Briony Larance1, Raimondo Bruno2, Nicholas Lintzeris3, Louisa Degenhardt4, Emma Black5, Amanda Brown6, Suzanne Nielsen7, Adrian Dunlop8, Rohan Holland6, Milton Cohen9, Richard P Mattick5. 1. National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia. Electronic address: b.larance@unsw.edu.au. 2. School of Medicine, University of Tasmania, Sandy Bay Campus, Hobart, Tasmania 7001, Australia. 3. The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; University of Sydney, Camperdown, NSW 2050, Australia. 4. National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia; School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia; Department of Global Health, School of Public Health, University of Washington, 325 9th Avenue, Seattle, WA 98104, USA. 5. National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia. 6. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia. 7. National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia; University of Sydney, Camperdown, NSW 2050, Australia. 8. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia; School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. 9. St Vincent's Clinical School, UNSW Australia, Darlinghurst, NSW 2010, Australia.
Abstract
BACKGROUND: Early identification of problems is essential in minimising the unintended consequences of opioid therapy. This study aimed to develop a brief scale that identifies and quantifies recent aberrant behaviour among diverse patient populations receiving long-term opioid treatment. METHOD: 40 scale items were generated via literature review and expert panel (N=19) and tested in surveys of: (i) N=41 key experts, and (ii) N=426 patients prescribed opioids >3 months (222 pain patients and 204 opioid substitution therapy (OST) patients). We employed item and scale psychometrics (exploratory factor analyses, confirmatory factor analyses and item-response theory statistics) to refine items to a brief scale. RESULTS: Following removal of problematic items (poor retest-reliability or wording, semantic redundancy, differential item functioning, collinearity or rarity) iterative factor analytic procedures identified a 10-item unifactorial scale with good model fit in the total sample (N=426; CFI=0.981, TLI=0.975, RMSEA=0.057), and among pain (CFI=0.969, TLI=0.960, RMSEA=0.062) and OST subgroups (CFI=0.989, TFI=0.986, RMSEA=0.051). The 10 items provided good discrimination between groups, demonstrated acceptable test-retest reliability (ICC 0.80, 95% CI 0.60-0.89; Cronbach's alpha=0.89), were moderately correlated with related constructs, including opioid dependence (SDS), depression and stress (DASS subscales) and Social Relationships and Environment domains of the WHO-QoL, and had strong face validity among advising clinicians. CONCLUSIONS: The Opioid-Related Behaviours In Treatment (ORBIT) scale is brief, reliable and validated for use in diverse patient groups receiving opioids. The ORBIT has potential applications as a checklist to prompt clinical discussions and as a tool to quantify aberrant behaviour and assess change over time.
BACKGROUND: Early identification of problems is essential in minimising the unintended consequences of opioid therapy. This study aimed to develop a brief scale that identifies and quantifies recent aberrant behaviour among diverse patient populations receiving long-term opioid treatment. METHOD: 40 scale items were generated via literature review and expert panel (N=19) and tested in surveys of: (i) N=41 key experts, and (ii) N=426 patients prescribed opioids >3 months (222 painpatients and 204 opioid substitution therapy (OST) patients). We employed item and scale psychometrics (exploratory factor analyses, confirmatory factor analyses and item-response theory statistics) to refine items to a brief scale. RESULTS: Following removal of problematic items (poor retest-reliability or wording, semantic redundancy, differential item functioning, collinearity or rarity) iterative factor analytic procedures identified a 10-item unifactorial scale with good model fit in the total sample (N=426; CFI=0.981, TLI=0.975, RMSEA=0.057), and among pain (CFI=0.969, TLI=0.960, RMSEA=0.062) and OST subgroups (CFI=0.989, TFI=0.986, RMSEA=0.051). The 10 items provided good discrimination between groups, demonstrated acceptable test-retest reliability (ICC 0.80, 95% CI 0.60-0.89; Cronbach's alpha=0.89), were moderately correlated with related constructs, including opioid dependence (SDS), depression and stress (DASS subscales) and Social Relationships and Environment domains of the WHO-QoL, and had strong face validity among advising clinicians. CONCLUSIONS: The Opioid-Related Behaviours In Treatment (ORBIT) scale is brief, reliable and validated for use in diverse patient groups receiving opioids. The ORBIT has potential applications as a checklist to prompt clinical discussions and as a tool to quantify aberrant behaviour and assess change over time.
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