4-Item Pain Intensity Measure (P4)

Original Editor - Evan Thomas

Top Contributors - Evan Thomas, Andeela Hafeez and WikiSysop

Summary[edit | edit source]

The P4 consists of 4 items that address pain intensity in the morning, afternoon, evening, and with activity over the past 2 days. Each item is scored on a 0-to-10 NPRS, therefore the total P4 scores can vary from 0 (no pain) to 40 (the highest possible pain level). Most patients can complete the P4 in less than a minute and clinicians can score the measure in 5 seconds without the use of computational aids.[1]

The purpose of developing this questionnaire was to attempt assessing change better than the two different versions of a single-item NPRS.[1]

Intended Population[edit | edit source]

Those over the age of 16 with non-chronic musculoskeletal pain.[1] It has also been shown to be valid when used in conjunction with the WOMAC in people with osteoarthritis awaiting total knee or total hip replacements.[2]

Method of Use[edit | edit source]

P4 Questionnaire.png

Patients are asked to circle a single number that corresponds to their pain at each time of day and with activity over the previous 2 days. The numbers are then totaled to yield a score out of 40.

Evidence[edit | edit source]

Reliability[edit | edit source]

Test-retest reliability = 0.78[1]

Validity[edit | edit source]

Longitudinal validity = 0.63 and 0.57 between the retrospective rating of change and the P4 and 24-hour NPRS (z = 1.73, P1 = .043), and 0.61 and 0.56 between the retrospective rating of change and the P4 and 2-day NPRS (z = 2.53, P1 = .006), respectively.[1]

Responsiveness[edit | edit source]

MDC90 = 9.1 points or 22.2% of the scale range[1]

Resources[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Spadoni GF, Stratford PW, Solomon PE, Wishart LR. The Evaluation of Change in Pain Intensity: A Comparison of the P4 and Single-Item Numeric Pain Rating Scales. J Orthop Sports Phys Ther, 2004: 34(4): 187-93.
  2. Stratford PW, Dogra M, Woodhouse L, Kennedy DM, Spadoni GF. Validating Self-Report Measures of Pain and Function in Patients Undergoing Hip or Knee Arthroplasty. Physiother Can, 2009: 61; 189-194.