Table 2 Feasibility and clinical utility of the Doloplus-2

Akbarzadeh, 2007, Sweden [33]

RNs and NAs

≥5^*

10

Mean total score

11.9 (6.5) for rater 1 and 12.6 (6.8) for rater 2

Median total score 12 (0–25) for rater 1 and rater 2

NR

NR

NR

NR

Ando, 2010, Japan [23]

First author and authors (CA) and RNs

≥5^*

10

NR

NR

All nurses were provided with in-depth instructions regarding scoring of the Doloplus-2

At admission to hospital, nurses observed the patients’ behavior in an attempt to learn their habits and usual condition by talking with family or health care workers who were familiar with the patient

Nurses’ (N = 14) were interviewed and the scale was said to be feasible

Ando, 2016, Japan [54]

RNs

≥5, 79%

10

Mean total score

Pre-test 7.5 (3.2)

Post-test 2.9 (2.1)

NR

One of the authors held meetings with the RNs to provide in-depth instructions regarding scoring of the Doloplus-2

NR

The experimental group, who was assessed with the Doloplus-2, received pain medication significantly more frequently than the control group who was not assessed with Doloplus-2: χ2 [1, 40] = 16.0, p < 0.001; φ = 0.6, and the mean pain score significantly decreased post treatment (p < 0.001)

Bauer, 2007, France [44]

NR

NR

5; Somatic complaints, Protection of sore areas, Expression, Communication and Problems of behavior

NR

NR

NR

NR

NR

Chen, 2010a, Taiwan [22]

RNs and RAs

≥5, 39.8%

10

Mean score

Total 4.5 (4.1); Somatic 1.3 (2.1);

Psychomotor 2.1 (1.9);

Psychosocial 1.1 (1.9)

NR

RNs in each institution received intensive training from the researcher in the use of the C-Doloplus-2, following the user manual

RNs must have worked in their dementia special care unit at least one month before data collection began

To ensure RAs familiarity with residents, they were asked to observe and record resident’s painful conditions at rest and after pain-provoked motion every day for one week

Nurses (N = 14) asked to rate on a 5-point Likert-type scale (5 = strongly agree to 1 = strongly disagree) “Do you think the C-Doloplus-2 is appropriate for assessing pain in cognitively impaired older people with communication difficulty?”

Mean score 4.1 (SD 0.8; range 3–5)

The RNs indicated it was difficult to distinguish whether there are behavioral changes in sleep pattern, communication and social life of older people with end-stage of dementia, but most agreed that the C-Doloplus-2 scale has clinical potential to detect pain in this group

Chen, 2010b, Taiwan [38]

RNs and NAs from the units and RAs with a Bachelor of Science or higher degrees and majors in psychology or nursing

≥5,

34% (RNs); 48% (NAs); 38% (RAs)

10

NR

NR

RAs underwent a series of training courses;

five hours of instruction about pain in older people with dementia and two weeks of clinical practice training about performing self-report and observational instruments to assess pain in older people with dementia

RNs and NAs must have worked in their dementia special care unit at least one month before data collection began

RAs observed resident’s painful conditions at rest and after pain-provoked motion and interviewed residents about their pain every day for one week prior to assessment with Doloplus-2

NR

Chen, 2014, Taiwan [45]

RAs with Bachelor of Science or higher degrees and majors in psychology or nursing

≥5, 33.8%

10

Mean total score 3.5 (3.2; range 0–15)

NR

The RAs received 6 h of instruction pertaining to pain, depression and agitation in dementia, and two weeks of skills training in observing and recording in clinical settings

For one week, the RAs observed the residents’ behavior directly as they performed ADL, noting pain behaviors

NR

Couilliot, 2013, France [55]

The hospital’s caregivers

NR

10

Baseline mean scores

Total 8.7 (4.7);

Somatic 4.7 (2.6);

Psychomotor 2.3 (1.3);

Psychosocial 1.6 (2.2)

NR

The hospital’s caregivers had been previously trained and were competent in assessment with the scale

NR

NR

Hadjistavropolous, 2008, Canada [46]

Research nurses

NR

10

Mean total score 4.5 (4.4)

NR

Research nurses completed 15 h of instruction on delirium, dementia, and depression from a member of the research team. Instruction on the research procedures as well as direct supervision in the data collection for 15 participants were also provided

NR

NR

Hølen, 2005, Norway [21]

Nurse in co-operation with a RA

≥5, 49%

10

Mean total score 5.2 (5.2)

NR

Nurses and RAs trained in accordance with the Doloplus-2 standard recommendations

The nurses administering the scale worked close to the patients and were familiar with their habits and regular condition

A debriefing questionnaire was completed by the administrators of the Doloplus-2 (N = 11):

- The standardized format makes the discussion of a patient more solid

- Small enough administrative burden and usable in routine care situations

- Items eight to ten (psychosocial reactions), should be cautiously scored because changes in these behavior can be a result of dementia, and not necessarily pain. Therefore, it is important to know the patient’s habits and regular behavioral patterns

- Training and reading of the instruction manual are important for using the scale correctly

Hølen, 2007, Norway [47]

RNs

5 out of 30^*

10

Mean total score 7.5 (5.1; range 0–22)

NR

Nurses who used the Dolplus-2 were trained, but no details provided

RNs administering the scale cared for the patients regularly and were familiar with their behavior

NR

Monacelli, 2013, Italy [53]

A nurse working in the NH

Higher than 5/30, 96%

10

NR

Average 8–10 min per patient

Adequate professional training with reference to Pickering, 2010 [54]

NR

Collection of professional comments on the administration of the scale defined it as handy and easy for clinical application and mostly suitable for a residential setting were professionals are engaged with a daily care of patients

After assessing with Doloplus-2 for 1 year:

- Reduced mean score below the pain threshold: Chi square = 14.8; p < 0.0001.

