Translation and Validation of the COMM and ASI-SR

NCT ID: NCT06084520

Last Updated: 2024-05-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

400 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-12-01

Study Completion Date

2026-12-31

Brief Summary

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The goal of this observational study is to translate the COMM (Current opinion misuse measure) form and validate it using the ASI-SR (Addiction severity score-self report)in a Swedish population of pain patients treated with opioids. The secondary aim is to investigate acceptability of the instrument in a Swedish population of pain patients with long-term opioid treatment (LOT).

The tertiary aim is to investigate the prevalence of alcohol and illicit substance use in a Swedish population of pain patients with LOT.

Detailed Description

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There is no validated instrument for the assessment of early detection of substance use disorder development in swedish language.

In order to address this gap, investigators plan to translate and validate the COMM questionnaire using the ASI-SR in a Swedish population of pain patients undergoing opioid treatment. In addition, study will investigate the prevalence of illicit substance use in this population and compare it to patients who are not receiving opioid treatment. The collection of material (blood) in the Uppsala Biobank for future analysis of neurobiological processes during long-term pain treatment will be performed.

Phase 1:

Translation of the instrument takes place according to the "Patient-Reported Outcome (PRO) Consortium translation process guidelines"and according to guidelines from the company MAPI ResearchTrust, which owns the rights to use of the instrument.

Phase 2: The subsequent phase entails validating the COMM instrument against the ASI-SR in a Swedish sample of patients experiencing long-term pain, in accordance with the "Cosmin guidelines" \[40\], and involves the following procedures. Firstly, the reliability of the COMM instrument by examining internal consistency, test-retest consistency, standard error of measurement (SEM), and conducting factor analysis with rotation in a Swedish population of patients with long-term pain andlong-term opioid treatment (LOT)will be assessed. Secondly, validity of the COMM instrument with regard to comprehensiveness, scope, user-friendliness, and predictability within this particular population will be investigated. Furthermore, investigators will assess the acceptability of the instrument among the study population. Finally, exploration of the prevalence of substance use alongside LOT in pain patients and compare it with pain patients who do not receive opioid treatment will be performed. Inclusion goal is to recruit 200 research subjects from various healthcare settings, including primary care, specialized pain care, other specialized care (e.g., Endometriosis Center), and addiction care (addiction medicine program for pain patients) for the test group. Additionally, 200 individuals are planned to be recruited from pain centers and primary care for the control group to measure prevalence rates. The control group will consist of patients with long-term pain who are not undergoing opioid treatment. Since the study involves two groups of patients with long-term pain (with and without opioid treatment), research group will inquire separately if participants are willing to provide blood samples for biomarker analysis of pain (O-link panel) and genetic analysis, which will be stored in the biobank for future research on the effects of opioids.

Validation will be conducted using the results of drug and alcohol analysis from salivatests and blood. Each category, as identified by the original COMMinstrument, will be evaluated against the following instruments:

1. Symptoms and signs of drug abuse (question 1) - AUDIT, DUDIT, ASI-SR, drug and alcohol test
2. Emotional and psychiatric problems (questions 2, 5, 7, 8, 13) - ASI-SR, GAD-7, PHQ9
3. Visitor characteristics/patterns (questions 3, 12, 17) - medical record data
4. Occurrence of untrue statements (doubt/lie/untruth) and drug use (questions 4, 6, 9, 10, 11) - medical record data, drug and alcohol tests
5. Medication use and deviation from prescription (non-compliance) (questions 14, 15, 16) - medical record data, occurrence of overprescription. Pain-related questions will be assessed using the BPI-SF.

In addition, research subjects will also be asked if they would like to be interviewed by a researcher in connection with their consent. Thirty of the initial research subjects who respond positively will undergo a semi-structured interview, where ease of use will be examined using the "think aloud" method. This involves asking subjects about their thoughts on the forms, including their understanding of the questions, language choices, and any possible negative associations. The interviews will then be reviewed using qualitative content analysis.

