Popular measures for presurgical evals

[LadyHalcyon]

I've been doing more of these recently and was wondering what measures people are using. Right now I'm doing the mmpi and the chronic pain coping inventory, but I don't feel like the CPCI is giving me enough info.

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[deleted343839]

Depends on the surgery. Are you talking about spinal cord stimulator evaluations?

 

[LadyHalcyon]

Depends on the surgery. Are you talking about spinal cord stimulator evaluations?

Yes

 

[Justanothergrad]

I assume you mean RF when you say MMPI.

 

[PsyDr]

MBMD

McGill for malingering

Psychosocial Pain Inventory, although it’s norms are supper outdated but the reinforcing aspects of pain ala fordyce is useful on a qualitative level.

 

[LadyHalcyon]

I assume you mean RF when you say MMPI.

I mean the first 370 questions of mmpi-2

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[deleted343839]

I mean the first 370 questions of mmpi-2

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Look up Andy Block's study on using the MMPI-2-RF in this population.

 

[AcronymAllergy]

Second recs for the RF and MBMD. And there's the WHYMPI.

 

[Justanothergrad]

I mean the first 370 questions of mmpi-2

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I'm not sure what you mean by this? you're doing an abbreviated mmpi-2 report?

As mentioned, check out Blocks work on the mmpi-2-rf if you dont know it already.

 

[LadyHalcyon]

I'm not sure what you mean by this? you're doing an abbreviated mmpi-2 report?

As mentioned, check out Blocks work on the mmpi-2-rf if you dont know it already.

Yes. It is fairly common to do this and in one of the studies I reviewed they even suggested administering only the first 370 due to back pain from sitting for extended periods of time. The RF is expensive, so I doubt I will purchase it just for these evals. At least not right now.

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[Justanothergrad]

Yes. It is fairly common to do this and in one of the studies I reviewed they even suggested administering only the first 370 due to back pain from sitting for extended periods of time. The RF is expensive, so I doubt I will purchase it just for these evals. At least not right now.

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I would not say that is a widely help belief within the MMPI community in terms of good assessment quality.

 

[LadyHalcyon]

Anyone ever use the BHI-2?

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[PsyDr]

Anyone ever use the BHI-2?

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Yeah, Bruns is super smart.

 

[bcliff]

You can supplement the CPCI with the SOPA if you want more information on pain attitudes.

FWIW, when I've seen an MMPI used in an assessment report (predominantly neuropsych), I can't think of any instances where the version used has been anything other than the MMPI-2-RF -- That might be idiosyncratic, but I mention it to underscore that the -RF is likely a solid investment if you're doing a lot of assessment work, even if it's assessment work with non-pain/pre-surg patients.

In terms of using the first 370 questions of the MMPI, I'd be wary of deviating too far from standard administration practices (e.g., having to defend uncommon methodology in court) -- I don't know the literature at all on this practice, so I don't how empirically/psychometrically sound of a decision it is. IMO, the peace of mind that I would enjoy from using something well validated like the RF would likely be worth the initial cost of purchasing it.

 

[LadyHalcyon]

You can supplement the CPCI with the SOPA if you want more information on pain attitudes.

FWIW, when I've seen an MMPI used in an assessment report (predominantly neuropsych), I can't think of any instances where the version used has been anything other than the MMPI-2-RF -- That might be idiosyncratic, but I mention it to underscore that the -RF is likely a solid investment if you're doing a lot of assessment work, even if it's assessment work with non-pain/pre-surg patients.

In terms of using the first 370 questions of the MMPI, I'd be wary of deviating too far from standard administration practices (e.g., having to defend uncommon methodology in court) -- I don't know the literature at all on this practice, so I don't how empirically/psychometrically sound of a decision it is. IMO, the peace of mind that I would enjoy from using something well validated like the RF would likely be worth the initial cost of purchasing it.

I worked at a forensic center and my supervisor commonly used thr abbreviated version. She went to court regularly. I typically don't use the mmpi-2, as I prefer the PAI. But for these evaluations I think the mmpi is better. I am confused as to why everyone seems to prefer the RF....

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[LadyHalcyon]

Yeah, Bruns is super smart.

I think I'm going to buy it. They have a medical risk interpretive report that seems useful

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[bcliff]

I worked at a forensic center and my supervisor commonly used thr abbreviated version. She went to court regularly. I typically don't use the mmpi-2, as I prefer the PAI. But for these evaluations I think the mmpi is better. I am confused as to why everyone seems to prefer the RF....

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In terms of preference for the -RF, I'm not sure if you mean about presurgical evaluations specifically or just in general.

In general, my understanding (which is limited to that of a trainee) is that the MMPI-2-RF possesses greater reliability (e.g., interrater) and validity (e.g., construct) than the MMPI-2. One reason for this is that a lot of the "noise" (e.g., demoralization) has been pulled out and each scale better reflects the underlying construct that it is purported to measure (e.g., RC2 and depression, etc.) -- Descriptors for MMPI-2-RF interpretation are therefore more standardized, which both simplifies interpretation and report writing as well as the prospect of having to defend or justify interpretation in a legal setting.

The -RF is obviously shorter than the MMPI-2 and its psychometric properties have been extensively examined -- From what I can tell (based on 5 minutes of Google Scholaring), it doesn't seem like the psychometric properties of the "MMPI-2-370," have been very extensively examined. So, personally, I would feel uncomfortable having to defend that measure in a courtroom, but that's just my opinion.

