C. Phelps1, S. Bellon1, M. Hinkey1, A. Nash1, J. Boyd1, C. Cook1, A. N Garcia1
1Duke University School of Medicine, Physical Therapy, Durham, United States

Background: With an emerging emphasis on the effect of sleep disorders on prevalent chronic pain conditions, the need for reliable and valid sleep questionnaires is paramount for clinical research and practice. To date, measurement properties of sleep questionnaires have not been extensively analyzed for use by clinicians for this population.

Purpose: To provide a comprehensive overview of the measurement properties of patient-reported outcome measures (PROMs) used to assess sleep quality in adult patients with prevalent pain-related conditions.

Methods: PubMed, Scopus, and Embase were searched from their inception to January 2020, without language restrictions. Independent reviewers screened and selected studies, extracted data, assessed the methodological quality using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias checklist and performed an evidence synthesis for each measurement property. The results were classified as sufficient, insufficient, inconsistent or indeterminate and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results: Twenty studies were included investigating fifteen PROMs and six pain-related conditions. Reliability, internal consistency, and structural validity were the most prevalent measurement properties investigated across the studies. Three questionnaires were investigated in more than one study (Jenkins Sleep Scale [JSS] and Pittsburgh Sleep Quality Scale [PSQI] and the Medical Outcomes Study - Sleep Scale [MOS-SS]). High-quality evidence was reported for sufficient content validity in the JSS and indeterminate responsiveness in the MOS-SS. Moderate to high evidence was reported for sufficient structural validity in the MOS-SS and PSQI, sufficient and insufficient criterion validity in the JSS and PSQI and sufficient and insufficient construct validity in the JSS And MOS-SS. Low to high evidence was reported for sufficient internal consistency in the MOS-SS and PSQI, while low to moderate evidence for sufficient reliability in the JSS, MOS-SS, and PSQI.

Conclusion(s): Studies reporting the most measurement properties included the JSS, MOS-SS, and PSQI in multiple prevalent pain-related conditions. Based on the results of this review, we would recommend the JSS in patients with RA and psoriatic arthritis. The CPSI and PSQ-3 are recommended for use in the chronic pain population. The PSQI and MOS-SS are recommended for use with fibromyalgia and the PSQI again, for temporomandibular pain. Not all measurement properties have been reported for these as well as other questionnaires, and much investigation is needed to ensure the quality of these questionnaires within high prevalence chronic pain conditions.

Implications: The reported presence of concomitant sleep and chronic pain disorders ranges from 40% to 88%. This high incidence is especially notable in prevalent chronic pain conditions such as low back and neck pain, fibromyalgia, rheumatoid arthritis, and osteoarthritis.

Funding, acknowledgements: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Keywords: measurement properties, sleep quality, sleep questionnaires

Topic: Research methodology, knowledge translation & implementation science

Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: This is a systematic review

All authors, affiliations and abstracts have been published as submitted.

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