1
|
Rapetti R, Franchino EC, Visca S, Riccomagno E, Porro F, Vittonetto D, Piacenza A. Observed and Perceived Pain: Findings of a Cross-Sectional Study in Hospitalized Subjects. Pain Manag Nurs 2024; 25:131-136. [PMID: 37923597 DOI: 10.1016/j.pmn.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Pain constitutes a serious problem of a health, economic, ethical, and social equity nature affecting negatively quality of life. Its assessment is often subjected to overestimation or underestimation. AIM The aim of this study is threefold: (1) to estimate the prevalence of pain in hospitalized patients; (2) to assess the grade of correlation between the level of pain observed by the nurses and the pain perceived by the patients; and (3) to examine the level of scientific knowledge among the healthcare professionals. DESIGN Cross-sectional study. METHODS The intensity level of observed and perceived pain has been evaluated in 401 patients with validated scales. Analyzed data have been extracted from the electronic medical record and integrated into the data-collection sheet. A questionnaire has been submitted to nurses to investigate their level of knowledge on pain assessment and management. RESULTS The study included 350 patients out of 401; for 51 patients the "pain" data was missing. Prevalence of perceived pain was 40.15%. Nurses overestimated pain in 7.43% of cases and underestimated it in 24.9%. The majority of the nursing staff claimed to be aware of the pain topic, however, they showed some uncertainties in clinical practice. CONCLUSIONS The differential variation between the observed pain and the perceived one resulted in 43.71% of cases, highlighting the dependence on the two variables: "area of hospitalization" and "intensity level". The observation and monitoring of pain did not appear to be a consolidated practice, thus representing an important area for investments in the nursing profession.
Collapse
Affiliation(s)
| | | | | | - Eva Riccomagno
- Department of Mathematics, University of Genoa, Genova, Italy
| | - Francesco Porro
- Department of Mathematics, University of Genoa, Genova, Italy
| | | | - Alberto Piacenza
- Local Healthcare Unit, Savona, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy.
| |
Collapse
|
2
|
Dunford E, West E, Sampson EL. Psychometric evaluation of the Pain Assessment in Advanced Dementia scale in an acute general hospital setting. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5830. [PMID: 36317464 PMCID: PMC9828226 DOI: 10.1002/gps.5830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/16/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with dementia are at risk of unplanned hospital admissions and commonly have painful conditions. Identifying pain is challenging and may lead to undertreatment. The psychometric properties of the Pain Assessment in Advanced Dementia (PAINAD) scale, in medical inpatients with dementia have not been evaluated. METHODS A secondary data analysis from a longitudinal study of 230 people with dementia admitted to two acute general hospitals in London, UK. Internal consistency, inter-rater reliability, test-retest reliability, concurrent validity, construct validity and discriminant validity of PAINAD were tested at rest and in movement. RESULTS This predominantly female (65.7%) sample had a mean age of 87.2 (Standard Deviation; SD = 5.92) years. Inter-rater reliability showed an intra-class correlation (ICC) of 0.92 at rest and 0.98 in movement, test-retest reliability ICC was 0.54 at rest and 0.66 in movement. Internal consistency was 0.76 at rest and 0.80 in movement (Cronbach's α). Concurrent validity was weak between PAINAD and a self-rating level of pain (Kendall's Tau; τ = 0.29; p > 0.001). There was no correlation between PAINAD and a measure of behavioural and psychological symptoms of dementia, suggesting no evidence of convergent validity. PAINAD scores were higher during movement than rest, providing evidence of discriminant validity (z = -8.01, p < 0.001). CONCLUSIONS We found good inter-rater reliability and internal consistency. The test-retest reliability was modest. This study raises concerns about the validity of the PAINAD in general acute hospitals. This provides an insight into pain assessment in general acute hospitals which may inform further refinements of the PAINAD.
Collapse
Affiliation(s)
- Emma Dunford
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUCLLondonUK
| | - Emily West
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUCLLondonUK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUCLLondonUK,Department of Psychological MedicineEast London NHS Foundation TrustRoyal London HospitalLondonUK
| |
Collapse
|
3
|
Aiello EN, D’Iorio A, Montemurro S, Maggi G, Giacobbe C, Bari V, Di Tella GS, Pischedda F, Bolognini N, Appollonio I, Arcara G, Santangelo G. Psychometrics, diagnostics and usability of Italian tools assessing behavioural and functional outcomes in neurological, geriatric and psychiatric disorders: a systematic review. Neurol Sci 2022; 43:6189-6214. [PMID: 35932375 PMCID: PMC9616758 DOI: 10.1007/s10072-022-06300-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Abstract
Background Psychometric instruments assessing behavioural and functional outcomes (BFIs) in neurological, geriatric and psychiatric populations are relevant towards diagnostics, prognosis and intervention. However, BFIs often happen not to meet methodological-statistical standards, thus lowering their level of recommendation in clinical practice and research. This work thus aimed at (1) providing an up-to-date compendium on psychometrics, diagnostics and usability of available Italian BFIs and (2) delivering evidence-based information on their level of recommendation. Methods This review was pre-registered (PROSPERO ID: CRD42021295430) and performed according to PRISMA guidelines. Several psychometric, diagnostic and usability measures were addressed as outcomes. Quality assessment was performed via an ad hoc checklist, the Behavioural and Functional Instrument Quality Assessment. Results Out of an initial N = 830 reports, 108 studies were included (N = 102 BFIs). Target constructs included behavioural/psychiatric symptoms, quality of life and physical functioning. BFIs were either self- or caregiver-/clinician-report. Studies in clinical conditions (including neurological, psychiatric and geriatric ones) were the most represented. Validity was investigated for 85 and reliability for 80 BFIs, respectively. Criterion and factorial validity testing were infrequent, whereas content and ecological validity and parallel forms were almost never addressed. Item response theory analyses were seldom carried out. Diagnostics and norms lacked for about one-third of BFIs. Information on administration time, ease of use and ceiling/floor effects were often unreported. Discussion Several available BFIs for the Italian population do not meet adequate statistical-methodological standards, this prompting a greater care from researchers involved in their development. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06300-8.
Collapse
|
4
|
Smith TO, Harvey K. Psychometric properties of pain measurements for people living with dementia: a COSMIN systematic review. Eur Geriatr Med 2022; 13:1029-1045. [PMID: 35622210 PMCID: PMC9553783 DOI: 10.1007/s41999-022-00655-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Detecting pain in older people with dementia is challenging. Consequentially, pain is often under-reported and under-treated. There remains uncertainty over what measures should be promoted for use to assess pain in this population. The purpose of this paper is to answer this question. METHODS A search of clinical trials registered on the ClinicalTrial.gov and ISRCTN registries was performed to identify outcome measures used to assess pain in people with dementia. Following this, a systematic review of published and unpublished databases was performed to 01 November 2021 to identify papers assessing the psychometric properties of these identified measures. Each paper and measure was assessed against the COSMIN checklist. A best evidence synthesis analysis was performed to assess the level of evidence for each measure. RESULTS From 188 clinical trials, nine outcome measures were identified. These included: Abbey Pain Scale, ALGOPLUS, DOLOPLUS-2, Facial Action Coding System, MOBID-2, self-reported pain through the NRS or VAS/thermometer or Philadelphia Geriatric Pain Intensity Scale, PACSLAC/PACSLAC-2, Pain Assessment in Advanced Dementia (PAINAD), and Checklist for non-verbal pain behavior (CNPI). From these, 51 papers (5924 people with dementia) were identified assessing the psychometric properties of these measures. From these, there was strong- and moderate-level evidence to support the use of the facial action coding system, PACSLAC and PACSLAC-II, CNPI, DOLOPLUS-2, ALGOPLUS, MOBID, and MOBID-2 tools for the assessment of pain with people living with dementia. CONCLUSION Whilst these reflect measurement tools used in research, further consideration on how these reflect clinical practice should be considered. PROSPERO REGISTRATION CRD42021282032.
