Cheung Gary, Choi Peter
Mental Health Services for Older People, Auckland District Health Board, New Zealand.
N Z Med J. 2008 Nov 28;121(1286):21-9.
Pain is often under-detected and under-treated in nonverbal patients with severe dementia. PACSLAC is a behavioural assessment tool designed to improve the detection of pain in severe dementia. Previous studies on PACSLAC were primarily with qualified nurses in Canada and The Netherlands. This pilot study is aimed to evaluate the inter-rater reliability of the PACSLAC when it is administrated by caregiver staff.
50 patients from four dementia care facilities were included. For each patient, a PACSLAC rating was completed independently by a medical undergraduate researcher and a caregiver following the caregiver attended the patient's usual personal care with the researcher observing in close proximity.
36 (72%) were female and 14 (28%) were male. The mean age was 82.9 years (SD=7.2) and the mean MMSE score was 7.5 (SD=7.9). A total of 12 caregivers participated in the study. The total PACSLAC scores ranged from 1 to 22 with a mean of 5.7 (SD=4.0). The average percentage of agreement was 0.89 and the Pearson correlation coefficient was 0.83 (p<0.01) for the total PASCLAC scores rated by the researcher and the caregivers.
This pilot study demonstrated PACSLAC has good inter-rater reliability when it is used by caregivers. We believe a baseline PACSLAC could be performed for each patient at the time of admission to a dementia care facility and re-administered on regular intervals to detect pain-related behaviour and to prompt earlier pain management. Future studies with larger samples and collaboration between different centres will be useful in providing normative PACSLAC values in New Zealand.
在患有严重痴呆症的无语言能力患者中，疼痛常常未被充分检测和治疗。PACSLAC是一种行为评估工具，旨在改善对严重痴呆症患者疼痛的检测。先前关于PACSLAC的研究主要是在加拿大和荷兰由合格护士进行的。这项试点研究旨在评估由护理人员使用PACSLAC时的评分者间信度。
纳入了来自四个痴呆症护理机构的50名患者。对于每位患者，在护理人员为患者进行日常个人护理时，由一名医学本科研究人员和一名护理人员独立完成PACSLAC评分，研究人员在附近观察。
36名（72%）为女性，14名（28%）为男性。平均年龄为82.9岁（标准差=7.2），平均MMSE评分为7.5（标准差=7.9）。共有12名护理人员参与了研究。PACSLAC总分范围为1至22分，平均分为5.7（标准差=4.0）。研究人员和护理人员对PASCLAC总分的平均一致率为0.89，Pearson相关系数为0.83（p<0.01）。
这项试点研究表明，护理人员使用PACSLAC时具有良好的评分者间信度。我们认为，在痴呆症护理机构收治每位患者时，可以进行一次基线PACSLAC评估，并定期重新进行评估，以检测与疼痛相关的行为，并促使更早地进行疼痛管理。未来进行更大样本量的研究以及不同中心之间的合作，将有助于提供新西兰的PACSLAC规范值。