I imagine that consensus regarding the -RF in presurgical evaluations reflects some of these reasons, but there may be other specific reasons for its use in this context that I didn't mention here. Using the first 370 items from the MMPI-2 is also not something I've spent a lot of time researching, so maybe there is a more robust literature base that I'm just not aware of/familiar with.

 

[BuckeyeLove]

I worked at a forensic center and my supervisor commonly used thr abbreviated version. She went to court regularly. I typically don't use the mmpi-2, as I prefer the PAI. But for these evaluations I think the mmpi is better. I am confused as to why everyone seems to prefer the RF....

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The no cross loading is enough for me to almost always go to it. and I am FAR from a big ben-porath guy.

 

[LadyHalcyon]

For those interested, the first 370 yields the following: L, F, and K, the clinical scales, the Harris-Lingoes, and Si subscales. I didn't intend for this post to turn into a discussion about this. I think it's personal preference and largely related to what people have been exposed to during training. As I mentioned previously, I'm on a budget and I don't think the RF would be a good purchase for me when I already have the mmpi-2. I appreciate the suggestions.

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[Justanothergrad]

I worked at a forensic center and my supervisor commonly used thr abbreviated version. She went to court regularly. I typically don't use the mmpi-2, as I prefer the PAI. But for these evaluations I think the mmpi is better. I am confused as to why everyone seems to prefer the RF....

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Because the literature base is way better all around (in terms of recency and strength of finding), as well as specific to spinal cord evals.

 

[deleted343839]

I am confused as to why everyone seems to prefer the RF....

In addition it being a more psychometrically sound test, and other reasons noted in the replies, there is also the issue of user friendliness. Interpretation is more straightforward than the old code type system.

But if you're going to use another test for now, perhaps you can hold out until MMPI-3 comes out in a year or so.

 

[LadyHalcyon]

In addition it being a more psychometrically sound test, and other reasons noted in the replies, there is also the issue of user friendliness. Interpretation is more straightforward than the old code type system.

But if you're going to use another test for now, perhaps you can hold out until MMPI-3 comes out in a year or so.

Oh really? I didn't know that. I hope it is good, and shorter!

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[erg923]

I'm genuinely curious about this, as I have done bariatric in the past but not dorsal column stims. I didn't do MMPI's (at least routinely) in my bariatric evals. I would think with these we are looking at much of the same issue (expectations and mental health issues that would affect benefit and ability to adhere?) but maybe with much more focus on substance abuse vulnerability and history? Maybe things like externalizing and paranoia? I really don't know the pain/pain psych area. Are we using the MMPI mainly for its validity scales here? Is it a CYA thing? I mean, MMPI profiles can be a total hot mess in pretty functional peeps, right?

 

[LadyHalcyon]

I'm genuinely curious about this, as I have done bariatric in the past but not dorsal column stims. I didn't do MMPI's (at least routinely) in my bariatric evals. I would think with these we are looking at much of the same issue (expectations and mental health issues that would affect benefit and ability to adhere?) but maybe with much more focus on substance abuse vulnerability and history? Maybe things like externalizing and paranoia? I really don't know the pain/pain psych area. Are we using the MMPI mainly for its validity scales here? Is it a CYA thing? I mean, MMPI profiles can be a total hot mess in pretty functional peeps, right?

Part of it is a CYA thing. I know the insurance companies around here want one. As for the Mmpi, chronic back pain patients typically elevate on the first three scales. I also always look for the conversion V, as that is indicative of a poorer prognosis. Substance use should definitely be ruled out, although anxiety and depression don't necessarily mean someone is a bad candidate. Borderline is obviously no good, as are unrealistic expectations and unhelpful pain coping strategies. PTSD is one of the main things insurance companies and physicians are worried about. I was told by my colleague that one patient with PTSD once clawed the stim out of his body.

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[BuckeyeLove]

I was told by my colleague that one patient with PTSD once clawed the stim out of his body

This is legit horrifying. Seen this a few times with psychotic folks on my unit, but never heard about it being solely resultant of a trauma response.

 

[LadyHalcyon]

This is legit horrifying. Seen this a few times with psychotic folks on my unit, but never heard about it being solely resultant of a trauma response.

I do sometimes see psychosis, not full blown, with severe ptsd. But yes, terrifying nonetheless!

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[PsyDr]

I'm genuinely curious about this, as I have done bariatric in the past but not dorsal column stims. I didn't do MMPI's (at least routinely) in my bariatric evals. I would think with these we are looking at much of the same issue (expectations and mental health issues that would affect benefit and ability to adhere?) but maybe with much more focus on substance abuse vulnerability and history? Maybe things like externalizing and paranoia? I really don't know the pain/pain psych area. Are we using the MMPI mainly for its validity scales here? Is it a CYA thing? I mean, MMPI profiles can be a total hot mess in pretty functional peeps, right?

The literature highly associates various psychological factors with surgical outcomes. And pain is defined as a psychological phenomenon, not a physiological one.

 

[WisNeuro]

The literature highly associates various psychological factors with surgical outcomes. And pain is defined as a psychological phenomenon, not a physiological one.

Pssh, just tell someone angling for Dilaudid that pain perception is generally more variable due to psychological factors than physiological ones.