Impact of event scale (IES-R)
Impact of event scale (IES-R)
The Impact of Event Scale-Revised (IES-R) is a 22-item survey developed to assess an individuals’ subjective distress to a specific traumatic event.
About
The IES-R is a self-administered 22-item survey comprised of three sub-scales related to intrusion, avoidance and hyperarousal. The IES-R is a revised version of the original IES. The IES-R was developed to also assess hyperarousal symptoms and therefore more closely parallel overall symptoms of post-traumatic stress.
The patient is asked to report the degree of distress experienced for each item over the past 7 days.
Each question has 5 response options: 0 (not at all), 1 (a little bit), 2 (moderately), 3 (quite a bit), or 4 (extremely).
When and why
Most people recover from the shock of an event such as a motor vehicle accident, however, a minority of individuals may continue to experience high levels of acute stress, or trauma-specific psychological reactions.5 Longitudinal data showed that clinical levels of posttraumatic stress symptoms were present at 3–4 weeks in approximately 25% of an acute whiplash cohort and persisted with 13% of the cohort as 6 months.6
When recovery is not apparent within 3-6 weeks, the IES-R can be administered to assess for posttraumatic stress symptoms.
Results
The IES-R developers suggest that mean scores for each subscale should be used to evaluate an individual’s symptomatic status.1,2 The scores therefore range from 0-4 for each subscale and 0-12 for the total, with higher scores indicating greater distress.
Rather than mean subscale scores, some researchers have suggested a total score where3,4 scores of ≥33 indicate higher levels of post-traumatic stress reaction. These individuals may benefit from referral to a psychologist with experience in the management of posttraumatic stress symptoms.
References
1. Weiss & Marmar (1997); The Impact of Events Scale—Revised. In: Wilson J, Keane T, editors. Assessing Psychological Trauma and PTSD: A Practitioner's Handbook, New York: The Guildford Press; p. 399-411.
2. Weiss (2004); The Impact of Events Scale-Revised. In Wilson & Keane (eds.) Assessing Psychological Trauma and PTSD: A Practitioners Handbook (2nd Ed.), New York: Guilford Press.
3. Creamer et al. Behaviour Research and Therapy 2003; 41:1489-96.
4. Morina et al. PLoS ONE 2013; 8:e83916.
5. Sterling & Kenardy. Manual Therapy 2008; 13:93-102.
6. Sterling et al. Pain 2006; 122:102-8.
Depression, Anxiety and Stress Scale
Depression, Anxiety and Stress Scale
The Depression, Anxiety and Stress Scale short version (DASS21) is a widely used, valid and reliable self-administered tool that is designed to assess symptoms of three negative emotional states: depression, anxiety and stress.
How to
- The 21 item self-administered survey contains three subscales: depression, anxiety and stress.
- Each subscale contains 7 items with 4 response options for each, ranging from 0 = Did not apply to me at all (NEVER), to 3 = Applied to me very much or most of the time (ALMOST ALWAYS).
- Scores are totalled for each subscale and compared with normative data.
- Higher scores on each subscale indicate increased symptom severity. However, it is important to note that the DASS21 does not allocate individuals to discrete diagnostic categories.
When and why
Evaluation of mood using a validated questionnaire such as DASS21 may help you evaluate a patient’s negative emotional state following a whiplash injury.
If moderate or severe symptoms are reported, you may refer the patient to a general practitioner or a psychologist with experience in managing mood disturbances for a complete psychological assessment.
Results
| Depression | Anxiety | Stress | |
|---|---|---|---|
| Normal | 0-4 | 0-3 | 0-7 |
| Mild | 5-6 | 4-5 | 8-9 |
| Moderate | 7-10 | 6-7 | 10-12 |
| Severe | 11-13 | 8-9 | 13-16 |
| Extremely severe | 14+ | 10+ | 17+ |
References
1. Lovibond, & Lovibond, 1995a. Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation.
2. Lovibond, & Lovibond. 1995b. The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behav Res Ther, 33, 335-343.
3. Parkitny & McAuley 2010. The Depression Anxiety Stress Scale (DASS). Journal of Physiotherapy, 56, p204
Pain Catastrophisation
Pain Catastrophisation
The Pain Catastrophising Scale (PCS) is a widely used, valid and reliable tool to measure catastrophic thinking about pain. Individuals who catastrophize tend to magnify their pain, feel helpless to manage their pain, and are unable to prevent pain-related thoughts.
