Warden Victoria, Hurley Ann C, Volicer Ladislav
Geriatric Research Education Clinical Center, Edith Nourse Rogers Memorial Veterans Medical Center, Bedford, Massachusetts 01730, USA.
J Am Med Dir Assoc. 2003 Jan-Feb;4(1):9-15. doi: 10.1097/01.JAM.0000043422.31640.F7.
To develop a clinically relevant and easy to use pain assessment tool for individuals with advanced dementia that has adequate psychometric properties.
Instrument development study using expert clinicians and behavioral observation methods. Measurement of sensitivity of the instrument to detect the effects of analgesic medications in a quality improvement activity.
Inpatient dementia special care units in a Veterans Administration Medical Center.
Nineteen residents with advanced dementia who were aphasic or lacked the ability to report their degree of pain and six professional staff members. Additionally, data from medical records of 25 residents who were receiving pain medications as required (PRN) were collected.
Based on the literature review, related assessment tools and consultation with expert clinicians, a five-item observational tool with a range of 0 to 10 was developed. The tool, Pain Assessment in Advanced Dementia (PAINAD), was compared with the Discomfort Scale and two visual analog scales (discomfort and pain) by trained raters/expert clinicians in the development study, and used for detection of analgesic efficacy in a quality improvement activity.
Adequate levels of interrater reliability were achieved between dyads of the principal investigator with each clinical research rater and between two raters. PAINAD had satisfactory reliability by internal consistency with a one factor solution. PAINADthe Discomfort Scale-Dementia of Alzheimer Type (DS-DAT) were significantly correlated, providing evidence of construct validity. PAINAD detected statistically significant difference between scores obtained before and after receiving a pain medication.
The PAINAD is a simple, valid, and reliable instrument for measurement of pain in noncommunicative patients. Since the patient population used for its development and testing was limited to a relatively small number of males, further research is needed before it can be universally recommended.
为晚期痴呆患者开发一种具有足够心理测量学特性、临床相关且易于使用的疼痛评估工具。
采用专家临床医生和行为观察方法的工具开发研究。在一项质量改进活动中测量该工具检测镇痛药效果的敏感性。
一家退伍军人管理局医疗中心的住院痴呆专科护理单元。
19名晚期痴呆患者，这些患者存在失语或缺乏报告疼痛程度的能力，以及6名专业工作人员。此外，收集了25名按需要接受止痛药治疗（PRN）的患者的病历数据。
基于文献综述、相关评估工具以及与专家临床医生的咨询，开发了一种范围为0至10分的五项观察工具。在开发研究中，由经过培训的评估者/专家临床医生将该工具“晚期痴呆疼痛评估（PAINAD）”与不适量表和两个视觉模拟量表（不适和疼痛）进行比较，并在一项质量改进活动中用于检测镇痛效果。
在首席研究员与每位临床研究评估者的二元组之间以及两名评估者之间实现了足够水平的评分者间信度。PAINAD通过单因素解决方案的内部一致性具有令人满意的信度。PAINAD与阿尔茨海默病型痴呆不适量表（DS - DAT）显著相关，提供了结构效度的证据。PAINAD检测到接受止痛药前后获得的分数之间存在统计学上的显著差异。
PAINAD是一种用于测量无沟通能力患者疼痛的简单、有效且可靠的工具。由于用于其开发和测试的患者群体仅限于相对较少数量的男性，在能够普遍推荐之前还需要进一步研究。
