# What constitutes important change in individual PROMIS-10 global health items in patients with high-impact chronic pain: a qualitative interview study

## TL;DR

This study explores how patients with chronic pain perceive important changes in health questionnaires, finding that even small improvements in physical and mental health are meaningful.

## Contribution

The first qualitative study to identify patient-perceived thresholds for important change in PROMIS-10 Global Health items.

## Key findings

- Patients perceive a 1- to 2-point improvement on 5-point items as important.
- A 4.36-point reduction in pain intensity on a 0–10 scale is seen as significant.
- Important changes are linked to better physical functioning, mental wellbeing, and social participation.

## Abstract

Health-related quality of life is a key outcome for patients with high-impact chronic pain, and the PROMIS-10 Global Health questionnaire is widely used to assess it. This study examined what patients perceive as important changes in PROMIS-10 Global Health items by 1) 1) examining how much each item should change to be perceived as important, and 2) exploring why and how these changes were considered important.

Individual semi-structured interviews with 17 participants with high-impact chronic pain were conducted. Analysis for objective one involved determining item-level thresholds for important change by aggregating participants’ reported change scores for each item. Analysis for objective two involved thematic analysis to explore how and why such changes were perceived as important.

For items rated on a 5-point Likert scale, change scores perceived as important ranged from a mean of 1.09 (median = 1) for item 1 (general health) to a mean of 1.84 (median = 2) for item 8r (fatigue). For item 7r (pain intensity), rated on a 0–10 scale, a mean change score of 4.36 (median = 4.25) was considered important. Thematic analysis identified one to two themes per item, reflecting perceived important improvement across physical, mental, and social health.

This is the first qualitative study to explore what patients with high-impact chronic pain perceive as important changes in PROMIS-10 Global Health items. Findings reflect important improvements across physical, mental, and social health, highlighting the value of patient perspectives in clinical use. Further qualitative research is needed to enhance interpretation and inform clinical applications.

The online version contains supplementary material available at 10.1007/s11136-026-04164-5.

Patients living with high-impact chronic pain often face serious challenges in their daily lives, including poor physical and mental health. For these patients, improving health-related quality of life is a key goal. To measure this, healthcare providers and researchers often use the PROMIS-10 Global Health questionnaire. However, little is known about what patients with high-impact chronic pain consider an important change in their responses to this questionnaire. This study aimed to explore how much each item in the PROMIS-10 Global Health needs to change for patients to see it as important, and why these changes are important to them. We interviewed 17 patients with high-impact chronic pain. They were asked how much each item would need to improve for them to perceive the changes as important and why these changes were considered important. Patients reported that a 1- to 2-point improvement on items rated from 1 to 5 was important. For pain intensity, rated from 0 to 10, a reduction of 4.36 points was seen as important. These changes were considered important because patients believed they would lead to better physical functioning, improved mental wellbeing, and more participation in social life. The results highlight the importance of listening to patients' perspectives when using health questionnaires, so that treatment and research can better reflect what truly matters to them.

The online version contains supplementary material available at 10.1007/s11136-026-04164-5.