About
The 13 item self-report questionnaire contains three subscales: rumination, magnification and helplessness.1
Patients reflect on past painful experiences and then indicate the extent to which they experience thoughts or feelings related to their pain. There are 5 response options ranging from 0 (not at all) to 4 (always). The sum of responses yields a score out of 52 with higher scores indicating greater pain catastrophising.
When and why
Pain catastrophising contributes to emotional distress and heightened levels of pain, and has been shown to be a risk factor for delayed recovery from a whiplash injury.2,3
Knowledge of an individual’s level of pain catastrophising may help the clinician understand the individual’s emotional distress and enable interventions to be implemented to target pain catastrophising.
Results
A PCS total score ≥24 indicates a high level of pain catastrophising.
References
1. Sullivan et al. Psychological Assessment 1995; 7:524-32.
2. Sullivan et al. Spine 2011; 36:s244-9.
3. Scott et al. Clinical Journal of Pain 2014; 30:183-90.
Pain Self-Efficacy Questionnaire
Pain Self-Efficacy Questionnaire
The Pain Self-Efficacy Questionnaire (PSEQ) is a 10 item survey that was developed to assess an individual’s confidence to perform specific tasks in the presence of pain.1 The 10 items reflect a wide variety of activities and tasks that have been commonly reported as problematic by patients with chronic pain such as household chores, socialising, work and coping without medication.
How to
THE PSEQ is a self-administered, 10 item questionnaire. The patient is asked to rate their confidence in performing each of the 10 activities/tasks despite their current pain.
The response options for each item range from 0 (not at all confident) to 6 (completely confident).
The responses are totalled to provide a score out of 60 with higher scores reflecting stronger self-efficacy beliefs.
When and why
- The PSEQ has been used as a screening tool and to evaluate outcomes in people with chronic pain.
- It provides more reliable and valid information about a patient’s confidence in their ability to perform certain activities or pursue a particular plan of action than simply asking a patient how confident they are in undertaking a specific activity.
- It provides the clinician with information about how the patient might respond to therapeutic management such as exercise.
Results
Normative data for a chronic pain condition suggests:
- scores of 40 and higher before treatment reflect a higher level of confidence in ability to manage pain and therefore, the individual may be more likely to be able to focus on therapeutic management.
- low scores (<20) reflect a higher focus on pain itself, and therefore, the individual may be more focussed on pain relief and less focussed on other therapies. Inclusion of strategies to address pain beliefs may help change an individual’s confidence in performing activities and tasks and therefore their ability to interact with therapeutic management.
References
1. Nicholas. European Journal of Pain 2007; 11:153-163
Perceived injustice
Perceived injustice
The Injustice Experience Questionnaire (IEQ) is a valid and reliable tool to assess an individual’s injury-related perceptions of injustice. An individual who has experienced an injury as a result of another person’s error or negligence might experience cognitions that include elements of pain-related loss, perceived irreparability of loss, a sense of unfairness, and blame; e.g., a sense of injustice.
About
- The IEQ is a 12 item questionnaire assessing two key factors: severity/irreparability of loss and blame/unfairness.1
- Patients indicate the extent to which they experience each of 12 thoughts or feelings related to the injury. There are 5 response options ranging from 0 (not at all) to 4 (always).
- The sum of responses yields a score out of 48 with higher scores indicating a greater sense of injury-related injustice.
When and why
- The optimal timing for administering the IEQ is unknown. Preliminary research indicates that assessing perceptions of injustice AFTER a standard rehabilitation program may help predict long-term risk of disability associated with perceived injustice.2
- Hence, assessment of perceived injustice may help guide additional therapy for individuals who do not appear to be responding to standard rehabilitation.
Results
Emerging evidence suggests that, for whiplash injured individuals, a post-treatment IEQ score ≥19 may be associated with reduced likelihood of returning to work; increased likelihood of experiencing post-treatment pain; and increased use of narcotics for pain relief.2
References
1. Sullivan et al. Journal of Occupational Rehabilitation 2008; 18:249-61.
2. Scott et al. Journal of Occupational Rehabilitation 2013; 23:557-65.