Psychometric properties of the portuguese version of the Pain Self Efficacy Questionnaire

ó gão o icial da sociedade po uguesa de euma ologia - a c a e u m a o l p o .2011;36:260-267 260 a i g o o i g i n a l p s y c h o m e i c p o p e i e s o h e p o u g u e s e e s i o n o h e p a i n s e l -e i c a c y q u e s i o n n a i e M. Alexand a Fe ei a-Valen e*,**,***, José L. Pais-Ribei o*,***, Ma k P. Jensen**** *Faculdade de Psicologia e Ciências da Educação da Uni e sidade do Po o, Po o, Po ugal; **Fundação pa a a Ciência e a Tecnologia, Po ugal ***Unidade de In es igação em Psicologia e Saúde, ISPA, Lisboa, Po ugal ****Uni e si y o Washing on School o Medicine, Sea le, USA. The p esen s udy was unde aken wi h he suppo o he i s au ho ’s FCT PhD g an SFRH/BD/ 40956/2007. he hypo hesized di ec ions, suppo ing i s cons - uc alidi y. Addi ionally, he con i ma o y ac o analysis suppo ed a single ac o solu ion, as hy- po hesized. Conclusions: The indings p o ide s ong suppo o he eliabili y and alidi y o he P-PSEQ. Re- sea ch is needed o de e mine he esponsi i y o he P-PSEQ and o es ablish he gene alizabili y o he esul s in o he samples o Po uguese pa ien s wi h ch onic pain. Keywo ds: Pain; Pain Assessmen ; In ac able Pain; Sel -E icacy. In oduc ion Biopsychosocial models o ch onic pain hypo he- size ha psychological and social ac o s play a key ole in he adjus men o ch onic pain. Pain sel - -e i cacy – ha is, he belie o con idence in one’s abi li y o engage in a speci ic beha iou o o he ac ion o achie e desi ed goals despi e pain1-4 – has been one o he ac o s hough o media e he im- pac o pain on disabili y and dep ession1,5-7. The e is s ong suppo o he impo ance o pain sel -e - icacy ac oss a b oad ange o pain popula ions and condi ions, wi h pa ien s endo sing highe le els o sel -e icacy epo ing lowe le els o pain in ensi- y, disabili y, dep ession and anxie y1,4,5,8-14, and highe quali y o li e and gene al heal h12,15. Fu - he mo e, sel -e icacy is hough o in luence hough s and eelings, which in u n can a ec unc ioning2,4,16-18. Sel -e icacy may also in luence he use o pain coping s a egies ia i s e ec s on eadiness o engage in hose coping espon - ses4,11,19-21, wi h pa ien s endo sing lowe le els o sel -e icacy being mo e likely o use passi e co - ping esponses and o ca as ophize in esponse o pain4,19. On he o he hand, pa ien s endo sing highe le els o sel -e icacy ha e been shown o Abs ac Aims: This s udy sough o ansla e and e alua e he psychome ic p ope ies o a Eu opean Po - uguese e sion o he Pain Sel -E icacy Ques ion- nai e (P-PSEQ), in o de o enable i s use in clinical and c oss-cul u al s udies. Ma e ial and Me hods: The Pain Sel -E icacy Ques- ionnai e was ansla ed in o Eu opean Po uguese and hen back- ansla ed in o English. A consensus e sion o he ansla ed e sion was p e- es ed wi h a pilo sample, ollowed by cogni i e deb ie ing, e- sul ing in a inal e sion o he measu e. A con enience sample o 174 Po uguese adul s wi h ch onic musculoskele al pain comple ed he Po uguese Pain Sel -E icacy Ques ionnai e (P-PSEQ) and c i e ion measu es o pain in ensi y (Nume ical Ra ings Scale), pain in e e ence (Po - uguese B ie Pain In en o y In e e ence Scale), quali y o li e and gene al heal h (SF-12), and psy- chological unc ioning (Hospi al Anxie y and De- p ession Scale). C onbach’s