Background

We aimed to appraise the evidence relating to the measurement properties of unidimensional tools to quantify pain after surgery. Furthermore, we wished to identify the tools used to assess interference of pain with functional recovery.

Methods

Four electronic sources (MEDLINE, Embase, CINAHL, PsycINFO) were searched in August 2020. Two reviewers independently screened articles and assessed risk of bias using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

Results

Thirty-one studies with a total of 12 498 participants were included. Most of the studies failed to meet the methodological quality standards required by COSMIN. Studies of unidimensional assessment tools were underpinned by low-quality evidence for reliability (five studies), and responsiveness (seven studies). Convergent validity was the most studied property (13 studies) with moderate to high correlation ranging from 0.5 to 0.9 between unidimensional tools. Interpretability results were available only for the visual analogue scale (seven studies) and numerical rating scale (four studies). Studies on functional assessment tools were scarce; only one study included an ‘Objective Pain Score,’ a tool assessing pain interference with respiratory function, and it had low-quality for convergent validity.

Conclusions

This systematic review challenges the validity and reliability of unidimensional tools in adult patients after surgery. We found no evidence that any one unidimensional tool has superior measurement properties in assessing postoperative pain. In addition, because promoting function is a crucial perioperative goal, psychometric validation studies of functional pain assessment tools are needed to improve pain assessment and management.

Clinical trial registration

PROSPERO CRD42020213495.

中文翻译：

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一维和功能性疼痛评估工具在成人术后患者中的效用：系统评价

背景

我们的目的是评估与一维工具的测量特性相关的证据，以量化手术后的疼痛。此外，我们希望确定用于评估疼痛对功能恢复的干扰的工具。

方法

2020 年 8 月检索了四个电子来源（MEDLINE、Embase、CINAHL、PsycINFO）。两名审稿人独立筛选文章，并使用基于共识的健康测量仪器选择标准 (COSMIN) 清单评估偏倚风险。

结果

共纳入 31 项研究，共有 12,498 名参与者。大多数研究未能达到 COSMIN 要求的方法学质量标准。单维评估工具的研究以可靠性（五项研究）和响应性（七项研究）的低质量证据为基础。收敛效度是研究最多的属性（13 项研究），一维工具之间具有中度到高度的相关性，范围为 0.5 到 0.9。可解释性结果仅适用于视觉模拟量表（七项研究）和数字评级量表（四项研究）。对功能评估工具的研究很少；只有一项研究包含“客观疼痛评分”，这是一种评估疼痛对呼吸功能干扰的工具，并且其收敛效度质量较低。

结论

这项系统评价对成年患者术后一维工具的有效性和可靠性提出了挑战。我们没有发现任何证据表明任何一种一维工具在评估术后疼痛方面具有优越的测量特性。此外，由于促进功能是围手术期的一个重要目标，因此需要对功能性疼痛评估工具进行心理测量验证研究，以改善疼痛评估和管理。

临床试验注册

普洛斯彼罗 CRD42020213495。