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Table 1 Overview of peer-reviewed journal articles identified for the scoping review

From: Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis



Brief Description of Methodology

Findings on Pain Assessment & Management in LTC

Bainbridge & Seow (2018) [46]


Bereaved caregivers (N = 1153) completed the CaregiverVoice Survey

• Caregivers rated the relief of physical pain for residents as excellent (~ 52.5%), very good (~ 7.5%), good (~ 22.5%), fair (~ 12.5%), and poor (~ 5%)

Cheung et al. (2018) [47]


LTC residents (N = 3897) were assessed using the RAI-MDS 2.0 at admission and repeated quarterly until death or discharge

• The proportion of residents reporting pain increased from baseline (42.3%) to follow-up (49.7%; p < .001)

• The presence of pain was significantly associated with the onset of delirium (OR: 1.64, p < .001)

Estabrooks et al. (2013) [40]

Alberta, Saskatchewan, Manitoba

RAI-MDS 2.0 completed for LTC residents (N = 5196)

• 27.1% of LTC residents had daily pain

• Alberta showed higher rates of worsening pain compared to Saskatchewan and Manitoba

• Public facilities also had higher rates of worsening pain compared to private-for-profit and voluntary facilities

Fuchs-Lacelle et al. (2008) [34]


Nursing staff regularly assessed residents with dementia using the PACSLAC (N = 89) or using a control measure (N = 84)

• Regular assessments using the PACSLAC resulted in improved pain management practices and reduced observable pain behaviours

• Nursing staff who regularly used the PACSLAC reported lower levels of stress and burnout

Gagnon et al. (2013) [48]


LTC staff (N = 148) evaluated a pain assessment training video and completed pain-related measures

• Pain assessment knowledge increased after staff viewed the training video

• Staff thought positively about the content and quality of the training video

• Barriers to implementing pain practices demonstrated in the training video included time, workload, and resistance to change

Ghandehari et al. (2013) [49]


LTC staff (N = 131) participated in an in-person pain education program or a control education program

• Pain knowledge, psychological beliefs about pain, and beliefs about pain and aging improved after staff participated in the education program

• Barriers to implementing pain practices suggested in the education program included difficult patient characteristics, time, resources, and communication breakdown across professions

Hadjistavropoulos et al. (2010) [23]


Review of clinical guidelines for pain assessment among LTC residents

• Only 4.2% of Canadian physiotherapists were working in LTC settings

• Physiotherapists can play a key role in assessing and managing pain among LTC residents

Hadjistavropoulos et al. (2011) [32]

British Columbia, Saskatchewan, Ontario

Stakeholders (N = 168) completed a Stakeholder Feedback Questionnaire regarding the possibility of implementing pain-related guidelines

• Stakeholders from Saskatchewan believed the policy recommendation of implementing a multidisciplinary geriatrics team less feasible compared to stakeholders from British Columbia and Ontario

• Care aides rated the clinical recommendation of a documented treatment plan for residents with moderate-to-severe pain as more helpful compared to nurses

• Care aides rated the policy recommendation of implementing a multidisciplinary geriatrics team and of reporting on results using a consistent set of performance measures as more feasible than did nurses and administrators

Hadjistavropoulos et al. (2014) [30]


Medication administration in LTC residents (N = 64) as well as interviews and focus groups with LTC staff (N = 19)

• LTC residents who were a part of a pain assessment protocol were given fewer psychotropic medications than residents in the control group

• Protocol implementation resulted in more careful pain evaluation of LTC residents, better communication with physicians, and greater appropriate prescribing of medications

Hadjistavropoulos et al. (2016) [33]


Two LTC facilities evaluated by quality indicators for pain as well as interviews and focus groups with LTC staff (N = 34)

• Pain was assessed more frequently following implementation of pain assessment program

• Staff reported a positive impact following pain assessment program implementation and maintenance

• Implementation success was dependent on management support and staff willingness

• No changes in percentages of patients with moderate-to-severe pain

Helmer-Smith et al. (2020) [50]


eConsult cases (N = 24) by primary care providers in LTC and focus groups (N = 4) on eConsult use in LTC homes

• Specialists (including Pain Medicine) reported benefits and feasibility of using the eConsult service

Hill et al. (2019) [71]

Alberta, Saskatchewan, Manitoba, Ontario, Quebec

Current national and provincial palliative care guiding documents (N = 25)

• Ineffective pain management was one of the clinical issues that stimulated the development of new guiding documents for palliative care

• The physical domain—which centers around pain and symptom management, maintaining cognition, and physical care—was addressed by 56% of guiding documents

Hirdes et al. (2011) [51]

Yukon, British Columbia, Saskatchewan, Manitoba, Ontario, Nova Scotia, Newfoundland & Labrador

Census data available from Statistics Canada’s Canadian Socioeconomic Information Management system regarding LTC residents (N = 128,168)

• Pain was commonly reported among LTC residents, such as 54.1 and 4.9% of residents in Saskatchewan who reported mild-to-moderate and excruciating pain, respectively

Hunter et al. (2020) [52]

Alberta, Saskatchewan, Manitoba, Ontario

Professional and non-professional LTC staff (N = 228) completed a survey assessing qualities regarding palliative care

• LTC staff are likely ready to embrace a palliative care mandate as indicated by their emotional well-being

Kaasalainen et al. (2010) [53]