Collapse
Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, OX3 7LD, UK.
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Karmen Harvey
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| |
Collapse
|
5
|
Abstract
BACKGROUND Pain is an important symptom in wound management, and the choice of treatment directly affects the patient's quality of life. Pain assessment (PA) is essential for quality wound care and, in Italy, mandatory by law. OBJECTIVE To administer a dedicated learning survey to obtain a better sense of current PA practices, ensure more training, improve procedures, and reduce malpractice. METHODS A 16-month learning survey of nurses based on a validated questionnaire developed for this project. RESULTS The survey sample comprised 512 questionnaires. Of respondents, 78% were female, 56.1% were older than 40 years, 94% were RNs, and 6% were wound care specialist nurses. Participants performed a range of dressing changes per week (1-5, 46.3%; 6-20, 34.4%; >21, 19.3%). Although 93% of respondents considered PA important, only 26% recognized it as a vital parameter, and barely one-quarter (25.4%) were aware of current legislation mandating PA. The majority (95.3%) believed that PA is not consistent with pain perceived by the patient. Further, 87.3% stated that they did not have adequate knowledge to conduct a PA, 91.4% did not consider themselves up-to-date on PA, and 81% did not document PA results. However, specific wound care training leads to significantly better PA (P < .001): 71.9% of wound care specialist nurses recognized pain as a vital parameter, and 59.4% were aware of current legislation regarding PA; further, 81.3% consistently evaluated pain, 59.4% documented PA results, and 50% communicated the outcome to the physician in charge. CONCLUSIONS The results illustrate the lack of sensitivity, training, and education that Italian RNs have regarding PA in wound care.
Collapse
|
6
|
Cantón-Habas V, Carrera-González MDP, Moreno-Casbas MT, Rich-Ruiz M. Spanish adaptation and validation of the Pain Assessment Scale in Advanced Dementia (PAINAD) in patients with dementia and impaired verbal communication: cross-sectional study. BMJ Open 2021; 11:e049211. [PMID: 34158307 PMCID: PMC8220480 DOI: 10.1136/bmjopen-2021-049211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to adapt and validate the Pain Assessment in Advanced Dementia (PAINAD) scale in Spanish. DESIGN Cross-sectional observational study. SETTING Two health districts of Andalusian provinces, located in the south of Spain, through the Andalusian network of Primary Healthcare centres and four institutions dedicated to the care of patients with dementia. PARTICIPANTS A total of 100 older people, with a medical diagnosis of dementia and a score on the Global Deterioration Scale between 5 and 7 were assessed using the PAINAD scale. PRIMARY AND SECONDARY OUTCOME MEASURES Psychometric properties including content validity, construct validity and reliability of the scale have been tested. RESULTS The overall Item Content Validity Index was excellent (0.95). Regarding construct validity, it was confirmed that a lower use of analgesics implied a lower score on the PAINAD scale (p<0.05). The internal consistency of the scale was 0.76 and it increases to 0.81 if we remove the breathing item. Furthermore, the intraclass correlation coefficient (ICC) used to assess interobserver reliability was 0.94, whereas the ICC used to assess temporary stability was 0.55. CONCLUSIONS The Spanish version of the PAINAD scale is a valid tool to assess pain in patients with dementia and inability to communicate verbally.
Collapse
Affiliation(s)
- Vanesa Cantón-Habas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Cordoba, Spain
| | - María Del Pilar Carrera-González
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Cordoba, Spain
- Experimental and Clinical Physiopathology Research Group, Department of Health Sciences, University of Jaen Faculty of Experimental Sciences, Jaen, Spain
| | - María Teresa Moreno-Casbas
- Ciber Fragility and Healthy Aging (CIBERFES), Madrid, Spain
- Instituto de Salud Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
| | - Manuel Rich-Ruiz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Cordoba, Spain
- Ciber Fragility and Healthy Aging (CIBERFES), Madrid, Spain
- Instituto de Salud Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
| |
Collapse
|
7
|
Reliability and Feasibility of the Pain Assessment in Advanced Dementia Scale-Korean Version (PAINAD-K). Pain Manag Nurs 2021; 22:660-667. [PMID: 33676858 DOI: 10.1016/j.pmn.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/24/2021] [Accepted: 01/31/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND There is currently no observational instrument for assessing pain in aged patients who are unable to provide self-report in long-term care hospitals in Korea. AIMS The goal of this research was to culturally adapt and test the validity, reliability, and feasibility of the Korean version of the Pain Assessment in Advanced Dementia Scale. DESIGN This was a methodologic study aiming to translate the Pain Assessment in Advanced Dementia Scale. PARTICIPANTS/SUBJECTS The inpatients in a 270-bed LTC hospital in D metropolitan city were assessed pain levels. METHODS The Pain Assessment in Advanced Dementia (PAINAD) Scale was used as an observation scale to assess 192 long-term care hospital patients, with observation durations of 1 and 5 minutes. RESULTS The interrater reliability (1 minute) for the scale showed substantial kappa agreement of .62, and scores for the 1- and 5-minute observations showed almost perfect agreement of .95. The criterion validity of the scale (1 minute) was high relative to the Face-Legs-Activity-Cry-Consolability (FLACC) Scale, and low compared with the numeric rating scale (NRS). Discriminant validity was established between patients with and without pain. The feasibility of the Pain Assessment in Advanced Dementia Scale-Korean Version (PAINAD-K) (1 minute) indicated low sensitivity of 41.3% and high specificity of 92.6%. CONCLUSIONS Therefore, the PAINAD-K is a valid and reliable tool to determine the absence of pain in non-verbal aged patients.
