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Tagliafico L, Maizza G, Ottaviani S, Muzyka M, Rovere FD, Nencioni A, Monacelli F. Pain in non-communicative older adults beyond dementia: a narrative review. Front Med (Lausanne) 2024; 11:1393367. [PMID: 39228804 PMCID: PMC11371413 DOI: 10.3389/fmed.2024.1393367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 08/06/2024] [Indexed: 09/05/2024] Open
Abstract
Aging is associated with an increased risk of developing pain, especially in the presence of concurrent chronic clinical conditions. Similarly, multimorbidity can affect the perception and ability of older adults to appropriately respond to and communicate pain, and there is a clinical heterogeneity in the processing of painful sensations in different neurological conditions. The present narrative review is aimed at assessing the prevalent diseases associated with poor communication and pain in older adults, together with the available diagnostic instruments for the clinical assessment of pain in such a vulnerable population. Dementia was the most described pathology identified in the current literature associated with poor communication in older adults affected by pain, along with Parkinson's disease and stroke. Notably, a common pattern of pain behaviors in these neurological disorders also emerged, indicating potential similarities in the clinical presentation and appropriate diagnostic workout. At the same time, there are many differences in the way patients express their pain according to their main neurological pathology. In addition to this, although a plethora of observation-based tools for pain in patients with dementia have been developed, there is no gold standard, and the clinical utility of such measurements is still largely unaddressed. Meanwhile, there is substantially no standardized observation-based tool for pain in non-communicative patients with Parkinson's disease, and only a few for stroke. Overall, the present narrative review provides an update on the prevalent diseases beyond dementia associated with a communicative disability and a painful condition in older adults.
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Affiliation(s)
- Luca Tagliafico
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giada Maizza
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Ottaviani
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mariya Muzyka
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Alessio Nencioni
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fiammetta Monacelli
- Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Foraciepe M, Silva AEVF, Fares TG, Santos FC. Pain in older adults with dementia: Brazilian validation of Pain Intensity Measure for Persons with Dementia (PIMD). ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:720-724. [PMID: 37647905 PMCID: PMC10468240 DOI: 10.1055/s-0043-1771174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/30/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Although there are several ways to assess pain in dementia, there is still a need for tools with better items to assess the presence of pain intensity in these individuals. OBJECTIVE To validate to Brazilian version of the "Pain Intensity Measure for Persons with Dementia - PIMD-p. METHODS Older adults, all demented with impaired verbal communication and exposed to potentially painful situations, were selected from an outpatient clinic and long-term care facility (LTCF). The PIMD-p was applied independently by 2 researchers (E1 and E2) on the same day. Within 14 days, the instrument was reapplied by one of the 2 researchers (E3). The pain intensity reported by participants' caregivers and LTCF nurses were recorded on a verbal numeric pain scale. For the statistical analysis, Cronbach's Alpha, Spearman's Coefficient and intraclass correlation Index were calculated. RESULTS A total of 50 older individuals were selected (mean age 86 years), majority with musculoskeletal pain. The PIMD-p demonstrated good internal consistency according to Cronbach's α (0.838), excellent intra and interobserver reproducibility (0.927 and 0.970, respectively; p < 0.001), and convergent validity (strong significant correlations between reported pain intensities and pain indicators on the PIMD-p (except for expressive eyes; corr = 0.106 and p = 0.462). A ROC curve was plotted to determine the best cut-off for the PIMD-P, and a score of 7.5 predicted moderate-to-severe pain, with 77.8% sensitivity and 95.7% specificity (p < 0.001). CONCLUSION The PIMD-p showed satisfactory psychometric properties for measuring intensity of pain in demented older adults with impaired verbal communication.
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Affiliation(s)
- Mariana Foraciepe
- Universidade Federal de São Paulo, Disciplina de Geriatria e Gerontologia, Serviço de Dor e Doenças Osteoarticulares, São Paulo SP, Brazil.
| | - Ana Elisa V. F. Silva
- Universidade Federal de São Paulo, Disciplina de Geriatria e Gerontologia, Serviço de Dor e Doenças Osteoarticulares, São Paulo SP, Brazil.
| | - Thais G. Fares
- Universidade Federal de São Paulo, Disciplina de Geriatria e Gerontologia, Serviço de Dor e Doenças Osteoarticulares, São Paulo SP, Brazil.
| | - Fânia Cristina Santos
- Universidade Federal de São Paulo, Disciplina de Geriatria e Gerontologia, Serviço de Dor e Doenças Osteoarticulares, São Paulo SP, Brazil.
