Faculty of Nursing, Oslo University College, Oslo, Norway.
BMC Geriatr. 2010 Feb 20;10:9. doi: 10.1186/1471-2318-10-9.
Pain measurement in nonverbal older adults is best based on behavioural observation, e.g. using an observational measurement tool such as Doloplus-2. The purposes of this study were to examine the use of Doloplus-2 in a nonverbal nursing home population, and to evaluate its reliability and validity by comparing registered nurses' estimation of pain with Doloplus-2 scores.
In this cross-sectional study, Doloplus-2 was used to observe the pain behaviour of patients aged above 65 years who were unable to self-report their pain. Nurses also recorded their perceptions of patient pain (yes, no, don't know) before they used Doloplus-2. Data on demographics, medical diagnoses, and prescribed pain treatment were collected from patient records. Daily life functioning was measured and participants were screened using the Mini Mental State Examination.
In total, 77 nursing home patients were included, 75% were women and the mean age was 86 years (SD 6.6, range 68-100). Over 50% were dependent on nursing care to a high or a medium degree, and all were severely cognitively impaired. The percentage of zero scores on Doloplus-2 ranged from 17% (somatic reactions) to 40% (psychosocial reactions). Cronbach's alpha was 0.71 for the total scale. In total, 52% of the patients were judged by nurses to be experiencing pain, compared with 68% when using Doloplus-2 (p = 0.01). For 29% of the sample, nurses were unable to report if the patients were in pain.
In the present study, more patients were categorized as having pain while using Doloplus-2 compared with nurses' estimation of pain without using any tools. The fact that nurses could not report if the patients were in pain in one third of the patients supports the claim that Doloplus-2 is a useful supplement for estimating pain in this population. However, nurses must use their clinical experience in addition to the use of Doloplus-2, as behaviour can have different meaning for different patients. Further research is still needed about the use of Doloplus-2 in patients not able to self-report their pain.
对于无法用言语表达的老年患者，疼痛的测量最好基于行为观察，例如使用 Doloplus-2 等观察性测量工具。本研究的目的是检验 Doloplus-2 在无法言语表达的养老院人群中的使用情况，并通过比较注册护士对疼痛的评估与 Doloplus-2 评分，评估其可靠性和有效性。
在这项横断面研究中，我们使用 Doloplus-2 观察无法自述疼痛的 65 岁以上患者的疼痛行为。护士在使用 Doloplus-2 之前还记录了他们对患者疼痛的感知（是、否、不知道）。从患者病历中收集了人口统计学、医疗诊断和规定的疼痛治疗数据。使用简易精神状态检查对日常生活功能进行了测量，并对参与者进行了筛查。
共有 77 名养老院患者纳入研究，75%为女性，平均年龄为 86 岁（标准差 6.6，范围 68-100）。超过 50%的患者高度或中度依赖护理，所有人都有严重的认知障碍。Doloplus-2 得分为 0 的比例范围为 17%（躯体反应）至 40%（心理社会反应）。总量表的克朗巴赫 α 系数为 0.71。总体而言，有 52%的患者被护士判断为疼痛，而使用 Doloplus-2 时则有 68%（p = 0.01）。对于样本中的 29%，护士无法报告患者是否疼痛。
在本研究中，与不使用任何工具的护士对疼痛的评估相比，使用 Doloplus-2 时更多的患者被归类为有疼痛。有三分之一的患者，护士无法报告患者是否疼痛，这一事实表明 Doloplus-2 是评估该人群疼痛的有用补充。但是，护士必须在使用 Doloplus-2 的基础上结合自己的临床经验，因为行为对不同的患者可能有不同的含义。关于无法自述疼痛的患者使用 Doloplus-2 仍需要进一步的研究。
