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Tata TK, Ohene LA, Dzansi GA, Aziato L. Factors influencing nurses' pain assessment and management of road traffic casualties: a qualitative study at a military hospital in Ghana. BMC Emerg Med 2024; 24:100. [PMID: 38886656 PMCID: PMC11184758 DOI: 10.1186/s12873-024-01016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Evidence shows that patients who visit the surgical and trauma emergency units may be discharged with untreated or increased pain levels. This study explored nurses' pain assessment and management approaches at a trauma-surgical emergency unit in Ghana. METHODS Seventeen nurses who work in the trauma department participated in this qualitative exploratory descriptive study. In-depth individual interviews were conducted, and the thematic analysis was utilized to identify emerging themes and subthemes. RESULTS Three main themes were identified: patient pain indicators, pain management, and institutional factors influencing pain management. The study revealed that nurses rely on verbal expressions, non-verbal cues, physiological changes, and the severity of pain communicated. The findings highlighted staff shortage, inadequate resources, and lack of standardized guidelines as factors affecting pain and management. CONCLUSIONS Although the study offers critical new perspectives on nurses' experiences regarding pain related issues at the trauma-surgical emergency units, its small sample size limited its generalizability.
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Affiliation(s)
- Thomas Kwame Tata
- 37 Military Hospital, Neghelli Barracks Liberation Rd 37, Accra, Ghana
| | - Lillian Akorfa Ohene
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Ghana, P. O Box LG 43, Legon, Accra, Ghana.
| | - Gladys Akorfa Dzansi
- Department of Adult Health Nursing, School of Nursing and Midwifery of Ghana, P. O Box LG 43, Legon, Accra, Ghana
| | - Lydia Aziato
- University of Health and Allied Sciences, PMB 31, Volta Region, Ho, Ghana
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2
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Sabater-Gárriz Á, Molina-Mula J, Montoya P, Riquelme I. Pain assessment tools in adults with communication disorders: systematic review and meta-analysis. BMC Neurol 2024; 24:66. [PMID: 38368314 PMCID: PMC10873938 DOI: 10.1186/s12883-024-03539-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/15/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Verbal communication is the "gold standard" for assessing pain. Consequently, individuals with communication disorders are particularly vulnerable to incomplete pain management. This review aims at identifying the current pain assessment instruments for adult patients with communication disorders. METHODS A systematic review with meta-analysis was conducted on PubMed, PEDRO, EBSCOhost, VHL and Cochrane databases from 2011 to 2023 using MeSH terms "pain assessment, "nonverbal communication" and "communication disorders" in conjunction with additional inclusion criteria: studies limited to humans, interventions involving adult patients, and empirical investigations. RESULTS Fifty articles were included in the review. Seven studies report sufficient data to perform the meta-analysis. Observational scales are the most common instruments to evaluate pain in individuals with communication disorders followed by physiological measures and facial recognition systems. While most pain assessments rely on observational scales, current evidence does not strongly endorse one scale over others for clinical practice. However, specific observational scales appear to be particularly suitable for identifying pain during certain potentially painful procedures, such as suctioning and mobilization, in these populations. Additionally, specific observational scales appear to be well-suited for certain conditions, such as mechanically ventilated patients. CONCLUSIONS While observational scales dominate pain assessment, no universal tool exists for adults with communication disorders. Specific scales exhibit promise for distinct populations, yet the diverse landscape of tools hampers a one-size-fits-all solution. Crucially, further high-quality research, offering quantitative data like reliability findings, is needed to identify optimal tools for various contexts. Clinicians should be informed to select tools judiciously, recognizing the nuanced appropriateness of each in diverse clinical situations. TRIAL REGISTRATION This systematic review is registered in PROSPERO (International prospective register of systematic reviews) with the ID: CRD42022323655 .
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Affiliation(s)
- Álvaro Sabater-Gárriz
- Balearic ASPACE Foundation, Marratxí, Spain
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, 07122, Spain
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma, 07122, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain
| | - Jesús Molina-Mula
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, 07122, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain
| | - Pedro Montoya
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma, 07122, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, 07122, Spain.
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma, 07122, Spain.
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain.
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Blakeman JR, Kim M, Eckhardt AL, Stapleton SJ, DeVon HA. A Nationwide Study of Emergency Nurses' Triage Decisions for Potential Acute Coronary Syndrome. J Emerg Nurs 2024; 50:72-83. [PMID: 37804278 DOI: 10.1016/j.jen.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/26/2023] [Accepted: 08/26/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION This study aimed to identify the symptoms used to assess angina, determine how emergency nurses make triage decisions for potential acute coronary syndrome, and determine emergency nurses' initial actions. METHODS This was a cross-sectional, survey-based design. Emergency nurses were recruited through a posting on the Emergency Nurses Association website and through postcards. Measures included demographic data, assessment of angina, and the Nurses' Cardiac Triage Instrument. Data were analyzed using descriptive statistics and ordinal logistic regression. RESULTS A total of 414 registered nurses with a mean age of 41.7 (SD = 12.0) years participated. They were predominantly female (80.7%), had a baccalaureate degree (60.1%), and worked as a registered nurse for a median 10.0 years. Common terms used to assess angina were chest pain (79.5%), chest pressure (77.3%), chest tightness (72.9%), and chest discomfort (72.5%). The severity of chest pressure (median 5.0, interquartile range 1.0) and nature of chest pain (median 5.0, interquartile range 1.0) had the highest overall median scores to support initial cardiac triage decisions. Associated symptoms of diaphoresis, fatigue, and shortness of breath along with health history contributed to decision making. DISCUSSION Emergency nurses primarily used chest symptoms and health history when deciding to evaluate for acute coronary syndrome in the emergency department. Associated symptoms of diaphoresis, fatigue, and shortness of breath, along with health history, also contributed to decision making. Initial registered nurse actions were to obtain an electrocardiogram, prepare the patient for the cardiac catheterization laboratory, and notify the emergency physician of the patient's admission.
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Shiber J, Fontane E, Patel J, Akinleye A, Kerwin A, Chiu W, Scalea T. Gestalt clinical severity score (GCSS) as a predictor of patient severity of illness or injury. Am J Emerg Med 2023; 66:11-15. [PMID: 36640694 DOI: 10.1016/j.ajem.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/26/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To determine if clinical judgement is accurate to predict the severity of injury or illness, and can be used at patient arrival when other formal scoring systems are not yet available. DESIGN A multicenter pilot study using a prospective observational convenience sample of patients arriving by EMS to the emergency department (ED) or Trauma Center. SETTING Two urban, Level 1 trauma centers at academic tertiary care hospitals. PATIENTS Medical and trauma patients age 18 and older transported by EMS (N = 216). Exclusion criteria (prior to arrival): intubation, assisted ventilation (BVM or NPPV), CPR in progress, prisoners, or previously present motor or speech deficits. MEASUREMENTS Completion of a novel 15-point scale of Verbal, Motor, and Facial Expression within 1-2 min of arrival by a clinician outside of the treatment team. Primary endpoint was the immediate disposition from the ED or Trauma Center: Home, Brief Observation (<24 h), Admission to Floor, ICU (OR and IR as surrogates since these patients ultimately go to the ICU), or Morgue. RESULTS Univariate analysis revealed a strong, positive monotonic correlation between GCSS and disposition (Rho = 0.693, p < .0001). Multivariable logistic regression revealed the "best" model included GCSS and age (group 18-44 years old versus all the other age groups) (p < .0001). There was a 156% increase in the odds of being discharged home (versus being admitted) for a one-unit increase in GCSS (OR = 2.56, 95% CI 1.94, 3.37). CONCLUSIONS Physicians can make accurate predictions of severity of injury and illness using a gestalt method and the scoring system we have developed as patient disposition correlates well with GCSS score. GCSS is most accurate with the 18-44 age group.
