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Classifying Patients with Chronic Pelvic Pain into Levels of Biopsychosocial Dysfunction Using Latent Class Modeling of Patient Reported Outcome Measures.

Fenton BW, Grey SF, Tossone K, McCarroll M, Von Gruenigen VE - Pain Res Treat (2015)

Bottom Line: Based on multiple fit criteria, a latent class model revealed four distinct classes of CPP: No dysfunction (3.2%); Low Dysfunction (17.8%); Moderate Dysfunction (53.2%); and High Dysfunction (25.8%).In addition to an essentially normal class, three classes of increasing biopsychosocial dysfunction were identified.The LCA approach has the potential for application to other complex multifactorial disease processes.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Summa Health System, Akron, OH 44304, USA.

ABSTRACT
Chronic pelvic pain affects multiple aspects of a patient's physical, social, and emotional functioning. Latent class analysis (LCA) of Patient Reported Outcome Measures Information System (PROMIS) domains has the potential to improve clinical insight into these patients' pain. Based on the 11 PROMIS domains applied to n=613 patients referred for evaluation in a chronic pelvic pain specialty center, exploratory factor analysis (EFA) was used to identify unidimensional superdomains. Latent profile analysis (LPA) was performed to identify the number of homogeneous classes present and to further define the pain classification system. The EFA combined the 11 PROMIS domains into four unidimensional superdomains of biopsychosocial dysfunction: Pain, Negative Affect, Fatigue, and Social Function. Based on multiple fit criteria, a latent class model revealed four distinct classes of CPP: No dysfunction (3.2%); Low Dysfunction (17.8%); Moderate Dysfunction (53.2%); and High Dysfunction (25.8%). This study is the first description of a novel approach to the complex disease process such as chronic pelvic pain and was validated by demographic, medical, and psychosocial variables. In addition to an essentially normal class, three classes of increasing biopsychosocial dysfunction were identified. The LCA approach has the potential for application to other complex multifactorial disease processes.

No MeSH data available.


Related in: MedlinePlus

Standardized scores in biopsychosocial superdomains for the four latent classes' model. The PROMIS domains are t score adjusted so that the population mean is 50 and 10 points represents one standard deviation. All domains are scored so that higher scores indicate more of what is being measured. For pain, negative affect, and fatigue high scores are worse. For social function low scores are worse. Pain and social function provide the clearest distinction and categorical progression of the latent classes.
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fig1: Standardized scores in biopsychosocial superdomains for the four latent classes' model. The PROMIS domains are t score adjusted so that the population mean is 50 and 10 points represents one standard deviation. All domains are scored so that higher scores indicate more of what is being measured. For pain, negative affect, and fatigue high scores are worse. For social function low scores are worse. Pain and social function provide the clearest distinction and categorical progression of the latent classes.

Mentions: Table 2 shows average latent class probabilities for most likely class membership based on the four latent classes' model. This table suggests that between 88 and 92 percent of the sample would be assigned consistently to the same class specification based on class membership likelihood. This indicates a good discrimination of the four-class LCA, as most CPP patients had a high probability of being in a single class with very low probabilities of being in other classes. Figure 1 graphs the average standardized scores in each of the biopsychosocial superdomains for the 4-class model. The biopsychosocial superdomains, like the original PROMIS measures, are t-scale standardized scores based on a US referent population of 22,000 individuals which produces a mean value of 50 and a standard deviation of 10. As shown in this plot, there is a considerable difference among classes on the four well-being domains, particularly between the first class and the fourth class in this model. This contrast is most obvious in the pain domain, where there is a difference of nearly 30 points between the first class and the fourth class. It is also noticeably different in the social function domain.


Classifying Patients with Chronic Pelvic Pain into Levels of Biopsychosocial Dysfunction Using Latent Class Modeling of Patient Reported Outcome Measures.

Fenton BW, Grey SF, Tossone K, McCarroll M, Von Gruenigen VE - Pain Res Treat (2015)

Standardized scores in biopsychosocial superdomains for the four latent classes' model. The PROMIS domains are t score adjusted so that the population mean is 50 and 10 points represents one standard deviation. All domains are scored so that higher scores indicate more of what is being measured. For pain, negative affect, and fatigue high scores are worse. For social function low scores are worse. Pain and social function provide the clearest distinction and categorical progression of the latent classes.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4556336&req=5

fig1: Standardized scores in biopsychosocial superdomains for the four latent classes' model. The PROMIS domains are t score adjusted so that the population mean is 50 and 10 points represents one standard deviation. All domains are scored so that higher scores indicate more of what is being measured. For pain, negative affect, and fatigue high scores are worse. For social function low scores are worse. Pain and social function provide the clearest distinction and categorical progression of the latent classes.
Mentions: Table 2 shows average latent class probabilities for most likely class membership based on the four latent classes' model. This table suggests that between 88 and 92 percent of the sample would be assigned consistently to the same class specification based on class membership likelihood. This indicates a good discrimination of the four-class LCA, as most CPP patients had a high probability of being in a single class with very low probabilities of being in other classes. Figure 1 graphs the average standardized scores in each of the biopsychosocial superdomains for the 4-class model. The biopsychosocial superdomains, like the original PROMIS measures, are t-scale standardized scores based on a US referent population of 22,000 individuals which produces a mean value of 50 and a standard deviation of 10. As shown in this plot, there is a considerable difference among classes on the four well-being domains, particularly between the first class and the fourth class in this model. This contrast is most obvious in the pain domain, where there is a difference of nearly 30 points between the first class and the fourth class. It is also noticeably different in the social function domain.

Bottom Line: Based on multiple fit criteria, a latent class model revealed four distinct classes of CPP: No dysfunction (3.2%); Low Dysfunction (17.8%); Moderate Dysfunction (53.2%); and High Dysfunction (25.8%).In addition to an essentially normal class, three classes of increasing biopsychosocial dysfunction were identified.The LCA approach has the potential for application to other complex multifactorial disease processes.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Summa Health System, Akron, OH 44304, USA.

ABSTRACT
Chronic pelvic pain affects multiple aspects of a patient's physical, social, and emotional functioning. Latent class analysis (LCA) of Patient Reported Outcome Measures Information System (PROMIS) domains has the potential to improve clinical insight into these patients' pain. Based on the 11 PROMIS domains applied to n=613 patients referred for evaluation in a chronic pelvic pain specialty center, exploratory factor analysis (EFA) was used to identify unidimensional superdomains. Latent profile analysis (LPA) was performed to identify the number of homogeneous classes present and to further define the pain classification system. The EFA combined the 11 PROMIS domains into four unidimensional superdomains of biopsychosocial dysfunction: Pain, Negative Affect, Fatigue, and Social Function. Based on multiple fit criteria, a latent class model revealed four distinct classes of CPP: No dysfunction (3.2%); Low Dysfunction (17.8%); Moderate Dysfunction (53.2%); and High Dysfunction (25.8%). This study is the first description of a novel approach to the complex disease process such as chronic pelvic pain and was validated by demographic, medical, and psychosocial variables. In addition to an essentially normal class, three classes of increasing biopsychosocial dysfunction were identified. The LCA approach has the potential for application to other complex multifactorial disease processes.

No MeSH data available.


Related in: MedlinePlus