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prognostics (Interventional Fragility vs. Interventional Resilience, Medication Abuse vs. Medication Competence, etc.) and more. Uses: Useful for assessment of basic personality types and how they cope with illness. Also useful for patients being referred for intensive treatment programs such as chronic pain, functional restoration, or work conditioning, for presurgical risk assessment, for impairment determinations, or when there are strong indications that psychological factors are delaying the recovery process. Benefits: When used as a part of a comprehensive evaluation, can contribute substantially to the understanding of psychosocial factors affecting medical patients. Understanding risk factors and patient personality type can help to optimize treatment protocols for a particular patient.
MMPI-2 (Minnesota Multiphasic Personality Inventory- 2nd edition ) Pearson Assessments www.pearsonassessments. com Standardization: S Scientific Review: JBG Intended for: P Research: 57-112 Restrictions: Psy, MD
567 items, 100+ scales and indices, critical items, 60-90 Minutes, computerized scoring and report, hand scoring. 6th grade reading level
symptoms. Benefits: When used as a part of a part of a comprehensive evaluation, measures a number of factors that have been associated with poor treatment outcome. MMPI-2-RF (Minnesota Multiphasic Personality Inventory- 2nd editionRestructured Form) Pearson Assessments www.pearsonassessments. com Standardization: S Scientific Review: JBG Intended for: P Research: 113-132 Restrictions: Psy, MD What it Measures: The MMPI-2-RF has been revised so extensively that it is virtually a new test. While this radical revision addresses many of the psychometric weaknesses of its predecessor, some studies concluded that it is less capable of assessing chronic pain or somatoform disorders, 72,73 while another study found the two tests to be roughly equivalent in this regard.49 Patients with chronic pain may be substantially less likely to appear to have psychopathology on the MMPI-2-RF as opposed to the MMPI-2. Uses: Useful for patients undergoing a more comprehensive psychological assessment. Designed for assessment of psychiatric patients, not pain patients. Useful for the assessment of exaggerating or minimizing symptoms. Benefits: When used as a part of a part of a comprehensive evaluation, can identify a wide variety of problematic psychiatric conditions and personality types.
338 items, 50 scales including 8 validity scales, critical items, 5th grade reading level 45-50 minutes.
PAI (Personality Assessment Inventory) PAR www.parinc.com Standardization: S Scientific Review: JBG Intended for: P Research: 133-139 Restrictions: Psy, MD
What it Measures: A good measure of general psychopathology. Measures depression, anxiety; somatic complaints, stress, alcohol and drug use reports, mania, paranoia, schizophrenia, borderline, antisocial and suicidal ideation and more than 30 others. Uses: Useful for patients undergoing a more comprehensive psychological assessment. Designed for assessment of psychiatric patients, not pain patients, which can bias results, and this should be a consideration when using. Benefits: When used as a part of a part of a comprehensive evaluation, can contribute substantially to the identification of a wide variety of risk factors that could potentially affect the medical patient. .
Strengths: Brief 5-minute screen can be administered first to see if the remainder of the test should be administered. English and Spanish versions available. Standardized audio tape administration for persons with literacy or reading problems, computerized administration available. Three norm groups available (community, psychiatric and college student). Weaknesses: Designed for psychiatric patients, not pain or rehab patients. Does not assess factors specific to pain treatment.
MPI (Multidimensional Pain Inventory) Published by Authors Standardization: PS Scientific Review: JG Research: 74, 143-180 Intended for: M Restrictions: U
for affective distress, pain, and function. Benefits: Can identify patients with high levels of disability perceptions, affective distress, or those prone to pain magnification. Serial administrations can track changes in measured variables during the course of treatment, and assess outcome. P-3 (Pain Patient Profile) Pearson Assessments www.pearsonassessments .com Standardization: S Scientific Review: JBG Intended for: P Research: 168, 181-190 Restrictions: H What it Measures: Assesses depression, anxiety, and somatization. Uses: Brief measure useful when assessing risk factors associated with disability, or as one test in a more comprehensive evaluation. Developed as a screen to measure psychological factors related to chronic pain conditions. Designed for computerized progress tracking using serial administrations. Benefits: Can identify patients needing treatment for depression and anxiety, as well as identify patients prone to somatization. Can compare the level of depression, anxiety and somatization to other pain patients and community members. Serial administrations can track changes in measured variables during the course of treatment, and assess outcome. What it Measures: Two assessment components consist of initial paper and pencil screen for patient, with follow-up structured interview by the physician. Assesses mood, anxiety, somatoform tendencies, alcohol and eating disorders.
