For physical therapists and other providers working with patients undergoing treatment at a rehab facility, outpatient and private practice included, you need a method to track, measure, and communicate about the level of pain each patient experiences, how it changes over time, and how much it interferes with a patient’s daily life. The PROMIS Pain Interference score provides a framework for discussing pain and using this information to better set goals and track progress during treatment.
Pain Interference is a patient-reported measure that tracks and measures pain levels over time, specifically how that pain interferes with the patient’s daily activities. It’s one of the domains covered by PROMIS testing. It measures the impact of the pain on social, physical, emotional, and cognitive activities. The assessment asks about how pain impacts the patient’s ability to do things like sleep, maintain relationships, move, work, enjoy life, and regulate mood rather than simply how much something hurts.
The goal of measuring Pain Interference is to better affect health outcomes, as well as to create more specific and relevant goals for treatment plans. Particularly for those experiencing chronic pain, more achievable goals are to restore function and improve the quality of life rather than the total elimination of pain. Understanding why the patient feels pain is key in treating properly. For those experiencing ongoing pain, Pain Interference scores can be a great help in developing short-term and long-term goals to track patient progress. Pain Interference measures help track and evaluate the progress toward these goals.
Patient-Reported Outcomes Measurement Information System (PROMIS) is a specific type of interference pain scale used in both research and practice settings. Northwestern University developed and implemented this system with funding from the National Institute of Health to evaluate patient outcomes over various domains. For Pain Interference, patients respond to questions about how much pain they have experienced over the past seven days and rate it on a number scale from one to five.
Additional questions are asked about how this level of pain has interfered with the patient’s life over the past seven days. Common questions about pain interference can include:
Pain Intensity is another domain within PROMIS scoring. It’s a key difference is that, while pain plays a role in creating interference in a patient’s life, pain alone isn’t sufficient to understand the best treatment. Some level of pain may be inevitable for certain injuries and conditions, or a patient may find that low-intensity pain still impacts their ability to perform activities they enjoy. That’s why Pain Interference is a key metric in developing treatment plans.
Another area evaluated by the PROMIS score is Pain Behaviors, though this is not included in the Pain Interference score. These are often physically observable behaviors that indicate the patient is currently experiencing pain. Questionnaire statements related to this dimension can include:
Finally, the PROMIS score evaluates the quality of the pain the patient experiences, though this is also a separate metric from Pain Interference. Pain Interference, Pain Behaviors, and Pain Quality are all unique PROMIS domains, though they’re similar and can be confusing. With Pain Quality, there are 37 descriptors of the pain, and patients are asked to rate each in terms of both frequency and severity. Prompts for this part of the scale can include:
While revisions have been made to the questions and format over the 20 years that the scale has been in use, the goal remains the same: to quickly evaluate the amount of pain a patient is in and understand how it affects their daily life.
The PROMIS pain scale assessment is scored on a T-scale model. Patients answer questions on a numbered scale. One represents never or normal functioning, and the higher number means always or more interference. Providers, or the software and technology if administering a PROMIS CAT test as discussed below, total the numbers of all answers and use the scoring table to create a T-score. A score of 50 is average on most scales, with scores greater than 50 reflecting the degree to which pain interferes with the patient’s life and activities.
The majority of ranges follow the standard pattern,but there are some where the cuts between average, mild, moderate, and severe change.
Using a computer adaptive test (CAT) makes scoring PROMIS even easier for providers. The program selects random questions from a large bank that adapts based on the responses provided. An answer to one question can influence which question is asked next. The goal is to ask a minimum number of questions and still calculate an accurate T-score. Generally, with 4-12 questions, the program produces a reliable result. Standard provider-administered tests can require 20 questions or more. PROMIS CAT uses large data sets to determine the best questions to ask based on provided responses.
The score is calculated immediately, saving time for both the provider and the patient. Because the test adapts to the individual,it can quickly assess multiple areas of functioning and deliver an accurate score. With one short assessment, you may have results for pain interference,physical functioning, mood, and more.
After the assessment is complete, whether CAT or manual, the score is used to determine how the patient compares to average. The average score is 50, and the standard deviation of the scores is 10. As an example, the average American will have a score of 50 for whatever metric is being measured, such as fatigue, depression, or physical functioning. If the patient taking the test scores 60, they are one standard deviation away from the average.
If the provider is assessing negative symptoms such as pain, a higher score indicates more impairment and a bigger impact on that area of the patient’s life. If you are assessing positive symptoms, such as feelings of meaning and purpose, higher scores indicate better functioning and less need for intervention.
