Consensus on functional assessment of chronic pain in primary care: a Delphi study

Figures & data

Table 1. Participant characteristics.

	First Round	Second Round
	N (%)	N(%)
Sex
Male	32 (46.4)	32 (47.1)
Female	37 (53.6)	36 (52.9)
Workplace
Urban population	43 (62.3)	43 (63.2)
Rural population	13 (18.8)	13 (19.1)
Mixed population	13 (18.8)	12 (17.6)
Professional practice in primary care	Mean 21.3 years (SD 8.8)	Mean 21.2 years (SD 8.8)
Total	69 (100.0)	68 (100.0)

*SD: standard deviation.

Table 2. Consensus results for first and second Delphi rounds.

		First Round					Second Round
Item	Statements	Disagree	Partially disagree	Partially agree	Agree	Strongly agree	Disagree	Partially disagree	Partially agree	Agree	Strongly agree
1	I consider the improvement of functioning as a key therapeutic goal/objective	2.9		8.8	41.2	47.1				23.5	76.5
2	In chronic pain management, reduction of pain is more important than improving functioning	1.5	20.6	35.3	22.1	20.6		13.2	60.3	23.5	2.9
3	I consider functioning to be only associated with joint recovery	33.8	26.5	30.9	7.4	1.5	57.4	5.9	30.9	2.9	2.9
4	Assessing the functioning of my patients with chronic pain requires time that I do not have	7.4	16.2	35.3	22.1	19.1	1.5	2.9	61.8	20.6	13.2
5	My patients’ ability to work is affected by their chronic pain				50.0	50.0				26.5	73.5
6	My patients’ mobility is affected by their chronic pain			4.4	60.3	35.3			1.5	82.4	16.2
7	My patients’ daily activities are affected by their chronic pain	1.5		7.4	55.9	35.3				82.4	17.6
8	Suffering from chronic pain affects patients’ emotional state			2.9	38.2	58.8				11.8	88.2
9	My patients’ social life is affected by their chronic pain		1.5	4.4	55.9	38.2			4.4	75.0	20.6
10	Chronic pain decreases the quality of life of patients who suffer from it, so pain reduction is important			2.9	20.6	76.5				7.4	92.6
11	Pain assessment should include, besides clinical assessment, an additional psychosocial assessment			1.5	32.4	66.2				13.2	86.8
12	I consider the motivational interview essential in the approach to chronic pain			16.2	41.2	42.6			2.9	41.2	55.9
13	I take into account patients’ expectations for treatment selection			10.3	52.9	36.8			1.5	75.0	23.5
14	If I teach the patient to live with pain, I will improve functional outcomes	2.9	2.9	27.9	29.4	36.8			4.4	42.6	52.9
15	I believe that the functioning of a patient with chronic pain affects the intensity of pain		2.9	14.7	50.0	32.4			2.9	75.0	22.1
16	Improving the functioning of a patient suffering from chronic pain depends on the patient’s own attitude	2.9	4.4	48.5	23.5	20.6		1.5	66.2	23.5	8.8
17	Management of chronic pain should be individualised, bearing in mind not only pain intensity but also the patient’s functioning			1.5	26.5	72.1			1.5	7.4	91.2
18	Patients with chronic pain have other associated comorbidities		1.5	17.6	41.2	39.7			5.9	66.2	27.9
19	I use scales to assess the intensity of pain objectively, note scales used	1.5	4.4	27.9	42.6	23.5	1.5	1.5	11.8	73.5	11.8
20	I don’t find it necessary to perform a specific evaluation of patients’ functioning	77.9	14.7	2.9	1.5	2.9	89.7	5.9	1.5	1.5	1.5
21	I am able to assess patients’ functioning based on my clinical experience, without using a scale	19.1	35.3	36.8	8.8		2.9	39.7	55.9	1.5
22	I use specific scales and questionnaires to measure patients’ functioning, note scales and questionnaires used	27.9	10.3	27.9	29.4	4.4	25.0	4.4	30.9	36.8	2.9
23	I don’t use any functioning scale due to lack of time	22.1	10.3	36.8	16.2	14.7	10.3	4.4	72.1	10.3	2.9
24	I don’t use any functioning scale due to lack of trained human resources or trained professionals (nurses, colleagues)	20.6	23.5	29.4	19.1	7.4	7.4	25.0	55.9	11.8
25	I don’t use any functioning scale because they are complex	39.7	16.2	32.4	11.8		48.5	7.4	38.2	5.9
26	I use chronic pain management guidelines in my clinical practice	1.5		30.9	57.4	10.3	1.5		8.8	85.3	4.4
27	I find existing chronic pain guidelines useful and practical	1.5	4.4	39.7	38.2	16.2		1.5	47.1	47.1	4.4
28	It is easy to classify patients according to the type of pain based on the guidelines	4.4	17.6	60.3	14.7	2.9		2.9	92.6	4.4
29	I keep up to date with all, or almost all, of the latest published chronic pain treatment guidelines	4.4	5.9	45.6	36.8	7.4	1.5	2.9	64.7	30.9
30	My objective is to reduce pain, functioning depends on other factors	38.2	30.9	23.5	5.9	1.5	54.4	35.3	8.8	1.5
31	I do not perform scheduled follow-ups on my patients. The patient attends a consultation according to their needs	57.4	25.0	10.3	7.4		80.9	10.3	5.9	2.9
32	I feel trained to assess the functioning of my chronic pain patients	5.9	26.5	42.6	19.1	5.9	5.9	7.4	72.1	13.2	1.5
33	There are limitations when selecting the ideal treatment for each patient	10.3	13.2	36.8	35.3	4.4		8.8	55.9	35.3
34	Applying the clinical guidelines takes into account functioning in their recommendations	4.4	19.1	50.0	25.0	1.5	1.5	2.9	80.9	14.7
35	I find difficulties in developing treatment strategies for patients suffering from chronic pain (e.g.: comorbidities, interactions …)	5.9	14.7	39.7	33.8	5.9	1.5	4.4	60.3	32.4	1.5

