In addition to the aforementioned fact that there are often complex interactions among chronic pain, impairment, and disability, what makes this issue even more complicated is that there are three broad categories of measures - physical, psychosocial, and overt behavior/function -that have all been used to assess patients.1 Again, however, these three major category measurements (or biopsy-chosocial referents) often do not display high concordance with one another when measuring a construct such as chronic pain, or impairment, or disability. Therefore, this creates a second layer of complexity. For example, if one uses a self-report measure (e.g. a visual analog rating scale) as a primary index of a construct such as pain, and compares it to the overt behavior/function measure (e.g. total distance walked during a certain amount of time) of this same pain construct, direct overlap or perfect correlation cannot be automatically expected. Moreover, two different self-report indices (e.g. a visual analog rating scale versus the McGill Pain Questionnaire) or behavior/function indices (e.g. total distance walked during a certain time period versus lifting performance) of this same pain construct may not be as highly correlated as one would expect. What has plagued the evaluation arena in general has been the lack of agreement in the wide variation in measures used to document constructs, such as chronic pain, impairment, and disability, as well as changes in these measures. Thus, the literature is replete with many different measurement techniques and tests of a construct, such as chronic pain.10,15 It is beyond the scope of the present chapter to review these complexities comprehensively. The scientific literature, though, is beginning to demonstrate which specific measures appear to be the most reliable and valid.1,15
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