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Affiliation(s)
| | | | - Jignesh Patel
- Houston Methodist Hospital, Houston, TX, United States of America
| | | | - Andy Kerwin
- UT HSC, Memphis, TN, United States of America.
| | - William Chiu
- UMMS/R Adams Cowley STC, Baltimore, MD, United States of America.
| | - Thomas Scalea
- UMMS/R Adams Cowley STC, Baltimore, MD, United States of America.
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5
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Aydın Aİ, Özyazıcıoğlu N. Assessment of postoperative pain in children with computer assisted facial expression analysis. J Pediatr Nurs 2023; 71:60-65. [PMID: 37004311 DOI: 10.1016/j.pedn.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The present study was conducted to evaluate the use of computer-aided facial expression analysis to assess postoperative pain in children. DESIGN AND METHODS This was a methodological observational study. The study population consisted of patients in the age group of 7-18 years who underwent surgery in the pediatric surgery clinic of a university hospital. The study sample consisted of 83 children who agreed to participate and met the sample selection criteria. Data were collected by the researcher using the Wong Baker Faces pain rating scale and Visual Analog Scale. Data were collected from the child, mother, nurse, and one external observer. Facial action units associated with pain were used for machine estimation. OpenFace was used to analyze the child's facial action units and Python was used for machine learning algorithms. The intraclass correlation coefficient was used for statistical analysis of the data. RESULTS The pain score predicted by the machine and the pain score assessments of the child, mother, nurse, and observer were compared. The pain assessment closest to the self-reported pain score by the child was in the order of machine prediction, mother, and nurse. CONCLUSIONS The machine learning method used in pain assessment in children performed well in estimating pain severity.It can code facial expressions of children's pain and reliably measure pain-related facial action units from video recordings. APPLICATION TO PRACTICE The machine learning method for facial expression analysis assessed in this study can potentially be used as a scalable, standard, and valid pain assessment method for nurses in clinical practice.
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Affiliation(s)
- Ayla İrem Aydın
- Department of Nursing, Faculty of Health Science, Bursa Uludag University, 16000 Bursa, Turkey.
| | - Nurcan Özyazıcıoğlu
- Department of Nursing, Faculty of Health Science, Bursa Uludag University, 16000 Bursa, Turkey.
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6
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Atee M, Hoti K, Chivers P, Hughes JD. Faces of Pain in Dementia: Learnings From a Real-World Study Using a Technology-Enabled Pain Assessment Tool. FRONTIERS IN PAIN RESEARCH 2022; 3:827551. [PMID: 35295796 PMCID: PMC8915628 DOI: 10.3389/fpain.2022.827551] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Pain is common in people living with dementia (PLWD), including those with limited verbal skills. Facial expressions are key behavioral indicators of the pain experience in this group. However, there is a lack of real-world studies to report the prevalence and associations of pain-relevant facial micro-expressions in PLWD. In this observational retrospective study, pain-related facial features were studied in a sample of 3,144 PLWD [mean age 83.3 years (SD = 9.0); 59.0% female] using the Face domain of PainChek®, a point-of-care medical device application. Pain assessments were completed by 389 users from two national dementia-specific care programs and 34 Australian aged care homes. Our analysis focused on the frequency, distribution, and associations of facial action units [AU(s)] with respect to various pain intensity groups. A total of 22,194 pain assessments were completed. Of the AUs present, AU7 (eyelid tightening) was the most frequent facial expression (48.6%) detected, followed by AU43 (closing eyes; 42.9%) and AU6 (cheek raising; 42.1%) during severe pain. AU20 (horizontal mouth stretch) was the most predictive facial action of higher pain scores. Eye-related AUs (AU6, AU7, AU43) and brow-related AUs (AU4) were more common than mouth-related AUs (e.g., AU20, AU25) during higher pain intensities. No significant effect was found for age or gender. These findings offer further understanding of facial expressions during clinical pain in PLWD and confirm the usefulness of artificial intelligence (AI)-enabled real-time analysis of the face as part of the assessment of pain in aged care clinical practice.
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Affiliation(s)
- Mustafa Atee
- The Dementia Centre, HammondCare, Osborne Park, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Kreshnik Hoti
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Division of Pharmacy, Faculty of Medicine, University of Pristina, Prishtina, Kosovo
| | - Paola Chivers
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Jeffery D. Hughes
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- *Correspondence: Jeffery D. Hughes
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Barney CC, Andersen RD, Defrin R, Genik LM, McGuire BE, Symons FJ. [Challenges in pain assessment and management among individuals with intellectual and developmental disabilities : German version]. Schmerz 2021; 36:49-58. [PMID: 34515871 DOI: 10.1007/s00482-021-00589-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Intellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language, behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional abilities and quality of life. OBJECTIVES This article addresses scientific and clinical challenges in pain assessment and management in individuals with severe IDD. METHODS This Clinical Update aligns with the 2019 IASP Global Year Against Pain in the Vulnerable and selectively reviews recurring issues as well as the best available evidence and practice. RESULTS The past decade of pain research has involved the development of standardized assessment tools appropriate for individuals with severe IDD; however, there is little empirical evidence that pain is being better assessed or managed clinically. There is limited evidence available to inform effective pain management practices; therefore, treatment approaches are largely empiric and highly variable. This is problematic because individuals with IDD are at risk of developing drug-related side effects, and treatment approaches effective for other populations may exacerbate pain in IDD populations. Scientifically, we are especially challenged by biases in self-reported and proxy-reported pain scores, identifying valid outcome measures for treatment trials, being able to adequately power studies due to small sample sizes, and our inability to easily explore the underlying pain mechanisms due to compromised ability to self-report. CONCLUSION Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD continue to emerge, and there are ongoing international collaborations.
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Affiliation(s)
- Chantel C Barney
- Gillette Children's Specialty Healthcare, 200 University Ave E., 55101, Saint Paul, MN, USA. .,Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA.
| | - Randi D Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norwegen
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine & Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Lara M Genik
- Department of Psychology, University of Guelph, Guelph, ON, Kanada
| | - Brian E McGuire
- School of Psychology and Centre for Pain Research, National University of Ireland, Galway, Irland
| | - Frank J Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
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8
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Hassan T, Seus D, Wollenberg J, Weitz K, Kunz M, Lautenbacher S, Garbas JU, Schmid U. Automatic Detection of Pain from Facial Expressions: A Survey. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2021; 43:1815-1831. [PMID: 31825861 DOI: 10.1109/tpami.2019.2958341] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pain sensation is essential for survival, since it draws attention to physical threat to the body. Pain assessment is usually done through self-reports. However, self-assessment of pain is not available in the case of noncommunicative patients, and therefore, observer reports should be relied upon. Observer reports of pain could be prone to errors due to subjective biases of observers. Moreover, continuous monitoring by humans is impractical. Therefore, automatic pain detection technology could be deployed to assist human caregivers and complement their service, thereby improving the quality of pain management, especially for noncommunicative patients. Facial expressions are a reliable indicator of pain, and are used in all observer-based pain assessment tools. Following the advancements in automatic facial expression analysis, computer vision researchers have tried to use this technology for developing approaches for automatically detecting pain from facial expressions. This paper surveys the literature published in this field over the past decade, categorizes it, and identifies future research directions. The survey covers the pain datasets used in the reviewed literature, the learning tasks targeted by the approaches, the features extracted from images and image sequences to represent pain-related information, and finally, the machine learning methods used.
