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Comprehensibility and readability of patient self-administered Opioid Assessment Screening Tools

Lorraine S. Wallace, PhD, Amy J. Keenum, PharmD, DO, Steven E. Roskos, MD


Objective: The aims of this study were to evaluate the cognitive complexity and reading demands of patient self-administered Opioid Assessment Screening Tools (OASTs) for use in adults with nonmalignant pain.
Methods: Using comprehensive search strategies, we identified english-language OASTs with established validity and reliability for inclusion in our study. Cognitive complexity of individual OAST statements or questions were assessed using three techniques (number of items, number of words, and linguistic problems), whereas readability was measured using the Flesch- Kinkaid formula.
Results: Four (n = 4) were identified and included in our review: Current Opioid Misuse Measure (COMM), Pain Medication Questionnaire (PMQ), Screener and Opioid Assessment for Patient with Pain, and Screening Tool for Addiction Risk (STAR). Number of total OAST statements or questions ranged from a low of 14 (STAR) to a high of 26 (PMQ), whereas number of words (length) per statement or question averaged from a low of 10.2 ± 1.1 (STAR) to a high of 15.9 ± 3.8 (PMQ). The STAR (1.3 ± 1.1) had the fewest number of linguistic problems per statement or question, whereas the PMQ (3.0 ± 1.4) had the most linguistic problems per statement or question. Although, readability of OASTs ranged from approximately sixth (STAR) to eighth (COMM, PMQ) grade, there was notable variation in readability across individual statements or questions.
Conclusions: Our study demonstrates that formatting characteristics, including linguistic problems, and high readability of several OAST statements or questions may hinder many patients’ ability to accurately complete and comprehend OASTs independently.


aberrant drug behaviors, addiction, assessment, chronic pain, opioids, screening

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