Primary care functioning scale showed validity and reliability in patients with chronic conditions: a psychometric study.

OBJECTIVES: We evaluated the psychometric properties of a newly developed self-report questionnaire that aims for a more person-centered approach in primary care for patients with chronic conditions, the Primary Care Functioning Scale (PCFS). STUDY DESIGN AND SETTING: To test the measurement properties of the PCFS, we asked patients with diabetes, cardiovascular disease, and chronic pulmonary disease to complete the PCFS questionnaire. The PCFS is entirely based on the International Classification of Functioning, Disability, and Health (ICF), consisting of 52 ICF-related items covering body functions, activities and participation, environmental factors, and personal factors. We analyzed three hypotheses representing different item sets of the 34 ICF-related items that assess the level of functioning (body functions, activities, and participation). We tested for unidimensionality, differential item functioning, reliability, and criterion-related validity. RESULTS: Five hundred and eighty-two patients completed the questionnaire. The total scores of the polytomous and dichotomized items from the overall set 'body functions, activities and participation' demonstrated unidimensionality, good reliability (>0.80), and stability over time without bias from background variables. CONCLUSION: In sum, the PCFS can be used as a valid and reliable instrument to measure functioning in patients with chronic morbidity in primary care.

Neurodegenerative properties of chronic pain: cognitive decline in patients with chronic pancreatitis.

Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance), use of opioids, and premorbid alcohol abuse. The cognitive profiles of 16 patients with severe pain due to chronic pancreatitis were determined using an extensive neuropsychological test battery. Data from three cognitive domains (psychomotor performance, memory, executive functions) were compared to data from healthy controls matched for age, gender and education. Multivariate multilevel analysis of the data showed decreased test scores in patients with chronic pancreatitis pain in different cognitive domains. Psychomotor performance and executive functions showed the most prominent decline. Interestingly, pain duration appeared to be the strongest predictor for observed cognitive decline. Depressive symptoms, sleep disturbance, opioid use and history of alcohol abuse provided additional explanations for the observed cognitive decline in some of the tests, but to a lesser extent than pain duration. The negative effect of pain duration on cognitive performance is compatible with the theory of neurodegenerative properties of chronic pain. Therefore, early and effective therapeutic interventions might reduce or prevent decline in cognitive performance, thereby improving outcomes and quality of life in these patients.