Because you can assess both positive and negative trends with the PROMIS Pain Interference score, practitioners need to track what the measurements are and how they should interpret the results. Transferring information about pain to a numerical value enables patients to communicate clearly how they experience their pain and the effect it has on their lives. It gives providers a plain language way to talk about pain and its effects. And a numerical scale is easier to track over time than reviewing progress notes in detail (though they absolutely have their place in patient care as well!).
Any scores outside of the normal range can be cause for further intervention and tracking, or for re-evaluating the current plan of care. A score in the mild range may be treated with minor interventions and prevent further deterioration. A moderate or severe score can be addressed immediately and support the provider’s decisions for more intensive treatment.While the score alone is a data point, providers and patients together can still make changes that will best address needs at that current moment. And seeing the number can help patients better understand how to participate in their care.
The PROMIS Pain Interference test asks about symptoms over the past seven days, and it can be repeated over time to track changes in symptoms and pain. The test can be administered around care milestones, like:
In an acute care setting, more frequent assessments are appropriate as progress is expected consistently. For providers treating chronic pain conditions, quarterly or biannually may be enough, since change is much slower. Standard outpatient treatment could be between the two, with three or four tests over the course of several weeks during treatment. The plan of care can then be adjusted based on the changes seen in subsequent tests, making for more adaptable treatment that can provide better patient outcomes.
With computer-assisted tests available to providers,using the PROMIS Pain Interference score is easy and flexible, as it can be used with patients of all ages and physical conditions. PROMIS scoring has been helpful in many areas.
Even specialists like oncologists, rheumatologists,and geriatric clinicians use PROMIS pain scores. While the test is intended for adults to self-report the severity of impact from their symptoms, there are also tests for children and versions for caregivers to respond on behalf of their children based on observable behaviors.
Pain is often subjective and difficult to quantify.This makes it challenging to prove the value of a treatment or intervention. By putting a numerical value on pain and the impact it has on daily functioning, providers can evaluate their treatment plans more objectively. Pain and functioning become both patient care outcome metrics and measurable KPIs for physical therapists when PROMIS scores are taken regularly.
PROMIS scores can support value-based care by:
Limber’s software allows increased data collection and tracking, giving clinicians more information to work with to tailor treatment over time. Data collection pre-visit and continuous tracking between visits means more frequent touchpoints. Automated survey delivery and the ability to integrate with care plans allow PTs and OTs to more easily access the data that can inform their plan of care.
PROMIS Pain Interference surveys provide insight, but it’s the consistency of data that really allows tailoring of care. Outcomes data brings more visibility into pain interference trends that can change the plan of care, and it provides a consistent outlet for patients to be more engaged in their own care. That also means that any changes needed to treatment can be made effectively.
Physical therapists will, without a doubt, work with PROMIS Pain Interference scores during their practice. Because they are easily accessible, simple for patients to respond to, and flexible enough to provide data for nearly any patient, they are a great testing tool. With just a few questions, you can compare the patient to the general population, as well as to their previous scores. This gives providers a kind of shortcut to evaluate what is working well and what treatment changes should be made to produce better patient results.
A high PROMIS Pain Interference score indicates a higher level of disruption to a patient’s life and normal activities due to their pain.
PROMIS Pain Interference is typically evaluated in ranges of 10, with 50 being the average level of pain across the population. 55-59 indicates mild pain, 60-69 indicates moderate pain, and 70-80 or higher severe pain. One recent study found the minimally clinically important difference (MCID) in pain interference to be 3.5 to 5.5 points.
No, Pain Interference scores can’t predict patient outcomes. However, changes in Pain Interference scores, much like other metrics, can both indicate positive progress towards the patient’s goals and increase patient engagement in their treatment. In turn, this is correlated with better outcomes.
PROMIS Pain Interference is best tracked at milestones within the patient’s treatment. While the survey can be administered at any time, measuring scores before treatment begins, at regular intervals within treatment, and at the end of the course of treatment is helpful. Intervals can vary based on patient interference level and how well they are progressing through their care.
Pain Intensity alone only measures how strong the patient’s pain is, but does not address how much their pain is impacting their normal activities. Pain Interference and Pain Intensity together can better show both the level of pain and how severely their life is impaired.
Pain Interference scores can either reinforce continuation of the current treatment plan or inform changes to the plan of care. If the patient’s Pain Interference scores don’t improve, patients may beat risk for low engagement or the plan of care isn’t working for them. This should trigger an evaluation of the treatment plan and adjust as needed.
.png)
.png)
