Table 3

Psychometric qualities of behavioural pain assessment scales for elderly people with a cognitive impairment

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)



Content

Criterion

Construct I relation other pain tools

Construct II differentiates

Inter-rater

Intra-rater or Test-retest


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


1

2

1

0

1

1

2

1

1

1

11


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


1

1

1

0

2

1

2

2

0

1

11


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


1

1

1

0

0

0

0

0

0

1

4


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


0

2

1

0

0

0

0

0

0

1

4


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


1

1

1

0

0

1

0

1

0

2

7


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


2

2

2

0

1

1

2

0

0

1

11


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.


1

0

1

0

2

2

1

2

0

2

11


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


2

1

2

0

0

1

1

2

1

0

10


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


1

1

2

0

2

0

2

0

0

1

9


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


1

2

1

0

1

1

2

0

0

2

10


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


1

0

1

0

2

0

0

0

0

1

5


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


2

0

2

0

0

0

0

0

0

0

4


? = 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

Open Data