripheral and central nervous system,
    leading to sensitization, plays a role in OA pain. Sensitization seems to
    be associated with neuropathic pain-like symptoms and assessment of
    these symptoms can help to identify patients who could benefit from
    additional treatment options. Several questionnaires are available to
    distinguish neuropathic from nociceptive pain symptoms. The modified
    painDETECT questionnaire (mPDQ) is a self-reported questionnaire
    developed to discriminate between nociceptive- and possible/likely
    neuropathic pain in knee OA patients. Recently the mPDQ was translated
    into Dutch and adjusted to also fit hip OA patients. The aim of this
    study was to assess the validity of the mPDQ-NL in patients with hip or
    knee OA.
    Methods: Primary hip and knee OA patients were recruited from three
    Dutch hospitals. Based on previous research, confirmatory factor analysis
    for two principal components was performed to assess structural
    validity. Construct validity (both convergent and divergent) was
    assessed using hypothesis testing. Predefined hypotheses were formulated
    concerning the correlation between the mPDQ-NL and the
    Self-reported Leeds Assessment of Neuropathic Symptoms and Signs (SLANSS),
    subscales of the Knee injury and Osteoarthritis Outcome score/
    Hip disability and Osteoarthritis Outcome Score (KOOS/HOOS), Visual
    Analogue Scale for pain (VAS pain), and subscales of the RAND-36
    health survey (RAND-36). According to the COSMIN criteria, construct
    validity of a questionnaire is sufficient if 75% of predefined hypotheses
    are met. Additionally, convergent validity was assessed with blunt Pain
    Pressure Thresholds (PPTs) in a subsample of participants. A reduced
    PPT is a somatosensory abnormality that is considered an indication of
    sensitization in OA. Therefore it was expected that reduction of PPTs
    was associated with higher mPDQ scores.
    Results: 168 participants were included. PPT measurements were
    performed in a sample of 46 participants. Factor analysis confirmed two
    principal components. The items that loaded on the first component
    could be described as “evoked neuropathic sensations”, the items that
    loaded on the second component as “spontaneous neuropathic sensations”.
    However there were two items that substantially loaded on both
    components. The item regarding pain pattern did not load on any
    component. Considering construct analysis, 80% of the predefined
    hypotheses concerning the correlation between mPDQ and self-reported
    questionnaires were met. Considering the correlation with PPT
    measurements, 50% of the predefined hypotheses were met.
    Conclusions: The mPDQ-NL seems to adequately reflect neuropathic
    pain-like symptoms experienced by hip and knee OA patients. Concerning
    structural validity, two determinative components seem to be
    present, in line with previous research. However, one particular item
    regarding pain pattern might not reflect the construct of neuropathic
    pain-like symptoms in hip or knee OA. Therefore, when using the mPDQ
    in hip or knee OA patients, it might be considered to skip this particular
    item. Construct validity can be considered sufficient, with over 75% of
    the predefined hypotheses regarding correlation between the mPDQNL
    and other questionnaires were met. However, only 50% of the hypotheses concerning PPT measurements were met, probably due to
    heterogeneity and limited sample size of this subgroup. To our
    knowledge, this study is the first to assess the structural validity of the
    mPDQ knee and hip by using factor analysis and to assess construct
    validity using elaborate hypothesis testing as proposed by the COSMIN
    Original languageEnglish
    PagesS440 - S441
    Publication statusPublished - Nov 2016


    • pain measurement
    • osteoarthritis
    • hips
    • knees


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