ArticleQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation2025
Frequency and severity response scales for pain and discomfort: psychometric insights from EQ-HWB.
Article in Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePain and discomfort are core dimensions of health-related quality of life. This study aimed to compare and evaluate the psychometric properties of frequency versus severity response scales in assessing pain and discomfort and determining their unique measurement contributions across different health conditions.
methodsThis secondary analysis utilized data from 1,008 participants derived through a dyadic study design of caregivers from the general population and their care recipients. Clinical data were based on self-reported health conditions. Pain and discomfort were assessed using the EQ-5D-5L and EQ-HWB experimental version. The analysis included Spearman's correlation, Shannon's indices, Item Response Theory (IRT), Differential Item Functioning (DIF), and ordinal logistic regression.
resultsPain frequency and severity items showed a strong correlation (rs=0.81, p<0.001), with similarly strong correlations across all pain and discomfort items (rs>0.5, p<0.001). Frequency scales demonstrated higher informativity than severity scales for both pain (H'=2.28, J'=0.98 vs H'=2.06, J'=0.89) and discomfort (H'=2.18, J'=0.94 vs H'=2.00, J'=0.86). IRT analysis revealed severity items had higher discrimination, while frequency items were more sensitive at lower trait levels. DIF analysis showed significant scale differences for pain (R2=0.24) but not discomfort (R2=0.001). Immunologic (OR=3.21) and musculoskeletal conditions (OR=2.65) were most strongly associated with pain frequency.
conclusionFrequency and severity scales capture distinct aspects of pain and discomfort. Frequency scales provide better informativity across trait levels, while severity scales offer superior discrimination at higher intensities. For a comprehensive assessment, both scales are valuable; however, frequency scales may be preferable in shorter instruments due to their broader measurement range and higher informativity.
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