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The Labor Pain Questionnaire: Reliability, Validity and Responsiveness in Women During Early Labor without Pain Relief
Abstract Number: T-58
Abstract Type: Original Research
Introduction: The Labor Pain Questionnaire(LPQ)is the first health-specific multidimensional psychometric instrument developed to measure women’s pain experiences during childbirth. This study examined the revised LPQ's reliability, validity, sensitivity to change/responsiveness in women in early labor without pain relief.
Methods: After informed consent, ASA 1-2 laboring women with term fetuses were recruited. Women were fluent in English, >18 years of age, ≤6cm cervical dilatation and contracting ≥3 minutes apart. Women answered the LPQ in mixed or standard item format during 2 test sessions separated by a 20min window. Both sessions were administered by the same trained interviewer. None of the women received pharmacologic pain relief. Pain inducing interventions were minimized. Study duration was 45min-1hour. Concurrently administered pain tools(NRS, verbal pain rating scale (VPRS),Pain Mastery Scale (PMS)) were completed during each session to permit assessment of convergent validity. Changes in pain between tests were rated using the Patient Global Impression of Change Scale(PGICS). Raw scores were transformed to percentage scores to ensure even representation of subscales in LPQ composite/total scale scores. Internal consistency of LPQ/subscale scores was assessed using Cronbach's alpha. Test-retest reliability was assessed in women with no change in pain using ICC. Women with changes in pain were used to assess the sensitivity to change and responsiveness of the LPQ and subscales using the t-statistic(paired-t test),Effect size(ES), Standardized Response Mean(SRM),and Guyatt's Responsiveness Index(RI). LPQ scores for response levels on the PGICS, VPRS and PMS were determined. Sample size estimate for test-retest reliability was 90 women.
Results: 104 women completed the study. LPQ completion took 3-5mins. Cronbach's alphas for LPQ composite and subscale scores were good(0.94 and 0.72-0.94,respectively). 49 women reported no change in pain between tests and were used to assess test-retest reliability for the LPQ and subscales; ICC's were excellent(0.93-0.98, p<0.001).
55 women reported changes in pain (43=minimal,12=much worse/much better).Sensitivity to change analyses showed:t-values(df=54),t=-2.4 to 3.0, p<0.017 for LPQ composite, Uterine Contraction and Fear/Anxiety Subscales. Birthing, Backpain/LongHaul(p=0.05)and Enormity of the Pain subscales were not statistically significant.
ES values were 0.29 to 0.46. SRMs were 0.8 to 1.4 and were interpreted as small to moderate based on study-derived ES thresholds. LPQ/subscale scores showed large levels of responsiveness based on RI's(0.84-1.5).Correlations between LPQ and NRS scores during tests were strong(r>0.77,p< 0.001)and moderate between the LPQ and PMS(r>0.57,p<0.001) LPQ and VPRS (r>0.50, p<0.001) supporting convergent validity of the tool.
Conclusions: The LPQ shows good test-retest reliability and acceptable sensitivity to change/responsiveness during early labor.