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Psychometric qualities of behavioural pain assessment scales for elderly people with a cognitive impairment |
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| Assessment tool/source |
Dimensions/items Scoring range |
Origin of items |
Number of participants/CI participants |
Validity |
Homogeneity IC |
Reliability |
Feasibility |
Overall judgement (range 0–20) |
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| Content |
Criterion |
Construct I relation other pain tools |
Construct II differentiates |
Inter-rater |
Intra-rater or Test-retest |
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| DOLOPLUS 2 Wary et al., (1992 first version, France) |
10 items, 3 dimensions somatic (N = 5 items) psychomotor (N = 2) psycho-social (N = 3) scoring range 0–30 |
modified pain scale for children (DEGR) |
N = 510 N> 100 CI (few non-communicative) |
y |
? |
Y VAS-DOLOPLUS r very significant |
y ? differs in time |
y alpha .82 |
y kappa = ?? |
y test-retest |
incl. instructions, lexicon scoring interpretation English version available |
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| 1 |
2 |
1 |
0 |
1 |
1 |
2 |
1 |
1 |
1 |
11 |
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| L'Echelle Comportementale pour Personne Agées (ECPA) Alix et al . (1993, France) |
11 items, 3 dimensions pre-care post-care during activities scoring range 0–44 |
modified pain scale for children (DEGR) |
N = 118 N = ?? CI |
y |
n |
y VAS-EPCA Pearson r = .67 (N = 16) |
? differs in time factor analysis |
y alpha .70 |
y Intra Class r = .80 |
? |
manageable scale scoring interpretation not available German version available |
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| 1 |
1 |
1 |
0 |
2 |
1 |
2 |
2 |
0 |
1 |
11 |
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| L'échelle Comportementale simplifiée (l'ECS) Baulon et al. (1995, France) |
10 items scoring range 0–14 |
newly developed, (multidisc. opinion) not specific for CI |
N = 146 N = ?? CI |
? |
n |
n |
? |
? |
? |
? |
incl. instructions, lexicon |
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| 1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
4 |
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| The Observational Behavior Tool Simons & Malabar (1995, UK) |
25 items, 7 dimensions verbal response (N = 8) facial expression (N = 3) body language (N = 5) conscious state (N = 3) physiological change (N = 3) behavioural change (N = 1) feedback from others (N = 2) scoring range 0–25 |
items derived from chronic back pain tool |
N = 105 39 of 105 non-verbal |
y |
n |
n |
n |
n |
n |
n |
? manageable scale scoring interpretation not available |
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| 0 |
2 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
4 |
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| Checklist of Non-Verbal Pain Indicators (CNPI) Feldt et al. (2000, USA) |
6 clustered items (rest vs. movement) scoring range 0–6 |
modified pain scale |
N = 88 elderly hip fracture patients 53 CI, 35 NI |
y |
n |
y r VDS/CNPI r = .372 at rest r = .428 movement |
y CNPI rest vs movement pre- vs post-operative |
y Low, alpha .54–.64 |
y 93% dichotomous Kappa .63–.82 (N = 12) |
n |
y short, incl. instructions, scoring interpretation |
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| 1 |
1 |
1 |
0 |
0 |
1 |
0 |
1 |
0 |
2 |
7 |
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| Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) Hadjistavropoulos et al. (2002, Canada) |
60 items, 4 dimensions facial expressions (N = 13) activity/body movements (N = 20) social/personality/mood (N = 12) physiological/eating/sleeping/vocal (N = 15) scoring range 0–60 |
newly developed for this group of elderly |
Study 1 N = 28 nurses Study 2 N = 40 nurses Study 3 N = 40 nurses |
y |
n |
y 0–10 scale/PACSLAC r = .39–.54 |
y differentiates pain and calm event r = .8 between pain scenes |
y moderate-good . 82–.87 total scale . 55–.73 subscales in study 3 |
n |
n (only for transcript interviews .94) |
y long but simple list |
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| 2 |
2 |
2 |
0 |
1 |
1 |
2 |
0 |
0 |
1 |
11 |
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| Pain Assessment in Advanced Dementia (PAINAD) Warden, Hurley and Volicer. (2002, USA) |
5 (categorical) items breathing negative vocalization facial expression body language consolability scoring range 0–10 |
modified pain scale |
N = 19 observed CI N = 25 records |
y |
n |
y VAS/PAINAID Pearson r = .75– .76 DS-DAT/PAINAID Pearson r = .76 |