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Yuyama EK, Lima NKDC, Ferrioli E, Dos Santos AFJ, Amorim RS, Moriguti JC. Palliative Care in Advanced Alzheimer's Disease Dementia: Evaluation of the Answers Given by Caregivers and Physicians to the Accuracy of Surprise Question, as a Prognostic Tool. Am J Hosp Palliat Care 2022:10499091221121328. [PMID: 35961638 DOI: 10.1177/10499091221121328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Alzheimer's disease (AD) dementia is the sixth leading cause of death in the United States. The surprise question (SQ) "Would you be surprised if this patient were to die within the next 12 months?" was used to identify death-risk patients, who could benefit from palliative care. Objective: To examine the prognostic accuracy of the SQ by physicians and caregivers in outpatients with AD dementia. Methods: This is a longitudinal and prospective study involving 101 patients along 1 year, applying the SAS 9.2 software and adopting a .05 P-value to assess the variables that influenced answers to the accuracy of SQ using the chi-square test. Results: 27 patients (26.7%) died during the follow-up. When caregivers answered the SQ, it presented a 51.8% sensitivity (CI 31.9 - 71.3), a 66.7% negative predictive value (20.7 - 63.6), a 56.2% specificity (CI 29.8 - 80.2), and a 40.9% positive predictive value of (CI 43.0 - 85.4) with a 53.4% accuracy (CI 38.5 - 68.4). When physicians answered, the SQ had an 88.8% sensitivity (CI 70.8 - 97.6), a 40% negative predictive value (CI 5.2 - 85.3), a 12.5% specificity (CI 1.5 - 38.3), a 63.1% positive predictive value (CI 45.9 - 78.1) with a 60.4% accuracy (CI 45.8 - 75). Conclusion: SQ remains a good tool with high sensitivity for the identification of patients with advanced AD dementia when presented to the attending physician for planning palliative advanced care with accuracy of 60.4% and caregivers' accuracy of 53.4%.
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Affiliation(s)
- Erika Kiyomi Yuyama
- Ribeirão Preto Medical School of the University of São Paulo [USP], Ribeirão Preto, Brazil
| | | | - Eduardo Ferrioli
- Ribeirão Preto Medical School of the University of São Paulo [USP], Ribeirão Preto, Brazil
| | | | | | - Julio Cesar Moriguti
- Ribeirão Preto Medical School of the University of São Paulo [USP], Ribeirão Preto, Brazil
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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: 12] [Impact Index Per Article: 6.0] [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.
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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
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Seixas-Moizes J, Boerlage A, Lia ÉN, Santos LELE, Zucoloto ML, Dach F, Papassidero PC, Wichert-Ana LAL, Della Pasqua O, Wiesebron ML, Icuma TR, Lanchote VL, Coelho EB, Tibboel D, Wichert-Ana L. Translation, Cross-Cultural Adaptation, and Validation of the Portuguese Version of the Rotterdam Elderly Pain Observation Scale. Dement Geriatr Cogn Dis Extra 2021; 11:314-323. [PMID: 35111191 PMCID: PMC8787539 DOI: 10.1159/000520455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> This study reports on the translation, cultural adaptation, and validation of a Portuguese version of the Rotterdam Elderly Pain Observation Scale (REPOS), a Dutch scale to assess pain in patients who cannot communicate, with or without dementia. <b><i>Methods:</i></b> This is a multicenter study in pain and neurological units involving Brazil (clinical phase) and the Netherlands (training phase). We performed a retrospective cross-sectional, 2-staged analysis, translating and culturally adapting the REPOS to a Portuguese version (REPOS-P) and evaluating its psychometric properties. Eight health professionals were trained to observe patients with low back pain. REPOS consists of 10 behavioral items scored as present or absent after a 2-min observation. The REPOS score of ≥3 in combination with the Numerical Rating Scale (NRS) of ≥4 indicated pain. The Content Validity Index (CVI) in all items and instructions showed CVI values at their maximum. According to the higher correlation coefficient found between NRS and REPOS-P, it may be suggested that there was an adequate convergent validity. <b><i>Results:</i></b> The REPOS-P was administered to 80 patients with a mean age of 60 years (SD 11.5). Cronbach’s alpha coefficient showed a moderate internal consistency of REPOS-P (α = 0.62), which is compatible with the original study of REPOS. All health professionals reached high levels of interrater agreement within a median of 10 weeks of training, assuring reproducibility. Cohen’s kappa was 0.96 (SD 0.03), and the intraclass correlation coefficient was 0.98 (SD 0.02), showing high reliability of REPOS-P scores between the trainer (researcher) and the trainees (healthcare professionals). The Pearson correlation coefficient was 0.95 (95% confidence interval 0.94–0.97), showing a significant correlation between the total scores of REPOS-P and NRS. <b><i>Conclusion:</i></b> The REPOS-P was a valuable scale for assessing elderly patients with low back pain by different healthcare professionals. Short application time, ease of use, clear instructions, and the brief training required for application were essential characteristics of REPOS-P.
