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J Pain. 2018 Mar;19(3):317-329. doi: 10.1016/j.jpain.2017.11.006. Epub 2017 Dec 2.

Dimensionality and Reliability of the Central Sensitization Inventory in a Pooled Multicountry Sample.

Author information

1
Department of Physiotherapy of the Faculty of Health Science at the University of Malaga, IBIMA, Málaga, Spain; Faculty of Health at the Queensland University of Technology, Brisbane, Australia. Electronic address: acuesta@uma.es.
2
PRIDE Research Foundation, Dallas, Texas.
3
Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands; Amsterdam Public Health, Amsterdam, The Netherlands.
4
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Pain in Motion International Research Group, Brussels, Belgium.
5
Pain in Motion International Research Group, Brussels, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.
6
Pain in Motion International Research Group, Brussels, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Transcare; transdisciplinary pain center, The Netherlands.
7
Neuro Musculo Skeletal Lab, Institute of clinical research (IREC), Université Catholique de Louvain, Brussels, Belgium; Department of Oral and Maxillofacial Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
8
Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia.
9
Department of Psychology, College of Science, University of Texas at Arlington, Arlington, Texas.
10
Department of Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
11
FACEit, Italian Association of Integrated Therapy for Cervico-Cranio-Facial Pain and Dysfunction, Italy; Department of Biomedical Sciences, University of Padova, Padova, Italy; Studio Fisioterapico Viti, Bologna, Italy.
12
Department of Physiotherapy of the Faculty of Health Science at the University of Malaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain.
13
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy.
14
Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Anesthesiologist, Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre, Laboratory of Pain and Neuromodulation at UFRGS, Porto Alegre, Brazil; Pain and Anesthesia in Surgery Department, School of Medicine, UFRGS, Porto Alegre, Brazil.
15
Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
16
Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain.

Abstract

Central sensitization (CS) involves the amplification of neural signaling within the central nervous system, which evokes pain hypersensitivity. The Central Sensitization Inventory (CSI) assesses 25 overlapping health-related symptom dimensions that have been reported to be associated with CS-related disorders. Previous studies have reported satisfactory test-retest reliability and internal consistency, but factor analyses have exhibited conflicting results in different language versions. The purpose of this cross-sectional study was to thoroughly examine the dimensionality and reliability of the CSI, with pooled data from 1,987 individuals, collected in several countries. The principal component analysis suggested that 1 general factor of CS best described the structure. A subsequent confirmatory factor analysis revealed that a bifactor model, which accounted for the covariance among CSI items, with regard to 1 general factor and 4 orthogonal factors, fit the CSI structure better than the unidimensional and the 4-factor models. Additional analyses indicated substantial reliability for the general factor (ie, Cronbach α = .92; ω = .95; and ω hierarchical = .89). Reliability results for the 4 specific factors were considered too low to be used for subscales. The results of this study clearly suggest that only total CSI scores should be used and reported.

PERSPECTIVE:

As far as we know, this is the first study that has examined the factor structure and reliability of the CSI in a large multicountry sample. The CSI is currently considered the leading self-report measure of CS-related symptoms worldwide.

KEYWORDS:

Central Sensitization Inventory; central sensitivity syndrome, chronic pain, psychometrics; central sensitization; multicountry sample

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