Strengths: Two norms groups are available, based on pain patient and community samples, computerized progress tracking. Standardized audio tape administration for persons with literacy or reading problems, computerized progress tracking, on line administration by computer or handheld electronic device. Computerized report compares patient to both community and chronic pain patient samples. Weaknesses: Not comprehensive, somewhat lengthy administration time for a screen.
Strengths: Structured interview has good interjudge reliability. Mood, alcohol and eating disorder modules have good criterion validty. Interview allows for diagnosis of 18 disorders. Weaknesses: Interview is very demanding of
26 items in five clinical modules plus structured interview, no validity measures. Average of 8 minutes or more of physician time for interview (can
Standardization: S Scientific Review: J Intended for: M Research:191-221 Restrictions: U PHQ (Patient Health Questionnaire) Pfizer Scientific Review: J Intended for: M Research: 192, 198, 199, 201, 203,
206, 208, 222-228
Uses: Clinical method useful in assessing mental health conditions commonly seen in primary care. Benefits: Able to screen primary care patients for commonly seen mental disorders.
What it Measures: A self-administered version of the PRIME-MD. Assesses mood, anxiety, somatoform tendencies, alcohol and eating disorders. Uses: Clinical method useful in assessing mental health conditions commonly seen in primary care. Benefits: Able to screen primary care patients for commonly seen mental disorders.
82 items in five clinical modules, no validity measures, administration time unknown Hand scoring only
Restrictions: U
SF 36 V2 The Health Institute: New England Medical Center Standardization: S Scientific Review: JBG Research: 153,159,229-265 Intended for: M Restrictions: U
What it Measures: A survey of general health well being, and functional states. Uses: Brief measure useful to assess patient perception of physical and emotional functioning, as an outcome measure, or as one test in a more comprehensive evaluation. Serial administrations could be used to track patient perceived functional changes. Benefits: Assesses a broad spectrum of patient disability reports. Serial administrations could be used to track patient perceived functional changes during the course of treatment, and assess outcome.
depression, anxiety and somatization to community members. Serial administrations could be used to track patient perceived functional changes during the course of treatment, and assess outcome. SCL-90-R (Symptom Checklist 90 Revised) Pearson Assessments www.pearsonassessments. com Standardization: S Scientific Review: JBG Research: 59,82,101,135,273-285 Intended for: P Restrictions: H What it Measures: Somatization, obsessivecompulsive, depression, anxiety, phobias, hostility, paranoia, psychoticism, and interpersonal sensitivity. Uses: Designed for assessment of psychiatric patients, not pain patients, which can bias results, which should be a consideration when using. Designed for computerized progress tracking using serial administrations. Benefits: Can identify patients needing treatment for depression and anxiety, as well as identify patients prone to somatization. Can compare the level of depression, anxiety and somatization to community members. Serial administrations could be used to track changes in measured variables during the course of treatment, and assess outcome. Strengths: Strong research base, relatively brief instrument with computerized progress tracking. English and Spanish versions. Standardized audio tape administration for persons with literacy or reading problems, computerized progress tracking, on line administration by computer. Note that the SCL-90-R is standardized, whereas the original SCL-90 is not. Weaknesses: Designed for and normed on psychiatric patients, not pain patients. Current norm base not appropriate for medical populations 90 items, 12 scales, no validity measures, computerized scoring and report, hand scoring. 15 minutes 6th grade reading level
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CES-D (Center for Epidemiological Studies Depression Scale) Unpublished, public domain Standardization: N Scientific Review: J Research: 286,308-317 Intended for: P Restrictions: U
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PDS (Post Traumatic Stress Diagnostic Scale) Pearson Assessments www.pearsonassessments. com Scientific Review: S Intended for: O Restrictions: BS Zung Depression Inventory Glaxowellcome www.glaxowellcome.com Standardization: PS Scientific Review: J Research: 64,99,143,241,299,318335
What it Measures: PTSD Uses: When PTSD diagnosis is suspected. Designed for computerized progress tracking using serial administrations. Benefits: Helps confirm PTSD diagnosis. Repeated administrations can track treatment progress of PTSD patients. What it Measures: Depression Uses: Intended as a brief measure of depression, useful as a screen or as one test in a more comprehensive evaluation. Designed for assessment of psychiatric patients, not pain patients, which can bias results, and this should be a consideration when using. Benefits: Can identify patients needing referral for further assessment and treatment for depression. Repeated administrations can track progress in treatment for depression.
