Miriam Kunz1,2, Margot W M de Waal3, Wilco P Achterberg3, Lydia Gimenez-Llort4, Frank Lobbezoo5, Elisabeth L Sampson6, Annelore H van Dalen-Kok3, Ruth Defrin7, Sara Invitto8, Ljubica Konstantinovic9, Joukje Oosterman10, Laura Petrini11, Jenny T van der Steen3, Liv-Inger Strand12, Marina de Tommaso13, Sandra Zwakhalen14, Bettina S Husebo15, Stefan Lautenbacher16. 1. Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany. 2. Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 3. Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. 4. Department of Psychiatry and Forensic Medicine, Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain. 5. Department of Orofacial Pain & Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands. 6. Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK. 7. Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel. 8. Department of Biological and Environmental Science and Technologies, DiSTeBA, University of Salento, Lecce, Italy. 9. Faculty of Medicine, University of Belgrade, Clinic for Rehabilitation "Dr Miroslav Zotovic", Belgrade, Serbia. 10. Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands. 11. Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. 12. Department of Global Public Health and Primary Care, Physiotherapy Research Group, Faculty of Medicine, University of Bergen, Bergen, Norway. 13. Applied neurophysiopathology and Pain Unit, Aldo Moro University, Bari, Italy. 14. Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands. 15. Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway. 16. Physiological Psychology, University of Bamberg, Bamberg, Germany.
Abstract
BACKGROUND: Over the last decades, a considerable number of observational scales have been developed to assess pain in persons with dementia. The time seems ripe now to build on the knowledge and expertize implemented in these scales to form an improved, "best-of" meta-tool. The EU-COST initiative "Pain in impaired cognition, especially dementia" aimed to do this by selecting items out of existing observational scales and critically re-assessing their suitability to detect pain in dementia. This paper reports on the final phase of this collaborative task. METHODS: Items from existing observational pain scales were tested for "frequency of occurrence (item difficulty)," "reliability" and "validity." This psychometric testing was carried out in eight countries, in different healthcare settings, and included clinical as well as experimental pain conditions. RESULTS: Across all studies, 587 persons with dementia, 27 individuals with intellectual disability, 12 Huntington's disease patients and 59 cognitively healthy controls were observed during rest and movement situations or while receiving experimental pressure pain, respectively. The psychometric outcomes for each item across the different studies were evaluated within an international and multidisciplinary team of experts and led a final selection of 15 items (5x facial expressions, 5x body movements, 5x vocalizations). CONCLUSIONS: The final list of 15 observational items have demonstrated psychometric quality and clinical usefulness both in their former scales and in the present international evaluation; accordingly, they qualified twice to form a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition, the PAIC-15 scale. SIGNIFICANCE: Using a meta-tool approach by building on previous observational pain assessment scales and putting the items of these scales through rigorous empirical testing (using experimental as well as clinical pain studies in several European countries), we were able to identify the best items for pain assessment in individuals with impaired cognition. These selected items form the novel PAIC15 scale (pain assessment in impaired cognition, 15 items).
BACKGROUND: Over the last decades, a considerable number of observational scales have been developed to assess pain in persons with dementia. The time seems ripe now to build on the knowledge and expertize implemented in these scales to form an improved, "best-of" meta-tool. The EU-COST initiative "Pain in impaired cognition, especially dementia" aimed to do this by selecting items out of existing observational scales and critically re-assessing their suitability to detect pain in dementia. This paper reports on the final phase of this collaborative task. METHODS: Items from existing observational pain scales were tested for "frequency of occurrence (item difficulty)," "reliability" and "validity." This psychometric testing was carried out in eight countries, in different healthcare settings, and included clinical as well as experimental pain conditions. RESULTS: Across all studies, 587 persons with dementia, 27 individuals with intellectual disability, 12 Huntington's disease patients and 59 cognitively healthy controls were observed during rest and movement situations or while receiving experimental pressure pain, respectively. The psychometric outcomes for each item across the different studies were evaluated within an international and multidisciplinary team of experts and led a final selection of 15 items (5x facial expressions, 5x body movements, 5x vocalizations). CONCLUSIONS: The final list of 15 observational items have demonstrated psychometric quality and clinical usefulness both in their former scales and in the present international evaluation; accordingly, they qualified twice to form a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition, the PAIC-15 scale. SIGNIFICANCE: Using a meta-tool approach by building on previous observational pain assessment scales and putting the items of these scales through rigorous empirical testing (using experimental as well as clinical pain studies in several European countries), we were able to identify the best items for pain assessment in individuals with impaired cognition. These selected items form the novel PAIC15 scale (pain assessment in impaired cognition, 15 items).
Authors: Alison R Anderson; W Larkin Iversen; Michael A Carter; Karen O Moss; Ronald L Cowan; Todd B Monroe Journal: J Am Assoc Nurse Pract Date: 2021-03-12 Impact factor: 1.495
Authors: Lydia Giménez-Llort; Maria Luisa Bernal; Rachael Docking; Aida Muntsant-Soria; Virginia Torres-Lista; Antoni Bulbena; Patricia A Schofield Journal: Front Neurol Date: 2020-11-20 Impact factor: 4.003
Authors: Maartje S Klapwijk; Natashe Lemos Dekker; Monique A A Caljouw; Wilco P Achterberg; Jenny T van der Steen Journal: BMC Palliat Care Date: 2020-11-30 Impact factor: 3.234
Authors: Jenny T van der Steen; Andrew Westzaan; Kimberley Hanemaayer; Muhamad Muhamad; Margot W M de Waal; Wilco P Achterberg Journal: Brain Sci Date: 2021-06-29