alpha and composi e eliabili y coe icien s we e compu ed as measu es o eliabili y, and con i ma o y ac o analysis was pe o med. Pea son co ela ion coe icien s be- ween he P-PSEQ sco e and he c i e ion measu es we e compu ed o e alua e he cons uc alidi y o he scale. Resul s: The P-PSEQ demons a ed good o excel- len eliabili y (C onbach’s alpha = 0.88 and Com- posi e eliabili y = 0.92), and showed mode a ely s ong associa ions wi h he c i e ion measu es in ó gão o icial da sociedade po uguesa de euma ologia - a c a e u m a o l p o .2011;36:260-267 261 m. alexand a e ei a- alen e e col. use mo e adap i e coping esponses2,11,19,22, e en a e con olling o demog aphic and medical s a- us a iables11. Gi en he impo ance o sel -e i- cacy in he adap i e managemen o ch onic pain, mul idisciplina y ea men p og ams o en aim o inc ease pain sel -e icacy as a way o inc ease pa ien s’ quali y o li e and enhance posi i e phy - sical and psychological ou comes in esponse o ea men . In o de o de e mine he e ec s o ea men on pain sel -e icacy as well as e alua e i s po en ial ole in adjus men o pain, a alid and eliable mea- su e o pain sel -e icacy is needed. Mo eo e , ansla ed measu es o he cons uc a e needed o c oss-cul u al esea ch o de e mine i he same ea men s ha e simila e ec s on ou comes ac oss cul u es. The Pain Sel -E icacy Ques ionnai e (PSEQ)4, which was de eloped om Bandu a’s So- cial Lea ning heo y2, is he only pain sel -e icacy measu e de eloped speci ically o assess con i- dence o pa ien s o engage in a numbe o ac i i- ies o daily li ing, despi e pain. The PSEQ was de- eloped o be applicable o pa ien s wi h all ch o - nic pain condi ions and o be easy o unde s and. I assesses sel -e icacy ega ding a wide ange o unc ions such as household cho es, social ac i i- ies, wo k, and coping wi h pain wi hou medica- ion, ye akes less han wo minu es o comple e. P e ious esea ch shows he PSEQ o be eliable and o ha e bo h ac o ial and p edic i e alidi y ac oss a numbe o languages, cul u es, and clini- cal se ings4,9,12,14,23-33. Al hough a Po uguese e sion o he PSEQ has been de eloped, i was ansla ed and alida ed o be used in B azilian popula ions14. Howe e , a Eu- opean Po uguese e sion o he PSEQ has no ye been ansla ed and alida ed. A Eu opean Po - uguese e sion o he PSEQ ha is dis inc om he B azilian Po uguese e sion is needed because o he cul u al and language di e ences be ween Eu opean Po uguese (as spoken in Po ugal) and B azilian Po uguese. The pu pose o his s udy is o ansla e and e alua e he psychome ic p ope ies o a Eu o- pean Po uguese e sion o he Pain Sel -E icacy Ques ionnai e (P-PSEQ), o enable i s use in clini- cal and c oss-cul u al s udies. Based on p e ious esea ch wi h he PSEQ in o he samples, we hy- po hesized ha : (1) he in e nal consis ency (C on- bach’s alpha) o he P-PSEQ would be good o ex- cellen (abo e 0.80)34; (2) he p edic i e alidi y o he P-PSEQ would be suppo ed ia a pa e n o signi ican nega i e associa ions wi h pain in en- si y ( be ween -0.12 and -0.39)4,5,9,12,14,30 and pain in- e e ence ( be ween -0.31 and -0.70)5,9,12,14,30, an - xie y ( be ween -0.49 and -0.56)4,12 and dep ession ( be ween -0.48 and -0.66)4,9,12,30 and mode a e o s ong co ela ions (i.e., 0.30 o la ge ) wi h mea- su es o global physical unc ioning and psycho- logical unc ioning12; and (3) a ac o