Collapse
|
8
|
Natavio T, McQuillen E, Dietrich MS, Wells N, Rhoten BA, Vallerand AH, Monroe TB. A Comparison of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD). Pain Manag Nurs 2020; 21:502-509. [DOI: 10.1016/j.pmn.2020.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/16/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
|
9
|
Gazineo D, Chiari P, Chiarabelli M, Morri M, D'Alessandro F, Sabattini T, Ambrosi E, Forni C. Predictive factors for category II pressure ulcers in older patients with hip fractures: a prospective study. J Wound Care 2020; 28:593-599. [PMID: 31513499 DOI: 10.12968/jowc.2019.28.9.593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify the incidence of category II or higher hospital-acquired pressure ulcers (HAPU) and significantly associated factors in older patients with hip fractures. PUs are a frequent complication in hip fracture patients, negatively impacting patients' quality of life, the health-care system and society. METHOD A prospective cohort study was conducted. A consecutive sample of patients with pertrochanteric, femoral neck or subtrochanteric fractures requiring surgical treatment, were included. A stepwise, multiple regression was performed to identify factors associated with PU development. RESULTS A total of 761 patients aged ≥65 years were sampled. The incidence of category II or higher PUs was 12%. The study identified five factors that were significantly, independently associated with category II or higher PU development, including a higher preoperative Braden score (Hazard Ratio [HR]: 0.884; 95% confidence interval [CI]: 0.806-0.969), surgical procedure with osteosynthesis (HR 1.876; 95%CI: 1.183-2.975), a higher percentage of days with the presence of foam valve before surgery (HR: 1.010; 95%CI: 1.010-1.023) and a urinary catheter (HR: 1.013; 95%CI: 1.006-1.019) and diaper (HR: 1.007; 95% CI 1.001-1.013) in the postoperative period. CONCLUSION Attention should be given by clinical staff to avoiding the use of foam valves, to limiting the use of diapers and to early removal of urinary catheters.
Collapse
Affiliation(s)
- Domenica Gazineo
- Evidence-based Nursing Centre, Azienda Ospedaliero-Universitaria, Via Albertoni 15, 40138, Bologna, Italy
| | - Paolo Chiari
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Matteo Chiarabelli
- Cardio-thoracic vascular Department, Azienda Ospedaliero-Universitaria, Via Massarenti 9, 40138, Bologna, Italy
| | - Mattia Morri
- Rizzoli Orthopedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| | | | - Tania Sabattini
- Rizzoli Orthopedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| | - Elisa Ambrosi
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Cristiana Forni
- Rizzoli Orthopedic Institute, Via Pupilli 1, 40136, Bologna, Italy
| |
Collapse
|
10
|
Spannella F, Giulietti F, Damiani E, Faloia L, Stronati M, Venezia A, Vincenzi P, Castellani D, Boccoli G, Dellabella M, Giampieri M, Sarzani R, Starnari R. Thoracic continuous spinal anesthesia for high-risk comorbid older patients undergoing major abdominal surgery: one-year experience of an Italian geriatric hospital. Minerva Anestesiol 2020; 86:261-269. [DOI: 10.23736/s0375-9393.19.13896-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
11
|
Muñoz-Narbona L, Cabrera-Jaime S, Lluch-Canut T, Castaño PB, Roldán-Merino J. E-Learning course for nurses on pain assessment in patients unable to self-report. Nurse Educ Pract 2020; 43:102728. [PMID: 32126502 DOI: 10.1016/j.nepr.2020.102728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 10/25/2022]
Abstract
Public hospitals in Catalonia, Spain, have recommended assessing pain in non-communicative inpatients by means of the Spanish version of the Pain Assessment in Advanced Dementia scale (PAINAD-Sp) since 2010; a modification for patients with neurologic disorders and cancer, PAINAD-Sp_Hosp, has also been validated. However, nurses are not routinely trained in the use of the scales. The aim of this study was to assess knowledge on pain assessment in nurses following an online training course. We surveyed participants prior to the course to determine baseline knowledge of pain and pain assessment. Course material included conceptual content on pain and practical videos demonstrating the scoring system for the PAINAD-Sp_Hosp scale. After completing the course, participants took a multiple choice quiz to test understanding of course content and a satisfaction survey to determine acceptability. Of the 836 nurses invited, 401 participated in the training course; 37.7% reported having no previous specific training on pain, and just 32.2% used the PAINAD-Sp scale regularly. Following the course, virtually all (99%) of the participants passed the quiz. Overall satisfaction among nurses with regard to the training received was 8.6/10. Thus, the e-learning course was effective and acceptable for training nurses on pain assessment using validated tools.
Collapse
Affiliation(s)
- Lucia Muñoz-Narbona
- Clinical Research Coordinator, Institute for Health Science Research Germans Trias I Pujol (IGTP), Department of Neurosciences, Ctra. Canyet s/n, 08916, Badalona, Barcelona, Spain; RETICS Research Group (Redes Temáticas de Investigación Cooperativa en Salud), RD16/0019/0020, Health Institute Carlos III, Av. Monforte de Lemos, 5 28029, Madrid, Spain.
| | - Sandra Cabrera-Jaime
- Corporate Care Management. Institut Català d'Oncologia (ICO). L'Hospitalet de LLobregat, Barcelona, Spain; GRIN Group, IDIBELL, Institute of Biomedical Research, Gran Via de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, University School of Nursing, Health Sciences Campus of Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Teresa Lluch-Canut
- Professor of Psychosocial and Mental Health, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, C/ Feixa Llarga s/n, 08870, Hospitalet de Llobregat, Barcelona, Spain; GEIMAC Research Group (2017-1681): Grupo de Estudios de Invarianza de los Instrumentos de Medida y Análisis del Cambio en los Ámbitos Social y de la Salud), Barcelona, Spain.
| | - Patricia Barroso Castaño
- Acute Pain Nurse, Pain Clinic. University Hospital Germans Trias I Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain.
| | - Juan Roldán-Merino
- GEIMAC Research Group (2017-1681): Grupo de Estudios de Invarianza de los Instrumentos de Medida y Análisis del Cambio en los Ámbitos Social y de la Salud), Barcelona, Spain; Teaching Campus, Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain; GIESS Research Group (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain; GIRISAME Research Group (International Researchers Group of Mental Health Nursing Care), Madrid, Spain; REICESMA Research Group (Red Española Investigación de Enfermería en Cuidados de Salud Mental y Adicciones), Madrid, Spain.
| |
Collapse
|
12
|
Muñoz-Narbona L, Roldán-Merino J, Lluch-Canut T, Juvé-Udina E, Llorca MB, Cabrera-Jaime S. Impact of a Training Intervention on the Pain Assessment in Advanced Dementia (PAINAD) Scale in Noncommunicative Inpatients. Pain Manag Nurs 2019; 20:468-474. [PMID: 31103507 DOI: 10.1016/j.pmn.2019.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/25/2018] [Accepted: 01/29/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Public hospitals in Catalonia (Spain) recommend using the Spanish version of the Pain Assessment in Advanced Dementia (PAINAD-Sp) scale for assessing pain in adult patients unable to self-report. However, since its inclusion in Catalonian nursing care plans in 2010, there have been no training programs for nurses, contributing to its current underuse. AIMS The aim of this study was to assess the impact of a nurse training intervention on the PAINAD-Sp scale in noncommunicative inpatients unable to self-report. DESIGN Before-after study. SETTINGS Two public hospitals in Catalonia (Spain). PARTICIPANTS/SUBJECTS Four hundred and one nurses participated in the training course and 219 patients received PAINAD-Sp assessments. METHODS We used a before-after study design, evaluating the use of the PAINAD-Sp scale over two 6-month periods before and after an online training intervention for nurses in February 2017, in two public hospitals. Data were collected from patient records in each center. The primary outcome was the number of patients receiving PAINAD-Sp assessments during admission. Secondary outcomes were the number of assessments undertaken per patient during admission, the total (0-10) and item-specific (0-2) PAINAD-Sp score, and pharmacologic treatment administered. RESULTS There were 401 nurses who took part in the training program. Over the study period, 219 patients received PAINAD-Sp assessments: 29 in the preintervention period and 190 in the postintervention period (p < .001). Administration of analgesics and antipyretics decreased (p < .001) after the intervention, whereas use of hypnotic drugs and sedatives increased. CONCLUSIONS Theoretical and practical training may be an effective way to improve nurses' approach to identifying, assessing, and managing pain in patients unable to self-report.
