Husebo Bettina S, Strand Liv I, Moe-Nilssen Rolf, Husebo Stein B, Ljunggren Anne E
Department of Public Health and Primary Health Care, Section for Physiotherapy Science, University of Bergen, Bergen, Norway.
Scand J Caring Sci. 2009 Mar;23(1):180-9. doi: 10.1111/j.1471-6712.2008.00606.x. Epub 2009 Jan 20.
Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed and under-treated pain. A nurse-administered assessment tool has been developed to unmask pain during standardised, guided movements, called Mobilisation-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale. The aim was to examine intra- and inter-rater reliability of pain behaviour indicators, inferred pain intensity, and the overall MOBID Pain Score. Twenty-six nursing home patients with severe dementia and chronic pain, 11 primary caregivers and three external raters at the Red Cross Nursing Home, Bergen were included. During video uptake the patients were guided by their primary caregivers to standardised movements of different body parts. Pain behaviour indicators (pain noises, facial expression and defence) were registered for each movement with subsequent rating of pain intensity by external raters, who assessed and scored the videos concurrently and independently at day 1, 4 and 8. Facial expression was most commonly observed, followed by pain noises and defence. Repeated assessments increased the number of observed pain behaviours, but did not improve reliability. Inter-rater reliability was highest for noises, followed by defence and facial expression (kappa = 0.44-0.92, kappa = 0.10-0.76 and kappa = 0.05-0.76 respectively, at day 8). Mobilisation of arms and legs were rated most painful. Intra- and inter-rater reliability of overall pain were very good [intraclass correlation coefficient (1,1) ranging 0.92-0.97 and 0.94-0.96 respectively, at day 8]. Reliability of pain intensity scores tended to increase by repeated assessment. Using video uptake, MOBID Pain Scale was shown to be sufficiently reliable to assess pain in older persons with severe dementia.
年龄增长与痴呆症的高患病率相关，且常伴有疼痛诊断不足和治疗不足的情况。已开发出一种由护士实施的评估工具，用于在标准化的引导动作中识别疼痛，即活动-观察-行为-强度-痴呆（MOBID）疼痛量表。目的是检验疼痛行为指标、推断的疼痛强度以及总体MOBID疼痛评分的评分者内和评分者间信度。纳入了卑尔根红十字养老院的26名患有严重痴呆和慢性疼痛的养老院患者、11名主要护理人员和3名外部评分者。在拍摄视频期间，患者在主要护理人员的引导下进行不同身体部位的标准化动作。记录每个动作的疼痛行为指标（疼痛声音、面部表情和防御动作），随后由外部评分者对疼痛强度进行评分，他们在第1天、第4天和第8天同时且独立地对视频进行评估和评分。最常观察到的是面部表情，其次是疼痛声音和防御动作。重复评估增加了观察到的疼痛行为数量，但并未提高信度。评分者间信度在声音方面最高，其次是防御动作和面部表情（第8天时，kappa分别为0.44 - 0.92、kappa为0.10 - 0.76和kappa为0.05 - 0.76）。手臂和腿部的活动被评为最疼痛。总体疼痛的评分者内和评分者间信度非常好[第8天时组内相关系数（1,1）分别为0.92 - 0.97和0.94 - 0.96]。疼痛强度评分的信度倾向于通过重复评估而增加。通过视频拍摄，MOBID疼痛量表被证明在评估患有严重痴呆的老年人的疼痛方面具有足够的信度。
