The International Spinal Cord Injury Pain Extended Data Set (iscipeds) The working-group consists of



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The International Spinal Cord Injury Pain Extended Data Set (ISCIPEDS)
The working-group consists of:

Eva Widerström-Noga, DDS PhD (Chair); Fin Biering-Sørensen, MD, PhD; Thomas N Bryce, MD; Diana D Cardenas, MD, MHA; Nanna Brix Finnerup, MD, PhD; Mark P Jensen, PhD; J Scott Richards, PhD; Elizabeth J Richardson, PhD, MSPH; Philip Siddall, MD, PhD


Our interdisciplinary working group consists of members with published research expertise in the area of spinal cord injury (SCI) related pain. The members have expertise with regard to the clinical condition of pain, pain taxonomy, psychophysics of pain, psychology, epidemiology and assessment of pain and represent the Executive Committee of the International Spinal Cord Injury Standards and Data Sets (ASIA/ISCoS; Biering-Sørensen) and major organizations with an interest in SCI-related pain (i.e., the International Spinal Cord Society (ISCoS), American Spinal Injury Association (ASIA), Association of Spinal Cord Injury Professionals (ASCIP), American Pain Society (APS) and International Association for the Study of Pain (IASP)). Most of the committee members have memberships in several of these organizations.
Pain after SCI is a significant problem for those who experience it as well as for their healthcare providers because of its persistent nature. Pain in people with SCI is classified in broad categories as nociceptive, neuropathic (at- or below level of injury), other or unknown (Bryce et al., 2012 a,b). Neuropathic pain may be associated with evoked pain, such as allodynia or hyperalgesia (Eide et al., 1996; Finnerup et al., 2001). The neuropathic pains are rarely completely eliminated by available treatment interventions but can be meaningfully reduced in some people (Siddall et al., 2006; Cardenas et al., 2013). Because of the persistent nature of pain associated with SCI, there is a need to understand and assess both pain and associated psychological factors.
The clinical presentation of pain after SCI often includes multiple concomitant pain problems that are superimposed upon various physical impairments and consequences of injury. This presents unique challenges in the assessment of both pain and associated psychosocial factors and ultimately for clinical management.
The overall purpose of the International Spinal Cord Injury Pain Data Sets (ISCIPDS) is to standardize the collection and reporting of pain in the SCI population. The ISCIPDS contains a basic (ISCIPBDS) and an extended (ISCIPEDS) data set. The ISCIPBDS contains a minimal amount of clinically relevant information concerning pain that can be collected in the daily practice of healthcare professionals with expertise in SCI. The first version of the International Spinal Cord Injury Pain Basic Data Set ISCIPBDS was published in 2008 (Widerstrom-Noga et al., 2008) and a revised version ISCIPBDS v2.0 (Widerstrom-Noga et al., 2014) in 2014. The revised version was shortened to increase its clinical utility and to reflect the new SCI pain taxonomy (Bryce et al., 2012 a,b). It is adopted by the National Institute of Health, National Institute of Neurological Disorders and Stroke (NINDS), Common Data Elements (CDEs) as a supplemental/highly recommended dataset to be collected in clinical SCI pain research

(www.commondataelements.ninds.nih.gov/SCI.aspx#tab=Data_Standards) (Jakeman et al., in press)


The ISCIPEDS is directly based on the pain problems identified in the ISCPBDS and is primarily intended to provide guidance regarding the assessment of pain, and associated sensory function and psychosocial factors in clinical pain studies and trials. Consistent evaluation of these factors will facilitate research collaboration between clinical centers and thus expedite the development of beneficial treatments. The use of comparable sets of outcome measures in research studies will increase efficiency and facilitate collaborations, translation, interpretation, and application of results.
The ISCIPEDS is intended to be collected by researchers or healthcare professionals involved in research studies and who are familiar with SCI. Data should be collected by interview (dependent on the recommended mode of administration for a specific instrument) and examination.

