Observational pain assessment in older persons with dementia in four countries: Observer agreement of items and factor structure of the Pain Assessment in Impaired Cognition.

de Waal, MWM; van Dalen-Kok, AH; de Vet, HCW; Gimenez-Llort, L; Konstantinovic, L; de Tommaso, M; Fischer, T; Lukas, A; Kunz, M; Lautenbacher, S; Lobbezoo, F; McGuire, BE; van der Steen, JT; Achterberg, WP

Observational pain assessment in older persons with dementia in four countries: Observer agreement of items and factor structure of the Pain Assessment in Impaired Cognition.

de Waal, MWM van Dalen-Kok, AH de Vet, HCW Gimenez-Llort, L Konstantinovic, L de Tommaso, M Fischer, T

Lukas, A Kunz, M Lautenbacher, S Lobbezoo, F McGuire, BE van der Steen, JT Achterberg, WP

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Publisher:: Wiley
Publication Type:: Journal Article
Citation:: European journal of pain (London, England), 2020, 24, (2), pp. 296-296
Issue Date:: 2020-02

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Field	Value	Language
dc.contributor.author	de Waal, MWM
dc.contributor.author	van Dalen-Kok, AH
dc.contributor.author	de Vet, HCW
dc.contributor.author	Gimenez-Llort, L
dc.contributor.author	Konstantinovic, L
dc.contributor.author	de Tommaso, M
dc.contributor.author	Fischer, T https://orcid.org/0000-0003-3779-4396
dc.contributor.author	Lukas, A
dc.contributor.author	Kunz, M
dc.contributor.author	Lautenbacher, S
dc.contributor.author	Lobbezoo, F
dc.contributor.author	McGuire, BE
dc.contributor.author	van der Steen, JT
dc.contributor.author	Achterberg, WP
dc.date.accessioned	2020-08-27T01:52:53Z
dc.date.available	2019-09-08
dc.date.available	2020-08-27T01:52:53Z
dc.date.issued	2020-02
dc.identifier.citation	European journal of pain (London, England), 2020, 24, (2), pp. 296-296
dc.identifier.issn	1090-3801
dc.identifier.issn	1532-2149
dc.identifier.uri	http://hdl.handle.net/10453/142389
dc.description.abstract	BACKGROUND:Recognition of pain in people with dementia is challenging. Observational scales have been developed, but there is a need to harmonize and improve the assessment process. In EU initiative COST-Action TD1005, 36 promising items were selected from existing scales to be tested further. We aimed to study the observer agreement of each item, and to analyse the factor structure of the complete set. METHODS:One hundred and ninety older persons with dementia were recruited in four different countries (Italy, Serbia, Spain and The Netherlands) from different types of healthcare facilities. Patients represented a convenience sample, with no pre-selection on presence of (suspected) pain. The Pain Assessment in Impaired Cognition (PAIC, research version) item pool includes facial expressions of pain (15 items), body movements (10 items) and vocalizations (11 items). Participants were observed by health professionals in two situations, at rest and during movement. Intrarater and interrater reliability was analysed by percentage agreement. The factor structure was examined with principal component analysis with orthogonal rotation. RESULTS:Health professionals performed observations in 40-57 patients in each country. Intrarater and interrater agreement was generally high (≥70%). However, for some facial expression items, agreement was sometimes below 70%. Factor analyses showed a six-component solution, which were named as follows: Vocal pain expression, Face anatomical descriptors, Protective body movements, Vocal defence, Tension and Lack of affect. CONCLUSIONS:Observation of PAIC items can be done reliably in healthcare settings. Observer agreement is quite promising already without extensive training. SIGNIFICANCE:In this international project, promising items from existing observational pain scales were identified and evaluated regarding their reliability as an alternative to pain self-report in people with dementia. Analysis on factor structure helped to understand the character of the items. Health professionals from four countries using four different European languages were able to rate items reliably. The results contributed to an informed reduction of items for a clinical observer scale (Pain Assessment in Impaired Cognition scale with 15 items: PAIC15).
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	European journal of pain (London, England)
dc.relation.isbasedon	10.1002/ejp.1484
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	1103 Clinical Sciences, 1109 Neurosciences, 1115 Pharmacology and Pharmaceutical Sciences
dc.subject.classification	Anesthesiology
dc.title	Observational pain assessment in older persons with dementia in four countries: Observer agreement of items and factor structure of the Pain Assessment in Impaired Cognition.
dc.type	Journal Article
utslib.citation.volume	24
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1109 Neurosciences
utslib.for	1115 Pharmacology and Pharmaceutical Sciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2020-08-27T01:52:49Z
pubs.issue	2
pubs.publication-status	Published
pubs.volume	24
utslib.citation.issue	2

Abstract:

BACKGROUND:Recognition of pain in people with dementia is challenging. Observational scales have been developed, but there is a need to harmonize and improve the assessment process. In EU initiative COST-Action TD1005, 36 promising items were selected from existing scales to be tested further. We aimed to study the observer agreement of each item, and to analyse the factor structure of the complete set. METHODS:One hundred and ninety older persons with dementia were recruited in four different countries (Italy, Serbia, Spain and The Netherlands) from different types of healthcare facilities. Patients represented a convenience sample, with no pre-selection on presence of (suspected) pain. The Pain Assessment in Impaired Cognition (PAIC, research version) item pool includes facial expressions of pain (15 items), body movements (10 items) and vocalizations (11 items). Participants were observed by health professionals in two situations, at rest and during movement. Intrarater and interrater reliability was analysed by percentage agreement. The factor structure was examined with principal component analysis with orthogonal rotation. RESULTS:Health professionals performed observations in 40-57 patients in each country. Intrarater and interrater agreement was generally high (≥70%). However, for some facial expression items, agreement was sometimes below 70%. Factor analyses showed a six-component solution, which were named as follows: Vocal pain expression, Face anatomical descriptors, Protective body movements, Vocal defence, Tension and Lack of affect. CONCLUSIONS:Observation of PAIC items can be done reliably in healthcare settings. Observer agreement is quite promising already without extensive training. SIGNIFICANCE:In this international project, promising items from existing observational pain scales were identified and evaluated regarding their reliability as an alternative to pain self-report in people with dementia. Analysis on factor structure helped to understand the character of the items. Health professionals from four countries using four different European languages were able to rate items reliably. The results contributed to an informed reduction of items for a clinical observer scale (Pain Assessment in Impaired Cognition scale with 15 items: PAIC15).

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http://hdl.handle.net/10453/142389