- Increased analgesic therapy: At the initial assessment, analgesic therapy was of 30% with only 1 level WHO group. After 1 year, the analgesic treatment was of 100% with 1 level WHO group of 15%, 2 level WHO group of 75% and 3 level WHO group of 10%

Neville, 2014, Australia [48]

RNs, enrolled nurses and assistants-in-nursing

5^*

10

Mean total score

First testing occasion: 9.0 (6.5) for rater 1 and 7.4 (6.2) for rater 2.

Second testing occasion: 7.1 (6.0) for rater 1 and 6.8 (5.9) for rater 2

NR

The nurses as rater of the Doloplus-2 scale, received training from a project team member, but no more details provided

The nurses were well aware of the person they were assessing

Nurse qualification was significantly associated with Doloplus-2 score at the first testing occasions

(R² = 0.1; p = .004). More highly qualified nurse raters tended to assign higher pain ratings. The scale may initially be susceptible to rater qualification, but this effect disappears with repeated use

There was no significant effect from different nurse raters producing pain ratings, over and above the effects of rater demographics (all p > 0.12), indicating that multiple raters does not bias pain scores

Pautex, 2007, Switzerland [49]

Nurses

≥5, 19%

10

Median total scale 4 (interquartile range 7)

Average 10 (6 to 12) minutes per patient

A nurse at each unit received extensive training to complete Doloplus-2 and had the responsibility to train other nurses in the unit for at least 1 h and supervised their use of the scale

NR

Constructed and tested a shortened version of the Doloplus-2 (5 items).

Internal consistency and correlation with VAS was similar to the complete Doloplus-2

Of the 88 patients who reported pain using VAS, 50 got a score lower than 5 and 21 got a score equal to 0 on the Dolplus-2. Patients report more pain using self-report (VAS) than nurses uncover with the Doloplus-2

Pickering, 2010, multinational [50]

Two physicians per team (9 teams)

NR

10

Mean total sore per language version

- Dutch: 5.4 (4.4) for rater 1 and 4.1 (3.8) for rater 2

- English: 8.3 (6.0) for rater 1 and 8.8 (6.5) for rater 2

- Italian: 12.7 (6.5) for rater 1 and 12.7 (6.8) for rater 2

- Portuguese: 6.1 (7.0) for rater 1 and 6.2 (7.0) for rater 2

- Spanish: 6.0 (4.9) for rater 1 and 6.3 (4.6) for rater 2

Average 5 min per patient

The team was provided with Doloplus-2 video, instructions for use, several evaluations with paper and video backups. Implemented the scale a few days before study start to familiarize themselves with it

All physicians were familiar with the patient and provided daily medical care

All participating physicians considered Doloplus-2 to be easy to use once they were familiar with it

Rodríguez-Mansilla, 2015, Spain [56]

An occupational therapist

Scores over 5^*

10

Mean total score baseline:

Ear acupressure 19.0 (5.1); Massage 22.7 (6.4); Control: 21.4 (2.7)

NR

NR

NR

NR

Sheu, 2011, Canada [51]

“Coders” over 19 years of age with healthy vision was recruited from a university campus

NR

1, only the ‘Facial expression’ item

NR

NR

NR

NR

NR

Stacpoole, 2014, UK [52]

Researcher with care staff

5 or more^*

10

NR

NR

NR

NR

NR

Torvik, 2009, Norway [43]

RNs

5, 67.5%

10

NR

NR

The researcher trained the RNs in data collection and was available during data collection

The RNs were the patients’ primary nurses who cared for the patient regularly

NR

Torvik, 2010, Norway [42]

RNs

5, 68%

10

Mean score

Total 6.9 (4.4);

Somatic 3.5 (2.7);

Psychomotor 1.6 (1.3); Psychosocial 2.0 (2.4)

NR

The researcher increased staff awareness of patients’ pain by teaching about pain and Doloplus-2. Staff received both oral and written information about how to use the Doloplus-2

The RNs were the patients’ primary nurses who cared for the patient regularly

The highest congruency between Doloplus-2 score > 5 and RNs reporting ‘Don’t know’ when proxy-rating pain, was found on the Psychosocial subscale

The highest congruence between the Doloplus-2 score and the proxy-rating occurred on the Psychomotor score

RNs evaluated significantly more patients as experiencing pain compared with proxy-rated pain (p = 0.001)

Voyer, 2008, Canada [41]

RAs who were nurses

5 out of 30, 44%

10

NR

NR

NR

NR

NR

Voyer, 2009, Canada [39]

Study nurses

5 out of 30, 45.8%

10

NR

NR

NR

NR

NR

Voyer, 2011, Canada [40]

Study nurses

5 out of 30, 50.7%

10

NR

NR

NR

NR

NR

Zwakhalen, 2006, the Netherlands [24]

Nurses

5 out of 30^*

10

Mean total score

‘Daily pain’ group 9.8 (6.0; range 2–23).

‘No pain group’ 5.1 (3.9; range 0–16)

NR

NR

P.212: “…the Doloplus-2 cannot be used without in-depth knowledge of the patient…”, “but not specify raters’ knowledge of the patients’ normal behavior”

Nurses’ (N = 12) ratings of clinical usefulness (scored on a 10-point scale): mean 5.6 (SD 2.2)

Qualitative information from nurses, p.: 217: “Doloplus-2 provides a more general view. A clear manual is provided. The scale is difficult to score and interpret. It’s questionable whether all items of the Doloplus are relevant to detect pain. The psychosocial items in particular are difficult to interpret as solid specific pain behavior. Other causes, like the dementia itself, could explain a change in psychosocial behavior.”