# Patients’ interpretations of individual PROMIS-10 Global Health items: a cognitive interview study in high-impact chronic pain

## TL;DR

This study explores how patients with chronic pain interpret the PROMIS-10 questionnaire, identifying areas where questions may not fully reflect their experiences.

## Contribution

The study provides insights into how patients interpret PROMIS-10 items, highlighting areas for refinement in the questionnaire for chronic pain patients.

## Key findings

- Participants often interpreted questions about fatigue and pain intensity over a longer timeframe than intended.
- Some items were perceived as overlapping, such as those about social roles and relationships.
- Examples provided in certain items influenced participants' responses, and some found the pain question irrelevant.

## Abstract

The purpose of this study was to explore the content validity of the Danish version of the PROMIS-10 Global Health questionnaire in patients with high-impact chronic pain by (1) identifying problematic items and reasons for misunderstandings between participants’ interpretations and the intended meaning, and (2) exploring how participants understand and interpret the items.

Individual cognitive interviews were conducted with participants with high-impact chronic pain referred to two Danish Pain Centers using a structured step-by-step interview approach. The first objective was analyzed mainly using a deductive structured approach, while the second objective was analyzed mainly using an inductive thematic approach focusing on participants’ perspectives.

Participants (n = 19) generally understood the items as intended but showed 21% and 11% non-congruency for items 8r (fatigue) and 7r (pain intensity), as they responded based on a longer timeframe than “the past 7 days”. Overall, participants interpreted the items through a physical, psychological and social perspective. Further, items 5 (social activities and relationships) and 6 (daily physical activities) were perceived to overlap thematically with item 9r (social activities and roles). Additionally, the provided examples in items 5 and 6 influenced responses, and some deemed item 7r irrelevant, as it did not reflect their pain experiences.

The findings contribute to the validation of PROMIS-10 Global Health in patients with high-impact chronic pain by providing insights into how participants understand and interpret the items, highlighting areas for minor refinement. Further qualitative research on the validity of PROMIS-10 Global Health in this population is needed.

People living with high-impact chronic pain are often asked to complete questionnaires to assess their health and quality of life. One widely used tool is the PROMIS-10 Global Health questionnaire. However, it is not clear whether the questions fully reflect the experiences of patients with high-impact chronic pain. In this study, 19 patients with high-impact chronic pain were interviewed to explore how they understood and interpreted the questionnaire. Most questions were understood as intended, but several challenges emerged. In particular, questions about fatigue and pain intensity were often answered based on a longer time period than the stated “past 7 days”. Some questions were experienced as overlapping, for example, those about social roles and relationships, while examples provided in certain items strongly influenced how participants responded. Furthermore, some participants found that the pain question did not capture the complexity of their pain experience. These findings suggest that, while the PROMIS-10 questionnaire is generally appropriate for patients with high-impact chronic pain, certain items could be improved to better match patients’ lived experiences. The study highlights the importance of including patient perspectives when validating health questionnaires to ensure they are relevant, clear, and meaningful.