Collapse
Affiliation(s)
- Lucia Muñoz-Narbona
- Institute for Health Science Research, Germans Trias I Pujol (IGTP), Department of Neurosciences, Barcelona, Spain; RETICS Research Group (Redes Temáticas de Investigación Cooperativa en Salud), Health Institute Carlos III, Madrid, Spain.
| | - Juan Roldán-Merino
- Teaching Campus Sant Joan de Déu-Fundació Privada School of Nursing, University of Barcelona, Barcelona, Spain; GIES Research Group (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain; GEIMAC Research Group (Gruop Consolidad 2017-1681: Grupo de Estudios de Invarianza de los Instrumentos de Medida y Análisis del Cambio en los Ámbitos Social y de la Salud), Barcelona, Spain; GIRISAME Research Group (International Researchers Group of Mental Health Nursing Care), Madrid, Spain; REICESMA Research Group (Red Española Investigación de Enfermería en Cuidados de Salud Mental y Adicciones), Madrid, Spain
| | - Teresa Lluch-Canut
- GEIMAC Research Group (Gruop Consolidad 2017-1681: Grupo de Estudios de Invarianza de los Instrumentos de Medida y Análisis del Cambio en los Ámbitos Social y de la Salud), Barcelona, Spain; School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Eulàlia Juvé-Udina
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Nursing Research Group (GRIN), IDIBELL, Biomedical Research Institute, Barcelona, Spain
| | | | - Sandra Cabrera-Jaime
- Nursing Research Group (GRIN), IDIBELL, Biomedical Research Institute, Barcelona, Spain; Nursing Research, Institut Català d'Oncologia, Barcelona, Spain; University of Barcelona, University School of Nursing, Health Sciences Campus of Bellvitge, Barcelona, Spain; Care Management, Institut Català d'Oncologia, Barcelona, Spain
| |
Collapse
|
13
|
Validation of the Spanish Version of the Pain Assessment in Advanced Dementia Scale (PAINAD-Sp) in Hospitalized Patients with Neurologic Disorders and Oncologic Patients Unable to Self-Report Their Pain. Pain Manag Nurs 2018; 20:323-330. [PMID: 30425015 DOI: 10.1016/j.pmn.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/31/2018] [Accepted: 08/24/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pain has a significant impact on hospitalized patients and is a quality indicator for nursing care. The Pain Assessment in Advanced Dementia (PAINAD) scale measures pain in people with communication disorders and advanced dementia, but it has not been validated in any other population. AIMS The aim of this study was to validate the Spanish version (PAINAD-Sp) in hospitalized patients with neurologic disorders and in end-of-life cancer patients with difficulty self-reporting. DESIGN The study had two phases: (1) analysis of the content by a committee of experts and (2) a cross-sectional study. SETTINGS We collected phase 2 data from January 2017 to December 2017 in four hospitals in Barcelona: Hospital Germans Trias i Pujol, Institut Català d'Oncologia, Hospital Vall d'Hebron, and Hospital de Bellvitge. PARTICIPANTS/SUBJECTS We included all adults who had either a neurological disorder affecting language or an oncological disease with an end-of-life prognosis and difficulty self-reporting pain. We excluded patients with a diagnosis of dementia. METHODS The cross-sectional study included 325 patients who were simultaneously evaluated by two observers both at rest and in movement. We analyzed psychometric properties in terms of construct validity, reliability, and sensitivity to change. RESULTS We obtained Cronbach α > .70 in both situations and an inter-rater reliability of 0.80. Confirmatory factor analysis indicated that the model adjusted adequately to a unidimensional structure. In terms of sensitivity to change, the mean difference was greater in movement than at rest (difference in means was 1.15). CONCLUSIONS The PAINAD-Sp_Hosp scale had good psychometric qualities in terms of validity and reliability in neurology and oncology patients unable to self-report pain.
Collapse
|
14
|
Fry M, Elliott R. Pragmatic evaluation of an observational pain assessment scale in the emergency department: The Pain Assessment in Advanced Dementia (PAINAD) scale. Australas Emerg Care 2018; 21:131-136. [DOI: 10.1016/j.auec.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/11/2018] [Accepted: 09/03/2018] [Indexed: 02/04/2023]
|
15
|
Prospective Prognostic Cohort Study of Pressure Injuries in Older Adult Patients with Hip Fractures. Adv Skin Wound Care 2018; 31:218-224. [PMID: 29672393 DOI: 10.1097/01.asw.0000530685.39114.98] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the rate of pressure injury and real predictors thereof in the older adult population with hip fractures in an orthopedic hospital. METHODS In this prospective prognostic cohort study, all patients admitted with fragility hip fractures were monitored over a 12-month period. On a daily basis, ward nurses and physiotherapists assessed the condition of the patients' skin and collected data about all the predictors connected to their healthcare and hospital organization until the patients were discharged from hospital or until the onset of pressure injury. RESULTS From October 1, 2013, to September 30, 2014, 467 older adult patients with fragility fractures were enrolled in the study. Of these, 27% (n = 127) developed a pressure injury. Multivariate analysis identified the following predictive factors: age older than 81 years, type of surgery, and placing the limb in a foam rubber splint. No other factor connected to the patient or medical, nursing, or rehabilitation treatment was significantly correlated to the onset of pressure injury, even when the univariate analysis showed some of them were possible predictors. CONCLUSIONS Pressure injury in older adults with hip fractures is a relatively common complication, especially in high-risk patients or following certain treatments. These potential indicators could help provide safe and targeted care by preemptively identifying patients at highest risk of pressure injury.
Collapse
|
16
|
Prevalence of Chronic Cancer and No-Cancer Pain in Elderly Hospitalized Patients: Elements for the Early Assessment of Palliative Care Needs. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2017.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
17
|
Predictive factors for thirty day mortality in geriatric patients with hip fractures: a prospective study. INTERNATIONAL ORTHOPAEDICS 2018; 43:275-281. [PMID: 30054670 DOI: 10.1007/s00264-018-4057-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/12/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE The study aims to analyze the incidence of 30-day mortality in elderly patients who underwent surgery for hip fractures and its associated factors. METHODS A prospective multicentric study was performed. All patients aged ≥ 65 years, with fragility hip fractures, consecutively admitted in two Italian hospitals were included. Patients with periprosthetic or pathological fractures were excluded. Logistic regression was used to identify patient and patient care variables that independently influenced the 30-day mortality and receiver operating characteristic (ROC) curve analysis to assess their predictive capacity on the outcome. RESULTS Of the patients, 728 met the inclusion criteria, of whom approximately 5% died within 30 days after admission. The 45.7% of the deceased patients died while hospitalized. Multivariate analysis showed that advancing age was the only independent predictor of 30-day mortality (OR = 1.084, 95% CI = 1.024-1.147), while a higher presence of informal caregivers was a protective factor (OR = 0.988, 95% CI = 0.979-0.997). The area under the ROC curve of the model was 0.723 (CI95% 0.676-0.770) for 30-day mortality in elderly hip fractures patients. CONCLUSIONS Patients with an advanced age need careful follow-up, especially within 30 days following operation for hip fracture; at the same time, the presence of informal caregivers at the patient's bedside should be promoted.
