Validation of the Pain Coping Questionnaire in Finnish.

OBJECTIVE: The Pain Coping Questionnaire (PCQ), the first validated pain coping measurement developed specifically for children, has lacked proper validation in Finnish. The original PCQ by Reid et al. (Pain 1998; 76; 83-96) comprises eight-first-order and three higher-order scales. The aim herein was to determine the factor structure and validity of the Finnish PCQ translation in Finnish children. METHODS: Exploratory factor analysis was used for the first-order and higher-order classification of 91 recruited patients aged 8-15. Cronbach's alpha was used for reliability. Relationships between the Children's Depression Inventory, patient-reported pain frequency and pain coping strategies were examined. RESULTS: Analyses were executed with 38 items; one was excluded. A structure of eight-first-order (Internalizing/Catastrophizing [IC], Positive Self-Statements [PSS], Information Seeking [IS], Seeking Social Support [SSS], Cognitive Distraction [CD], Externalizing [EXT], Behavioural Distraction [BD], Problem Solving [PS]) and three higher-order scales (Approach [APP], Emotion-Focused Avoidance [EFA], Distraction [DIS]) proved the most consistent. Four first-order scales (PSS, CD, EXT, BD) emerged as identical to the original solution. Internal consistency reliability coefficients for all individual first- and second-order scales were satisfactory. A higher CDI score was positively related to EFA and negatively to DIS, and pain frequency positively related to APP and EFA. CONCLUSION: The exploratory factor analysis of the PCQ provided a both culturally and statistically satisfactory structure in the Finnish translation. This supports the reliability and validity of the PCQ in future national use and the value of the questionnaire also outside English-speaking countries. SIGNIFICANCE: This study showed both culturally and statistically satisfactory factor structure of PCQ in the Finnish translation. This result supports reliability and validity of the PCQ in the national use in the future. The result shows that the PCQ is a reliable method to be used in different linguistic and cultural surroundings and, thus, encourages using it in various countries. The data consist of two patient groups, adolescents with JIA and musculoskeletal pain. Pain and specifically coping with pain are important aspects of clinical work. A valid pain coping scale may enhance distinguishing vulnerable pain coping style in children and adolescent before pain becomes chronic.

Empirical classification of children with JIA: a multidimensional approach to pain and well-being.

OBJECTIVE: To investigate the relationship between children's arthritis self-efficacy, trait-anxiety, depression, clinical state of the disease (pain, disability, number of somatic complaints and active joints) and age of the child. METHODS: Trait anxiety and depression of JIA patients were measured by standardized scales (STAIC and CDI). For assessing self-efficacy CASE-scale was used. Pain, CHAQ and active joint count were used as indicators of the disease severity. The K-means cluster procedure was used to classify 145 consecutively recruited patients aged 8 to 15, regarding age, trait-anxiety and depression. One-way multivariate analysis of variance (MANOVA) followed by separate ANOVA's was used for comparisons between the cluster groups. Associations between the cluster groups and the children's self-efficacy were then evaluated using multivariate analysis of variance (MANOVA). RESULTS: Four cluster groups were identified based on the degree of depression and trait-anxiety. Clinical disease-related parameters differed significantly in the cluster groups. Pain was not necessarily related to the severity of the disease or to the diagnosis (oligoarthritis, oligoextended and polyarthritis). A higher level of self-efficacy was related to lower levels of depression, trait anxiety and pain. CONCLUSION: In JIA, the clinical classification of disease activity and severity did not directly correspond with depression and trait-anxiety in children with JIA. Instead, these were regulated by a self-efficacy, which was associated with less pain and somatic complaints.

Improved factor structure for self-efficacy scales for children with JIA (CASE) and their parents (PASE).

OBJECTIVE: Self-efficacy is an important factor in helping children to cope with a chronic disease. In order to study it, we have to be able to develop a valid and reliable scale. We validated and further developed the CASE (Children's Arthritis Self-Efficacy) and PASE (Parent's Arthritis Self-Efficacy) scales in a Finnish juvenile idiopathic arthritis (JIA) patient and parent population. METHODS: One hundred and twenty JIA children and their parents completed the CASE and PASE assessments, respectively. Exploratory Factor Analysis (EFA) applying the Principal Axis Factoring method was conducted and extended by the use of Confirmatory Factor Analysis (CFA) to allow a theory-driven approach to determine the latent dimensions for both CASE and PASE scales. Construct validity was analysed by measuring the extent to which the CASE and PASE variables correlated with variables of children's and parents' depression scales and with the clinical parameters of the child in a way that can be explained theoretically. RESULTS: A two-factor solution in PASE corresponding to Barlow's factor solution did not fit the sample of Finnish parents. Instead, a three-factor model similar to that of the CASE scale fitted the data for the PASE scale with self-efficacy in somatic symptoms and psychological and social functioning as subscales. Construct validity was confirmed for both scales. CONCLUSION: The refined three-factor structure of the PASE scale and the slightly modified three-dimensional CASE scale were found to be robust scales enabling disease-specific analysis of somatic, psychological and social self-efficacy and comparisons between the patients and parents.