Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, OX3 7LD, UK.
Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
Eur Geriatr Med. 2022 Oct;13(5):1029-1045. doi: 10.1007/s41999-022-00655-z. Epub 2022 May 27.
Detecting pain in older people with dementia is challenging. Consequentially, pain is often under-reported and under-treated. There remains uncertainty over what measures should be promoted for use to assess pain in this population. The purpose of this paper is to answer this question.
A search of clinical trials registered on the ClinicalTrial.gov and ISRCTN registries was performed to identify outcome measures used to assess pain in people with dementia. Following this, a systematic review of published and unpublished databases was performed to 01 November 2021 to identify papers assessing the psychometric properties of these identified measures. Each paper and measure was assessed against the COSMIN checklist. A best evidence synthesis analysis was performed to assess the level of evidence for each measure.
From 188 clinical trials, nine outcome measures were identified. These included: Abbey Pain Scale, ALGOPLUS, DOLOPLUS-2, Facial Action Coding System, MOBID-2, self-reported pain through the NRS or VAS/thermometer or Philadelphia Geriatric Pain Intensity Scale, PACSLAC/PACSLAC-2, Pain Assessment in Advanced Dementia (PAINAD), and Checklist for non-verbal pain behavior (CNPI). From these, 51 papers (5924 people with dementia) were identified assessing the psychometric properties of these measures. From these, there was strong- and moderate-level evidence to support the use of the facial action coding system, PACSLAC and PACSLAC-II, CNPI, DOLOPLUS-2, ALGOPLUS, MOBID, and MOBID-2 tools for the assessment of pain with people living with dementia.
Whilst these reflect measurement tools used in research, further consideration on how these reflect clinical practice should be considered.
CRD42021282032.
在患有痴呆症的老年人中检测疼痛具有挑战性。因此，疼痛常常被漏报和治疗不足。对于应该推广哪些措施来评估这一人群的疼痛，仍然存在不确定性。本文旨在回答这个问题。
在 ClinicalTrial.gov 和 ISRCTN 登记处对临床试验进行了检索，以确定用于评估痴呆症患者疼痛的结局测量指标。在此之后，对已发表和未发表的数据库进行了系统回顾，以确定截至 2021 年 11 月 1 日评估这些已确定指标的心理测量特性的论文。对每篇论文和测量指标都根据 COSMIN 清单进行了评估。对最佳证据综合分析进行了评估，以确定每个测量指标的证据水平。
从 188 项临床试验中确定了 9 种结局测量指标。这些指标包括：Abbey 疼痛量表、ALGOPLUS、DOLOPLUS-2、面部动作编码系统、MOBID-2、通过 NRS 或 VAS/温度计或费城老年疼痛强度量表、PACSLAC/PACSLAC-2、痴呆症患者疼痛评估（PAINAD）和非言语疼痛行为检查表（CNPI）。从这些指标中，确定了 51 篇论文（涉及 5924 名患有痴呆症的患者），评估了这些指标的心理测量特性。从这些研究中，有强有力和中等强度的证据支持使用面部动作编码系统、PACSLAC 和 PACSLAC-II、CNPI、DOLOPLUS-2、ALGOPLUS、MOBID、和 MOBID-2 工具来评估与痴呆症患者的疼痛。
虽然这些反映了研究中使用的测量工具，但应进一步考虑如何将这些工具反映临床实践。
CRD42021282032。
