Abstract
Background and aim: Those living in challenging socio-economic circumstances are more susceptible to mental and physical health issues, as well as unmet health and social needs (complex needs). Proper assessment is essential to enable more effective management of these issues, planning of appropriate integrated care, and reduction of health inequities. Validated questionnaires to assess the complexity of needs are available (e.g. INTERMED), but their length often present a barrier to their use in clinical practice. PORTRAIT-10 is a 10-item, self-administered questionnaire designed to assess the complexity of biopsychosocial needs in clinical settings. The aim of this study was to evaluate the psychometric properties of the PORTRAIT-10 in individuals living with chronic pain.
Approach: Study design: This was a validation study. Patient partners were integrated into the research team at every stage of the study. Recruitment and participants: The study was proposed by email to members of the Quebec Association of Chronic Pain (Canada). The advertisement included a web link to the study procedures and an informed consent form. The study was open to individuals who had been living with chronic pain for a minimum of three months, were aged 18 or over, had access to the Internet, and spoke French. Data collection: The participants were requested to complete the following online questionnaires: 1) the reference standard INTERMED-Self Assessment (IMSA), 2) PORTRAIT-10, and 3) the Pain Catastrophizing Scale (PCS). Three weeks later, participants were requested to complete the PORTRAIT-10 once more. Analysis: The socio-demographic characteristics of the participants were presented using descriptive statistics. Cronbach alpha (α) coefficients were calculated to assess internal consistency. Spearman correlation coefficients were calculated to assess test-retest reliability. Convergent validity was evaluated by correlating PORTRAIT-10 scores with IMSA scores. Discriminant validity was assessed by correlating PORTRAIT-10 scores with PCS scores. Receiver operator characteristic (ROC) curves were used to explore possible cut-off scores on the PORTRAIT-10 to discriminate between people with and without complex needs.
Results: A total of 295 individuals participated in the study, with 88.3% identifying as female. The mean age was 53.3 ± 9.3 years, and the pain duration ranged from 2 to 65 years (median: 15 years, interquartile range: 17). PORTRAIT-10 demonstrated satisfactory internal consistency (α = 0.67). The Spearman correlation coefficient demonstrated excellent test-retest reliability (ρ = 0.85, p < .0001). The Spearman correlation coefficient demonstrated a significant correlation between the PORTRAIT-10 and the IMSA (ρ = 0.74, p < 0.0001), indicating excellent convergent validity. As anticipated, the PORTRAIT-10 demonstrated a weak correlation with the PCS (ρ = 0.34), indicating a high level of discriminant validity. A score of 10 or above on the PORTRAIT-10 would provide the optimal level of discrimination between cases with complex and non-complex needs. This cut-off score demonstrated good sensitivity (0.86) and specificity (0.71).
Implications: The PORTRAIT-10 is a valuable tool for assessing the complexity of biopsychosocial needs in practice. It enables the identification of individuals with the most complex needs and facilitates the provision of appropriate integrated care, essential for reducing health inequities.