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9
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Babicova I, Cross A, Forman D, Hughes J, Hoti K. Evaluation of the Psychometric Properties of PainChek® in UK Aged Care Residents with advanced dementia. BMC Geriatr 2021; 21:337. [PMID: 34049501 PMCID: PMC8161561 DOI: 10.1186/s12877-021-02280-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 05/11/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this study was to further validate PainChek®, an electronic pain assessment instrument, with a population living with dementia in a UK care home. METHOD This study utilised a correlational design to evaluate the psychometric properties of PainChek® when compared to the Abbey Pain Scale (APS). Blinded paired pain assessments were completed at rest and immediately post-movement by a researcher and a nurse. A total of 22 participants with a diagnosis of moderate-to-severe dementia and a painful condition were recruited using opportunity sampling. RESULTS Overall, 302 paired assessments were collected for 22 participants. Out of these 179 were conducted during rest and 123 were immediately post-movement. The results demonstrated a positive significant correlation between overall PainChek® pain scores and overall APS pain scores (r = 0.818, N = 302, p < .001, one-tailed), satisfactory internal consistency (α = 0.810), moderate single measure intraclass correlation (ICC = 0.680) and substantial inter-rater agreement (κ = 0.719). CONCLUSIONS PainChek® has demonstrated to be a valid and reliable instrument to assess the presence and severity of pain in people with moderate-to-severe dementia living in aged care.
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Affiliation(s)
- Ivana Babicova
- College of Health, Psychology & Social Care, University of Derby, Derby, UK.
| | - Ainslea Cross
- University of Derby Online Learning, University of Derby, Derby, UK
| | - Dawn Forman
- College of Health, Psychology & Social Care, University of Derby, Derby, UK
| | - Jeffery Hughes
- Curtin Medical School, Curtin University, Perth, Australia
| | - Kreshnik Hoti
- Curtin Medical School, Curtin University, Perth, Australia
- Division of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
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10
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The effect of PARO robotic seals for hospitalized patients with dementia: A feasibility study. Geriatr Nurs 2020; 42:37-45. [PMID: 33221556 DOI: 10.1016/j.gerinurse.2020.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 01/14/2023]
Abstract
Robotic seals have been studied in long-term care settings; though, no studies of patients with dementia in the acute care setting have been reported. The purpose of this study was to evaluate the feasibility of PARO interventions for hospitalized patients with dementia, determine physiological effects and describe social-affective interactions. Using a prospective descriptive design with pre-post PARO intervention physiological measurements, we studied 55 participants who received up to five 15-min PARO interventions. The PARO was favorably accepted for 212 (95%) of the 223 PARO interventions. Differences in pre- and post-physiological measures for mean arterial pressure, pulse, respiration, oxygenation, stress, and pain levels were evaluated using Wilcoxon Signed Rank test with statistically significant pre and post differences (p=<0.05); however, the differences were not clinically significant. Participants (95%) demonstrated beneficial PARO interactions with the most frequent interactions being speaking and petting. The PARO shows promise for enhancing social and affective responses for hospitalized patients with dementia.
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11
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Tyler KR, Hullick C, Newton BA, Adams CB, Arendts G. Emergency department pain management in older patients. Emerg Med Australas 2020; 32:840-846. [PMID: 32594659 DOI: 10.1111/1742-6723.13562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Katren R Tyler
- Department of Emergency Medicine, University of California, Davis, Davis, California, USA
| | - Carolyn Hullick
- Emergency Department, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Brittany A Newton
- Department of Pharmacy Services, UC Davis Health System, University of California, Davis, Davis, California, USA
| | - Christopher B Adams
- Department of Pharmacy Services, UC Davis Health System, University of California, Davis, Davis, California, USA
| | - Glenn Arendts
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
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12
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Challenges in pain assessment and management among individuals with intellectual and developmental disabilities. Pain Rep 2020; 5:e821. [PMID: 32656458 PMCID: PMC7302581 DOI: 10.1097/pr9.0000000000000822] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
Pain is common for individuals with intellectual and developmental disabilities, and we need to accelerate the use of evidence-based approaches to assess and manage pain. Introduction: Intellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language, behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional abilities and quality of life. Objectives: This article addresses scientific and clinical challenges in pain assessment and management in individuals with severe IDD. Methods: This Clinical Update aligns with the 2019 IASP Global Year Against Pain in the Vulnerable and selectively reviews recurring issues as well as the best available evidence and practice. Results: The past decade of pain research has involved the development of standardized assessment tools appropriate for individuals with severe IDD; however, there is little empirical evidence that pain is being better assessed or managed clinically. There is limited evidence available to inform effective pain management practices; therefore, treatment approaches are largely empiric and highly variable. This is problematic because individuals with IDD are at risk of developing drug-related side effects, and treatment approaches effective for other populations may exacerbate pain in IDD populations. Scientifically, we are especially challenged by biases in self-reported and proxy-reported pain scores, identifying valid outcome measures for treatment trials, being able to adequately power studies due to small sample sizes, and our inability to easily explore the underlying pain mechanisms due to compromised ability to self-report. Conclusion: Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD continue to emerge, and there are ongoing international collaborations.
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13
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Craig KD. A child in pain: A psychologist’s perspective on changing priorities in scientific understanding and clinical care. PAEDIATRIC AND NEONATAL PAIN 2020; 2:40-49. [PMID: 35548593 PMCID: PMC8975203 DOI: 10.1002/pne2.12034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022]
Abstract
My research and clinical career followed a trajectory of increasing appreciation for the importance of social factors as determinants of pain experience and expression. The social contexts of children’s lives determine whether infants and children are exposed to pain, how socialization in family and ethnocultural contexts lead to pain as a social experience, comprised of thoughts and feelings as well as sensory input, how others shape pain experience and expression, less so for automatic/reflexive features than purposeful representations, and how other's appraisals of children’s pain reflect the observer's unique background and capacities for intervening in the child’s interests. A greater understanding of the social dimensions of pain, as reflected in the social communication model of pain, would support innovation of psychological and social interventions.
