Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany.
Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Pain. 2020 Jan;24(1):192-208. doi: 10.1002/ejp.1477. Epub 2019 Oct 13.
Over the last decades, a considerable number of observational scales have been developed to assess pain in persons with dementia. The time seems ripe now to build on the knowledge and expertize implemented in these scales to form an improved, "best-of" meta-tool. The EU-COST initiative "Pain in impaired cognition, especially dementia" aimed to do this by selecting items out of existing observational scales and critically re-assessing their suitability to detect pain in dementia. This paper reports on the final phase of this collaborative task.
Items from existing observational pain scales were tested for "frequency of occurrence (item difficulty)," "reliability" and "validity." This psychometric testing was carried out in eight countries, in different healthcare settings, and included clinical as well as experimental pain conditions.
Across all studies, 587 persons with dementia, 27 individuals with intellectual disability, 12 Huntington's disease patients and 59 cognitively healthy controls were observed during rest and movement situations or while receiving experimental pressure pain, respectively. The psychometric outcomes for each item across the different studies were evaluated within an international and multidisciplinary team of experts and led a final selection of 15 items (5x facial expressions, 5x body movements, 5x vocalizations).
The final list of 15 observational items have demonstrated psychometric quality and clinical usefulness both in their former scales and in the present international evaluation; accordingly, they qualified twice to form a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition, the PAIC-15 scale.
Using a meta-tool approach by building on previous observational pain assessment scales and putting the items of these scales through rigorous empirical testing (using experimental as well as clinical pain studies in several European countries), we were able to identify the best items for pain assessment in individuals with impaired cognition. These selected items form the novel PAIC15 scale (pain assessment in impaired cognition, 15 items).
在过去几十年中，已经开发出相当数量的观察量表来评估痴呆患者的疼痛。现在似乎是时候利用这些量表中实施的知识和专业知识来形成一个改进的、“最佳”的综合工具了。欧盟 COST 倡议“认知障碍相关疼痛，尤其是痴呆”旨在通过从现有观察量表中选择项目，并批判性地重新评估其在痴呆症中检测疼痛的适用性来实现这一目标。本文报告了这一合作任务的最后阶段。
从现有的观察性疼痛量表中选择项目，测试其“出现频率（项目难度）”、“可靠性”和“有效性”。这种心理测量测试在八个国家的不同医疗环境中进行，包括临床和实验性疼痛条件。
在所有研究中，分别在休息和运动状态下或接受实验性压力疼痛时，观察了 587 名痴呆症患者、27 名智力障碍患者、12 名亨廷顿病患者和 59 名认知健康对照者。在一个国际和多学科专家团队中，对每个项目在不同研究中的心理测量结果进行了评估，并最终选择了 15 个项目（5x 面部表情、5x 身体动作、5x 发声）。
这 15 个观察项目的最终清单在其以前的量表以及当前的国际评估中都表现出了心理测量质量和临床实用性；因此，它们两次有资格形成一个新的国际公认的认知障碍疼痛评估综合工具，即 PAIC-15 量表。
通过利用以前的观察性疼痛评估量表，并通过在几个欧洲国家进行的实验和临床疼痛研究对这些量表的项目进行严格的实证测试，我们能够确定用于评估认知障碍个体疼痛的最佳项目。这些选定的项目构成了新的 PAIC15 量表（认知障碍疼痛评估，15 项）。
