The pain behavior scale: Modification and validation for outpatient use

The present study investigated the validity of an inpatient pain behavior rating scale modified for outpatient use. A series of 43 consecutive outpatients referred for evaluation of chronic pain was examined using the Pain Behavior Scale (PBS) and other psychometric instruments. Analyses revealed significantly higher Pain Behavior Scale scores for low back and multiple pain-site groups. The results also indicated a high degree of internal consistency of the scale. A multiple regression analysis, predicting observed pain behavior from reported pain behavior, indicated that decreased activity accounted for 32% of the variance in the PBS score. A similar regression for pain experience found that the pain level and the sensory scale score on the McGill Pain Questionnaire accounted for 39% of the PBS variance. Psychological characteristics including disease conviction, self-control, depression, and anxiety explained 45% of the variability in the PBS score. Thus, the scale is related to pain intensity, interference with activities, and a variety of psychological characteristics. The scale provides a measure of observable pain behavior that is also relatively independent of these clinical data sources. The Pain Behavior Scale as modified for outpatient use provides a brief index of pain behavior with potential use in the comprehensive evaluation of the pain patient.     

A critical review of theS/L reliability index

The meaning and properties of a commonly used index of reliability, S/L,were examined critically. It was found that the index does not reflect any conventional concept of reliability. When used for an identical behavioral observation session, it is not statistically correlated with other reliability indices. Within an observation session, the standardizing measure of Lis beyond the control of the investigator. Furthermore, the reason for the choice of Las the standard is unclear. The role of chance agreement in S/Lis not known. The exact interpretation of the index depends on which observer reports L.Overall the conceptual and mathematical meaning of S/Lis dubious. It is suggested that the S/Lindex should not be used until its nature is shown to be a measure of reliability. Other approaches such as the intraclass correlations and generalizability coefficients should be used instead.The authors are indebted to Johnny Matson for his critique of an earlier version of this paper.     

AN INDEX FOR ASSESSING WEIGHT CHANGE IN CHILDREN: WEIGHT/HEIGHT RATIOS1

Weight and height data from two studies were recomputed, and original data were computed using a Weight Index formula that accounts for the interaction of actual weight/height changes in growing children and compares this ratio with that of normed weight/height ratios for equal-aged children. Recomputing the data of one study showed that the Weight Index is a more sensitive procedure for assessing long-term behavioral treatment of obesity for girls than weight alone. Recomputing the data of a second study showed that the Weight Index formula is consistent for boys and girls and is a more sensitive procedure for assessing long-term effects of a variety of medical treatments for obesity than the Ponderal Index or weight alone. Computation of the data for 17 “normal” children in a preschool class showed a zero Weight Index score before and after a six-month interval elapsed without treatment. The procedure may be useful in assessing ponderosity or anorexia over intervals of six months or more with growing children or difference between actual and normed weight over shorter intervals.     

A note on analyzing ordered alternatives

A general method of devising stepwise multiple testing procedures with fixed experimentwise error is applied to the problem of non-parametric randomized block design with ordered alternatives. In addition, the method is applied to other models with ordered alternatives.The author wishes to thank the referees for helpful suggestions.     

Reliability of multiple classifications

Cohen's kappa index is reformulated for multiple classifications based on exchangeable random variables. It is found that kappa is between 0 and 1 inclusive. Two characterizations for kappa are stated in terms of the relationship between such random variables. Within the normal test score model, kappa increases with test reliability and test length. Furthermore, when based on binary classifications, kappa is an inverse U-shaped function of the cutoff score. These trends also hold for the beta-binomial test score model.Paper read at the Spring meeting of the Psychometric Society, Bell Laboratories (Murray Hill, New Jersey), March 1976.The editorial assistance and helpful comments of Leonard S. Feldt, Sarah P. Seaman-Huynh, and the three referees are gratefully acknowledged.     

Quantifiers and question answering in young children

Two hypotheses were tested about how young children answer questions with the quantifiers all and some: (a) that children use syntactic cues in determining which noun phrase is quantified, and (b) that children evaluate a some-statement as part of evaluating an all-statement. To test these hypotheses, the same group of 60 4- to 7-year-olds were asked four contrasting types of quantitative questions. The results indicated that children can use syntactic cues under some presentation conditions. However, there was no evidence for an asymmetry between the all-and some-questions. A model of how young children might answer quantitative questions was then considered.     

The effect of sex differences on sociometric data generated by a roster-rating scale instrument

Sociometric data generated by roster-rating scale instruments are being used for assessment and evaluation purposes. Little information exists, however, on the influence of peer gender on this particular type of sociometric data. In a sample of 441 male and 455 female fourth, fifth, and sixth grade children, this study found same-sex ratings to be significantly higher than opposite-sex ratings. Opposite-sex ratings, while significantly lower, were slightly correlated with the higher same-sex ratings. Differing methods for interpreting roster-rating scale data are discussed in light of the above results.The author is Assistant Professor at the School of Social Welfare, State University of New York at Albany currently on leave at the Baerwald School of Social Work, Hebrew University, Jerusalem, Israel. This project was completed under the auspices of the Interpersonal Skill Training and Research Project of the School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin.     

Central deafness and subcortical motor aphasia

Clinical and autopsy studies were made on a right-handed man who had central deafness and subcortical motor aphasia, and the literature on central deafness and on subcortical motor aphasia was analyzed. Central deafness is due to bilateral destruction of the primary auditory cortex. It is sometimes difficult to distinguish from word deafness and from auditory agnosia, which are due to pathology in other parts of the temporal lobes. There is almost always some preserved hearing in central deafness, possibly from some auditory pathway other than the classical pathway. In this patient the subcortical motor aphasia was due to bilateral destruction of the motor cortex for the mouth and throat. In some other cases subcortical motor aphasia was due to the same pathology that usually causes Broca's aphasia; in these cases the unexpected preservation of writing was perhaps related to some difference in how language functions were organized in the brain.