analysis o he P-PSEQ i ems would yield one ac o ha ex- plains a subs an ial po ion o he a iance in he i ems. Ma e ials and Me hods Subjec s One-hund ed and se en y ou pa ien s, all o e 18 yea s old, wi h ch onic musculoskele al pain om se en heal h ca e ins i u ions in no he n and cen al Po ugal comple ed he s udy p o ocol. In- clusion c i e ia included: (1) expe iencing pain due o a diagnosed musculoskele al condi ion o a leas 3 mon hs; (2) being a leas 18 yea s old; (3) and being willing o pa icipa e in a esea ch. Ex- clusion c i e ia included: (1) ha ing a physical o cogni i e disabili y which p e en ed pa icipa ion, (2) known/diagnosed se e e dep ession o o he se e e men al heal h condi ion, and (3) pain due o ib omyalgia. As can be seen in Table I, he pa icipan s’ ages anged om 23 o 90 yea s (M = 59.18, SD = 16.11), 60.2% we e ma ied o li - ing wi h a signi ican o he , 26.3% we e ei he sin- gle o di o ced/sepa a e and 8.8% o he pa ici- pan s we e widowed. The majo i y o he pa ici- pan s we e emale (60.2%). Mos pa icipan s had a his o y o ch onic pain o a leas wo yea s (65.3%), and 38.8% epo ed ha ing had pain o mo e han 10 yea s. Measu es All pa icipan s we e asked o p o ide basic de- mog aphic and pain his o y in o ma ion (e.g. age, sex, ma i al s a us, le el o educa ion, p o essio nal s a us, du a ion o pain, pain loca ion and cause o pain). They we e also asked o a e hei pain in- ensi y a i s maximum, minimum and on a e age du ing he p e ious 24hou s on a 0 o 10 Nume i- cal Ra ing Scale (NRS). Resea ch suppo s he a- lidi y o he NRS as a measu e o pain in ensi y35. The Po uguese BPI Pain In e e ence subscale was used o assess pain in e e ence ac oss se en daily li e ac i i ies (gene al ac i i y, mood, walking ó gão o icial da sociedade po uguesa de euma ologia - a c a e u m a o l p o .2011;36:260-267 262 po uguese pain sel -e icacy ques ionnai e -e icacy belie s. The 10-i em scale assesses con i- dence o pa ien s o engage in a numbe o ac i i- ies o daily li ing despi e pain on 0 - 6 nume ical a ing scales, whe e 0 = “no a all con iden ” and 6 = “comple ely con iden ”. Highe sco es ( anging om 0 o 60) e lec s onge sel -e icacy belie s. P ocedu e The ini ial phase o he s udy in ol ed ansla ing and back- ansla ing he ins uc ions and i ems o he PSEQ. Th ough expe discussion, we a i ed a a consensus e sion, and e i ied ha i s con en assessed he same cons uc as he o i gi nal. To en- su e ha he indi iduals in ou popula ion unde - s ood he ins uc ions and scale i ems, we hen pe o med a p e- es o he P-PSEQ in a pilo sam- ple o 15 pa ien s, ollowed by a cogni i e deb ie - ing. A e making inal modi ica ions based on he esul s o he cogni i e es ing, we in i ed a sam- ple o pa ien s wi h ch onic musculoskele al pain o comple e all o he s udy measu es. All pa ien s who ag eed hen signed an in o med consen o m and we e adminis e ed he 0-10 NRS, P-BPI In e - e ence Scale, SF-12, HADS and P-PSEQ ques ion- nai es. Da a Analysis Means and s anda d de ia ions o he s udy a ia - bles we e compu ed o desc ip i e pu poses. In- e nal consis ency o he P-PSEQ was assessed by compu ing a C onbach’s alpha. Composi e elia- bili y was also compu ed41,42. Then, o es a hy- po hesized one- ac o model o he P-PSEQ i ems, we pe o med a con i ma o y ac o analysis (CFA). Model quali y o i ness was e alua ed using