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What it Measures: Measures cognitive, emotional and sensory aspects of pain. Uses: Assesses pain experience, useful as a screen or as one test in a more comprehensive evaluation. Benefits: Can identify patients prone to pain magnification. Repeated administrations can track progress in treatment for pain.
62,75,90,97,98,100,104,169,251,271,283,3
Strengths: Well-known and researched in the pain community. Variations of this test have been translated into 12 languages. Provides a way to describe pain and measure treatment utility including organic and affective components. Weaknesses: Unpublished test with no test manual. Good reliability, but psychometric problems include a lack of discriminate validity and high intercorrelations between subscales that reduce their usefulness. Four different scoring methods have been proposed in the literature. Overall score may be the only useful score clinically. Strengths: Shorter version of a well known test. Weaknesses: Unpublished test with no test manual. Good reliability, but psychometric problems include a lack of discriminate validity and high intercorrelations between subscales that reduce their usefulness. Overall score may be the only useful score clinically.
MPQ-SF (McGill Pain Questionnaire Short Form) Unpublished test Scientific Review: J Research: 376 Intended for: M Restrictions: U Oswestry Disability Questionnaire Unpublished test Scientific Review: JB Research: 64,159,320,377-384 Intended for: M
What it Measures: Measures emotional and sensory aspects of pain. Uses: A shorter version of the MPQ, that intercorrelates highly with it, and may make administering the whole test unnecessary. Benefits: Can identify patients prone to pain magnification. Repeated administrations can track progress in treatment for pain. What it Measures: Perceived disability secondary to low back pain. Uses: Brief measure useful to assess patient perception of disability, as an outcome measure, or as one test in a more comprehensive evaluation. 14
Strengths: Considerable research base, commonly used as an outcome measure, well known. Weaknesses: Unpublished test with no test manual, and no norms. Limited to use with low back pain patients. Does not assess any
Restrictions: U
Benefits: Can measure patients self-perceptions of disability. Serial administrations could be used to track changes in self-perceptions of functional ability during the course of treatment, and assess outcome. What it Measures: Graphical measure of patients pain report. Uses: Extremely brief measure of pain, useful when relative, as opposed to standardized, assessment of pain is acceptable. Serial administration may be used to assess changes in pain, or as an outcome measure. Benefits: Quantifies patients pain reports. Serial administrations could be used to track changes in pain reports during the course of treatment, and assess outcome.
Visual Analogue Pain Scale (VAS) Unpublished test Scientific Review: J Intended for: M Restrictions: U
Strengths: Very simple nonpsychometric instrument, extremely quick to administer and score. Widely used in research, and has been shown to correlate with the intensity of physical stimuli. Weaknesses: Unpublished test with no test manual. No standardized visual stimulus, with both vertical and horizontal versions. No standardized instructions (rate pain right now, rate pain recently, etc), and no agreement as to what label to apply to the highest score. This has resulted in a multitude of versions of the VAS scale that are not equivalent. No norms or reliability information is available. Some individuals have difficulty with the spatial aspect of responding required.