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Ersek M, Herr K, Hilgeman MM, Neradilek MB, Polissar N, Cook KF, Nash P, Snow AL, McDarby M, Nelson FX. Developing a Pain Intensity Measure for Persons with Dementia: Initial Construction and Testing. PAIN MEDICINE 2020; 20:1078-1092. [PMID: 30285252 DOI: 10.1093/pm/pny180] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The goal of this study was to identify a limited set of pain indicators that were most predicive of physical pain. We began with 140 items culled from existing pain observation tools and used a modified Delphi approach followed by statistical analyses to reduce the item pool. METHODS Through the Delphi Method, we created a candidate item set of behavioral indicators. Next, trained staff observed nursing home residents and rated the items on scales of behavior intensity and frequency. We evaluated associations among the items and expert clinicians' assessment of pain intensity. SETTING Four government-owned nursing homes and 12 community nursing homes in Alabama and Southeastern Pennsylvania. PARTICIPANTS Ninety-five residents (mean age = 84.9 years) with moderate to severe cognitive impairment. RESULTS Using the least absolute shrinkage and selection operator model, we identified seven items that best predicted clinicians' evaluations of pain intensity. These items were rigid/stiff body or body parts, bracing, complaining, expressive eyes, grimacing, frowning, and sighing. We also found that a model based on ratings of frequency of behaviors did not have better predictive ability than a model based on ratings of intensity of behaviors. CONCLUSIONS We used two complementary approaches-expert opinion and statistical analysis-to reduce a large pool of behavioral indicators to a parsimonious set of items to predict pain intensity in persons with dementia. Future studies are needed to examine the psychometric properties of this scale, which is called the Pain Intensity Measure for Persons with Dementia.
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Affiliation(s)
- Mary Ersek
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Keela Herr
- University of Iowa College of Nursing, Iowa City, Iowa
| | - Michelle M Hilgeman
- Tuscaloosa VA Medical Center, Tuscaloosa, Alabama.,Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Nayak Polissar
- The Mountain-Whisper-Light Statistics, Seattle, Washington
| | - Karon F Cook
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - A Lynn Snow
- Tuscaloosa VA Medical Center, Tuscaloosa, Alabama.,Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa, Alabama
| | | | - Francis X Nelson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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Herr K, Sefcik JS, Neradilek MB, Hilgeman MM, Nash P, Ersek M. Psychometric Evaluation of the MOBID Dementia Pain Scale in U.S. Nursing Homes. Pain Manag Nurs 2019; 20:253-260. [PMID: 31085096 DOI: 10.1016/j.pmn.2018.11.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/19/2018] [Accepted: 11/28/2018] [Indexed: 10/26/2022]
Abstract
PURPOSE The Mobilization-Observation-Behavior-Intensity-Dementia (MOBID) Pain Scale is an observational tool in which raters estimate pain intensity on a 0-10 scale following five standardized movements. The tool has been shown to be valid and reliable in northern European samples and could be useful in the United States (US) for research and clinical purposes. The goal of this study was to examine the validity and reliability of the MOBID among English-speaking nursing home residents in the US. DESIGN Cross-sectional study. SETTINGS Sixteen nursing homes in Pennsylvania, New Jersey, Georgia and Alabama. PARTICIPANTS One hundred thirty-eight older adults with dementia and moderate to severe cognitive impairment. METHODS Validity was evaluated using Spearman correlations between the MOBID overall pain intensity score and 1) an expert clinician's pain intensity rating (ECPIR), 2) nursing staff surrogate pain intensity ratings, and 3) known correlates of pain. We assessed internal consistency by Cronbach's alpha. RESULTS MOBID overall scores were significantly associated with expert clinician's rating of current and worst pain in the past week (rho = 0.54, and 0.57; p < .001, respectively). Statistically significant associations also were found between the MOBID overall score and nursing staff current and worst pain intensity ratings as well as the Cornell Scale for Depression in Dementia (rho = 0.29; p < .001). Internal consistency was acceptable (α = 0.83). CONCLUSIONS AND CLINICAL IMPLICATIONS Result of this study support the use of the MOBID in English-speaking staff and residents in the US. Findings also suggest that the tool can be completed by trained, nonclinical staff.
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Affiliation(s)
- Keela Herr
- University of Iowa College of Nursing, Iowa City, Iowa
| | - Justine S Sefcik
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | | | - Michelle M Hilgeman
- Tuscaloosa VA Medical Center, Tuscaloosa, Alabama; The University of Alabama Alabama Research Institute on Aging & Department of Psychology, Tuscaloosa, Alabama; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Mary Ersek
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
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16
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Geddis-Regan AR, Stewart M, Wassall RR. Orofacial pain assessment and management for patients with dementia: A meta-ethnography. J Oral Rehabil 2018; 46:189-199. [PMID: 30307635 DOI: 10.1111/joor.12732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 11/30/2022]
Abstract
Delivering dental treatment for patients with dementia can be challenging, and the complexity of treatment provision can increase as dementia progresses. Treatment at the later stages of dementia can be associated with ethical challenges and procedural risk meaning that a comprehensive patient assessment is crucial; the presence of orofacial pain is a key indication for active intervention from dental teams. To explore the process of oro-facial pain assessment and management, a comprehensive review of qualitative literature was undertaken by searching six electronic databases. No literature specific to orofacial pain assessment was identified. The inclusion criteria were widened to explore assessment and management of pain in general for patients with dementia. Meta-ethnography with reciprocal translation was used to identify key concepts and themes and synthesise information applicable to the dental setting. Three major themes arose as follows: challenges with pain assessment, challenges with pain management and logistics and education. Healthcare teams struggle with pain identification in patients with dementia though many signs were identified which may suggest a patient is experiencing pain. The long-term knowledge of individual patients held by family members and care teams can allow identification of deviation from patients' normal states; this knowledge can assist healthcare professionals in determining whether to provide specific treatments or interventions. Pain assessment tools were found to be problematic and are unlikely to be a practical solution to use for complex patients in dental settings. Education for dental and wider care teams on orofacial pain would be highly valuable; yet, this needs to be based on suitable evidence.
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Affiliation(s)
| | - Margaret Stewart
- Patient and Public Involvement Researcher, Newcastle upon Tyne, UK
| | - Rebecca R Wassall
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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17
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Lautenbacher S, Sampson EL, Pähl S, Kunz M. Which Facial Descriptors Do Care Home Nurses Use to Infer Whether a Person with Dementia Is in Pain? PAIN MEDICINE 2018; 18:2105-2115. [PMID: 28034977 DOI: 10.1093/pm/pnw281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objectives Pain assessment in people with advanced dementia relies strongly on observable pain behaviors, such as facial expressions, body movement, and vocalizations. However, the process of inferring pain in others based on such observations is not well understood. We aimed to investigate which features of facial expressions caregivers rely on when inferring the presence and intensity of pain in people with dementia. Methods A questionnaire, including items on 13 facial descriptors, which were extracted from established observational scales for pain in dementia, was sent to 366 nursing homes in Germany. We asked the nurses to observe patients with dementia and then rate their observations using the facial descriptors, as well as to provide an overall pain estimate of the residents' pain. We used regression analyses to identify which facial descriptors nurses use most commonly to infer whether a person with dementia is in pain and to grade the pain's intensity. Results Seventy-nine nursing homes participated (22% response rate), and a total of 284 completed observer ratings were returned. The observed individuals suffered from moderate to severe dementia and were observed in everyday care situations. The average pain estimated by the caregivers was slight to moderate. Mainly anatomically based descriptors ("frowning," "narrowed eyes") and indicators of emotional arousal ("looking tense," looking frightened") significantly predicted the overall pain ratings by nurses, explaining approximately 45% of the variance. Conclusions Although all presented facial descriptors were used by the nurses, some descriptors were used clearly more frequently than others to infer whether a resident with dementia was in pain. Development of observational pain tools and training in their use should consider the preexisting assumptions that nurses use to infer pain as well as their potential bias.
