The Pain Behaviors for Osteoarthritis Instrument for Cognitively Impaired Elders (PBOICIE).

Older adults with severe cognitive impairment have trouble responding to questions about their osteoarthritis knee or hip pain, which makes pain management difficult. Therefore, the Pain Behaviors for Osteoarthritis Instrument for Cognitively Impaired Elders (PBOICIE) was developed as an alternative. This article reports the development and psychometric testing of the PBOICIE in three studies. The 6-item PBOICIE was not associated with the Verbal Descriptor Scale but was significantly associated with Keefe's method for observing pain behaviors in patients with knee osteoarthritis, with r=0.36 to 0.55, indicating good concurrent validity. The 6-item PBOICIE was able to discriminate older adults' pain behaviors before and after administration of an analgesic agent (2.9+/-1.89 versus 1.97+/-1.98; p<0.001). This study has shown that multifaceted pain assessments are needed in older adults with osteoarthritis knee or hip pain, as the observed behaviors did not parallel but added information to verbal report.