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Test Security Level/ Purchasing Restrictions: Psy MD BS Psychologist Physician ** BS/BA in health sciences** MS H U Masters level mental heath ** Licensed health professional ** Unpublished, unrestricted
** With documentation of psychometric training Notes: Along with the ACOEM385 and ODG386 guidelines, the Colorado Medical Treatment Guidelines (CMTG)387 mandate the use of pretreatment psychological assessments, with the CMTG advocating identifying both primary and secondary biopsychosocial risk factors.23 The CMTG mandate a best-practice, evidence-based biopsychosocial approach, have the status of legal regulations388, and have been associated with evidence of reduction in cost while also decreasing disability.9 This desk reference is an auxiliary document developed in conjunction with the CMTG. This desk reference document was developed by Daniel Bruns, PsyD, and was accepted April, 2013 after review and revisions by the Chronic Pain Task Force and the Colorado Division of Worker Compensation. Disclosure: Dr. Bruns is the coauthor of the BHI 2 and BBHI 2 tests. All listed tests were judged to have acceptable evidence of validity and reliability except as noted. Tests published by major publishers are generally better standardized, and have manuals describing their psychometric characteristics and use. Published tests are also generally more difficult to fake, as access to test materials is restricted to qualified professionals. Third party peer review (by scientific journal or Buros Institute) supports the credibility of the test. Test norms provide a benchmark to which an individuals score can be compared. Tests with patient norms detect patients who are having unusual psychological reactions, but may overlook psychological conditions common to patients. Community norms are often more sensitive to detecting psychological conditions common to patients, but are also more prone to false positives. Double normed tests (with both patient and community norms) combine the advantages of both methods. Preference should be given to psychological tests designed and normed for the population you wish to assess. Psychological tests designed for medical patients often assess syndromes unique to medical patients, and are constructed to avoid common pitfalls in the psychological assessment of medical patients. Psychological tests designed for psychiatric patients are generally more difficult to interpret when administered to medical patients, as they tend to assume that all physical symptoms present are psychogenic in nature (e.g. numbness and tingling may be assumed to be a sign of somatization). This increases the risk of false positive psychological findings. Tests sometimes undergo revision and features may change. When a test is updated, the use of the newer version of the test is strongly encouraged. 16
References
1. Bruns D, Disorbio JM. Assessment of Biopsychosocial Risk Factors For Medical Treatment: A Collaborative Approach. Journal of Clinical Psychology in Medical Settings 2009; http://www.healthpsych.com/bhi/patient_selection.pdf . Accessed March, 30, 2009. Fishbain D, Lewis J, Bruns D, Meyer L, Gao J, Disorbio JM. The prevalence of smokers within chronic pain patients and highest pain levels versus comparison groups. Pain Medicine. 2013;14:403-416. Gorgens K, Meyer LJ, Bruns D, Disorbio JM. Clinical predictors of delayed sleep onset in rehabilitation patients. Rehabilitation Psychology 2012 National Conference; 2012. Fishbain DA, Lewis JE, Bruns D, Gao J, Disorbio JM, Meyer L. Patient predictor variables for six forms of suicidality. European journal of pain. May 2012;16(5):706-717. Fishbain DA, Bruns D, Meyer LJ, Lewis JE, Gao J, Disorbio JM. Exploration of the relationship between disability perception, preference for death over disability, and suicidality in patients with acute and chronic pain. Pain Med. Apr 2012;13(4):552-561. Disorbio JM, Bruns D, Bruns A. The reliability of a standardized method for assessing Blocks criteria for psychosocial risk in patients being treated for pain and injury. Pain Medicine. 2012;13(2s). Disorbio JM, Bruns D, Bruns A. Standardized norms for Blocks criteria for psychosocial risk in patients being treated for pain and injury. Pain Medicine. 2012;13(2s). Disorbio JM, Bruns D, Bruns A. The reliability of a standardized method for assessing Blocks criteria for psychosocial risk in patients being treated for pain and injury. American Academy of Pain Medicines 2012 Annual Meeting; 2012; Palm Springs, CA. Bruns D, Mueller K, Warren PA. Biopsychosocial law, health care reform, and the control of medical inflation in Colorado. Rehabilitation psychology. May 2012;57(2):81-97. Fishbain DA, Bruns D, Lewis JE, Disorbio JM, Gao J, Meyer LJ. Predictors of Homicide-Suicide Affirmation in Acute and Chronic Pain Patients. Pain Med. Jan 2011;12(1):127-137. Fishbain D, Lewis J, Bruns D, Gao J, Disorbio JM, Meyer LJ. Somatic symptom clusters in community patients with pain, acute pain patietns and chronic pain patients. . Pain Medicine. 