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Affiliation(s)
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Sonja Pähl
- Physiological Psychology, Otto-Friedrich University, Bamberg, Germany
| | - Miriam Kunz
- Physiological Psychology, Otto-Friedrich University, Bamberg, Germany.,Gerontology Section, Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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18
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Atee M, Hoti K, Parsons R, Hughes JD. A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia. Clin Interv Aging 2018; 13:1245-1258. [PMID: 30038491 PMCID: PMC6052926 DOI: 10.2147/cia.s168024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. STUDY DESIGN A 2-week observational study. SETTING An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. PARTICIPANTS Subjects were 10 residents (age range: 63.1-84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. MEASUREMENTS ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. RESULTS A total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters' agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85-0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κw=0.72 (95% CI: 0.58-0.86) at rest and κw=0.69 (95% CI: 0.50-0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; p<0.0012) and following mobilization (mean: 2.5 vs 1.7; p<0.0001) compared to no pain and rest, respectively. CONCLUSIONS ePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia.
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Affiliation(s)
- Mustafa Atee
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia,
| | - Kreshnik Hoti
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia,
- Division of Pharmacy, Faculty of Medicine, University of Pristina, Prishtina, Kosovo
| | - Richard Parsons
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia,
| | - Jeffery D Hughes
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia,
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19
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Atee M, Hoti K, Parsons R, Hughes JD. Pain Assessment in Dementia: Evaluation of a Point-of-Care Technological Solution. J Alzheimers Dis 2018; 60:137-150. [PMID: 28800333 PMCID: PMC5611807 DOI: 10.3233/jad-170375] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pain is common among people with moderate to severe dementia, but inability of patients to self-report means it often goes undetected and untreated. We developed the electronic Pain Assessment Tool (ePAT) to address this issue. A point-of-care App, it utilizes facial recognition technology to detect facial micro-expressions indicative of pain. ePAT also records the presence of pain-related behaviors under five additional domains (Voice, Movement, Behavior, Activity, and Body). In this observational study, we assessed the psychometric properties of ePAT compared to the Abbey Pain Scale (APS). Forty aged care residents (70% females) over the age of 60 years, with moderate to severe dementia and a history of pain-related condition(s) were recruited into the study. Three hundred and fifty-three paired pain assessments (either at rest or post-movement) were recorded and analyzed. The ePAT demonstrated excellent concurrent validity (r = 0.882, 95% CI: 0.857–0.903) and good discriminant validity. Inter-rater reliability score was good overall (weighted κ= 0.74, 95% CI: 0.68–0.80) while internal consistency was excellent. ePAT has psychometric properties which make it suitable for use in non-communicative patients with dementia. ePAT also has the advantage of automated facial expression assessment which provides objective and reproducible evidence of the presence of pain.
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Affiliation(s)
- Mustafa Atee
- School of Pharmacy, Curtin University, Bentley, WA, Australia
| | - Kreshnik Hoti
- School of Pharmacy, Curtin University, Bentley, WA, Australia.,Division of Pharmacy, Faculty of Medicine, University of Pristina, Pristina, Kosovo
| | - Richard Parsons
- School of Pharmacy, Curtin University, Bentley, WA, Australia
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20
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Lautenbacher S, Walz AL, Kunz M. Using observational facial descriptors to infer pain in persons with and without dementia. BMC Geriatr 2018; 18:88. [PMID: 29642850 PMCID: PMC5896123 DOI: 10.1186/s12877-018-0773-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background For patients with advanced dementia, pain diagnosis and assessment requires observations of pain-indicative behavior by others. One type of behavior that has been shown to be a promising candidate is the facial response to pain. To further test how pain-indicative facial responses are, we investigated the predictive power of observational facial descriptors to (i) predict the self-report of pain and (ii) to differentiate between non-painful and painful conditions. In addition, the expertise of the observers (nurses vs. healthy controls) and the cognitive status of the observed (dementia vs. cognitively healthy) were considered. Methods Overall 62 participants (32 nurses and 30 control subjects) watched 40 video-clips, showing facial expressions of older individuals with and without dementia during non-painful and painful pressure stimulation. After each clip, participants were asked to rate the videos using commonly used facial descriptors of pain and also to provide global pain estimate ratings of how much pain the observed individual might have experienced. Results Out of the 12 facial descriptors used, only 7 were able to differentiate between non-painful and painful conditions. Moreover, participants were better in predicting the pain self-report of the observed individuals when using facial descriptors than when using global pain estimates. Especially, the anatomically-orienting descriptors (e.g. opened mouth, narrowing eyes) showed greatest predictive power. Results were not affected by pain-expertise of the observers (nurses vs. control subjects) or diagnostic status of the observed (patients with dementia vs. cognitively unimpaired subjects). Conclusions The fine-grained and specific observation of facial responses to acute pain appeared to provide valid indication of pain that is not compromised when patients with dementia are observed. The regular professional training does not put nurses at advantage to detect pain via facial responses.
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Affiliation(s)
- Stefan Lautenbacher
- Physiological Psychology, University of Bamberg, Markuspl. 3, 96045, Bamberg, Germany.
| | - Anna Lena Walz
- Physiological Psychology, University of Bamberg, Markuspl. 3, 96045, Bamberg, Germany
| | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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21
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Dawes TR, Eden-Green B, Rosten C, Giles J, Governo R, Marcelline F, Nduka C. Objectively measuring pain using facial expression: is the technology finally ready? Pain Manag 2018; 8:105-113. [PMID: 29468939 DOI: 10.2217/pmt-2017-0049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Currently, clinicians observe pain-related behaviors and use patient self-report measures in order to determine pain severity. This paper reviews the evidence when facial expression is used as a measure of pain. We review the literature reporting the relevance of facial expression as a diagnostic measure, which facial movements are indicative of pain, and whether such movements can be reliably used to measure pain. We conclude that although the technology for objective pain measurement is not yet ready for use in clinical settings, the potential benefits to patients in improved pain management, combined with the advances being made in sensor technology and artificial intelligence, provide opportunities for research and innovation.
