OBJECTIVES: We sought to determine a cutoff score for the observational Pain Assessment in Advanced Dementia (PAINAD), to adequately assess pain in clinical nursing home practice and research. DESIGN AND SETTING: We used data from multiple sources. We performed a literature review on PAINAD, performed secondary data analysis of a study examining psychometric properties of PAINAD in nursing home patients with dementia, and performed another study in nursing home patients with dementia specifically aimed at determining a cutoff score for PAINAD. PARTICIPANTS: Patients with dementia in long term care facilities. MEASUREMENTS: We related PAINAD scores (range 0 to 10) to (1) self-reported and proxy-reported pain by global clinical judgment and (2) scores on another pain assessment instrument (DOLOPLUS-2), and (3) we compared scores between painful and supposedly less painful conditions. RESULTS: Findings from this study showed that a cutoff value of 2 should serve as a trigger for a trial with pain treatment. Although the majority of patients scoring 1 or 0 were not in pain, pain could be ruled out. CONCLUSION: Based on the findings of multiple available data sources, we recommend that a PAINAD score of 2 or more can be used as an indicator of probable pain. A score of 1 is a sign to be attentive to possible pain. Future work may focus on cutoff scores for the presence of pain and severe pain in other frequently used pain tools, and on further development of methodology to assess cutoff scores.
OBJECTIVES: We sought to determine a cutoff score for the observational Pain Assessment in Advanced Dementia (PAINAD), to adequately assess pain in clinical nursing home practice and research. DESIGN AND SETTING: We used data from multiple sources. We performed a literature review on PAINAD, performed secondary data analysis of a study examining psychometric properties of PAINAD in nursing home patients with dementia, and performed another study in nursing home patients with dementia specifically aimed at determining a cutoff score for PAINAD. PARTICIPANTS: Patients with dementia in long term care facilities. MEASUREMENTS: We related PAINAD scores (range 0 to 10) to (1) self-reported and proxy-reported pain by global clinical judgment and (2) scores on another pain assessment instrument (DOLOPLUS-2), and (3) we compared scores between painful and supposedly less painful conditions. RESULTS: Findings from this study showed that a cutoff value of 2 should serve as a trigger for a trial with pain treatment. Although the majority of patients scoring 1 or 0 were not in pain, pain could be ruled out. CONCLUSION: Based on the findings of multiple available data sources, we recommend that a PAINAD score of 2 or more can be used as an indicator of probable pain. A score of 1 is a sign to be attentive to possible pain. Future work may focus on cutoff scores for the presence of pain and severe pain in other frequently used pain tools, and on further development of methodology to assess cutoff scores.
Authors: J Osterbrink; M Hufnagel; P Kutschar; B Mitterlehner; C Krüger; Z Bauer; W Aschauer; M Weichbold; E Sirsch; C Drebenstedt; K M Perrar; A Ewers Journal: Schmerz Date: 2012-02 Impact factor: 1.107
Authors: Luis Carlos Escobar Pinzon; Matthias Claus; Klaus Maria Perrar; Kirsten Isabel Zepf; Stephan Letzel; Martin Weber Journal: Dtsch Arztebl Int Date: 2013-03-22 Impact factor: 5.594
Authors: Janine van Kooten; Suzanne Delwel; Tarik T Binnekade; Martin Smalbrugge; Johannes C van der Wouden; Roberto S G M Perez; Didi Rhebergen; Wouter W A Zuurmond; Max L Stek; Frank Lobbezoo; Cees M P M Hertogh; Erik J A Scherder Journal: BMC Geriatr Date: 2015-03-21 Impact factor: 3.921
Authors: Maartje S Klapwijk; Monique A A Caljouw; Mirjam C van Soest-Poortvliet; Jenny T van der Steen; Wilco P Achterberg Journal: BMC Geriatr Date: 2014-09-02 Impact factor: 3.921