Item Response Analyses And Application Of Related Psychological Disorders For Patients With Pain

Purpose In order to provide practical evidence for the benefits of usingItem response theory (IRT) to analyze clinical psychological measures, ClassicalTesting Theory (CTT), unidimensional IRT and multidimensional IRT modelswere used to analyze pain related psychological factors, and the differencesbetween these methods were compared. Additionally, the influences of painseverity and other demographic factors to severity of psychological disorder forpatients with pain were analyzed systematically. All this work was conducted toprovide primary reference for comprising of pain management system, and toprovide guidance for clinical practice.Methods Ten medical departments were enrolled in this study, locating inBeijing, Xi’an, Chongqing, and Lanzhou cities. Questionnaires were deliveredto outpatients with pain symptoms. Hospital Anxiety and Depression Scale(HAD) and Illness Behavior Questionnaire (IBQ) were used to measure patients’ psychological disorders. Visual analogue scale (VAS), verbal rating scale (VRS)and Short-form of McGill pain questionnaire (SF-MPQ) were used to evaluatethe severity of pain in patients. Also other information of patients wasdocumented, including sex, living in the city or in the country, and classificationof their illnesses. Data was analyzed using the combination of different methods,including factor analysis, coefficients of internal consistency, graded responsemodel (GRM), two-parametric logistic model (2PL), bi-factor model and so on.Different criteria were also used to compare the different methods, includingconstruct validity, consistency, item and test information etc. At the same time,3methods of evaluating the severity of pain were also compared. Based on theseresults, correlation analysis and multivariate analysis of variance wereconducted to assess the influences of pain severity and other demographicfactors having on severity of psychological disorders.Results We got the following results in this study.1. The unidimensionality of subscales of HAD and IBQ were not so well.Among the3methods, bi-factor analysis was more appropriate for theconstructs of these two scales and items’ contents. And psychological criteria ofbi-factor analysis were better.2. Bi-factor analysis made the correlations between different psychologicalsymptoms clearer, and specific characteristics were more obvious.3. VAS was better when evaluating the severity of pain. And SF-MPQcould provide more detailed information of the characteristics of pain.4. Compared with male pain patients, females were more passive (specificcharacteristics of depression).5. Compared with pain patients living in the cities, patients living in thecountry were more active (specific characteristics of anxiety), and had more obvious inappropriate illness behaviors.6. Among the pain patients, female cancer patients living in the cities andfemale patients with acute pain living in the country had more severepsychological disorders. And doctors should treat them more patiently.Conclusion In this study we could know that IRT could be applied in theanalysis of clinical psychological evaluations. And multidimensional modelscould get better results for scales with multidimensional characteristics.Obviously, psychological disorders of pain patients were correlated significantlywith their pain severity. Besides, sex, living in the city or the country, andclassification of illnesses could also exert influences on their psychologicalfactors. As a primary exploration for constructing a comprehensive evaluatingsystem of pain, this study could provide some suggestions for clinical practice.However, limited in the time and resources, we still have many shortcomingsneeding to be improved.