Key Findings
- Purpose
To evaluate the criterion validity of the Functional Status Pain Assessment (FSPA), a 10-item functional assessment tool, by examining its relationship with pain intensity and hospital length of stay (LOS) among adults hospitalized with vaso-occlusive crises (VOC). - Population (Model)
Prospective observational study of 561 daily functional and pain assessments collected from 91 adults with sickle cell disease hospitalized on a specialized SCD nursing unit between January 2018 and June 2019. The mean age was 34 ± 12.2 years, 59.3% were female, and just over half had HbSS genotype. - Headline Result
The FSPA did not demonstrate criterion validity for predicting changes in pain intensity or hospital LOS. FSPA scores on the day of discharge explained only 5.69% of the variance in LOS, while FSPA factors explained only 19.66% of the variance in pain intensity. Neither admission nor discharge FSPA scores were significant determinants of LOS. In addition, changes in pain intensity from admission to discharge were not associated with LOS (P = .92). - Why It Matters
Clinicians often rely on pain scores and functional status assessments when discussing readiness for discharge during VOC hospitalizations. This study suggests that neither pain intensity nor FSPA scores adequately explain variation in hospital LOS among adults with SCD. The findings support the authors’ view that hospital stay duration is likely influenced by a broader set of clinical, environmental, psychosocial, and economic factors that are not routinely measured during hospitalization.
- Evidence Gaps & Limitations
The study did not directly measure many factors that may influence LOS, including quality of life, coping strategies, stigma, mental health, self-efficacy, healthcare access, and other contextual variables discussed by the authors. The findings were derived from a single specialized SCD inpatient unit and may not be generalizable to other care settings. Additional research is needed to identify multidimensional measures that better reflect recovery and discharge readiness during VOC admissions.
Source: Journal of Sickle Cell Disease- “Criterion validity of the functional status and pain assessment scale versus pain and length of stay in hospitalized adults with SCD”
Regulatory & Guideline Watch
Current American Society of Hematology guidance for SCD pain management emphasizes comprehensive assessment of acute and chronic pain, incorporating both patient-reported outcomes and clinical judgment. This study highlights the challenges of relying on a single functional assessment tool or pain-intensity measure to guide discharge decisions and underscores the complexity of inpatient VOC management.