Observation scales for pain assessment in older adults with cognitive impairments or communication difficulties

BACKGROUND: Several pain observation scales have been developed to accurately assess and manage pain in older adults with severe cognitive impairments, communication difficulties, or both. OBJECTIVE: To review relevant pain observation scales and the psychometric qualities of these scales. METHODS: The literature was searched for articles reporting the use of a pain observation scale in an empirical study and describing psychometric properties in older adults with cognitive impairments, communication difficulties, or both. RESULTS: Thirteen pain observation scales were included. Scales differed in numbers of items, types of categories, and psychometric properties. Facial expression, vocalization, motor behavior, and social behavior or mood are categories present in most of the scales. In terms of reliability and validity, however, most studies are too limited or incomplete to allow definite conclusions to be drawn about usefulness in daily practice. DISCUSSION: As different methods of evaluating reliability and validity were used, and different aims (e.g., type of pain) were pursued, the available scales cannot be compared easily. Nevertheless, a few are promising, given preliminary results. These should be examined further on psychometric properties and usefulness in different populations because optimal pain assessment is necessary for efficient and effective pain treatment.     

A pain assessment tool for patients with limited communication ability

This article outlines the development and implementation of a multi-dimensional pain assessment tool for use in acute hospitals. The tool can assist nurses in caring for various patient groups, including patients with limited communication.     

Capsule endoscopy for the evaluation of patients with chronic abdominal pain

BACKGROUND AND STUDY AIMS: Chronic abdominal pain is a common complaint and in many patients even an extensive work-up does not reveal the cause for the pain. Given Imaging wireless capsule endoscopy is a new method for visualization of the entire small bowel. The aim of our study was to determine the role of capsule endoscopy in the evaluation of patients with unexplained chronic abdominal pain. PATIENTS AND METHODS: 20 patients with chronic abdominal pain of 6 - 96 months' duration were enrolled in the study. They had had an extensive diagnostic work-up which was negative. Capsule endoscopy was performed in all patients. RESULTS: Imaging of the small intestine was excellent and the colon was reached in 16 patients. In 14 patients the study was completely normal; in six patients the procedure revealed findings which were considered to be clinically insignificant. All patients tolerated the capsule well and had no adverse effects. CONCLUSION: Capsule endoscopy did not seem to have any significant clinical value in the evaluation of our patients with obscure chronic abdominal pain.     

认知障碍病人疼痛评估工具研究进展

介绍了国外认知障碍病人疼痛评估工具研究进展,对痴呆病人疼痛评估工具和语言交流障碍病人疼痛评估工具进行了综述.     

认知障碍病人疼痛评估工具研究进展

介绍了国外认知障碍病人疼痛评估工具研究进展，对痴呆病人疼痛评估工具和语言交流障碍病人疼痛评估工具进行了综述。     

Screening and assessment of chronic pain among children with cerebral palsy: a process evaluation of a pain toolbox

Abstract

Purpose: Though high numbers of children with cerebral palsy experience chronic pain, it remains under-recognized. This paper describes an evaluation of implementation supports and adoption of the Chronic Pain Assessment Toolbox for Children with Disabilities (the Toolbox) to enhance pain screening and assessment practices within a pediatric rehabilitation and complex continuing care hospital.

Methods: A multicomponent knowledge translation strategy facilitated Toolbox adoption, inclusive of a clinical practice guideline, cerebral palsy practice points and assessment tools. Across the hospital, seven ambulatory care clinics with cerebral palsy caseloads participated in a staggered roll-out (Group 1: exclusive CP caseloads, March–December; Group 2: mixed diagnostic caseloads, August–December). Evaluation measures included client electronic medical record audit, document review and healthcare provider survey and interviews.

Results: A significant change in documentation of pain screening and assessment practice from pre-Toolbox (<2%) to post-Toolbox adoption (53%) was found. Uptake in Group 2 clinics lagged behind Group 1. Opportunities to use the Toolbox consistently (based on diagnostic caseload) and frequently (based on client appointments) were noted among contextual factors identified. Overall, the Toolbox was positively received and clinically useful.

Conclusion: Findings affirm that the Toolbox, in conjunction with the application of integrated knowledge translation principles and an established knowledge translation framework, has potential to be a useful resource to enrich and standardize chronic pain screening and assessment practices among children with cerebral palsy.

• Implications for Rehabilitation

• It is important to engage healthcare providers in the conceptualization, development, implementation and evaluation of a knowledge-to-action best practice product.

• The Chronic Pain Toolbox for Children with Disabilities provides rehabilitation staff with guidance on pain screening and assessment best practice and offers a range of validated tools that can be incorporated in ambulatory clinic settings to meet varied client needs.

• Considering unique clinical contexts (i.e., opportunities for use, provider engagement, staffing absences/turnover) is required to optimize and sustain chronic pain screening and assessment practices in rehabilitation outpatient settings.