he Chi Squa e (χ2/d ), Compa a i e Fi Index (CFI), Pa simony Compa a i e Fi Index (PCFI), Good- ness o Fi Index (GFI), Pa simony Goodness o Fi Index (PGFI), and Roo Mean Squa e E o o Ap- p oxima ion (RMSEA). The model was conside ed o ha e accep able i i χ2/d was less han 5 42-44, CFI and GFI highe han 0.842, he PCFI and PGFI we e bo h highe han 0.642,45,46, he RMSEA was lo - we han 0.1042,43. The model was conside ed o ha - e a good i i χ2/d was less han 242-44, he CFI and GFI we e highe han 0.942, PCFI and PGFI highe han 0.842,45, and he RMSEA was lowe han 0.0843. Mo del adjus men was pe o med, s ep-by-s ep, ia Modi ica ion Indices analysis (highe han 11; p<0.001)42,43 and based on heo y. We also used he Expec ed C oss-Valida ion Index (ECVI), o com- pa e i a e models’ adjus men , wi h lowe ECVI abili y, no mal wo k, ela ions wi h o he people, sleep, and enjoymen o li e) on 0 o 10 nume ical a ing scales. Resea ch suppo s he alidi y and e- liabili y o BPI in se e al samples, cul u es and lan- guages, including Eu opean Po uguese36-38. The Po uguese SF-1239 was used as a measu e o pe - cei ed Physical (Physical Componen Summa y, PCS) and Men al (Men al Componen Summa y, MCS) heal h s a us, wi h highe sco es ( anging om 0 o 100) indica ing be e heal h. The Po - uguese e sion has e idence suppo ing i s elia- bili y and alidi y39. The Po uguese e sion o he Hospi al Anxie y and Dep ession Scale (HADS)40 was used o assess psychological unc ioning. I asks esponden s o a e he se e i y o 14 dep es- si e o anxie y symp oms on 4-poin Like scales, and has shown good eliabili y and alidi y40. The possible sco es ange om 0 o 21. Highe sco es e lec highe anxie y o dep essi e symp oma olo - gy. The Po uguese Pain Sel -E icacy Ques ionnai - e (P-PSEQ)4was used o assess pain- ela ed sel - Table I. Demog aphic In o ma ion Po uguese sample F equency Mean (%) (SD) Age – 59.18 (16.11) Sex ( emale pa icipan s) 103 (60.2) – Educa ion Le el P ima y educa ion 76 (44.7) – Incomple e High School 35 (20.6) – High School 27 (15.9) – College 32 (18.9) – Ma i al S a us Single 31 (18.1) – Ma ied/Li ing wi h o he 103 (60.2) – Di o ced 15 (8.8) – Widow 22 (12.9) – P o essional S a us Employed 68 (39.8) – Unemployed 19 (11.1) – Re i ed (due o disabili y) 47 (27.5) – Re i ed (no mal age) 37 (21.6) – Du a ion o Pain 3 mon hs o 1 yea 36 (21.2) – 1 o 2 yea s 23 (13.5) – 2 o 10 yea s 45 (26.5) – Mo e han 10 yea s 66 (38.8) – ó gão o icial da sociedade po uguesa de euma ologia - a c a e u m a o l p o .2011;36:260-267 263 m. alexand a e ei a- alen e e col. Resul s Desc ip i e in o ma ion As can be seen in Table II, he s udy pa icipan s e- po ed mild o mode a e le els o pain se e i y (NRS) and pain- ela ed disabili y (BPI Pain In e - e ence). Mean sco es o SF-12 Physical Compo- nen Summa y and SF-12 Men al Componen Summa y indica e signi ican dys unc ion in hese a eas, ela i e o published no ms o heal hy in- di iduals39. O e all, he mean sco es on he HADS sugges ed mild le els o anxie y, simila o indi- iduals wi h a a ie y o medical diso de s, and no mal a ings o dep essi e symp oms40. Finally, he sample was cha ac e ized by ela i ely high le - els o sel -e icacy, on a e age, acco ding o he cu o s sugges ed by Tonkin47 (mean > 40), and when compa ed o no ma i e da ase s o pa ien s wi h ch onic pain, as epo ed by Nicholas