Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
Pain Med. 2019 Jun 1;20(6):1093-1104. doi: 10.1093/pm/pny166.
The goal of this study was to conduct initial psychometric analyses of a seven-item pain intensity measure for persons with dementia (PIMD) that was developed using items from existing pain observational measures.
We evaluated validity by examining associations with an expert clinician's pain intensity rating (ECPIR) and an established pain observation tool (Mobilization Observation Behaviour Intensity Dementia [MOBID]). We also examined correlations between the PIMD and known correlates of pain: depression, sleep disturbances, agitation, painful diagnoses, and caregiver pain reports. We examined the differences between PIMD scores for "at rest" and "during movement" observations. We assessed reliability by calculating Cronbach's alpha and estimating inter-rater reliability using intraclass correlations (ICCs). Finally, we examined whether six additional "recent changes in behavior" items improved the PIMD's ability to predict expert clinicians' pain ratings.
Sixteen nursing homes located in Alabama, Georgia, Pennsylvania, and New Jersey.
One hundred ninety residents with moderate to severe cognitive impairment, mean age of 84 years, 49.5% female, and 70% white.
PIMD during movement scores were highly correlated with the ECPIR and overall MOBID scores. As expected, there were large differences between at rest and during movement PIMD scores. Associations of PIMD with known correlates of pain were generally low and statistically nonsignificant. Internal consistency was supported with a Cronbach alpha of 0.72 and an inter-rater ICC of 0.82 for during movement PIMD scores.
Initial evaluation of the PIMD supports its validity and reliability. Additional testing is needed to evaluate the tool's sensitivity to changes in pain intensity.
本研究的目的是对使用现有疼痛观察量表中的项目开发的痴呆症患者疼痛强度测量七项量表（PIMD）进行初步心理测量学分析。
我们通过检查与专家临床医生的疼痛强度评分（ECPIR）和既定的疼痛观察工具（Mobilization Observation Behaviour Intensity Dementia [MOBID]）之间的关联来评估有效性。我们还检查了 PIMD 与疼痛的已知相关因素（抑郁、睡眠障碍、躁动、疼痛诊断和护理人员疼痛报告）之间的相关性。我们检查了“休息时”和“运动时”观察的 PIMD 评分之间的差异。我们通过计算 Cronbach 的 alpha 和使用组内相关系数（ICC）估计内部一致性来评估可靠性。最后，我们检查了六个额外的“最近行为变化”项目是否改善了 PIMD 预测专家临床医生疼痛评分的能力。
位于阿拉巴马州、佐治亚州、宾夕法尼亚州和新泽西州的 16 家养老院。
190 名认知障碍程度为中度至重度的居民，平均年龄为 84 岁，49.5%为女性，70%为白人。
运动时 PIMD 评分与 ECPIR 和总体 MOBID 评分高度相关。如预期的那样，休息时和运动时 PIMD 评分之间存在很大差异。PIMD 与疼痛已知相关因素的关联通常较低且无统计学意义。在运动时 PIMD 评分中，内部一致性得到了 Cronbach alpha 为 0.72 和组内相关系数 ICC 为 0.82 的支持。
对 PIMD 的初步评估支持其有效性和可靠性。需要进一步测试来评估该工具对疼痛强度变化的敏感性。