     

Screening patients for communication difficulty: The diagnostic accuracy of the IFCI staff questionnaire

Purpose: Many patients have difficulty communicating about their healthcare. At present there is no tool to identify these patients. This research investigated whether the Inpatient Functional Communication Interview Staff Questionnaire (IFCI SQ) could detect patients who have difficulty communicating their healthcare needs by investigating the sensitivity, specificity and internal consistency of the IFCI SQ.

Method: Fifty patients and their nurses participated in this research. Every second consecutive admission on the general medical ward of a hospital was assessed for communication difficulty by a speech-language pathologist on the IFCI and screened for communication difficulty by a nurse using the IFCI SQ.

Result: At a cut off score of?<2, the IFCI SQ had a sensitivity of 95% and a specificity of 77% compared with the IFCI. The IFCI SQ is a useful test in identifying patients who have communication difficulty and is an extremely good test at ruling out patients who do not have communication difficulty. The internal consistency of the IFCI SQ was also high at 0.954.

Conclusion: The IFCI SQ is a promising tool to detect patients in hospital with communication difficulty. Further research is required to explore the psychometric properties of the IFCI SQ in more detail.     

Introduction of a pain scale for palliative care patients with cognitive impairment

AIM: To describe the development and introduction of a pain scale for patients with cognitive impairment who are admitted to homes for older people and nursing homes in the region of northwest Flanders in Belgium. DESIGN: A questionnaire comparing the Abbey and Pain Assessment in Advanced Dementia (PAINAD) scales was distributed in 17 homes; 185 care providers participated, evaluating 157 patients. FINDINGS: Approximately half of the care providers evaluated both scales as being good measures of pain and easy to use. Of the different items scored in both scales, care providers agreed upon three indicators as being most valuable to use for measuring pain: facial expression; vocalization; and body language. CONCLUSION: The findings were not conclusive for the introduction of either Abbey or PAINAD. Based on the results, a simplified pain observation scale consisting of three items was developed. It has been introduced in the homes of the region and is being tested currently.     

Cognitions related to chronic pain: revision and extension of the cognitive evaluation questionnaire

OBJECTIVES: The assessment of cognitive reactions to chronic pain is less well developed than other areas of pain assessment. The aim of the first study was to revise the Cognitive Evaluation Questionnaire of Philips whereas the second study examined its properties and validity in a new sample of people with chronic pain. METHODS: The revised scale underwent item analysis in 87 undergraduates, all of whom had pain of at least 1-month duration during the previous year, and was correlated with Skevington's Beliefs about Pain Control Questionnaire and 3 ratings of pain severity over time. In a second study, 96 participants with chronic pain (50 females) completed the Revised Cognitive Evaluation Questionnaire, the Survey of Pain Attitudes-Brief, the Center for Epidemiologic Studies Depression Scale, and sections of the Sickness Impact Profile. Hierarchical regression examined the construct validity of the revised scales in relation to psychosocial functioning and depression. RESULTS: Results showed acceptable internal consistency in both samples, and significant correlations with pain severity and the beliefs scales in Study 1. In Study 2, all but 2 scales showed correlations with the measure of beliefs about pain. The hierarchical multiple regression results showed that only Disability belief predicted psychosocial functioning, whereas Control from the beliefs measure and the new revised Causal Rumination and Concern with Effects of Pain scales predicted the CES-D depression scores. DISCUSSION: The revised cognitive scales in themselves were significant predictors in Study 2, and their contribution was more effective for depression than for psychosocial functioning. The results showed promise for the revised scale and are discussed in relation to previous research, with recommendations for future research into the cognitive reactions of individuals with chronic pain.     

Screening of patients with complex regional pain syndrome for antecedent infections.

OBJECTIVE: This study was designed to investigate whether Complex Regional Pain Syndrome type I (CRPS I) could be linked to any previous infection. PATIENTS: Fifty-two patients with CRPS I of one extremity were screened for the presence of antibodies against mostly neurotropic microorganisms. RESULTS: Of these 52 patients, none had antibodies against Treponema pallidum, Borrelia burgdorferi, or HTLV-1. Only four patients were positive for Campylobacter jejuni. For cytomegalovirus, Epstein-Barr virus, herpes simplex virus, and Toxoplasma gondii, seroprevalences were similar to control values. The total seroprevalence of Parvovirus B 19 in our CRPS population was 77%, which was significantly higher than in an independent Dutch population group (59%). Seroprevalence in lower extremity CRPS 1 (94%) was significantly higher than in upper extremity CRPS I patients (68%). In this study all patients were seropositive for varicella zoster virus (VZV) antibodies, but a high prevalence of VZV antibodies is similar to its prevalence in a normal population (>90%). CONCLUSIONS: In this study we found a significantly higher seroprevalence of Parvovirus B19 in CRPS I and this is most striking in lower extremity CRPS I patients. Further serologic research in other geographic areas is needed to provide additional information about a potential role of Parvovirus B 19 or other microorganisms in the etiopathogenesis of CRPS I.