Interviews or focus groups were conducted with and survey was completed by pharmacists (N = 2), and physiotherapists (N = 2), administrators (N = 4), physicians (N = 4), care aides (N = 20), and nurses (N = 21)

• Based on the survey, barriers to pain assessment included residents’ limited ability to self-report their pain, residents’ reluctance to report pain, and inadequate time for staff

• Based on interviews and focus groups, barriers were organized at the resident/family (e.g., residents’ inability to communicate), healthcare provider (e.g., staff not believing residents’ report of pain), and system (e.g., time constraints) levels

Kaasalainen et al. (2016) [54]


LTC residents (N = 345) participated in a pain management team led by a nurse practitioner, were led by a nurse practitioner without a pain management team, or had no nurse practitioner or pain management team

• Residents receiving care from the pain management team led by a nurse practitioner experienced reduced pain and improved functional status

• Clinical practice behaviours improved in the nurse-led pain management team

• Barriers to effective team functioning included lack of staff knowledge about medication management, establishing the role of the nurse practitioner on the team, and effectively communicating about residents’ pain across staff

Lane et al. (2019) [55]


Database review of LTC residents (N = 12,334) receiving disability assessments at admission and subsequent 2 years

• Daily pain was not associated with greater disability at admission or over time

Mashouri et al. (2020) [56]


LTC homes (N = 594) classified based on RAI-MDS quality indicators to predict performance

• Quality indicator of worsening pain predicted the LTC homes needing improvement

McArthur et al. (2019) [57]

Alberta, Ontario, British Columbia, Manitoba, Nova Scotia, Newfoundland, Saskatchewan, Yukon

RAI-MDS 2.0 data on Complex Continuing Care (N = 2455) and LTC residents (N = 142,386) who are comatose

• Lower proportion of residents who are comatose had documented pain compared to residents who are not comatose

McCleary et al. (2018) [58]

Alberta, Saskatchewan, Manitoba, Ontario

Focus groups with LTC staff (N = 77) and family members of persons with dementia living in LTC (N = 19)

• Staff and families thought that end-of-life pain management was critically important for residents

• Staff reported difficulties in assessing pain among residents with dementia

• Staff and families believed that pain assessment and management for residents with or without dementia were more accurate when they knew the resident well

Nemiroff et al. (2019) [59]

Nova Scotia

Review of LTC resident charts and database notes (N = 748) from time periods

• Decisions to transfer LTC residents to hospital were influenced by inadequate pain control at the LTC as well as requests by family members or residents, inability to contact physician, injury, management and symptom control, and palliation

Ramage-Morin (2008) [60]


Data from LTC residents (N = 2287) were obtained from the data from the National Population Health Survey

• 37.9% of LTC residents reported experiencing chronic pain, with women experiencing higher rates of chronic pain than men

• Of LTC residents reporting chronic pain, reported pain intensities were mild for 22.4%, moderate for 50.0%, and severe for 27.6% of residents

• Pain was found to interfere more with daily activities for those LTC residents who reported moderate or severe pain compared to those who reported mild pain

Rosenberg et al. (2019) [61]

British Columbia

Individuals (N = 380) receiving home-based primary geriatric care in the community assessed using frailty and quality of life measures

• Chronic pain did not predict transfer to LTC facilities

Senderovich et al. (2019) [62]


Literature search on efficacy of herpes zoster vaccine in LTC from 2013 to 2018 (N = 10)

• Vaccine was associated with shorter pain duration and reductions in pain severity

Tadrous et al. (2020) [63]


LTC residents (N = 5363) who were provided with antipsychotics using academic detailing vs. usual care

• Residents who received academic detailing reported a reduction in pain compared to those who received usual care

Turcotte et al. (2018) [64]


LTC residents with Alzheimer’s disease or related dementias (N = 107,381) who were assessed using the RAI-MDS 2.0

• Of LTC residents with Alzheimer’s disease and related dementias, 57.9% reported no pain, 39.3% reported mild to moderate pain, and 2.8% reported excruciating pain

Watt-Watson et al. (2013) [21]


Documents were evaluated for entry-to-practice competency requirements related to pain knowledge, skill, or judgment (N = 21)

• Pain-specific competencies were only listed for dentistry (N = 2), nursing (N = 9), and veterinary (N = 9) documents

Wilchesky et al. (2018) [65]


Medication intervention among residents with severe dementia (N = 44)

• Slight increase in pain from pre-intervention (8.1) to post follow up (9.7, p < .0001) but unclear if increase is the result of intervention or disease progression

Wilkinson et al. (2019) [66]


RAI-MDS 2.0 completed for LTC residents (N = 614)

• Improvement in quality performance (including pain management) over time in LTC homes from 2012 to 2017

Yoon et al. (2018) [67]

Alberta, Manitoba, Ontario, New Brunswick

LTC residents (N = 559) received a standardized oral health examination

• Less than 20% of residents with dentures reported pain in teeth or jaw pain but self-report may underestimate prevalence

Yoon et al. (2020) [68]


Nine focus groups with LTC staff (N = 44) on residents’ oral and dental health

• Staff primarily relied on resident self-reports of mouth pain

• Pain was inferred from changes in eating and non-verbal expressions of pain (i.e., facial grimacing)

Yu et al. (2020) [69]


Newly admitted LTC residents (N = 4853) following a stroke assessed for care needs and mortality

• Female LTC residents more likely to have pain compared to male LTC residents