y factor analysis differentiates between pleasant and aversive pre/post-medication |
y moderate < .70 |
y Pearson r = .82–.97 |
n |
y categorical but short, manageable scale item explanation incl. |
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| 1 |
0 |
1 |
0 |
2 |
2 |
1 |
2 |
0 |
2 |
11 |
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| Pain Assessment in Dementing Elderly (PADE) Villanueva et al. (2003, USA) |
24 items, 3 parts physically observable facial expressions global pain assessment functional activities |
newly developed for this group of elderly (literature, interviews, observations) |
Study 1 N = 25 CI Study 2 N = 40 CI |
y |
n |
? |
y differentiates between pain and no pain CMAI (agitation)/PADE r = .3–.4 |
y alpha= 0.24–0.88 part 1 good part 3 low |
y Intra Class r study 1 .81–.96 study 2 .54–.96 |
y test-retest Intra Class r study 1 .34–.89 study 2 .70–.98 (part 2 lowest) |
? difficult format due to different scaling (Likert, VAS, Multiple choice), long list |
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| 2 |
1 |
2 |
0 |
0 |
1 |
1 |
2 |
1 |
0 |
10 |
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| Rating Pain in Dementia (RaPID) Sign & Orrell. (2003, UK) |
18 (clustered) items, 4 dimensions behavioural (N = 11) emotional (N = 2) autonomic (N = 2) postural (N = 3) scoring range 0–54 |
newly developed for this group of elderly (literature, experts) |
N = 48 demented |
y |
n |
y RaPID/McGill/VAS scores r = .8–.86 |
n |
y .79 total scale |
y mean .97 based on interviews with caregiver- pat. |
y test-retest >.75 for all items based on interviews with caregiver- pat. |
y clustered but list of acceptable length scoring interpretation not available |
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| 1 |
1 |
2 |
0 |
2 |
0 |
2 |
0 |
0 |
1 |
9 |
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| The Abbey Pain Scale Abbey et al. (2004, Australia) |
6 (categorical) items vocalisation facial expression change in body language behavioural change physiological change physical change scoring range 0–18 |
modified pain scale (items derived from Hurley (1992) and Simons & Malabar (1995) Modified by experts trough a Delphi study |
Stage 1 N = 52 CI (770 pain episodes) Stage 2 N = 61 CI (236 pain episodes) |
y |
n |
y nurses holistic assessment/Abbey scale r = .59 |
y differentiates between pre and post intervention |
y .74–.81 total scale |
y low-modest coefficient = ?? |
n |
y categorical but short, manageable scale |
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| 1 |
2 |
1 |
0 |
1 |
1 |
2 |
0 |
0 |
2 |
10 |
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| The Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN) Snow et al. (2004, USA) |
4 sections/parts e.g. observed daily activities pain response (6 items: words, pain faces, noises, bracing, rubbing, restlessness on a 6 point Likert scale) pain location pain thermometer |
(multidisc. expert opinion) No specific information about origin of the items |
N = 37 CI in a initial feasibility study N = 21 NA (6 video's) |
y |
n |
y video gold standard/NA ratings kappa = .87 low intensity pain condition had smallest parameters |
n |
n |
n |
n |
y brief, not time consuming scoring interpretation not available |
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| 1 |
0 |
1 |
0 |
2 |
0 |
0 |
0 |
0 |
1 |
5 |
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| Pain Assessment Tool for Use with Cognitive Impaired Adults Davies et al. (2004, Australia) |
11 sections/parts e.g. existing painful conditions physiological measures self-report of pain facial expression usual behaviours changes in behaviours (5 headings: vocalisation, body posture, activities of daily living, cognitive functioning, physical changes) usual and new comfort measures |
newly developed for this group of elderly (literature, experts, focus group discussion) |
N = 27 CI N = 14 nurses |
y |
n |
n |
n |
n |
n |
n |
y difficult format due to different scaling (e.g. body map, physiological and behavioural items), long list, time consuming |
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| 2 |
0 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
4 |
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? = no clear information/data available CI = cognitively impaired, NI= non-impaired, NA = nursing assistants, y = information provided, n = no information provided Overall quality judgement by the reviewers (see table 1 for criteria) | ||||||||||||
Zwakhalen et al. BMC Geriatrics 2006 6:3 doi:10.1186/1471-2318-6-3 |
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