and col- leagues48 in a s udy o 6124 pa ien s om ac oss he Aus alian s a e o New Sou h Wales. Reliabili y The P-PSEQ’s in e nal consis encies (C onbach’s alphas) in ou sample and in p e ious samples a e lis ed in Table III. The scale shows a e y good le - el o in e nal consis ency in ou sample ha is consis en wi h o he samples, wi h an alpha coe - icien o 0.8834. Values o alpha i single i ems a e dele ed a e compa able o he o e all alpha, sug- Table II. Desc ip i e S a is ics S udy Va iables Min- Mean (SD) Max Pain In ensi y (NRS) Maximum (las 24 hou s) 5.70 (2.49) 0-10 Minimum (las 24 hou s) 2.97 (2.25) 0-9 A e age Pain 4.59 (2.18) 0-10 Pain In e e ence (P-BPI) 4.03 (2.44) 0-9 Physical Componen 39.07 (23.51) 0-100 Summa y (SF-12) Men al Componen 57.02 (20.39) 10-100 Summa y (SF-12) Anxie y (HADS-A) 7.58 (3.91) 1-20 Dep ession (HADS-D) 6.07 (3.87) 0-17 Sel E icacy (P-PSEQ) 40.83 (11.31) 6-60 No e: NRS = Nume ical Ra ing Scale o pain in ensi y; P-BPI = Po uguese B ie Pain In en o y – In e e ence scale; HADS-A = Hospi al Anxie y and Dep ession Scale – Anxie y scale; HADS-D = Hospi al Anxie y and Dep ession Scale – Dep ession scale; P-PSEQ = Po uguese Pain Sel -E icacy Ques ionnai e. Table III. Reliabili y Analyses o B ie Pain In en o y In e e ence Scale P-PSEQ To al scale o i em Ou sample Aus alia4B azil14 China12 I an9 C onbach's Alpha P-PSEQ To al scale 0.88 0.92 0.90 0.93 0.92 C onbach's Alpha i i em dele ed (I em To al Co ela ion) P-PSEQ I ems I em 1 0.87 (0.48) - (0.70) - (0.79) 0.92 (0.72) – I em 2 0.86 (0.56) - (0.72) - (0.73) 0.92 (0.71) – I em 3 0.86 (0.61) - (0.71) - (0.67) 0.92 (0.66) – I em 4 0.85 (0.70) - (0.83) - (0.71) 0.92 (0.66) – I em 5 0.86 (0.61) - (0.74) - (0.76) 0.92 (0.71) – I em 6 0.85 (0.67) - (0.79) - (0.77) 0.92 (0.81) – I em 7 0.88 (0.43) - (0.67) - (0.50) 0.93 (0.62) – I em 8 0.86 (0.62) - (0.79) - (0.82) 0.92 (0.80) – I em 9 0.85 (0.72) - (0.84) - (0.80) 0.92 (0.78) – I em 10 0.86 (0.63) - (0.84) - (0.79) 0.92 (0.75) – No e: P-PSEQ = Po uguese Pain Sel -E icacy Ques ionnai e e lec ing be e i . Finally, Pea son co ela ion co- e icien s be ween he P-PSEQ sco e (o sco es) and he c i e ion measu es we e compu ed o e alua e he cons uc alidi y o he scale. S a is ical ana - lyses we e pe o med using so wa e PASW S a is- ics ( .18, SPSS Inc. Chicago, IL) and AMOS ( .18, SPSS Inc. Chicago, IL). ó gão o icial da sociedade po uguesa de euma ologia - a c a e u m a o l p o .2011;36:260-267 264 po uguese pain sel -e icacy ques ionnai e ges ing ha no i em de ac s om he eliabili y o he measu e. Addi ionally, he Composi e Reliabi - li y coe icien 41,42 o 0.92 indica es excellen elia- bili y34,41,42,49. Fac o Analysis A ac o analysis o he PSEQ in he o iginal scale de elopmen sample esul ed in a single ac o ha accoun ed o 59% o he a iance. This esul has been eplica ed in o he samples o pa ien s om B azil14 and China12. We used a con i ma o y ac o analysis, using maximum likelihood o es ima e model pa ame e s, o de e mine he i o a single ac o model. Fou o he se en combined i indices o he CFA suppo ed a one- ac o solu ion wi h accep able i . Howe e , he i ness quali y o he one- ac o solu ion appea ed somewha limi ed in ou sample [χ2(35) = 155.58 (p<0.001); χ2/d = 4.44; CFI = 0.83; PCFI = 0.65; GFI = 0.84; PGFI = 0.54; RMSEA = 0.14 (p<0.001); ECVI = 1.15] (Figu e 1). Inspec