The ISCIPEDS includes several important assessment components divided in 4 sections: (1) Pain symptom assessment including individual variables related to the temporal course, severity, unpleasantness, tolerability of pain, as well as questionnaires related to the pain type and symptom severity. This section is divided into: A. Overall pain (assessments are intended to provide an overall assessment of all pain that a person may experience). B. Each pain problem (assessments are intended to be performed for each separate pain problem identified in the ISCIPBDS); and C. Recommended questionnaires intended to provide supplemental information as appropriate for a specific purpose or interest. (2) Sensory assessment to detect and quantify common sensory abnormalities, including light touch, pinprick, and cold sensation in a neuropathic pain area; (3) Treatments used in the past 12 months and for ongoing treatments, dose (if appropriate), frequency of treatment, any adverse effects, and a rating of global impression of change; and (4) Psychosocial domains and comorbid conditions including outcomes, mediating factors, or comorbid conditions (e.g., depression, anxiety, quality of life). Forms for all assessment variables except for questionnaires can be found in the Appendix.


Pain symptoms and signs are particularly important to evaluate in populations, such as SCI, where pain is typically heterogeneous, persistent and often severe. Symptoms and signs associated with neuropathic pain may not only facilitate a better understanding of the clinical condition but may also provide a foundation for subgroup analyses in clinical trials and thus facilitate future mechanisms-based treatment interventions (Baron et al., 2012; Demant et al., 2014 ). The pain symptom measures included in the ISCIPEDS are intended to be simple, and clinically useful. They are divided into measures that can be used to assess overall pain and measures that are more useful if asked for a specific pain problem. There is also a section of recommended pain questionnaires that assess the presence and severity of pain symptoms and have data supporting their utility after SCI. These measures are intended to provide supplemental information as appropriate for a specific purpose or interest. The sensory measures are intended to detect and quantify common sensory abnormalities, including mechanical allodynia, mechanical hyperalgesia, and thermal allodynia commonly associated with neuropathic pain types.
Information regarding a persons’ previous and current experience with various treatment interventions is important both for the planning of clinical studies and facilitates screening of potential participants of a clinical trial. The ISCIPEDS is designed to capture information regarding both past (last 12 months) and current treatments. Due to possible recall biases, the effectiveness of past treatments are not captured in detail but only whether a person has had the treatment in the past 12 months and if it was helpful or not, or unknown. For current, ongoing treatments, more details are captured, including the dose (if appropriate), frequency of treatment, any adverse effects, and a rating of global impression of change (Guy 1976).
The psychosocial domains that researchers should consider assessing in their studies of SCI pain include outcome variables, mediating variables and comorbid conditions that would be of interest to those seeking to develop, test, or expand biopsychosocial models of SCI-related pain. The ISCIPEDS working group selected those domains, and identified potential measures of those domains, as a function of (a) their relevance to individuals with SCI and chronic pain and (b) the existence of published findings that support the validity of the measures selected in samples of individuals with SCI, and as much as possible (c) their availability in the public domain.
There is a vast array of outcomes measures that have been recommended for use in neuropathic pain research (Haanpӓӓ et al., 2011) and in SCI pain research specifically (Bryce et al., 2007). Reviewing all such measures is beyond the scope of the ISCIPEDS. We recommend that researchers carefully examine the appropriateness of any measure they might like to use with respect to utility in the SCI chronic pain population. For example, standard measures for pain-related outcomes may have content that is inappropriate for persons with SCI, or that can be misleading if endorsed (e.g., unusual sensory experiences). The instruments in the ISCIPEDS were selected in part to minimize that problem. The reader is also referred to the SCIRE (www.scireproject.com) and NINDS CDEs (www.commondataelements.ninds.nih.gov/SCI.aspx) websites where an extensive number of outcome measures are evaluated with respect to their applicability and psychometric properties. While the measures reviewed in these loci are not focused only on pain per se, they offer other resources for SCI researchers who want to use the most valid scales, particularly those which are being proposed for adoption across studies.
Acknowledgements: We thank William Bauman, Susan Charlifue, and Vanessa Noonan for valuable comments and suggestions.


  1. PAIN SYMPTOM ASSESSMENT:




  1. Overall pain (assessment includes all pain problems but could also be assessed for each pain problem (previously identified by the ISCIPBDS) if appropriate).

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VARIABLE NAME: Number of days with pain in the last 7 days including today
DESCRIPTION: This variable specifies the total number of days with pain during the last 7 days, including today.
CODES: 0 none

1 – one day

2 – two days

3 – three days

4 – four days

5 – five days

6 – six days

7 – seven days

Unknown
COMMENTS: “Today” is the day the individual answers the question regardless time of day. The duration of pain during the day does not matter in answering this question.

