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Patient utilities in chronic musculoskeletal pain: how useful is the standard gamble method? Fibromyalgia research

  [ 68 votes ]   [ Discuss This Article ] • March 15, 1999

The main goal of current pain management approaches is to
increase the patients' quality of life by improving pain
coping skills and by reducing the levels of disability in
daily life, often despite persistent pain. Direct measurement
of quality of life is of crucial importance in economic
evaluation research, in which not only is the estimation of
financial costs and benefits included, but so is the
evaluation of costs and benefits in terms of changes in health
states. The purpose of this study is to compare the
psychometric qualities of two instruments for assessing
patients' utilities, the rating scale (RS) and the standard
gamble (SG). Such instruments are designed for their
application in economic evaluation research, but have seldomly
been used in chronic pain trials. Both methods provide a
single measure between 0 and 1. The relationship between these
utility measures and descriptive and domain-specific quality
of life measures was examined in 133 fibromyalgia patients and
148 patients with chronic non-specific low back pain. Mean
utility score at baseline was 0.43 with the RS and 0.78 for
the SG. The correlation between both methods was found to be
poor (r = 0.21). Both measures appeared to be fairly stable in
a 2-week test-retest period (intra class correlation
coefficient (ICC) = 0.74 and 0.77). Scores on the description
of patient's own health on six domains, global assessment of
change and domain specific measures correlated moderately with
the RS scores and low with the SG. Multiple regression
analyses demonstrated that 32% of the variance in RS values
and only 13% of the variance in SG utilities could be
explained by domain-specific measures. These results suggest
an acceptable construct validity for the RS but insufficient
construct validity for the SG. Valuations of ones own health
appear only partially to be related to the assessment of the
pain-specific measures and measures of distress. It can be
concluded that the RS and domain-specific measures assess
partly different, but nevertheless complementary aspects of
health- related quality of life. It is therefore recommended
to include in economic evaluation studies both domain-specific
measures and valuation measures. Finally, in chronic
musculoskeletal pain patients, RS scores were found to be more
responsive in detecting significant changes in preferences
than SG scores. For use in patients with chronic
musculoskeletal pain, the RS is preferred to the SG for
establishing accurate decisions about the impact of new
interventions on their health outcomes.

Goossens ME, Vlaeyen JW, Rutten-van Molken MP, van der Linden SM

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