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Table 3 Psychometric qualities of behavioural pain assessment scales for elderly people with a cognitive impairment

From: Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools

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
  1. ? = no clear information/data available CI = cognitively impaired, NI= non-impaired, NA = nursing assistants, y = information provided, n = no information provided
  2. Overall quality judgement by the reviewers (see table 1 for criteria)