Husebo Bettina S, Strand Liv I, Moe-Nilssen Rolf, Husebo Stein B, Ljunggren Anne E
Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
Scand J Caring Sci. 2010 Jun;24(2):380-91. doi: 10.1111/j.1471-6712.2009.00710.x. Epub 2010 Feb 19.
To assess pain in older persons with severe dementia is a challenge due to reduced self-report capacity. Recently, the development and psychometric property testing of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale was described using video-recording. The purpose of this article was to present the further development of this instrument. In MOBID-2 Pain Scale, the assessment of inferred pain intensity is based on patient's pain behaviours in connection with standardized, guided movements of different body parts (Part 1). In addition, MOBID-2 includes the observation of pain behaviours related to internal organs, head and skin registered on pain drawings and monitored over time (Part 2).
The aim of this study was to examine psychometric properties of the MOBID-2 Pain Scale, like inter-rater and test-retest reliability, internal consistency, as well as face-, construct- and concurrent validity.
Patients with severe dementia (n = 77) were examined by 28 primary caregivers in clinical practice, who concurrently and independently completed the MOBID-2 Pain Scale. Characteristics of the patients' pain were also investigated by their physicians (n = 4).
Prevalence of any pain was 81%, with predominance to the musculoskeletal system, highly associated with the MOBID-2 overall pain score (rho = 0.82). Most frequent and painful were mobilizing legs. Pain in pelvis and/or genital organs was frequently observed. Moderate to excellent agreement was demonstrated for behaviours and pain drawings (kappa = 0.41-0.90 and kappa = 0.46-0.93). Inter-rater and test-retest reliability for pain intensity was very good, ICC (1, 1) ranging 0.80-0.94 and 0.60-0.94. Internal consistency was highly satisfactory; Cronbach's alpha ranging 0.82-0.84. Face-, construct- and concurrent validity was good. Overall pain intensity by MOBID-2 was well correlated with physicians' clinical examination and defined pain variables (rho = 0.41-0.64).
On the basis of pain behaviours, standardized movements and pain drawings, MOBID-2 Pain Scale was shown to be sufficiently reliable, valid and time-effective for nurses to assess pain in patients with severe dementia.
由于自我报告能力下降，评估重度痴呆老年人的疼痛是一项挑战。最近，使用视频记录描述了活动-观察-行为-强度-痴呆（MOBID）疼痛量表的开发和心理测量特性测试。本文的目的是介绍该工具的进一步发展。在MOBID-2疼痛量表中，推断疼痛强度的评估基于患者与不同身体部位的标准化、指导性动作相关的疼痛行为（第1部分）。此外，MOBID-2包括观察与内脏、头部和皮肤相关的疼痛行为，这些行为记录在疼痛图上并随时间进行监测（第2部分）。
本研究的目的是检验MOBID-2疼痛量表的心理测量特性，如评分者间信度和重测信度、内部一致性以及表面效度、结构效度和同时效度。
28名初级护理人员在临床实践中对77名重度痴呆患者进行了检查，他们同时且独立地完成了MOBID-2疼痛量表。患者的疼痛特征也由他们的医生（4名）进行了调查。
任何疼痛的患病率为81%，主要集中在肌肉骨骼系统，与MOBID-2总体疼痛评分高度相关（rho = 0.82）。最常见且疼痛的是活动腿部。经常观察到骨盆和/或生殖器官疼痛。行为和疼痛图显示出中度至高度一致性（kappa = 0.41 - 0.90和kappa = 0.46 - 0.93）。疼痛强度的评分者间信度和重测信度非常好，组内相关系数（ICC）（1, 1）范围为0.80 - 0.94和0.60 - 0.94。内部一致性非常令人满意；Cronbach's alpha范围为0.82 - 0.84。表面效度、结构效度和同时效度良好。MOBID-2的总体疼痛强度与医生的临床检查和确定的疼痛变量密切相关（rho = 0.41 - 0.64）。
基于疼痛行为、标准化动作和疼痛图，MOBID-2疼痛量表被证明对于护士评估重度痴呆患者的疼痛具有足够的可靠性、有效性和时效性。