Collapse
|
18
|
Büyükturan Ö, Naharci Mİ, Büyükturan B, Kirdi N, Yetiş A. The Turkish Version of Pain Assessment in Advanced Dementia (PAINAD) Scale. ACTA ACUST UNITED AC 2018; 55:271-275. [PMID: 30224875 DOI: 10.29399/npa.22997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/12/2017] [Indexed: 11/07/2022]
Abstract
Introduction This study was conducted to test the reliability and validity of the Turkish version of the "Pain Assessment In Advanced Dementia (PAINAD) Scale". Methods One hundred and six older adults with advanced dementia (AD) were recruited in the study. Detailed medical history and demographic data of the participants were recorded. Initially, the Turkish version of PAINAD (PAINAD-TR), which was prepared by means of "back-translation", was applied. Along with this scale, Mini Mental State Examination, Clinical Dementia Rating scale, and Visual Analog Scale were also used. Results The Cronbach's α coefficient was 0.82 and 0.85 for the test and re-test, respectively. For the test-retest reliability of the PAINAD-TR scale, values of the intraclass correlation coefficient (ICC) and 95% confidence interval (CI) were 0.812 and 0.763-0.850 respectively. According to the results of a factor analysis carried out on the scale, a 2-domain structure was proved. Conclusion The PAINAD-TR scale can be used for the assessment and management of pain in non-communicative older adults with AD.
Collapse
Affiliation(s)
- Öznur Büyükturan
- Ahi Evran University, School of Physical Therapy and Rehabilitation, Kırşehir, Turkey
| | - Mehmet İlkin Naharci
- Health Sciences University, Gülhane Training and Research Hospital, Divisions of Geriatrics, Ankara, Turkey
| | - Buket Büyükturan
- Ahi Evran University, School of Physical Therapy and Rehabilitation, Kırşehir, Turkey
| | - Nuray Kirdi
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Aysu Yetiş
- Ahi Evran University, Training and Research Hospital, Department of Neurology, Kırşehir, Turkey
| |
Collapse
|
19
|
Monacelli F, Signori A, Roffredo L, Pace K, Nencioni A, Pickering G, Nicolas M, Odetti P. Algoplus® Scale in Older Patients with Dementia: A Reliable Real-World Pain Assessment Tool. J Alzheimers Dis 2018; 56:519-527. [PMID: 27935555 DOI: 10.3233/jad-160790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pain is still a neglected clinical issue in elderly people with dementia and/or communicative disorders, with an unacceptable higher rate of under diagnosis and under treatment. Cognitive deficit and emotional and psychological disturbances entangle pain symptoms, affecting patient self-report. So far, observational pain tools do not have fully adequate clinimetric properties and quality requirements for easy-to-use daily rating. Older patients with dementia represent a clinical challenge. The assessment of pain is important for improving clinical outcomes, such as functional status, frailty trajectories, comorbidity, and quality of life. The PAINAID scale appears to be the most accurate pain tool in people with dementia along with the Algoplus® scale, a recently developed tool to rapidly assess acute pain in hospitals settings. The present study aimed to assess the clinimetric properties of the Algoplus®, as compared to PAINAID, for detecting acute pain in a real-world cohort of hospitalized older patients with dementia.
Collapse
Affiliation(s)
- Fiammetta Monacelli
- DIMi, Department of Internal Medicine and Medical Specialties, Section of Geriatrics, University of Genoa, Genoa, Italy
| | - Alessio Signori
- DISSAL, Department of Health Science, University of Genoa, Genoa, Italy
| | - Laura Roffredo
- DIMi, Department of Internal Medicine and Medical Specialties, Section of Geriatrics, University of Genoa, Genoa, Italy
| | - Katiuscia Pace
- IRCCS AUO San Martino Hospital, Section of Geriatrics, Genoa, Italy
| | - Alessio Nencioni
- DIMi, Department of Internal Medicine and Medical Specialties, Section of Geriatrics, University of Genoa, Genoa, Italy
| | - Gisele Pickering
- Département de Pharmacologie, Faculté de Médecine, INSERM CIC 501 and U766, Université d'Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Collectif Doloplus, Centre de Soins Palliatifs, CHR Metz-Thionville, Thionville, France
| | - Macian Nicolas
- Département de Pharmacologie, Faculté de Médecine, INSERM CIC 501 and U766, Université d'Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Patrizio Odetti
- DIMi, Department of Internal Medicine and Medical Specialties, Section of Geriatrics, University of Genoa, Genoa, Italy
| |
Collapse
|
20
|
Which factors are independent predictors of early recovery of mobility in the older adults' population after hip fracture? A cohort prognostic study. Arch Orthop Trauma Surg 2018; 138:35-41. [PMID: 28956152 DOI: 10.1007/s00402-017-2803-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of the present study was to identify all factors that might influence the short-term recovery of mobility in older adults' patients after hip surgery. METHODS A prospective cohort prognostic study was carried out. The study enrolled all consecutive patients aged 65 years or over admitted for hip fracture due to fragility. Patients were monitored from their admission into the emergency department of the hospital, until their discharge. The level of mobility was measured by the ILOA scale, administered during the 6th day of hospitalisation. The identified variables were divided into baseline patient variables, linked to the patient's characteristics, and, healthcare/hospital variables, linked to the program of care within post-surgery hospitalisation. RESULTS The total number of patients enrolled and examined at discharge was 484. Six days after surgery, the level of mobility achieved by patients, as measured by ILOA Scale, was 42.4 (± 6.0). Increased age (B = 0.111; p = 0,042), pressure sore mattress with a motor used (B = 3.817; p < 0.0005), delay in achieving an upright position (B = 0.509; p < 0.0005), no recovery of walking (b = 2.339; p < 0.0005), prolonged use of diapers (B = 0.004; p < 0.0005) or catheter (B = 0.089; p < 0.0005), indication for no weight bearing (B = 2.023; p = 0.031), and temperature for fewer days (B = 0.040; p = 0.023) are factors able to affect negatively recovery of mobility in the initial post-operative period in patients surgically treated for hip fracture. CONCLUSION Therapy and physiotherapy choices after surgery for hip fracture are significantly associated with early recovery of mobility of older adults' patients, regardless of their baseline conditions. Early removal of supporting devices promoting prolonged bed immobility, such as air mattress, catheter, and incontinence pad, together with achieving an early upright position, are elements to take into account when planning future trials to understand its efficacy in enabling better recovery of mobility.