Moreover, an extensive assessment will be undertaken, involving the input of 10 esteemed professionals in Sweden who specialize in various fields related to this subject matter, such as pain doctors, addiction medicine doctors, psychologists, behavioral scientists, and others. These experts will be approached to provide their valuable insights by responding to a set of carefully devised questions concerning the evaluation of content validity. Their estimations will serve as the fundamental basis for calculating the Content Validity Index (CVI).

In order to collect and analyze the health data, information from medical records, relevant forms, and laboratory responses are compiled into a study database and then transferred to a statistics program. To ensure internal consistency and reliability, Cronbach's alpha is used, with the expectation that it will be higher than 0.70 at a significance level of p\<0.05. Additionally, the agreement between the two test occasions of COMM is assessed using the intraclass correlation coefficient (ICC). The ICC is classified as satisfactory if below 0.40, good if between 0.40-0.59, and excellent if between 0.60-0.70. The correlation between the results of COMM and the ASI-SR is examined using both the Pearson and Spearman correlation coefficients, which are calculated for the respective clusters of questions in the form. Furthermore, confirmatory factor analysis with rotation is employed to investigate the relationship between different clusters or dimensions of questions that can be identified for correlation purposes. The discriminant validity of ASI-SR composite scores and external validity measures are determined by calculating the intercorrelation matrix between COMM groups of questions, ASI-SR composite scores, and external validation measures. The minimum requirement for correlation is set at \>0.40. Statistical processing is conducted using SPSS, SAP, and Amos programs. It should be noted that the qualitative aspect of the study is not covered by the statistical plan. In terms of prevalence estimation, both the test group and the control group will be described using descriptive statistics. The occurrence of addictive drugs, non-prescribed drugs, and measures of alcohol use (PETh) during the last three weeks in both groups will be compared using a chi-square test. Odds analysis will be performed to assess secondary use of illegal substances, parallel dependence on other substances, and drugs and alcohol during the length of the study.

Conditions

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Opioid Use Opioid Use Disorder Alcohol Use Disorder Pain, Chronic

Study Design

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Observational Model Type

OTHER

Study Time Perspective

PROSPECTIVE

Study Groups

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Test group - patients with chronic pain treated with opioids

Patients with long-term, non-cancer-related pain (\>3 months) at least 3 days a week, age 18-75 years, who have been treated with opioids for at least 1 month and who can speak, read and write in Swedish, recruited within Uppsala County Primary, Secondary and Tertiary Care.

Current Opioid Misuse Measure (COMM)-SWE

Intervention Type DIAGNOSTIC_TEST

Patients in test group should fulfill the the COMM and the battery of validation forms as well as leave the oral fluid for illicit drugs test and whole blod for phosphatidylethanol test.

Oral fluid drug test

Intervention Type DIAGNOSTIC_TEST

Oral fluid sampling to detect drugs. Analysis with LC-HRMS

PETh

Intervention Type DIAGNOSTIC_TEST

Alcohol use detection

ASI-SR

Intervention Type DIAGNOSTIC_TEST

Cross-validation form

AUDIT

Intervention Type DIAGNOSTIC_TEST

Cross-validation form

DUDIT

Intervention Type DIAGNOSTIC_TEST

Cross-validation form

Brief Pain Inventory - BPI

Intervention Type DIAGNOSTIC_TEST

Cross-validation form

Patient Global Impression of Change PGIC

Intervention Type DIAGNOSTIC_TEST

Cross-validation form

GAD-7

Intervention Type DIAGNOSTIC_TEST

Cross-validation form

Patient Health questionnaire (PHQ9)

Intervention Type DIAGNOSTIC_TEST

Cross-validation form

DBS - cannabis test

Intervention Type DIAGNOSTIC_TEST

cross-validation form

Sample of Blood for later DNA and immunological analysis in future studies

Intervention Type OTHER

sample collection for future studies

Control group - patients with chronic pain not-treated with opioids

Patients with long-term, non-cancer-related pain (\>3 months) at least 3 days a week, age 18-75 years, who are not treated with opioids (at inclusion and during the last 3 months) and who can speak, read and write in Swedish, recruited within Uppsala County Primary, Secondary and Tertiary Care.