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Affiliation(s)
- Thomas Richard Dawes
- Department of Anaesthesia, Queen Victoria Hospital, East Grinstead, West Sussex RH19 3DZ, UK
| | - Ben Eden-Green
- Department of Anaesthesia, Queen Victoria Hospital, East Grinstead, West Sussex RH19 3DZ, UK
| | - Claire Rosten
- School of Health Sciences, University of Brighton, Falmer BN1 6PP, UK
| | - Julian Giles
- Department of Anaesthesia, Queen Victoria Hospital, East Grinstead, West Sussex RH19 3DZ, UK
| | - Ricardo Governo
- Brighton & Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK
| | - Francesca Marcelline
- Brighton & Sussex Library & Knowledge Service, Royal Sussex County Hospital, Brighton BN2 5BE, UK
| | - Charles Nduka
- Department of Plastic & Reconstructive Surgery, Queen Victoria Hospital, East Grinstead, West Sussex RH19 3DZ, UK
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22
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Hadjistavropoulos T, Browne ME, Prkachin KM, Taati B, Ashraf A, Mihailidis A. Pain in severe dementia: A comparison of a fine-grained assessment approach to an observational checklist designed for clinical settings. Eur J Pain 2018; 22:915-925. [PMID: 29359875 PMCID: PMC5947563 DOI: 10.1002/ejp.1177] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 11/16/2022]
Abstract
Background Fine‐grained observational approaches to pain assessment (e.g. the Facial Action Coding System; FACS) are used to evaluate pain in individuals with and without dementia. These approaches are difficult to utilize in clinical settings as they require specialized training and equipment. Easy‐to‐use observational approaches (e.g. the Pain Assessment Checklist for Limited Ability to Communicate‐II; PACSLAC‐II) have been developed for clinical settings. Our goal was to compare a FACS‐based fine‐grained system to the PACSLAC‐II in differentiating painful from non‐painful states in older adults with and without dementia. Method We video‐recorded older long‐term care residents with dementia and older adult outpatients without dementia, during a quiet baseline condition and while they took part in a physiotherapy examination designed to identify painful areas. Videos were coded using pain‐related behaviours from the FACS and the PACSLAC‐II. Results Both tools differentiated between painful and non‐painful states, but the PACSLAC‐II accounted for more variance than the FACS‐based approach. Participants with dementia scored higher on the PACSLAC‐II than participants without dementia. Conclusion The results suggest that easy‐to‐use observational approaches for clinical settings are valid and that there may not be any clinically important advantages to using more resource‐intensive coding approaches based on FACS. We acknowledge, as a limitation of our study, that we used as baseline a quiet condition that did not involve significant patient movement. In contrast, our pain condition involved systematic patient movement. Future research should be aimed at replicating our results using a baseline condition that involves non‐painful movements. Significance Examining older adults with and without dementia, a brief observational clinical approach was found to be valid and accounted for more variance in differentiating pain‐related and non‐pain‐related states than did a detailed time‐consuming fine‐grained approach.
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Affiliation(s)
- T Hadjistavropoulos
- Department of Psychology, University of Regina, SK, Canada.,Centre on Aging and Health, University of Regina, SK, Canada.,AGE-WELL NCE Inc., Toronto, ON, Canada
| | - M E Browne
- Department of Psychology, University of Regina, SK, Canada.,AGE-WELL NCE Inc., Toronto, ON, Canada
| | - K M Prkachin
- AGE-WELL NCE Inc., Toronto, ON, Canada.,Department of Psychology, University of Northern British Columbia, Prince George, BC, Canada
| | - B Taati
- AGE-WELL NCE Inc., Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Computer Science, University of Toronto, ON, Canada.,Institute of Biomaterials & Biomedical Engineering, University of Toronto, ON, Canada
| | - A Ashraf
- AGE-WELL NCE Inc., Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - A Mihailidis
- AGE-WELL NCE Inc., Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, ON, Canada
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23
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Rostad HM, Utne I, Grov EK, Puts M, Halvorsrud L. Measurement properties, feasibility and clinical utility of the Doloplus-2 pain scale in older adults with cognitive impairment: a systematic review. BMC Geriatr 2017; 17:257. [PMID: 29096611 PMCID: PMC5667437 DOI: 10.1186/s12877-017-0643-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Doloplus-2 is a pain assessment scale for assessing pain in older adults with cognitive impairment. It is used in clinical practice and research. However, evidence for its measurement properties, feasibility and clinical utility remain incomplete. This systematic review synthesizes previous research on the measurement properties, feasibility and clinical utility of the scale. Method We conducted a systematic search in three databases (CINAHL, Medline and PsycINFO) for studies published in English, French, German, Dutch/Flemish or a Scandinavian language between 1990 and April 2017. We also reviewed the Doloplus-2 homepage and reference lists of included studies to supplement our search. Two reviewers independently reviewed titles and abstracts and performed the quality assessment and data abstraction. Results A total of 24 studies were included in this systematic review. The quality of the studies varied, but many lacked sufficient detail about the samples and response rates. The Doloplus-2 has been studied using diverse samples in a variety of settings; most study participants were in long-term care and in people with dementia. Sixteen studies addressed various aspects of the scale’s feasibility and clinical utility, but their results are limited and inconsistent across settings and samples. Support for the scale’s reliability, validity and responsiveness varied widely across the studies. Generally, the reliability coefficients reached acceptable benchmarks, but the evidence for different aspects of the scale’s validity and responsiveness was incomplete. Conclusion Additional high-quality studies are warranted to determine in which populations of older adults with cognitive impairment the Doloplus-2 is reliable, valid and feasible. The ability of the Doloplus-2 to meaningfully quantify pain, measure treatment response and improve patient outcomes also needs further investigation. Trial registration PROSPERO reg. no.: CRD42016049697 registered 20. Oct. 2016. Electronic supplementary material The online version of this article (10.1186/s12877-017-0643-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanne Marie Rostad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway. .,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway.
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway.,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway.,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway
| | - Martine Puts
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo, Norway.,Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs Plass, N-0130, Oslo, Norway
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24
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Arnstein P, Herr KA, Butcher HK. Evidence-Based Practice Guideline: Persistent Pain Management in Older Adults. J Gerontol Nurs 2017. [DOI: 10.3928/00989134-20170419-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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25
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Frasca M, Burucoa B, Domecq S, Robinson N, Dousset V, Cadenne M, Sztark F, Floccia M. Validation of the Behavioural Observation Scale 3 for the evaluation of pain in adults. Eur J Pain 2017; 21:1475-1484. [DOI: 10.1002/ejp.1049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 11/10/2022]
Affiliation(s)
- M. Frasca
- Department of Palliative Care; University Hospital of Bordeaux; France
| | - B. Burucoa
- Department of Palliative Care; University Hospital of Bordeaux; France
| | - S. Domecq
- CCECQA Coordination and Clinical Evaluation of Quality in Aquitaine; Bordeaux France
| | - N. Robinson
- CCECQA Coordination and Clinical Evaluation of Quality in Aquitaine; Bordeaux France
| | - V. Dousset
- Centre of Evaluation and Treatment of the Pain; University Hospital of Bordeaux; France
| | - M. Cadenne
- Centre of Evaluation and Treatment of the Pain; University Hospital of Bordeaux; France
| | - F. Sztark
- Department of Anaesthesia and Resuscitation; University Hospital of Bordeaux; France
| | - M. Floccia
- Department of Geriatrics; University Hospital of Bordeaux; France
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26
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Benromano T, Pick CG, Granovsky Y, Defrin R. Increased Evoked Potentials and Behavioral Indices in Response to Pain Among Individuals with Intellectual Disability. PAIN MEDICINE 2017; 18:1715-1730. [DOI: 10.1093/pm/pnw349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Cornelius R, Herr KA, Gordon DB, Kretzer K, Butcher HK. Evidence-Based Practice Guideline : Acute Pain Management in Older Adults. J Gerontol Nurs 2017; 43:18-27. [DOI: 10.3928/00989134-20170111-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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28
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Kunz M, Seuss D, Hassan T, Garbas JU, Siebers M, Schmid U, Schöberl M, Lautenbacher S. Problems of video-based pain detection in patients with dementia: a road map to an interdisciplinary solution. BMC Geriatr 2017; 17:33. [PMID: 28125956 PMCID: PMC5270300 DOI: 10.1186/s12877-017-0427-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Given the unreliable self-report in patients with dementia, pain assessment should also rely on the observation of pain behaviors, such as facial expressions. Ideal observers should be well trained and should observe the patient continuously in order to pick up any pain-indicative behavior; which are requisitions beyond realistic possibilities of pain care. Therefore, the need for video-based pain detection systems has been repeatedly voiced. Such systems would allow for constant monitoring of pain behaviors and thereby allow for a timely adjustment of pain management in these fragile patients, who are often undertreated for pain. METHODS In this road map paper we describe an interdisciplinary approach to develop such a video-based pain detection system. The development starts with the selection of appropriate video material of people in pain as well as the development of technical methods to capture their faces. Furthermore, single facial motions are automatically extracted according to an international coding system. Computer algorithms are trained to detect the combination and timing of those motions, which are pain-indicative. RESULTS/CONCLUSION We hope to encourage colleagues to join forces and to inform end-users about an imminent solution of a pressing pain-care problem. For the near future, implementation of such systems can be foreseen to monitor immobile patients in intensive and postoperative care situations.