Collapse
|
21
|
Fry M, Chenoweth L, Arendts G. Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial. Emerg Med J 2017; 35:33-38. [PMID: 28780493 DOI: 10.1136/emermed-2016-206065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/03/2017] [Accepted: 07/16/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The primary objective of the study was to measure the impact of an observational pain assessment dementia tool on time from ED arrival to first dose of analgesic medicine. METHODS A multisite cluster randomised controlled trial was conducted to test the Pain Assessment in Advanced Dementia (PAINAD) tool. Patients aged 65 years or older suspected of a long bone fracture were screened for cognitive impairment using the Six-Item Screening (SIS) tool. Patients scoring 4 or less on SIS (intervention sites) were assessed for pain using PAINAD. Control sites, assessed pain using standard methods. The primary outcome was time to first dose of analgesia and was analysed on an intention-to-treat basis with a sensitivity analysis. RESULTS We enrolled 602 patients, of which 323 (54%) were at intervention sites (n=4). The median time to analgesia was 82 min (IQR 45-151 min). There was no statistically significant difference in median time to analgesia for intervention 83 (IQR 48-158 min) and non-intervention 82 min (IQR 41-147 min) sites (p=0.414). After adjusting for age, fracture type, arrival mode and triage category, there remained no significant difference in time to analgesia (HR 0.97, 95% CI 0.80 to 1.17, p=0.74). Of the 602 patients enrolled, 273 actually had cognitive impairment. A sensitivity analysis demonstrated patients at intervention sites received analgesia 13 min sooner (90 vs 103 min, p=0.91). CONCLUSION Use of the PAINAD was not associated with a shorter time to analgesia, although there was a clinically important but non-significant improvement in the cognitively impaired patient group. Further research is needed to address this clinically important and complex issue.
Collapse
Affiliation(s)
- Margaret Fry
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia.,Director Research and Practice Development, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Lynn Chenoweth
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Glenn Arendts
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
22
|
Fry M, Arendts G, Chenoweth L. Emergency nurses' evaluation of observational pain assessment tools for older people with cognitive impairment. J Clin Nurs 2017; 26:1281-1290. [PMID: 27680895 DOI: 10.1111/jocn.13591] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore emergency nurses' perceptions of the feasibility and utility of Pain Assessment in Advanced Dementia tool in people over 65 with cognitive impairment. The Pain Assessment in Advanced Dementia tool was then compared with The Abbey Pain Scale, Doloplus-2 and PACSLAC. The objective was to determine which observational pain assessment tool was the most appropriate for the emergency department context and the cognitively impaired older person. BACKGROUND The number of older people with cognitive impairment conditions, such as dementia, presenting to the emergency department is increasing. Approximately 28% of people over 65 years who present will have cognitive impairment. Older people with cognitive impairment often receive suboptimal pain management in the ED. There is limited evidence of the use and/or appropriateness of dementia-specific pain observation assessment tools in the ED. DESIGN This was a multicentre exploratory qualitative study, which was conducted within a constructivist paradigm. METHODS Focus group interviews were conducted with nurses across three hospital emergency departments. Data were subject to thematic analysis. RESULTS Six focus groups were conducted with 36 nurses over a 12-week period. Four themes emerged from the analysis: 1) cognitive impairment is a barrier to pain management; 2) PAINAD gives structure to pain assessment; 3) PAINAD assists to convey pain intensity; and 4) selection of an appropriate observational pain assessment tool. CONCLUSIONS This study identified that emergency nurses find it challenging to detect, assess and manage pain in cognitively impaired people. While the use of the PAINAD helped to address these challenges compared to other tools, nurses also identified the important role that family and carers can play in pain assessment and management for older people with cognitive impairment. RELEVANCE TO CLINICAL PRACTICE This study has generated new knowledge that has broad application across clinical settings, which can assist to transform pain management practice and reduce human suffering. The use of an observational pain assessment tool can provide for greater practice consistency for patients with communication difficulties. Pain management for older people with cognitive impairment is best achieved by the use an appropriate observational pain assessment tool and with a multidisciplinary approach that includes the person and their family/carer.
Collapse
Affiliation(s)
- Margaret Fry
- Northern Sydney Local Health District, Faculty of Health University of Technology, Sydney, Australia
| | - Glenn Arendts
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, WA, Australia
| | - Lynn Chenoweth
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
23
|
Abstract
Introduction The aim was to investigate whether therapeutic massage was effective in relieving pain in elderly residents with dementia. Methods A randomized controlled study was conducted in an aged care facility. Ten participants with dementia or advanced dementia were allocated to an intervention group or a control group. The intervention group received 10 min of massage (effleurage, kneading, and trigger point therapy) four times per week for 4 weeks. The Pain Assessment in Advanced Dementia scale was used as the outcome measure. Results No significant changes in mean outcome measure scores were found post intervention (Intervention mean = 5.0 ± 3.49; Control mean = 5.2 ± 3.49: t(8) = 0.09, p = 0.93). However, the Intervention Group had a greater magnitude of change (1.200 ± 1.78) when compared to the control group (0.800 ± 2.16). Conclusion Therapeutic massage may provide a useful adjunct to the current pain management plan of patients with dementia.
Collapse
Affiliation(s)
- Yamini Kapoor
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Australia
| | - Robin Orr
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Australia
| |
Collapse
|
24
|
Pinto MCM, Minson FP, Lopes ACB, Laselva CR. Cultural adaptation and reproducibility validation of the Brazilian Portuguese version of the Pain Assessment in Advanced Dementia (PAINAD-Brazil) scale in non-verbal adult patients. EINSTEIN-SAO PAULO 2015; 13:14-9. [PMID: 25993063 PMCID: PMC4977604 DOI: 10.1590/s1679-45082015ao3036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 10/07/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To adapt the Pain Assessment in Advanced Dementia (PAINAD) scale to Brazilian Portuguese with respect to semantic equivalence and cultural aspects, and to evaluate the respective psychometric properties (validity, feasibility, clinical utility and inter-rater agreement). Methods Two-stage descriptive, cross-sectional retrospective study involving cultural and semantic validation of the Brazilian Portuguese version of the scale, and investigation of its psychometric properties (validity, reliability and clinical utility). The sample consisted of 63 inpatients presenting with neurological deficits and unable to self-report pain. Results Semantic and cultural validation of the PAINAD scale was easily achieved. The scale indicators most commonly used by nurses to assess pain were “Facial expression”, “Body language” and “Consolability”. The Brazilian Portuguese version of the scale has proved to be valid and accurate; good levels of inter-rater agreement assured reproducibility. Conclusion The scale has proved to be useful in daily routine care of hospitalized adult and elderly patients in a variety of clinical settings. Short application time, ease of use, clear instructions and the simplicity of training required for application were emphasized. However, interpretation of facial expression and consolability should be given special attention during pain assessment training.