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VARIABLE NAME: Average pain intensity of the worst pain in the last week
DESCRIPTION: A 0 – 10 Numerical Rating Scale (ranging from 0 = “No pain” to a maximum of 10 = “The most intense pain imaginable”) of average pain intensity for the worst pain problem the respondents experience). Please note that “last week” specifically refers to the last seven days including today.
CODES: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10

COMMENTS: Pain intensity is the most common pain domain assessed in research and clinical settings. Although different rating scales have proven to be valid for assessing pain intensity, including the Numerical Rating Scale (NRS), the Verbal Rating Scale (VRS), and the Visual Analogue Scale (VAS), the 0 – 10 NRS has the most strengths and fewest weaknesses of available measures (Jensen & Karoly, 2000). Moreover the 0 – 10 NRS has been recommended by the IMMPACT consensus group for use in pain clinical trials (Dworkin et al., 2005) and by the 2006 NIDRR SCI Pain outcome measures consensus group (Bryce et al., 2007).

The seven day time frame was selected to balance the need to assess pain over a long enough epoch to capture usual pain, against the need to keep the time frame short enough to maximize recall accuracy.

The instruction and endpoints used were designed to differentiate between pain intensity and pain unpleasantness (Dannecker et al., 2007). For example, the intensity of pain is how strong the pain feels and the unpleasantness of pain is how disturbing the pain is. In order to better understand the difference between pain intensity and unpleasantness one can substitute the word “sound” for “pain”. Pain intensity is analogous to the loudness of a sound while unpleasantness is analogous to the aversiveness of a sound not necessarily related to its loudness.

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VARIABLE NAME: Average pain unpleasantness in the last week


DESCRIPTION: A 0 – 10 Numerical Rating Scale (ranging from 0 = “Not at all unpleasant” to a maximum of 10 = “The most unpleasant pain imaginable”) of average pain unpleasantness for (up to) three pain problems (the three worst pain problems respondents experience). Please note that “last week” specifically refers to the last seven days including today.
CODES: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10

COMMENTS: Pain is a result of sensory, cognitive, and affective dimensions, and the emotional dimension can be evaluated separately from intensity (Price et al., 1987). Although different rating scales have proven to be valid for assessing pain intensity, including the Numerical Rating Scale (NRS), the Verbal Rating Scale (VRS), and the Visual Analogue Scale (VAS), the 0 – 10 NRS has the most strengths and fewest weaknesses of available measures (Jensen & Karoly, 2000).


The instruction and endpoints used were designed to differentiate between pain intensity and pain unpleasantness (Dannecker et al., 2007). For example, the intensity of pain is how strong the pain feels and the unpleasantness of pain is how disturbing the pain is. In order to better understand the difference between pain intensity and unpleasantness one can substitute the word “sound” for “pain”. Pain intensity is analogous to the loudness of a sound while unpleasantness is analogous to the aversiveness of a sound not necessarily related to its loudness.
__________________________________________________________________________________
VARIABLE NAME: Number of days with manageable/tolerable pain in the last 7 days including today

DESCRIPTION: This variable specifies the total number of days with pain during the last 7 days, including today.


CODES: 0 none

1 – one day

2 – two days

3 – three days

4 – four days

5 – five days

6 – six days

7 – seven days

Unknown

COMMENTS: “Today” is the day the individual answers the question regardless time of day. The duration of manageable/tolerable pain during the day does not matter in answering this question.


Manageable or tolerable pain is a construct reported by Zelman et al., 2004, and not specific to pain after SCI. Focus group methodology has suggested that manageable or tolerable pain is pain that permits concentration on something other than the pain, perhaps by using a treatment or self-remedy that “takes the edge off” pain and allows performance of daily activities or “getting something done.” Other factors associated with manageable pain are lower levels of negative mood, feeling well enough to socialize and not experiencing excessive adverse effects of ongoing treatments including medication.

