Assessing pain science education; the measurement properties of assessment instruments of conceptual change: A narrative and rapid review

Despite the widespread use and benefits of Pain Science Education, no standardized approach exists for assessing outcomes relevant to individuals with pain. This review amied to identify: (1) instruments assessing the proximal outcomes of Pain Science Education (pain-related knowledge or understanding, beliefs and attitudes), and present their psychometric properties, (2) domains that could be used to assess distal outcomes (focusing on the process and impact). In a three phase process, two series of expert panel discussions and a rapid review process were done, to identify and appraise articles reporting on instrument development and psychometric evaluation. The psychometric properties of the instruments were mapped against the COSMIN criteria. 32 instruments targeting proximal outcomes were identified. Gaps remain regarding instruments for specific populations, particularly those with low health literacy. Psychometric assessments focussed on internal consistency and structural validity, with limited exploration of content validity, reliability, responsiveness, or application of Item Response Theory methods. Distal outcomes were identified: process variables focused on pain self-efficacy, fear of movement and pain catastrophizing, and impact variables, like pain intensity, physical activity, emotional wellbeing/distress and fatigue, overlapping with core outcome sets created for chronic pain. A mixed-methods approach with qualitative and quantitative components is required to properly assess conceptual change. More psychometrically robust assessments of outcomes of PSE that are easy and quick to complete, and sufficiently flexible to use with multiple populations, would facilitate more targeted conceptual change strategies, and elucidate the nature and magnitude of impact of those strategies, in both clinical and research settings.