Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
In Reply: In response to Mr Roy, we do not
believe that there are inherent biases in our self-report method. We specifically
addressed this issue in our article. In particular, we believe that the self-attribution
method works well for pain-related conditions like headache and back pain
and is less prone to overestimation bias when compared with alternatives.
For instance, we have previously estimated lost productive time by ascribing
all such time to conditions identified by the respondents.1- 3 We
found that such estimates of lost productive time for headache, however, were
higher than in our current study. We do agree that diagnostic validity is
a challenge for other conditions and are currently addressing this issue for
back pain and arthritis using diagnostic questionnaires.
Stewart WF, Ricci JA. Loss of Productive Time Due to Pain—Reply. JAMA. 2004;291(6):694. doi:10.1001/jama.291.6.694-b