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Affiliation(s)
- Miriam Kunz
- Physiological Psychology, Otto-Friedrich University Bamberg, Bamberg, Germany.
- Department of General Practice, Section Gerontology, University of Groningen, University Medical Center Groningen, PO Box 196 (HPC FA21), 9700 AD, Groningen, The Netherlands.
| | - Dominik Seuss
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
- Cognitive Systems Group, Faculty Information Systems and Applied Computer Science, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Teena Hassan
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
| | - Jens U Garbas
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
| | - Michael Siebers
- Cognitive Systems Group, Faculty Information Systems and Applied Computer Science, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Ute Schmid
- Cognitive Systems Group, Faculty Information Systems and Applied Computer Science, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Michael Schöberl
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
| | - Stefan Lautenbacher
- Physiological Psychology, Otto-Friedrich University Bamberg, Bamberg, Germany
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30
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The Influence of Executive Functioning on Facial and Subjective Pain Responses in Older Adults. Behav Neurol 2016; 2016:1984827. [PMID: 27274618 PMCID: PMC4871961 DOI: 10.1155/2016/1984827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/05/2016] [Indexed: 11/23/2022] Open
Abstract
Cognitive decline is known to reduce reliability of subjective pain reports. Although facial expressions of pain are generally considered to be less affected by this decline, empirical support for this assumption is sparse. The present study therefore examined how cognitive functioning relates to facial expressions of pain and whether cognition acts as a moderator between nociceptive intensity and facial reactivity. Facial and subjective responses of 51 elderly participants to mechanical stimulation at three intensities levels (50 kPa, 200 kPa, and 400 kPa) were assessed. Moreover, participants completed a neuropsychological examination of executive functioning (planning, cognitive inhibition, and working memory), episodic memory, and psychomotor speed. The results showed that executive functioning has a unique relationship with facial reactivity at low pain intensity levels (200 kPa). Moreover, cognitive inhibition (but not other executive functions) moderated the effect of pressure intensity on facial pain expressions, suggesting that the relationship between pressure intensity and facial reactivity was less pronounced in participants with high levels of cognitive inhibition. A similar interaction effect was found for cognitive inhibition and subjective pain report. Consequently, caution is needed when interpreting facial (as well as subjective) pain responses in individuals with a high level of cognitive inhibition.
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Oosterman JM, Zwakhalen S, Sampson EL, Kunz M. The use of facial expressions for pain assessment purposes in dementia: a narrative review. Neurodegener Dis Manag 2016; 6:119-31. [DOI: 10.2217/nmt-2015-0006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Facial expressions convey reliable nonverbal signals about pain and thus are very useful for assessing pain in patients with limited communicative ability, such as patients with dementia. In this review, we present an overview of the available pain observation tools and how they make use of facial expressions. Utility and reliability of facial expressions to measure pain in dementia are discussed, together with the effect of dementia severity on these facial expressions. Next, we present how behavioral alterations may overlap with facial expressions of pain, and may even influence the extent to which pain is facially expressed. The main focus is on disinhibition, apathy and emotional changes. Finally, an overview of theoretical considerations and practical implications is presented for assessing pain using facial expressions in clinical settings.
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Affiliation(s)
- Joukje M Oosterman
- Radboud University Nijmegen, Donders Institute for Brain, Cognition & Behaviour, Nijmegen, The Netherlands
| | - Sandra Zwakhalen
- Maastricht University, Department of Health Services Research, CAPHRI School for Public Health & Primary Care, Maastricht, The Netherlands
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London Medical School, London, UK
- North Middlesex University Hospital, Barnet Enfield & Haringey Mental Health Trust, London, UK
| | - Miriam Kunz
- University of Groningen, University Medical Center Groningen, Department of General Practice, Section Gerontology, Groningen, The Netherlands
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Beach PA, Huck JT, Miranda MM, Bozoki AC. Autonomic, Behavioral, and Subjective Pain Responses in Alzheimer's Disease. PAIN MEDICINE 2015; 16:1930-42. [DOI: 10.1111/pme.12769] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/11/2015] [Accepted: 03/25/2015] [Indexed: 12/31/2022]
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Ethnic Differences in Nonverbal Pain Behaviors Observed in Older Adults with Dementia. Pain Manag Nurs 2015; 16:692-700. [PMID: 25962546 DOI: 10.1016/j.pmn.2015.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/12/2015] [Indexed: 11/24/2022]
Abstract
Research supports using nonverbal pain behaviors to identify pain in persons with dementia. It is unknown whether variations exist among ethnic groups in the expression of nonverbal pain behaviors in this special population. The purpose of this descriptive study was to examine ethnic differences in the presentation and intensity of nonverbal pain behaviors among African American, Caucasian, and Hispanic older adults with dementia when screened for pain by certified nursing assistants. Six certified nursing assistants were trained to review and score 28 video recordings of subjects with dementia for nonverbal pain behaviors using the Non-Communicative Patient's Pain Assessment Instrument. Chi-square was used to examine differences among ethnic groups with regard to the display of nonverbal pain behaviors, and ANOVA was used to evaluate differences in the intensity of overall pain across ethnic groups. Of the 168 assessments, pain words (28%), pain noises (29.8%), and pain faces (28%) were observed most often as indicators of pain. Rubbing, bracing, and restlessness were rarely noted. Chi-square analysis revealed ethnic differences in the expression of pain words (χ(2) = 19.167, p < .001). No significant differences were noted across ethnic groups with regards to overall pain intensity. These findings are the first to examine ethnic differences in nonverbal pain behaviors for older adults with dementia. However, future work should examine assessment tendencies of providers in a larger, more diverse sample.
