Clinical utility and validity of the functional disability inventory among a multicenter sample of youth with chronic pain
Open accessAbstract
The Functional Disability Inventory (FDI) is a well-established and commonly used measure of physical functioning and disability in youth with chronic pain. Further validation of the measure has been called for, in particular, examination of the clinical utility and factor structure of the measure. To address this need, we utilized a large multicenter dataset of pediatric patients with chronic pain who had completed the FDI and other measures assessing pain and emotional functioning. Clinical reference points to allow for interpretation of raw scores were developed to enhance clinical utility of the measure, and exploratory factor analysis was performed to examine its factor structure. Participants included 1300 youth ages 8 to 18 years (mean=14.2 years; 76% female) with chronic pain. Examination of the distribution of FDI scores and validation with measures of depressive symptoms and pain intensity yielded 3 distinct categories of disability: No/Minimal Disability, Moderate Disability, and Severe Disability. Factor analysis of FDI scores revealed a 2-factor solution representing vigorous Physical Activities and non-physically strenuous Daily Activities. The 3-level classification system and factor structure were further explored via comparison across the 4 most commonly encountered pain conditions in clinical settings (head, back, abdominal, and widespread pain). Our findings provide important new information regarding the clinical utility and validity of the FDI. This will greatly enhance the interpretability of scores for research and clinical use in a wide range of pediatric pain conditions. In particular, these findings will facilitate use of the FDI as an outcome measure in future clinical trials.
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Patients were randomized to GL or MPM and stratified by pain-related fear and functional disability to minimize imbalance.
“Following the pre-treatment baseline phase, patients were randomized to one of two treatment conditions (GL or MPM) and were stratified by pain-related fear (low/moderate [FOPQ-C <50], and high [FOPQ-C=50–96]; derived from validation sample[57]) and functional disability (low/moderate [FDI<30] and severe [FDI=30–60][28]) to minimize the probability of imbalance between the two treatment arms.”
From A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain (2024) · cites this paper as [28]
The FDI ≥13 indicates moderate to high functional disability.
“moderate to high functional disability (Functional Disability Inventory; FDI ≥ 13)[28]”
From A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain (2024) · cites this paper as [28]
Higher scores on the reliable and valid FDI reflect more pain-related disability with 3 clinical reference points.
“Higher scores on the reliable and valid measure reflect more pain-related disability with 3 clinical reference points: No/Minimal Disability (0–12), Moderate Disability (13–29), and Severe Disability (≥30) [29].”
From Multi-family pediatric pain group therapy: Capturing acceptance and cultivating change (2017) · cites this paper as [29]
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Biased interpretations of ambiguous bodily threat information in adolescents with chronic pain
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The Role of Patient and Parental Resilience in Adolescents with Chronic Musculoskeletal Pain
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Integrating Psychological Screening Into Medical Care for Youth With Abdominal Pain
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Assessment of Pain-related Disability in Pediatric Chronic Pain
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Pain Interference Mediates the Relationship between Pain and Functioning in Pediatric Chronic Pain
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Does intensive interdisciplinary pain treatment improve pediatric headache-related disability?
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- Authors
- Kashikar-Zuck, S., Flowers, S. R., Claar, R. L., Guite, J. W., Logan, D. E., Lynch-Jordan, A. M., Palermo, T. M., & Wilson, A. C.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Boston Children's Hospital (US)
- Children's Hospital of Philadelphia (US)
- University of Washington (US)
- Oregon Health & Science University (US)
- Venue
- Pain
- Published
- 2011-07
- Volume
- 152
- Issue
- 7
- Pages
- 1600-1607
- ISSN
- 0304-3959 (ISSN-L)
- PMC
- PMC3114262
- OpenAlex
- W2093036714
- Cited by
- 337
- References
- 40
- Citations by year
- 2026: 16 · 2025: 22 · 2024: 24 · 2023: 18 · 2022: 26 · 2021: 34 · 2020: 26 · 2019: 22 · 2018: 24 · 2017: 26 · 2016: 23 · 2015: 22 · 2014: 21 · 2013: 16 · 2012: 10
- FWCI
- 15.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- CORE Scholar (Wright State University) (submittedVersion)
- Journal of Bioresource Management (submittedVersion, cc-by)
- Funders
- National Institutes of Health (AR056687, HD060068)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- chronic pain, pediatric chronic pain, disability assessment, physical function, factor structure, clinical utility, score interpretation, depressive symptoms, pain intensity, outcome measures, headache, back pain, abdominal pain, widespread pain
- MeSH terms
- Activities of Daily Living, Adolescent, Child, Developmental Disabilities, Chronic Disease, Depression, Disability Evaluation, Factor Analysis, Statistical, Female, Persons with Disabilities, Disabled Persons, Humans, Male, Pain, Pain Measurement, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Reproducibility of Results
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