Oral fluid drug test

Intervention Type DIAGNOSTIC_TEST

Oral fluid sampling to detect drugs. Analysis with LC-HRMS

PETh

Intervention Type DIAGNOSTIC_TEST

Alcohol use detection

DBS - cannabis test

Intervention Type DIAGNOSTIC_TEST

cross-validation form

Sample of Blood for later DNA and immunological analysis in future studies

Intervention Type OTHER

sample collection for future studies

Interventions

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Current Opioid Misuse Measure (COMM)-SWE

Patients in test group should fulfill the the COMM and the battery of validation forms as well as leave the oral fluid for illicit drugs test and whole blod for phosphatidylethanol test.

Intervention Type DIAGNOSTIC_TEST

Oral fluid drug test

Oral fluid sampling to detect drugs. Analysis with LC-HRMS

Intervention Type DIAGNOSTIC_TEST

PETh

Alcohol use detection

Intervention Type DIAGNOSTIC_TEST

ASI-SR

Cross-validation form

Intervention Type DIAGNOSTIC_TEST

AUDIT

Cross-validation form

Intervention Type DIAGNOSTIC_TEST

DUDIT

Cross-validation form

Intervention Type DIAGNOSTIC_TEST

Brief Pain Inventory - BPI

Cross-validation form

Intervention Type DIAGNOSTIC_TEST

Patient Global Impression of Change PGIC

Cross-validation form

Intervention Type DIAGNOSTIC_TEST

GAD-7

Cross-validation form

Intervention Type DIAGNOSTIC_TEST

Patient Health questionnaire (PHQ9)

Cross-validation form

Intervention Type DIAGNOSTIC_TEST

DBS - cannabis test

cross-validation form

Intervention Type DIAGNOSTIC_TEST

Sample of Blood for later DNA and immunological analysis in future studies

sample collection for future studies

Intervention Type OTHER

Other Intervention Names

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Phosphatydilethanol in blood Addiction Severity Score - Short version Alkohol Use Disorder Identification Test Drug Use Disorder Identification Test Generalized anxiety disorder 7-items scale

Eligibility Criteria

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Inclusion Criteria

Intervention group:

* Patients with long-term, non-cancer-related pain (\>3 months) at least 3 days a week
* opioid treatment for at least 1 month during last 6 months
* age 18-75 years
* fluent in spoken and written Swedish.

Control group:

* Patients with long-term, non-cancer-related pain (\>3 months) at least 3 days a week
* no opioid treatment at inclusion and during last 3 months
* age 18-75 years
* fluent in spoken and written Swedish

Exclusion Criteria

* ongoing diseases or conditions that prevents the patient from completing to the study according to the doctor's assessment
* serious cognitive disorder that makes answering the questions impossible. - - ongoing or treated cancer in the last 10 years
* Insufficient knowledge of Swedish
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Kamprad Family Foundation for Entrepreneurship, Research & Charity

OTHER

Sponsor Role collaborator

Uppsala University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Rolf Karlsten, PhD

Role: PRINCIPAL_INVESTIGATOR

Uppsala University

Locations

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Multidisciplinary Pain Center

Uppsala, Uppland, Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Lenka Katila, MD

Role: CONTACT

+46186113739

Rolf Karlsten, PhD

Role: CONTACT

+46186113518

Facility Contacts

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Lenka Katila, MD

Role: primary

0186113739

Ann-Charlotte Meuller Danielsson

Role: backup

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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FoU 2023-00093

Identifier Type: -

Identifier Source: org_study_id

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