2011;12(3):473. 12. Fishbain D, Lewis J, Bruns D, Disorbio JM, Gao J, Meyer LJ. Exploration of Anger Constructs in Acute and Chronic Pain Patients versus Community Patients Pain Medicine. 2011;12(3):495. Fishbain D, Bruns D, Meyer LJ, Lewis J, Gao J, Disorbio JM. Is endorsement of preference for death over disability associated with suicidality in chronic pain patients? Pain Medicine. 2011;12(3):495-496. Bruns D, Warren PA. The Assessment Of Psychosocial Contributions To Disability. In: Warren PA, ed. Handbook of Behavioral Health Disability. New York: Springer; 2011:73-104. Bruns D, Bruns A. Sleep disorders, affect, substance use and widespread pain: a factor analytic study. Journal of Pain. 2011(Supplement):P15. Tragesser SL, Bruns D, Disorbio JM. Borderline personality disorder features and pain: the mediating role of negative affect in a pain patient sample. Clin J Pain. May 2010;26(4):348-353. Fishbain DA, Lewis JE, Bruns D, Disorbio JM, Gao J, Meyer LJ. Exploration of Anger Constructs in Acute and Chronic Pain Patients vs. Community Patients. Pain Pract 2010; 2010/08/27:http://www.ncbi.nlm.nih.gov/entrez/query .fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&lis t_uids=20738789. Fishbain DA, Bruns D, Disorbio JM, Lewis JE, Gao J. Variables associated with self-prediction of psychopharmacological treatment adherence in acute and chronic pain patients. Pain Pract. Nov-Dec 2010;10(6):508-519. Fishbain DA, Bruns D, Disorbio JM, Lewis JE, Gao J. Exploration of the illness uncertainty concept in acute and chronic pain patients vs community patients. Pain Med. May 2010;11(5):658-669. Bruns D, Fishbain DA, Disorbio JM, Lewis JE. What Variables Are Associated With an Expressed Wish to Kill a Doctor in Community and Injured Patient Samples? J Clin Psychol Med Settings. Mar 30 2010. Fishbain DA, Bruns D, Disorbio JM, Lewis JE. Risk for five forms of suicidality in acute pain patients and chronic pain patients vs pain-free community controls. Pain Med. Sep 2009;10(6):1095-1105. Fishbain DA, Bruns D, Disorbio JM, Lewis JE. Correlates of self-reported violent ideation against physicians in acute--and chronic-pain patients. Pain Med. Apr 2009;10(3):573-585. Bruns D, Disorbio JM. Assessment of biopsychosocial risk factors for medical treatment: a collaborative approach. J Clin Psychol Med Settings. Jun 2009;16(2):127-147. Fishbain DA, Bruns D, Disorbio JM, Lewis JE. What are the variables that are associated with the patient's wish to sue his physician in patients with acute and chronic pain? Pain Med. Nov 2008;9(8):1130-1142. Bruns D. Chronic pain. In: Leong FTL, ed. Encyclopedia of counseling. Los Angeles: SAGE Publications; 2008. Fishbain DA, Bruns D, Disorbio JM, Lewis JE. What patient attributes are associated with thoughts of suing a physician? Arch Phys Med Rehabil. May 2007;88(5):589-596. Bruns D, Disorbio JM, Hanks R. Chronic pain and violent ideation: testing a model of patient violence. Pain Med. Apr 2007;8(3):207-215. Disorbio JM, Bruns D, Barolat G. Assessment and treatment of chronic pain: A physicians guide to a biopsychosocial approach. Practical Pain Management. March 2006;6(2):11-27. Bruns D, Disorbio JM, Bennett DB, Simon S, Shoemaker S, Portenoy RK. Degree of pain intolerance and adverse outcomes in chronic noncancer pain patients. Journal of Pain. March 2005 2005;6(3(S)):s74. Bruns D, Disorbio JM. Chronic pain and biopsychosocial disorders. Practical Pain Management. November/December 2005;5(7):52-61. Bruns D, Disorbio JM, Hanks R. Chronic nonmalignant pain and violent behavior. Curr Pain Headache Rep. Apr 2003;7(2):127-132. Bruns D, Disorbio JM. Battery for Health Improvement 2 Manual. Minneapolis: Pearson; 2003. Freedenfeld RN, Bailey BE, Bruns D, Fuchs PN, Kiser RS. Prediction of Interdisciplinary Pain Treatment Outcome using the Battery for Health Improvement. Paper presented at: Proceedings of the 10th World Congress on Pain2002; San Francisco. Bruns D, Disorbio JM. Hostility and violent ideation: physical rehabilitation patient and community samples. Pain Med. Jun 2000;1(2):131-139. Meyer LJ, Bruns D, Disorbio JM, Bruns A. Reliability of den Boers criteria. Pain Practice. 2012;12(s1). Meyer LJ, Bruns D, Disorbio JM, Bruns A. Standardizing den Boers criteria for presurgical psychological assessment. Pain Practice. 2012;12(s1).
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