Psychometric Assessment of a New Pain-Specific Patient-Reported Outcome Measure for Pelvic Floor Surgery Using Exploratory Factor Analysis

INTRODUCTION AND HYPOTHESIS: Pelvic floor procedures are associated with pain in some women, adversely affecting health-related quality of life (HRQoL). Current patient-reported outcome measures (PROMs) are inadequate for assessing pain following pelvic floor procedures. A new 16-item pain-specific PROM, the Pelvic Floor Procedure Pain Questionnaire (PPPQ), was developed to address this gap. This study aimed to undertake a psychometric assessment of the PPPQ through field testing and to understand its latent structure. METHODS: The PPPQ was administered online to 103 adult women from pelvic mesh support groups who underwent pelvic floor surgery. Exploratory factor analysis (EFA) using principal axis factoring and Promax rotation was conducted to assess the PROM's psychometric properties (i.e. structural validity, internal consistency), refine items, and explore the relationship between items. RESULTS: Most commonly, participants were aged 60-69 years (n = 46, 44.7%) and from the United Kingdom (n = 48, 46.6%). EFA identified a 3-factor model comprising: (1) HRQoL disruptions from post-pelvic floor procedure pain, (2) characteristics and management of post-pelvic floor procedure pain, and (3) pain avoidance behaviours, resulting in a refined 11-item PPPQ. The PPPQ and its items demonstrated acceptable internal consistency (Cronbach's α > 0.70), with items clustering into expected pain-related themes confirming structural validity. CONCLUSIONS: Study findings suggest that the revised, 11-item PPPQ has good reliability (internal consistency) and structural validity. While the psychometric evaluation demonstrates its suitability in assessing pain post-pelvic floor surgery, additional psychometric testing is needed. Full development of the PROM could offer deeper insights into pain and help monitor health outcomes in this population.