Collapse
|
25
|
Cecchi F, Paperini A, Molino Lova R, Pasquini G, Boni R, Castagnoli C, Vannetti F, Padua L, Macchi C. Pain in patients attending outpatient rehabilitation: results of a pilot study. Intern Emerg Med 2015; 10:351-7. [PMID: 25666513 DOI: 10.1007/s11739-015-1199-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/16/2015] [Indexed: 11/30/2022]
Abstract
The aim of the study was to investigate pain occurrence, characteristics and correlations in an outpatient rehabilitation setting. This was an observational pilot study. The setting was an outpatient rehabilitation facility. The subjects included all patients attending physiotherapy in the week 25th to 29th September 2010 and the interventions were made using self-administered questionnaire. Ongoing pain was assessed by a yes-no question, pain intensity by a numeric rating scale (NRS) ranging 0-10. Pain-related medication was investigated, along with pain characteristics, patient treatment expectations, life satisfaction, and catastrophism. Of the 201 patients, 12 were excluded and 189 enrolled (age 63.6 ± 15.6; 70.4% women). Pain (mean NRS = 5.6 ± 2.4) was reported by 60.9% patients (66% orthopedic and 40% neurological). In 87.8% cases, pain was chronic (>6 months). According to patients reporting pain, the main objectives of treatment were both pain relief and functional recovery for 51%; pain relief for 24.9%; functional recovery for 22.8%. Low treatment expectations were reported by 15.3% patients; catastrophism by 40.7%; 28.6% patients were on pain medication: use of drugs was related to age (p = 0.005), pain intensity (p = 0.009) and catastrophism (p = 0.0003). In a multivariate analysis, pain was independently correlated with an orthopedic versus neurological diagnosis (p = 0.000), and with reduced treatment expectations (p = 0.020), while independent of age (p = 0.74) gender (p = 0.22), and catastrophism (0.17). A high prevalence of pain was observed in outpatients undergoing rehabilitation. Pain was chronic in most cases. Pain relief was the most desired treatment outcome by patients reporting pain. Pain complaint was independently correlated to orthopedic vs neurological diagnosis and to reduced treatment expectations.
Collapse
Affiliation(s)
- Francesca Cecchi
- Fondazione Don Carlo Gnocchi, Scientific Institute, Florence, Italy,
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Varrassi G, Fusco M, Coaccioli S, Paladini A. Chronic pain and neurodegenerative processes in elderly people. Pain Pract 2014; 15:1-3. [PMID: 25353291 DOI: 10.1111/papr.12254] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
27
|
Evidence-based Development and Initial Validation of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate-II (PACSLAC-II). Clin J Pain 2014; 30:816-24. [DOI: 10.1097/ajp.0000000000000039] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Valera GG, Carezzato NL, Vale FAC, Hortense P. [Cultural adaptation of the scale Pain Assessment in Advanced Dementia - PAINAD to Brazil]. Rev Esc Enferm USP 2014; 48:462-8. [PMID: 25076274 DOI: 10.1590/s0080-623420140000300011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/01/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To translate and culturally adapt to Brazil the scale Pain Assessment in Advanced Dementia(PAINAD). METHOD The cultural adaptation process followed the methodology of a theorical reference, in five steps: translation to Brazilian Portuguese, consensual version of translations, back-translation to the original language, revision by a committee of specialists in the field and a equivalency pre-test. The instrument was assessed and applied by 27 health professionals in the last step. RESULTS The Escala de Avaliação de Dor em Demência Avançada was culturally adapted to Brazil and presented semantic equivalency to the original, besides clarity, applicability and easy comprehension of the instrument items. CONCLUSION This process secured the psychometric properties as the reliability and content validity of the referred scale.
Collapse
Affiliation(s)
- Gabriela Gallego Valera
- Nursing Department, Center of Biological Sciences and Health, Universidade Federal de São Carlos, São Carlos, SP, Brazil,
| | - Natália Lindemann Carezzato
- Nursing Department, Center of Biological Sciences and Health, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Francisco Assis Carvalho Vale
- Medical Department, Center of Biological Sciences and Health, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Priscilla Hortense
- Nursing Department, Center of Biological Sciences and Health, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| |
Collapse
|
29
|
Carezzato NL, Valera GG, Vale FAC, Hortense P. Instruments for assessing pain in persons with severe dementia. Dement Neuropsychol 2014; 8:99-106. [PMID: 29213889 PMCID: PMC5619115 DOI: 10.1590/s1980-57642014dn82000003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Through an integrative literature review involving the CINAHL, Cochrane, Embase,
LILACS, PsycINFO, PubMed databases, tools available in the literature for
assessing pain in individuals with severe dementia were identified along with
versions validated for use in Brazil. We found 1501 relevant articles which,
after selection of abstracts and full reading, yielded a final sample of 33
articles. The analysis enabled the identification of 12 instruments: ABBEY PAIN
SCALE; ADD; CNPI; CPAT; DOLOPLUS-2; MOBID and MOBID-2; MPS; NOPPAIN; PACSLAC;
PADE; PAINAD and PAINE. Despite the wide variety of tools for assessing pain in
individuals with severe dementia worldwide, it was observed that only four are
available in Portuguese, of which two are culturally adapted for Brazilian
Portuguese (NOPPAIN and PACSLAC) and two validated for Portuguese of Portugal
(DOLOPLUS and PAINAD), pointing to the need for further validation of
instruments for use in Brazil.
Collapse
Affiliation(s)
- Natália Lindemann Carezzato
- Resident Nurse in Nursing in Health of Adults and Elderly - UNICAMP, Campinas SP, Brazil. Bachelor and Licentiate degree in Nursing from the Federal University of São Carlos, Center for Biological Science and Health/Department of Nursing, São Carlos SP, Brazil
| | - Gabriela Gallego Valera
- Nurse, Master's in Nursing. Center for Biological Science and Health/Department of Nursing - Federal University of São Carlos, São Carlos SP, Brazil
| | - Francisco Assis Carvalho Vale
- Medical Doctor, PhD in Neurology/Neurosciences, Associate Professor. Center for Biological Science and Health/Department of Medicine - Federal University of São Carlos, São Carlos SP, Brazil
| | - Priscilla Hortense
- Nurse, PhD in Nursing, Associate Professor. Center for Biological Science and Health/Department of Nursing - Federal University of São Carlos, São Carlos SP, Brazil
| |
Collapse
|
30
|
García-Soler Á, Sánchez-Iglesias I, Buiza C, Alaba J, Navarro AB, Arriola E, Zulaica A, Vaca R, Hernández C. [Adaptation and validation of the Spanish version of the Pain Evaluation Scale in patients with advanced dementia: PAINAD-Sp]. Rev Esp Geriatr Gerontol 2014; 49:10-14. [PMID: 23746393 DOI: 10.1016/j.regg.2013.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Pain in elderly people is considered a major concern in nursing home facilities affecting between 49% and 83% of the residents. Progression of Alzheimer's Disease causes more communication difficulties in patients with advanced dementia and therefore more problems to understand even the most simple pain evaluation scales. Identification and implementation of appropriate pain management strategies depends on an adequate pain assessment. MATERIAL AND METHODS The main objective of the study was to validate the Spanish version of the PAINAD Scale (PAINAD-Sp) and to assess its applicability in Spanish Geriatric Nursing Homes. The 20 patients diagnosed with severe dementia from a Geriatric Centre in Spain were observed by five observers with different professional profiles for 5 minutes to each participant, and PAINAD-Sp Scale was administered simultaneously to a Visual Analogical Scale-VAS. Three different observational conditions were established: resting condition, during presumably pleasant activity and during presumable painful activity. RESULTS Cronbach's alpha ranged between 0.467 and 0.827 (average 0.692), and rose if Breathing item was deleted. Inter-rater reliability ranged between 0.587 and 0.956. Correlation between PAINAD-Sp Scale total measures and VAS was statistically significant (P<.05) in all measures and ranged from 0.517 to 0.868. CONCLUSIONS Findings in the study showed that the scale is useful to measure pain in non communicative patients suffering from dementia. The scale maintains good levels of reliability for different healthcare professionals even when they have little training.
