Development and Validation of the 'Working With Chronic Pain: Assessment of Impacts' (WORC-PAIN) Questionnaire for People in Paid Work With Chronic Pain.

BACKGROUND

Chronic pain (CP) impacts people's work in a variety of ways but no instrument captures the totality of these impacts. This study aimed to develop and validate a new instrument, 'Working with Chronic Pain: Assessment of Impacts' (WORC-PAIN).

METHODS

We employed a sequential mixed-methods design: 1. Focus groups with people with CP and other stakeholders to identify key domains of work affected by CP; 2. A multi-stage Delphi process to refine items based on identified domains; 3. Testing WORC-PAIN within a cohort of people working with CP and analysing responses using factor analysis to identify subscales which were tested for internal consistency, concurrent validity, and test-retest reliability. Concurrently, item comprehension was evaluated via a Think Aloud process.

RESULTS

50 focus group participants defined domains for inclusion. Items were drafted based on domains, and input from 12 Delphi Stage 1 and 55 Delphi Stage 2 participants further refined these. 919 people with CP completed the WORC-PAIN questionnaire and nine participated in the Think Aloud process. Three key domains were identified from the factor analysis: wider impacts of working with CP, day-to-day impacts, and individual and job-based facilitators to support working with CP. Subscales were generated for each domain and were shown to have good internal consistency (α = 0.60-0.89), convergent validity, and test-retest reliability (intraclass correlation coefficients = 0.82-0.92).

CONCLUSIONS

WORC-PAIN is a new instrument, developed with people living with CP, which can quantify effects of CP on work and which will facilitate interventions to better support people living with CP to work.

SIGNIFICANCE: This article presents on the development and validation of a new instrument to measure impacts of chronic pain on work. Over 100 people with experience of working with chronic pain and other key stakeholders were involved in its development, and the new 'Working with Chronic Pain: Assessment of Impacts' (WORC-PAIN) instrument can validly and reliably measure impacts that are important to people working with chronic pain at a population-level.