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Affiliation(s)
- Julieta Seixas-Moizes
- Department of Radiology, Hematology, and Oncology, University of São Paulo, Ribeirão Preto, Brazil
| | - Anneke Boerlage
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands
| | - Érica Negrini Lia
- Department of Radiology, Hematology, and Oncology, University of São Paulo, Ribeirão Preto, Brazil
- Department of Dentistry, Health Sciences School, University of Brasília (UNB), Brasília, Brazil
| | | | | | - Fabíola Dach
- Department of Neurosciences and Behavioral Sciences, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | - Oscar Della Pasqua
- Division of Pharmacology, Leiden Academic Centre for Drug Research, University of Leiden, Leiden, The Netherlands
- Clinical Pharmacology & Therapeutics, School of Life and Medical Sciences, University College London, London, United Kingdom
| | | | - Tatiana Reis Icuma
- Department of Social Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Vera Lucia Lanchote
- Department of Clinical Analysis, Food Science and Toxicology, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Eduardo Barbosa Coelho
- Internal Medicine of the Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Dick Tibboel
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands
| | - Lauro Wichert-Ana
- Department of Radiology, Hematology, and Oncology, University of São Paulo, Ribeirão Preto, Brazil
- *Lauro Wichert-Ana,
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Instruments for pain assessment in patients with advanced dementia: A systematic review of the evidence for Latin America. Palliat Support Care 2021; 18:741-747. [PMID: 31918779 DOI: 10.1017/s147895151900107x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Pain treatment is an essential component of care for elderly patients with advanced dementia. The objective of this study was to identify and analyze the different scales used for pain assessment in elderly persons diagnosed with dementia, in the literature available at the Latin American level. METHOD A systematic review was performed on the existing scales for pain assessment in elderly people diagnosed with Alzheimer's disease, vascular dementia, and dementia with Lewy bodies. RESULTS 226 articles were retrieved from the PUBMED, BIREME, and Scielo databases, of which a total of 10 articles entered the systematic review. The instruments identified in these publications were PAINAD, Abbey, McGill, and PACSLAC, while the Colored Pain Scale, Faces Pain Scale, and VAS scales were used as the silver standard. In Spanish, the Abbey scale, and in Portuguese, the PACSLAC scale showed the best reliability and validity coefficients. SIGNIFICANCE OF RESULTS It is concluded that there are only two appropriate scales for the assessment of pain in people with dementia in the region of interest of this study. It is recommended to generate more evidence for a more accurate assessment of pain in people with dementia.
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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.
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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
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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.
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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.
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Souza TSPD, Lopez LCS. Translation and cultural adaptation of the Self-Talk Questionnaire for sports (S-TQ) into Brazilian Portuguese. REVISTA BRASILEIRA DE CIÊNCIAS DO ESPORTE 2019. [DOI: 10.1016/j.rbce.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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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.
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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
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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: 5] [Impact Index Per Article: 0.8] [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.
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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]
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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.
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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
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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.
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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
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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.
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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
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Thé KB, Gazoni FM, Cherpak GL, Lorenzet IC, Santos LAD, Nardes EM, Santos FCD. Pain assessment in elderly with dementia: Brazilian validation of the PACSLAC scale. EINSTEIN-SAO PAULO 2016; 14:152-7. [PMID: 27462888 PMCID: PMC4943348 DOI: 10.1590/s1679-45082016ao3628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022] Open
Abstract
Objective To validate the Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese in demented elderly and to analyze its measurement properties. Methods We evaluated 50 elderly with dementia, residing in a nursing home and with limited communication ability, when exposed to potentially painful situations. The tool was applied at two different moments. First, two interviewers applied it simultaneously, and the intensity of pain was asked based on the caregiver’s opinion. After 14 days, with no analgesic intervention, one of the interviewers applied it again. Results The sample comprised more females, aged over 80 years, with dementia due to Alzheimer, presenting musculoskeletal pain of moderate to severe intensity. The psychometric properties of the tool demonstrated appropriate internal consistency (Cronbach’s alpha coefficient of 0.827). The scale had excellent reproducibility, according to the intraclass correlation coefficient, and the tool has been duly validated. Conclusion The Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese had adequate measuring properties for use with elderly presenting limited communication.
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Affiliation(s)
- Karol Bezerra Thé
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Fry M, Chenoweth L, Arendts G. Assessment and management of acute pain in the older person with cognitive impairment: A qualitative study. Int Emerg Nurs 2016; 24:54-60. [DOI: 10.1016/j.ienj.2015.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/01/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
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