ion o P-PSEQ i ems sugges s ha some i ems ha e e y simila con en , which could po- en ially explain he educed i ness le els o he one- ac o solu ion. Fo example, I em 2 (“I can do mos household cho es (e.g. idying-up, washing dishes, e c.), despi e he pain”) and I em 5 (“I can do some o m o wo k, despi e he pain. (“wo k” in- cludes housewo k, paid and unpaid wo k)”) ap- pea o assess a e y simila domain, as do I em 8 (“I can s ill accomplish mos o my goals in li e, des pi e he pain”) and I em 9 (“I can li e a no mal li es yle, despi e he pain”). Based on an inspec ion o he modi ica ion indexes, speci ic e o e ms Fi gu e 1. Con i ma o y Fac o Analysis: Ini ial Model χ2(35) = 155.58 (p<0.001); χ2/d = 4.44; CFI = 0.83; PCFI = 0.65; GFI = 0.84; PGFI = 0.54; RMSEA = 0.14 (p<0.001); ECVI = 1.15 Fi gu e 2. Con i ma o y Fac o Analysis: Final Model χ2(33) = 66.95 (p<0.001); χ2/d = 2.03; CFI = 0.95; PCFI = 0.70; GFI = 0.93; PGFI = 0.56; RMSEA = 0.08 (p=0.05); ECVI = 0.65 ó gão o icial da sociedade po uguesa de euma ologia - a c a e u m a o l p o .2011;36:260-267 265 m. alexand a e ei a- alen e e col. we e co ela ed sequen ially, which esul ed in a new model (Figu e 2) ha main ained all he i ems o he o iginal P-PSEQ. A e aking in o accoun he e o e m co ela- ions, he combined i indices o he CFA, suppo he one ac o solu ion hypo hesized [χ2(33) = 66.95 (p<0.001); χ2/d = 2.03; CFI = 0.95; PCFI = 0.70; GFI = 0.93; PGFI = 0.56; RMSEA = 0.08 (p=0.05); ECVI = 0.65], wi h six o he se en combined i in- dices o he CFA suppo ing his solu ions, wi h accep able o good i . This new model e ealed a goodness o i signi ican ly hi ghe han he ini ial model [χ2(33) = 66.95 (p < 0.001), and ECVI conside - ably di e en : 1.15 s. 0.65]. Co ela ional Analysis Table IV p esen s he Pea son co ela ion coe i- cien s compu ed be ween he P-PSEQ sco e and he c i e ion a iables. As hypo hesized, s a is i- cally signi ican nega i e associa ions we e ound be ween he sel -e icacy sco e and pain in ensi y [ anging be ween -0.27 and -0.32, p < 0.01], pain in- e e ence [ = -0.41, p < 0.01], anxie y [ = -0.39, p < 0.01] and dep ession [ = -0.55, p < 0.01]. Mo e- o e , a s a is ically signi ican posi i e associa ion was ound be ween he P-PSEQ sco e and he SF-12 Physical Heal h sco e [ = 0.51, p < 0.01] and SF-12 Men al Heal h sco e [ = 0.46, p < 0.01]. All o he sig- ni ican associa ions we e in he hypo hesized di- ec ions and showed magni udes ha we e wi hin he an icipa ed anges, wi h he excep ion o anxie - y, which was sligh ly lowe han expec ed, al hough e en o his c i e ion a mode a e associa ion wi h sel -e icacy in he hypo hesized di ec ion was ound. Discussion Consis en wi h p e ious indings o o he e sions o he PSEQ, ou esul s p o ide s ong suppo o he eliabili y and alidi y o he Po uguese PSEQ. I s in e nal consis ency (C onbach’s alpha) is g ea e han 0.80, indica ing good eliabili y. Mo e- o e , i s Composi e Reliabili y coe icien o 0.92 in- dica es excellen eliabili y34,41,42,49. These alues a e simila o hose ound in he o igi nal scale de elop - men sample and o he ansla ed e sions o he measu e4,9,12,14. In addi ion, he esul s o a con i - ma o y ac o analysis suppo a one ac o solu- ion41-46,50 and p o ides u he suppo o a high le el o in e nal consis ency. The co ela ion coe - icien s be ween P-PSEQ scale sco e and c i e