Hølen Jacob C, Saltvedt Ingvild, Fayers Peter M, Hjermstad Marianne J, Loge Jon H, Kaasa Stein
Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
BMC Geriatr. 2007 Dec 19;7:29. doi: 10.1186/1471-2318-7-29.
The Doloplus-2 is used for behavioural pain assessment in cognitively impaired patients. Little data exists on the psychometric properties of the Doloplus-2. Our objectives were to test the criterion validity and inter-rater reliability of the Doloplus-2, and to explore a design for validations of behavioural pain assessment tools.
Fifty-one nursing home patients and 22 patients admitted to a geriatric hospital ward were included. All were cognitively impaired and unable to self-report pain. Each patient was examined by an expert in pain evaluation and treatment, who rated the pain on a numerical rating scale. The ratings were based on information from the medical record, reports from nurses and patients (if possible) about pain during the past 24 hours, and a clinical examination. These ratings were used as pain criterion. The Doloplus-2 was administered by the attending nurse. Regression analyses were used to estimate the ability of the Doloplus-2 to explain the expert's ratings. The inter-rater reliability of the Doloplus-2 was evaluated in 16 patients by comparing the ratings of two nurses administrating the Doloplus-2.
There was no association between the Doloplus-2 and the expert's pain ratings (R2 = 0.02). There was an association (R2 = 0.54) between the expert's ratings and the Doloplus-2 scores in a subgroup of 16 patients assessed by a geriatric expert nurse (the most experienced Doloplus-2 administrator). The inter-rater reliability between the Doloplus-2 administrators assessed by the intra-class coefficient was 0.77. The pain expert's ratings were compared with ratings of two independent geriatricians in a sub sample of 15, and were found satisfactory (intra-class correlation 0.74).
It was challenging to conduct such a study in patients with cognitive impairment and the study has several limitations. The results do not support the validity of the Doloplus-2 in its present version and they indicate that it demands specific administration skills.
Doloplus-2用于认知障碍患者的行为疼痛评估。关于Doloplus-2心理测量特性的数据很少。我们的目标是测试Doloplus-2的标准效度和评分者间信度，并探索行为疼痛评估工具验证的设计。
纳入了51名疗养院患者和22名老年医院病房的患者。所有患者均有认知障碍且无法自我报告疼痛。每位患者由疼痛评估和治疗专家进行检查，专家使用数字评分量表对疼痛进行评分。评分基于病历信息、护士和患者（如果可能）关于过去24小时内疼痛的报告以及临床检查。这些评分用作疼痛标准。Doloplus-2由主治护士进行评估。采用回归分析来估计Doloplus-2解释专家评分的能力。通过比较两名实施Doloplus-2评估的护士的评分，对16名患者的Doloplus-2评分者间信度进行了评估。
Doloplus-2与专家的疼痛评分之间无关联（R2 = 0.02）。在由老年专家护士（最有经验的Doloplus-2评估者）评估的16名患者亚组中，专家评分与Doloplus-2得分之间存在关联（R2 = 0.54）。通过组内系数评估的Doloplus-2评估者间信度为0.77。在15名患者的子样本中，将疼痛专家的评分与两名独立老年病医生的评分进行比较，结果令人满意（组内相关性为0.74）。
在认知障碍患者中进行此类研究具有挑战性，且该研究有几个局限性。结果不支持当前版本的Doloplus-2的效度，表明其需要特定的评估技能。
