Learning Objective #1: Identify variables essential to the measurement of pain management outcomes in the postoperative orthopedic patient

Learning Objective #2: Discuss the importance of multidimensional measurement of pain outcomes

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This secondary data analysis used confirmatory factor analysis (CFA) to identify variables essential to the measurement of pain outcomes. Patient-related pain management barriers and pain outcomes (pain control and satisfaction) were conceptualized as multidimensional measures. Responses from 505 adult post-operative elective orthopedic surgery patients who completed the Total Pain Quality Management™ survey between July 26, 2000 and July 2, 2001 and utilized IM, IVPCA, or IVPCA-CI analgesic therapy were used.

The barriers construct was measured by wait time, beliefs, side effects, and patient education adequacy. Pain control was measured by pain score now, worst pain at rest, worst pain with movement, degree of interference with function, and frequency of moderate to severe pain. Satisfaction was measured by degree of satisfaction, degree to which expectations were met, and whether improvement was needed. Higher scores indicate a lack of pain control (range 0 - 37) and greater satisfaction (range 0 – 13).

LISREL® 8.0 was utilized to conduct the CFA. An adequate measurement model could not be obtained (Sattora Bentler X2 = 160.75, df = 51, p <.01; X2/df = 3.15; RMSEA = .065; NNFI = .92; CFI =.94; Critical N= 124.97; GFI = .90). Barriers items demonstrated low reliability, so they were deleted from further analyses. An adequate measurement model was obtained (Sattora Bentler X2 = 44.03, df =16, p <.01; X2/df = 2.75; RMSEA = .059; NNFI = .97; CFI =.98; Critical N = 213.63; GFI = .96). Factor loadings ranged from -.56 (expectation) to .81 (frequency of moderate to severe pain) for pain control and .18 (expectations - double loading) to .82 (satisfaction level) for satisfaction. R2 ranged from .41 (interference with function) to .70 (pain frequency) for pain control items and from .5 (expectations) to .67 (satisfaction level) for satisfaction, indicating adequate reliability and validity.