van Herk Rhodee, van Dijk Monique, Biemold Nathalie, Tibboel Dick, Baar Frans P M, de Wit Rianne
Pain Expertise Centre, Erasmus MC, Rotterdam, The Netherlands.
J Clin Nurs. 2009 Sep;18(17):2478-85. doi: 10.1111/j.1365-2702.2008.02776.x. Epub 2009 Jul 8.
Aim. To compare pain reports of nursing home residents to ratings by proxies. Background. It is not easy to assess pain in cognitively impaired residents. For residents who are unable to report pain intensity themselves, proxies (i.e. relatives or caregivers) might serve as sources of information. The utility of these proxies in assessing residents' pain is not clear however. Design. A multicenter cross-sectional study. Methods. Pain intensity was rated on a Numeric Rating Scale; proxies were asked how certain they were about their observations. Agreements on ratings were computed by means of intra class correlation (ICC) coefficients for continuous variables and multiple linear regression analyses were performed with the level of pain intensity by proxies as the dependent variable. Results. The sample consisted of 174 residents (median age 82 years), of whom 124 were cognitively impaired and 50 intact, and 293 proxies: 171 caregivers and 122 relatives. All three parties reported median pain intensity during the preceding week as 6.0. Data were consistent with low-to-moderate correlation coefficients between residents and caregivers (ICC = -0.12 to 0.25), residents and relatives (ICC = -0.51 to 0.48) and caregivers and relatives (ICC = 0.03 to 0.31). Residents themselves judged pain intensity at rest significantly higher than did proxies (p = 0.05). Caregivers scored significantly higher ratings for residents on analgesics (p = 0.001) and significantly lower pain ratings if they were more satisfied with the prescribed analgesics (p = 0.01). Conclusions. Proxy report of relatives and caregivers on presence and intensity of pain is unreliable, especially for cognitively impaired persons. The use of a standardised pain observation scale could be helpful. Relevance to clinical practice. Pain management in nursing home residents could be improved by educating caregivers about assessment and treatment of chronic pain. Relatives should be informed about chronic pain and learn how to alleviate pain through non-pharmacological interventions.
目的。比较养老院居民的疼痛报告与代理人的评分。背景。评估认知受损居民的疼痛并非易事。对于无法自行报告疼痛强度的居民，代理人（即亲属或护理人员）可能作为信息来源。然而，这些代理人在评估居民疼痛方面的效用尚不清楚。设计。一项多中心横断面研究。方法。采用数字评分量表对疼痛强度进行评分；询问代理人对其观察结果的确定程度。通过组内相关系数（ICC）计算连续变量评分的一致性，并以代理人的疼痛强度水平作为因变量进行多元线性回归分析。结果。样本包括174名居民（中位年龄82岁），其中124名认知受损，50名未受损，以及293名代理人：171名护理人员和122名亲属。三方报告前一周的中位疼痛强度均为6.0。数据显示居民与护理人员之间（ICC = -0.12至0.25）、居民与亲属之间（ICC = -0.51至0.48）以及护理人员与亲属之间（ICC = 0.03至0.31）的相关性系数较低至中等。居民自己判断静息时的疼痛强度明显高于代理人（p = 0.05）。护理人员对使用镇痛药的居民评分显著更高（p = 0.001），如果他们对规定的镇痛药更满意，则疼痛评分显著更低（p = 0.01）。结论。亲属和护理人员对疼痛存在及强度的代理报告不可靠，尤其是对于认知受损者。使用标准化疼痛观察量表可能会有所帮助。与临床实践的相关性。通过对护理人员进行慢性疼痛评估和治疗的教育，可改善养老院居民的疼痛管理。应告知亲属有关慢性疼痛的情况，并让他们学习如何通过非药物干预缓解疼痛。