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  1. Each pain problem (to be assessed for each pain problem previously identified by the ISCIBPDS)

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VARIABLE NAME: Pain intensity in present moment
DESCRIPTION: A 0 – 10 Numerical Rating Scale (ranging from 0 = “No pain” to a maximum of 10 = “The most intense pain imaginable”) of present pain intensity for (up to) three pain problems (the three worst pain problems respondents experience). Please note that “present” specifically refers to this moment.
CODES: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10

COMMENTS: Pain intensity is the most common pain domain assessed in research and clinical settings. Although different rating scales have proven to be valid for assessing pain intensity, including the Numerical Rating Scale (NRS), the Verbal Rating Scale (VRS), and the Visual Analogue Scale (VAS), the 0 – 10 NRS has the most strengths and fewest weaknesses of available measures (Jensen & Karoly, 2000). Moreover the 0 – 10 NRS has been recommended by the IMMPACT consensus group for use in pain clinical trials (Dworkin et al., 2005) and by the 2006 NIDRR SCI Pain outcome measures consensus group (Bryce et al., 2007).



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VARIABLE NAME: How long does your pain usually last?

DESCRIPTION: This variable provides an estimate of the duration of pain. Some pain types are very brief and may be felt several times per day. This question refers to the duration of each separate pain event.

CODES: One minute or less

More than one minute but less than one hour

At least one hour, but less than 24 hours

At least 24 hours but not continuous

Constant or continuous

Unknown


COMMENTS: The duration of pain can be defined when a specific pain follows a predictable pattern. If no predictable pattern for a specific pain exists, the answer “unknown” is given.

VARIABLE NAME: When during the day is the pain most intense?

DESCRIPTION: This variable identifies the diurnal peak in pain intensity.

CODES: Morning

Afternoon

Evening

Night

Unpredictable; pain is not consistently more intense at any one time of day
COMMENTS: “Morning” is between 6.01 am and 12.00 am (06.01 and 12.00); “Afternoon” is between 12.01 am and 6.00 pm (12.01 and 18.00); “Evening” is between 6.01 pm and 12.00 pm (18.01 and 24.00); “Night” is between 0.01am and 6.00 am (00.01 and 06.00)

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  1. Recommended questionnaires


Instruments for the assessment of pain type or pain symptom severity are listed in Table 1.
Nociceptive pain assessment
The assessment for nociceptive pain will be assessed as in non-SCI populations.

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  1. SENSORY ASSESSMENT

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VARIABLE NAME: Dynamic light touch
DESCRIPTION: Sensation rated as normal (compared to a control area in a non-affected skin area), absent (no sensation felt), hypoesthesia (decreased sensation compared to control area), hyperesthesia (increased sensation compared to control area), allodynia (the touch provokes pain), other (changed sensation that cannot be categorized otherwise). If allodynia is present the pain is rated on a 0 – 10 Numerical Rating Scale (ranging from 0 = “No pain” to a maximum of 10 = “Pain as bad as you can imagine”).
COMMENTS: Can be assessed by light stroking the skin with an innocuous moving stimuli, e.g. a cotton wisp, cotton wool tip, or a brush (e.g. Somedic standardized brush, Sweden) of approximately 2 cm with a speed of 1-2 cm/sec. (Rolke et al. 2006).

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VARIABLE NAME: Pinprick
DESCRIPTION: Sensation rated as normal (compared to a control area in a non-affected skin area), absent (no sensation felt), hypoalgesia (decreased pain sensation compared to control area), hyperalgesia (increased pain sensation compared to control area), other (changed sensation that cannot be categorized otherwise). If hyperalgesia is present the pain is rated on a 0 – 10 Numerical Rating Scale (ranging from 0 = “No pain” to a maximum of 10 = “Pain as bad as you can imagine”).
COMMENTS: Can be assessed using a disposable safety pin or calibrated monofilaments (Rolke et al., 2006)

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VARIABLE NAME: Cold
DESCRIPTION: Sensation rated as normal (compared to a control area in a non-affected skin area), absent (no sensation felt), hypoesthesia (decreased sensation compared to control area), hyperesthesia (increased sensation compared to control area), allodynia (the cold provokes pain), other (changed sensation that cannot be categorized otherwise). If allodynia is present the pain is rated on a 0 – 10 Numerical Rating Scale (ranging from 0 = “No pain” to a maximum of 10 = “Pain as bad as you can imagine”).
COMMENTS: Can be assessed using a cold thermoroll (Somedic Sweden) of 20 or 25C, a piece of cold metal, an ice cube or an acetone droplet. For determination of cold detection and cold pain thresholds, thermal tests can be performed using thermo testers (TSA, Medoc, Israel or MSA, Somedic, Sweden) (Rolke et al. 2006).