Collapse
Affiliation(s)
- Álvaro García-Soler
- Departamento I+D, Fundación Instituto Gerontológico Matia-INGEMA, Madrid, España; Grupo de demencias, Fundación Instituto Gerontológico Matia-INGEMA, San Sebastián-Donostia, Guipúzcoa, España.
| | - Iván Sánchez-Iglesias
- Departamento de Metodología de las Ciencias del Comportamiento, Universidad Complutense de Madrid, Madrid, España
| | - Cristina Buiza
- Grupo de demencias, Fundación Instituto Gerontológico Matia-INGEMA, San Sebastián-Donostia, Guipúzcoa, España; Centro Gerontológico Julián Rezola, Fundación Matia, San Sebastián-Donostia, Guipúzcoa, España
| | - Javier Alaba
- Grupo de demencias, Fundación Instituto Gerontológico Matia-INGEMA, San Sebastián-Donostia, Guipúzcoa, España; Centro Gerontológico Txara I, Fundación Matia, San Sebastián-Donostia, Guipúzcoa, España
| | - Ana Belén Navarro
- Grupo de demencias, Fundación Instituto Gerontológico Matia-INGEMA, San Sebastián-Donostia, Guipúzcoa, España; Departamento de Psicología Evolutiva y de la Educación, Universidad de Salamanca, Salamanca, España
| | - Enrique Arriola
- Grupo de demencias, Fundación Instituto Gerontológico Matia-INGEMA, San Sebastián-Donostia, Guipúzcoa, España; Centro Gerontológico Ricardo Bermingham, Fundación Matia, San Sebastián-Donostia, Guipúzcoa, España
| | - Amaia Zulaica
- Grupo de demencias, Fundación Instituto Gerontológico Matia-INGEMA, San Sebastián-Donostia, Guipúzcoa, España; Centro de Atención Especializada para Discapacitados IZA, Fundación Matia, San Sebastián-Donostia, Guipúzcoa, España
| | - Raúl Vaca
- Departamento I+D, Fundación Instituto Gerontológico Matia-INGEMA, Madrid, España; Grupo de demencias, Fundación Instituto Gerontológico Matia-INGEMA, San Sebastián-Donostia, Guipúzcoa, España
| | - Carmen Hernández
- Grupo de demencias, Fundación Instituto Gerontológico Matia-INGEMA, San Sebastián-Donostia, Guipúzcoa, España; Centro de Recursos Sociales Elizarán, Fundación Matia, San Sebastián-Donostia, Guipúzcoa, España
| |
Collapse
|
31
|
Zwakhalen SMG, van der Steen JT, Najim MD. Which score most likely represents pain on the observational PAINAD pain scale for patients with dementia? J Am Med Dir Assoc 2012; 13:384-9. [PMID: 21640656 DOI: 10.1016/j.jamda.2011.04.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 03/30/2011] [Accepted: 04/01/2011] [Indexed: 11/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Sandra M G Zwakhalen
- Maastricht University, School for Public Health and Primary Care (Caphri), Maastricht, the Netherlands.
| | | | | |
Collapse
|
32
|
Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain Assessment in the Patient Unable to Self-Report: Position Statement with Clinical Practice Recommendations. Pain Manag Nurs 2011; 12:230-50. [DOI: 10.1016/j.pmn.2011.10.002] [Citation(s) in RCA: 333] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 08/22/2011] [Indexed: 01/16/2023]
|
33
|
Lin PC, Lin LC, Lotus Shyu YI, Hua MS. Chinese version of the Pain Assessment in Advanced Dementia Scale: initial psychometric evaluation. J Adv Nurs 2010; 66:2360-8. [DOI: 10.1111/j.1365-2648.2010.05405.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Ersek M, Herr K, Neradilek MB, Buck HG, Black B. Comparing the psychometric properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) instruments. PAIN MEDICINE (MALDEN, MASS.) 2010; 11:395-404. [PMID: 20088854 PMCID: PMC2866060 DOI: 10.1111/j.1526-4637.2009.00787.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia. DESIGN In a cross-sectional descriptive study nursing home (NH) residents were videotaped at rest and during a structured movement procedure. Following one training session and one practice session, two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools. SETTING Fourteen NHs in Western Washington State participating in a randomized controlled trial of an intervention to enhance pain assessment and management. PARTICIPANTS Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment. MEASURES Checklist of Nonverbal Pain Indicators (CNPI) and the Pain Assessment in Advanced Dementia (PAINAD), demographic and pain-related data (Minimum Data Set), nursing assistant reports of participants' usual pain intensity, and Pittsburgh Agitation Scale. RESULTS Internal consistency for both tools was good except for the CNPI at rest for one rater. Inter-rater reliability for pain presence was fair (K = 0.25 for CNPI with movement; K = 0.31 for PAINAD at rest) to moderate (K = 0.43 for CNPI at rest; K = 0.54 for PAINAD with movement). There were significant differences in mean CNPI and PAINAD scores at rest and during movement, providing support for construct validity. However, both tools demonstrated marked floor effects, particularly when participants were at rest. CONCLUSIONS Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD, findings from the current study indicate that these measures warrant further study with clinical users, should be used cautiously both in research and clinical settings and only as part of a comprehensive approach to pain assessment.
Collapse
Affiliation(s)
- Mary Ersek
- School of Nursing, University of Pennsylvania, Room 329, 418 Curie Bld, Philadelphia, PA 19104-6096, USA.
| | | | | | | | | |
Collapse
|
35
|
Herr K, Bursch H, Ersek M, Miller LL, Swafford K. Use of Pain-Behavioral Assessment Tools in the Nursing Home: Expert Consensus Recommendations for Practice. J Gerontol Nurs 2010; 36:3-4. [DOI: 10.3928/00989134-20100108-04] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 10/05/2009] [Indexed: 01/08/2023]
|
36
|
|
37
|
Abstract
Pain in older adults is very often undertreated, and it may be especially so in older adults with severe dementia. Changes in a patient's ability to communicate verbally present special challenges in treating pain, and unrelieved pain can have serious consequences, including declines in physical function and diminished appetite. The Pain Assessment in Advanced Dementia (PAINAD) scale has been designed to assess pain in this population by looking at five specific indicators: breathing, vocalization, facial expression, body language, and consolability. A trained nurse or other health care worker can use the scale in less than five minutes of observation. For an online video showing nurses using the PAINAD scale and other pain-assessment tools, go to http://links.lww.com/A251.
Collapse
|
38
|
|