The shaded numbers mean: the percentage is higher than 70%.

Table 3. Results for “Functional outcomes in patients with chronic pain”.

Item		First round		Second round
		IQR	CV	IQR	CV
1	I consider the improvement of functioning as a key therapeutic goal/objective	1.0	20.1	0.0	9.0
2	In chronic pain management, reduction of pain is more important than improving functioning	1.0	31.8	1.0	21.6
3	I consider functioning to be only associated with joint recovery	2.0	47.7	2.0	59.9
4	Assessing the functioning of my patients with chronic pain requires time that I do not have	1.0	35.6	1.0	23.9
5	My patients’ ability to work is affected by their chronic pain	1.0	11.2	1.0	9.4
6	My patients’ mobility is affected by their chronic pain	1.0	12.8	0.0	9.6
7	My patients’ daily activities are affected by their chronic pain	1.0	16.9	0.0	9.2
8	Suffering from chronic pain affects patients’ emotional state	1.0	12.2	0.0	6.6
9	My patients’ social life is affected by their chronic pain	0.0	14.6	0.0	11.5
10	Chronic pain decreases the quality of life of patients who suffer from it, so pain reduction is important	1.0	10.7	0.0	5.3
11	Pain assessment should include, besides clinical assessment, an additional psychosocial assessment	1.0	11.0	0.0	7.0
12	I consider the motivational interview essential in the approach to chronic pain	1.0	17.0	1.0	12.3
13	I take into account patients’ expectations for treatment selection	1.0	14.9	0.0	10.7
14	If I teach the patient to live with pain, I will improve functional outcomes	2.0	25.9	1.0	13.1
15	I believe that the functioning of a patient with chronic pain affects the intensity of pain	1.0	18.5	0.0	11.1
16	Improving the functioning of a patient suffering from chronic pain depends on the patient’s own attitude	1.0	27.3	1.0	19.8
17	Management of chronic pain should be individualised, bearing in mind not only pain intensity but also the patient’s functioning	1.0	10.4	0.0	7.2
18	Patients with chronic pain have other associated comorbidities	1.0	18.6	1.0	12.8

Note. IQR (Interquartile Range) ≤ 1 = Consensus reached/CV, Coefficient of variation.

The values in bold mean: the IQR>1.

Table 4. Results for “Use of specific scales and guidelines”.

Item		First round		Second round
		IQR	CV	IQR	CV
19	I use scales to assess the intensity of pain objectively, note scales used	1.0	23.5	0.0	16.6
20	I don’t find it necessary to perform a specific evaluation of patients’ functioning	0.0	63.0	0.0	56.7
21	am able to assess patients’ functioning based on my clinical experience, without using a scale	1.0	38.0	1.0	22.8
22	I use specific scales and questionnaires to measure patients’ functioning, note scales and questionnaires used	3.0	47.0	2.5	43.0
23	I don’t use any functioning scale due to lack of time	2.0	45.5	0.0	28.3
24	I don’t use any functioning scale due to lack of trained human resources or trained professionals (nurses, colleagues)	2.0	45.1	1.0	28.3
25	I don’t use any functioning scale because they are complex	2.0	50.3	2.0	52.5
26	I use chronic pain management guidelines in my clinical practice	1.0	18.6	0.0	13.1
27	I find existing chronic pain guidelines useful and practical	1.0	23.7	1.0	17.2
28	It is easy to classify patients according to the type of pain based on the guidelines	0.0	26.8	0.0	9.0
29	I keep up to date with all, or almost all, of the latest published chronic pain treatment guidelines	1.0	26.1	1.0	17.9
30	My objective is to reduce pain, functioning depends on other factors	2.0	49.6	1.0	45.7
31	I do not perform scheduled follow-ups on my patients. The patient attends a consultation according to their needs	1.0	55.9	0.0	54.8
32	I feel trained to assess the functioning of my chronic pain patients	1.5	33.0	0.0	24.0
33	There are limitations when selecting the ideal treatment for each patient	1.0	33.5	1.0	18.8
34	Applying the clinical guidelines takes into account functioning in their recommendations	1.0	27.6	0.0	15.6
35	I find difficulties in developing treatment strategies for patients suffering from chronic pain (e.g.: comorbidities, interactions …)	1.0	30.3	1.0	19.6

Note. IQR ≥1 = Consensus reached/CV, Coefficient of variation.

The values in bold mean: the IQR>1.

Figure 1. Use of scales to evaluate intensity of chronic pain in clinical practice.