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  1. TREATMENTS

__________________________________________________________________________________
VARIABLE NAME: Past treatment
DESCRIPTION: This variable specifies treatments for pain received in the past and treatment response.
COMMENTS: Person to indicate (“Check”) each treatment that they have received in the past for their pain. Where possible, the person also indicates whether it was helpful (“Yes”) or not helpful (“No”). If the person, cannot remember or is uncertain about effectiveness they indicate “Uncertain”. The section can be completed to indicate treatments and response for all types of pain overall or multiple forms for specific pain types. Due to the fact that the management of pain in SCI is challenging with a wide range of treatments being tried, including pain medications, such as opioids, non-steroidal anti-inflammatory drugs, acetaminophen, tricyclic antidepressants and anticonvulsants, as well as physical therapy and alternative treatment approaches, such as massage, marijuana, acupuncture and hypnosis (Cardenas and Jensen 2006, Murphy and Reid 2001, Norrbrink Budh and Lundeberg 2004), self-management (Umlauf 1992), as well as relaxation and psychotherapy, procedural and surgical interventions the list provided is very long to cover most possibilities.

__________________________________________________________________________________
VARIABLE NAME: Current treatment
DESCRIPTION: This variable specifies the current treatments for pain, timing of treatment, response and side effects.
COMMENTS: Person to indicate current treatments for pain, including dose (“Dose”) (if medication) and frequency (“How often”). Effectiveness is assessed using the Patient Global Impression of Change (“PGIC”); (Guy, 1976, Bryce et al., 2007). Any side effects or adverse events (“Side effects/adverse events”) related to the treatment are also to be noted. The section can be completed to indicate treatments and response for all types of pain overall or multiple forms for specific pain types.
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  1. PSYCHSOCIAL AND COMORBID CONDITIONS

A number of psychometric instruments are available for assessing pain relevant domains and these are listed in Table 2.

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Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov.

Whiteneck GG, Charlifue SW, Gerhart KA, Overholser JD, Richardson GN. (1992). Quantifying handicap: a new measure of long-term rehabilitation outcomes. Arch Phys Med Rehabil 73(6): 519-26. PMID: 1622299.

Widerström-Noga E, Biering-Sørensen F, Bryce T, Cardenas DD, Finnerup NB, Jensen MP, Richards JS, Siddall PJ. (2008). The international spinal cord injury pain basic data set. Spinal Cord 46(12): 818-23. PMID: 18521092.

Widerström-Noga E, Biering-Sørensen F, Bryce TN, Cardenas DD, Finnerup NB, Jensen MP, Richards JS, Siddall PJ. (2014).The International Spinal Cord Injury Pain Basic Data Set (version 2.0). Spinal Cord 52(4): 282-6. PMID: 24469147.

Table 1. Instruments for determining pain type and/or pain symptom severity.

Domain

Instrument

Construct Measured

Intended Population

Mode of administration

Length

References

Availability

Pain Type (screening only- not for individual assessment)

Douleur Neuropathique 4 questions (DN4)

Neuropathic pain type

General

Self or Examiner

7 items for Self; 10 items for Examiner

Bouhassira, et al. (2005); Hallstrom, et al. (2011).

Free for non-funded academic users . Visit www.proqolid.org/instruments/neuropathic_pain_4_questions_dn4




Spinal Cord Injury Pain Instrument (SCIPI)

Neuropathic pain type

SCI

Self or Examiner

4 or 7 items

Bryce et al., 2014

Free for use.

Can be accessed in the appendix of article by Bryce et al., 2014.



Pain Quality

Pain Quality Assessment Scale (PQAS)

Pain symptom severity

General

Self

20 items

Jensen et al. (2006)

Free for non-funded academic users . Visit

www.proqolid.org/instruments/pain_quality_assessment_scale_and_revised_pain_quality_assessment_scale_pqas_and_pqas_r






Short form McGill Pain Questionnaire 2 (SF-MPQ-2)

Pain symptom severity

General

Self

22 items

Dworkin et al. (2009)

Free for academic users if used in studies not funded by commercial companies. Visit

www.proqolid.org/instruments/short_form_mcgill_pain_questionnaire_sf_mpq_2?fromSearch=yes&text=yes.