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Hadjistavropoulos T, Herr K, Prkachin KM, Craig KD, Gibson SJ, Lukas A, Smith JH. Pain assessment in elderly adults with dementia. Lancet Neurol 2014; 13:1216-27. [DOI: 10.1016/s1474-4422(14)70103-6] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kim EK, Kim SY, Eom MR, Kim HS, Lee E. [Validity and reliability of the Korean version of the pain assessment checklist for seniors with limited ability to communicate]. J Korean Acad Nurs 2014; 44:398-406. [PMID: 25231805 DOI: 10.4040/jkan.2014.44.4.398] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to develop and test the validity and reliability of the Korean version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-K) in assessing pain of elders with dementia living in long-term care facilities. METHODS The PACSLAC-K was developed through forward-backward translation techniques. Survey data were collected from 307 elders with dementia living in 5 long-term care facilities in Korea. Data were analyzed using descriptive statistics, Pearson correlation, Spearman's rho, paired t-test, ROC (receiver operation characteristic) curve with the SPSS/WIN (20.0) program. RESULTS The PACSLAC-K showed high internal consistency (.90), inter-rater reliability (.86), intra-rater reliability (.93), and high concurrent validity (.74) in paired t-test with PAINAD. Discriminant validity also showed a significant difference compared with no pain. The PACSLAC-K showed a sensitivity of .93, specificity of .88, and Area Under the Curve of .95 in the ROC curve. CONCLUSION The findings of this study demonstrate that PACSLAC-K is useful in assessing pain for elders with dementia living in long-term care facilities.
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Affiliation(s)
- Eun-Kyung Kim
- Department of Nursing, Chungbuk National University, Cheongju, Korea
| | - Se Young Kim
- Department of Nursing, Changwon National University, Changwon, Korea
| | - Mi Ran Eom
- Department of Nursing, Mokpo National University, Muan, Korea
| | - Hyun Sook Kim
- Department of Nursing, Eulji University, Daejeon, Korea
| | - Eunpyo Lee
- Department of Medicine, Eulji University, Daejeon, Korea.
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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]
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Liao L, Long H, Zhang L, Chen H, Zhou Y, Ye N, Lai W. Evaluation of pain in rats through facial expression following experimental tooth movement. Eur J Oral Sci 2014; 122:121-4. [PMID: 24428464 DOI: 10.1111/eos.12110] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 02/05/2023]
Affiliation(s)
- Lina Liao
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Hu Long
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Li Zhang
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Helin Chen
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Yang Zhou
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Niansong Ye
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Wenli Lai
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu China
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Takai Y, Yamamoto-Mitani N, Suzuki M, Furuta Y, Sato A, Fujimaki Y. Developing and validating a Japanese version of the Assessment of Pain in Elderly People with Communication Impairment. Arch Gerontol Geriatr 2013; 57:403-10. [DOI: 10.1016/j.archger.2013.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 05/22/2013] [Accepted: 06/01/2013] [Indexed: 10/26/2022]
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Cook KF, Keefe F, Jensen MP, Roddey TS, Callahan LF, Revicki D, Bamer AM, Kim J, Chung H, Salem R, Amtmann D. Development and validation of a new self-report measure of pain behaviors. Pain 2013; 154:2867-2876. [PMID: 23994451 DOI: 10.1016/j.pain.2013.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
Pain behaviors that are maintained beyond the acute stage after injury can contribute to subsequent psychosocial and physical disability. Critical to the study of pain behaviors is the availability of psychometrically sound pain behavior measures. In this study we developed a self-report measure of pain behaviors, the Pain Behaviors Self Report (PaB-SR). PaB-SR scores were developed using item response theory and evaluated using a rigorous, multiple-witness approach to validity testing. Participants included 661 survey participants with chronic pain and with multiple sclerosis, back pain, or arthritis; 618 survey participants who were significant others of a chronic pain participant; and 86 participants in a videotaped pain behavior observation protocol. Scores on the PaB-SR were found to be measurement invariant with respect to clinical condition. PaB-SR scores, observer reports, and the videotaped protocol yielded distinct, but convergent views of pain behavior, supporting the validity of the new measure. The PaB-SR is expected to be of substantial utility to researchers wishing to explore the relationship between pain behaviors and constructs such as pain intensity, pain interference, and disability.
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Affiliation(s)
- Karon F Cook
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC, USA Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA School of Physical Therapy, Texas Woman's University Houston Center, Houston, TX, USA Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD, USA Department of Education, College of Education, Chungnam National University, Yuseong-gu, Daejeon, South Korea
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Smith T, Hameed Y, Cross J, Sahota O, Fox C. Assessment of people with cognitive impairment and hip fracture: a systematic review and meta-analysis. Arch Gerontol Geriatr 2013; 57:117-26. [PMID: 23680535 DOI: 10.1016/j.archger.2013.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/26/2013] [Accepted: 04/18/2013] [Indexed: 01/12/2023]
Abstract
This study systematically assesses the literature pertaining to the diagnostic test accuracy of assessment instruments to evaluate patients following hip fracture surgery who present with cognitive impairment. A systematic review and meta-analysis was performed. Studies assessing the reliability, validity, sensitivity or specificity of assessment tools for patients following hip fracture who were cognitively impaired were included. An assessment of published (MEDLINE, EMBASE, CINHAL, AMED, Cochrane library, PEDro) and unpublished/trial registry (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials, the UK National Research Register Archive) databases were undertaken. Methodological quality of the literature was assessed using the QUADAS-2 appraisal tool. Nine studies including 690 participants, with a mean age of 82.1 years were included. The literature demonstrated a high risk of bias for study methodology, but low risk of bias for applicability. Two assessment domains were recognized: pain and delirium. For pain, the Facial Action Coding System (FACS) and DOLOPLUS-2 tools possessed strong inter-rater reliability and internal consistency, with the FACS demonstrating concurrent validity with other pain scales. For delirium, the Delirium Rating Scale-Revisited-98 (DRS-R-98) demonstrated high inter-rater reliability and sensitivity and specificity, with the NEECHAM Confusion Scale possessing high internal consistency. To conclude, there is a paucity of literature assessing the reliability, validity and diagnostic test accuracy of instruments to assess people with cognitive impairment following hip fracture surgery. Based on the current available data, delirium may be best assessed using the NEECHAM Confusion Scale or DRS-R-98. Pain is most accurately evaluated using the FACS.
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Affiliation(s)
- Toby Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
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O Connor L. Case report: A patient with dementia presenting with hip fracture in the emergency department – Challenges of acute pain assessment. Int Emerg Nurs 2012; 20:255-60. [DOI: 10.1016/j.ienj.2012.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/18/2012] [Indexed: 11/30/2022]
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Schnakers C, Chatelle C, Demertzi A, Majerus S, Laureys S. What about pain in disorders of consciousness? AAPS JOURNAL 2012; 14:437-44. [PMID: 22528502 DOI: 10.1208/s12248-012-9346-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 03/12/2012] [Indexed: 01/18/2023]
Abstract
The management and treatment of acute pain is very difficult in non-communicative patients with disorders of consciousness (i.e., vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state), creating an ethical dilemma for caregivers and an emotional burden among both relatives and caregivers. In this review, we summarize recent findings about the neural substrates of nociception and pain in VS/UWS patients as well as recent behavioral assessment methods of nociception specifically designed for patients in altered states of consciousness. We will finally discuss implications for pain treatment in these patients.
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Affiliation(s)
- C Schnakers
- Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium.
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