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Background

Balance assessment scales are important clinical tests to identify balance impairments. Chronic pain (> 3 months) is associated with impaired dynamic balance; however, very few balance assessment scales are psychometrically evaluated for the population. The purpose of this study was to evaluate the construct validity and internal consistency of the Mini-BESTest for individuals with chronic pain in specialized pain care.

Methods

In this cross-sectional study, 180 individuals with chronic pain (> 3 months) were assessed with the Mini-BESTest and included in the analyses. For construct validity, five alternative factor structures were evaluated using a confirmatory factor analysis. In addition, we tested the a priori hypotheses about convergent validity with the 10-meter walk test, and divergent validity with the Brief Pain Inventory (BPI): pain intensity, the Tampa Scale of Kinesiophobia-11 (TSK-11), and the Pain Catastrophizing Scale (PCS-SW). Internal consistency was evaluated for the model with the best fit.

Results

A one-factor model with added covariance via the modification indices showed adequate fit indices. In line with our hypotheses, Mini-BESTest showed convergent validity (r_s = > 0.70) with the 10-meter walk test, and divergent validity (r_s = < 0.50) with BPI pain intensity, TSK-11, and PCS-SW. Internal consistency for the one-factor model was good (α = 0.92).

Conclusions

Our study supported the construct validity and internal consistency of the Mini-BESTest for measuring balance in individuals with chronic pain, who were referred to specialized pain care. The one-factor model showed an adequate fit. In comparison, models with subscales did not reach convergence, or showed high correlations between subscales, implying that Mini-BESTest is measuring one construct in this sample. We, therefore, propose using the total score, instead of subscale scores, for individuals with chronic pain. However, further studies are necessary to establish the reliability of the Mini-BESTest in the population.

Background: This study aimed to examine: (a) characteristics associated with long-term opioid use and (b) characteristics associated with problematic opioid use, here defined as prescription opioid use disorder (P-OUD), in patients referred to specialised pain care.

Methods: This cross-sectional study utilised baseline data from a clinical chronic pain cohort. Eligible participants included adults > 18 years old, not undergoing cancer treatment, had pain > 3 months, and had been referred to a specialised pain care centre in Sweden. Bivariate logistic regression and multivariable logistic regression with forward selection were used to examine the associations between biopsychosocial variables and either long-term opioid use or P-OUD.

Results: Of the 339 patients included, 194 (57%) were using opioids, 159 (47%) had long-term opioid use (> 90 days), and 34 (21% of those with long-term opioid use) had P-OUD. Longer pain duration, unemployment, more pain catastrophising, lower health-related quality of life, and worse balance increased the likelihood of long-term opioid use. Long-term use of high doses was associated with a greater prevalence of psychiatric and cognitive-behavioural problems compared to long-term use at low to moderate doses. Long-term opioid use, younger age, trauma exposure, more pain catastrophising, and fear of movement increased the likelihood of P-OUD.

Conclusions: Our results demonstrate the importance of identifying and treating salient factors that may sustain both the pain condition and long-term opioid use. Many of the biopsychosocial variables associated with long-term opioid use and P-OUD can be addressed within interdisciplinary pain management and rehabilitation programmes.