Neuropathic Pain Symptom Inventory (NPSI)

Pain symptom severity

Neuropathic pain

Self

12 items

Bouhassira et al. (2004)

Copyright. Free for non-funded academic users. Visit www.proqolid.org/instruments/neuropathic_pain_symptom_inventory_npsi




Neuropathic Pain Questionnaire (NPQ)

Pain symptom severity

Neuropathic pain

Self

12 items

Krause and Backonja (2003)

Free for use. Can be accessed in the appendix of article by Krause and Backonja, 2003.




PainDETECT (PD-Q)

Pain symptom severity

Neuropathic pain

Self

10 items

Freynhagen et al. (2006)

Copyright. Free. See www.pfizerpatientreportedoutcomes.com/therapeutic-areas/pain/neuropathic-pain


Table 2. Psychosocial instruments available for assessing pain relevant domains.

Domain

Instrument

Construct Measured

Intended Population

Mode of administration

Length

References

Availability

Depression

Patient Health Questionnaire-9 (PHQ-9)

Depression symptoms

Primary care; core measure in SCI model system

Self

9 items; 8-item and 2-item versions available

Spitzer et al., 1999; Kroenke et al., 2003.

Free via Pfizer

www.phqscreeners.com/






PROMIS Depression -Short Form

Depression; minimizes somatic confounds

General

Self

8 items

Amtmann et al., 2011; Amtmann et al., 2014.

Free via Assessment Center. Visit www.assessmentcenter.net

to complete a request for online pdf versions of available instruments.



Anxiety

Generalized Anxiety Disorder-7 (GAD-7)

Anxiety symptoms

Primary care

Self

7 items

Spitzer et al., 2006.

Free via Pfizer

www.phqscreeners.com/






PROMIS Anxiety - Short Form

Anxiety symptoms

General

Self

8 items

Amtmann et al., 2011.

Free via Assessment Center. Visit www.assessmentcenter.net

to complete a request for online pdf versions of available instruments.






Tampa Scale of Kinesiophobia (TSK)

Fear of pain/re-injury

Developed for low back pain; used across chronic pain populations

Self

17 items

Miller et al., 1991; Vlaeyen et al., 1995.

Items can be found in the article by Vlaeyen et al.




PTSD Checklist – Civilian Version (PCL-C)

PTSD symptoms

General

Self

20 items

Weathers et al., 2013.

To obtain this scale, visit the VA National Center for PTSD website to complete the online request form:www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp


Quality of Life/ Satisfaction with Life

Short-Form-36 (SF-36)

Perceived functional health and well-being

General medical

Self or Examiner

36 items; 8 sub-scales

Ware et al., 1993.

To obtain licensing, visit:

www.sf-36.org






EuroQoL-5 Dimension Questionnaire (EQ-5D)

Health-related quality of life

General medical

Self

5 items

EuroQol Group, 1990.

To register study and submit licensing fees (if applicable):

www.euroqol.org






Quality of Life Index (QLI) - SCI version

Satisfaction and quality of life

Spinal cord injury

Self or Examiner

37 items

May & Warren, 2001; May & Warren 2002.

For direct access:

www.uic.edu/orgs/qli/questionaires/questionnairehome.htm






International SCI Basic Data Set - QoL items

General quality of life; satisfaction with physical and mental health

Spinal cord injury

Self

3

Charlifue et al., 2012.

Items can be found in the Charlifue et al. article.

Resilience

Connor Davidson Resilience Scale (CD-RISC)

Psychological resilience

General

Self

25 items; 10-item, 2-item versions available

Connor & Davidson, 2003.

To obtain any version of the scale, a request form can be found at: www.cd-risc.com/

Mood

Positive and Negative Affect Schedule (PANAS)7


positive and negative affect

General

Self

20 items

Watson et al., 1998.

Can be accessed in the appendix of the original article by Watson et al.

Participation

Craig Handicap Assessment and Reporting Technique (CHART) – SF

Community integration and independence

Variety of physical rehabilitation populations

Self or Examiner

19 items for CHART-SF

Whiteneck et al., 1992.

Available via Craig Hospital website: www.craighospital.org/repository/documents/Research%20Instruments/CHART%20Manual.pdf



Appendix


  1. PAIN SYMPTOM ASSESSMENT




  1. Overall pain


Number of days with pain in the last 7 days including today:

 none;  1;  2;  3;  4;  5;  6;  7;  unknown



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