ion measu es a e consis en wi h hose ound in p e i- ous s udies4,9,12,14,30, and suppo he alidi y o he P-PSEQ. Consis en wi h p e ious esea ch1,4,5,8-14, ou indings suppo he impo ance o sel -e icacy as a p edic o o adjus men o ch onic pain, gi en i s signi ican associa ions wi h pain in ensi y, phy - sical and psychological unc ioning (pain in e e - ence, anxie y and dep ession), as well as wi h glo - bal quali y o li e and gene al heal h12,15. As a g oup, he indings om he cu en and p e ious s udies sugges ha he concep and e ec s o pain sel -e - icacy a e simila ac oss cul u es, in line wi h he indings a ailable o he e ec s o sel -e icacy be- lie s on pe o mance17,51. The e a e a numbe o s udy limi a ions ha should be conside ed when in e p e ing he in - dings. Fi s , we employed a c oss-sec ional co e- la ional design. As a esul , we we e unable o exa - mine he es - e es s abili y o he P-PSEQ. Also, such a design does no allow o an e alua ion o he causal e ec s o sel -e icacy on unc ioning. Fu - he esea ch is needed o s udy he s abili y o P-PSEQ sco e o e ime, as well as o de e mine he po en ial bene icial e ec s o in e en ions ha in- c ease pain sel -e icacy belie s. Second, he s udy sample was one o con enience. We we e no able o de e mine how ep esen a i e he sample is o Table IV. Co ela ions wi h Measu es o Pain In ensi y, Physical Dys unc ion and Psychological Func ioning Sel -E icacy Scale (P-PSEQ) Pain In ensi y (NRS) Maximum (las 24 hou s) -0.27** Minimum (las 24 hou s) -0.32** A e age Pain -0.28** Pain In e e ence (P-BPI) -0.41** Physical Func ioning (SF-12, PCS) 0.51** Men al Heal h (SF-12, MCS) 0.46** Anxie y (HADS-A) -0.39** Dep ession (HADS-D) -0.55** **p < 0.01 No e: P-PSEQ = Po uguese Pain Sel -E icacy Ques ionnai e; NRS = Nume ical Ra ing Scale o pain in ensi y; P-BPI = Po uguese B ie Pain In en o y – In e e ence scale; HADS-A = Hospi al Anxie y and Dep ession Scale – Anxie y scale; HADS-D = Hospi al Anxie y and Dep ession Scale – Dep ession scale ó gão o icial da sociedade po uguesa de euma ologia - a c a e u m a o l p o .2011;36:260-267 266 po uguese pain sel -e icacy ques ionnai e he popula ion o pa ien s in Po ugal wi h ch o - nic musculoskele al pain. Resea ch is he e o e needed o help es ablish he gene alizabili y o he indings. Thi d, we did no adminis e o he mea- su es o sel -e icacy o help es ablish he con e - gen alidi y o he P-PSEQ. Addi ional esea ch is needed o help de e mine he ex en o o e lap be- ween he P-PSEQ and o he pain sel -e icacy measu es. Ne e heless, ou indings p o ide suppo o he eliabili y and alidi y o he Po uguese PSEQ, and sugges ha he measu e may be use ul o unde s anding he impo ance o he sel -e icacy concep o pain and adjus men o pain in Po - uguese pa ien s wi h ch onic pain, as well as o c oss-cul u al esea ch examining simila i ies and di e ences in he ole ha sel -e icacy plays in pa- ien s om Po ugal and pa ien s om o he coun- ies and cul u es. Acknowledgmen s M. Alexand a Fe ei a-Valen e has ecei ed PhD g an SFRH/BD/ 40956/2007 in he pas yea om he Po - uguese Founda ion o Science and Technology. Co espondence o M. Alexand a Fe ei a-Valen e Rua 25 de Ab il, n.º 5, Idanha – Belas 2605-119 Belas, Po ugal Phone: (00351) 969082988 E-mail: [email p o ec ed] Re e ences 1. A ns ein P. 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