Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, Hippocratespad 21, Zone V0-P, Leiden, 2300 RC, the Netherlands.
TOPAZ Geriatric Rehabilitation Center Revitel, Leiden, the Netherlands.
BMC Neurol. 2024 Sep 5;24(1):319. doi: 10.1186/s12883-024-03824-8.
The use of self-report pain scales in persons with aphasia can be challenging due to communication and cognitive problems, while for assessing pain self-report pain is considered the gold standard (Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis. 2015;39(3-4):190-201.). An observational scale may be used as an alternative. This study examines the validity and reliability of the observational Pain Assessment in Impaired Cognition (PAIC15) scale in persons with aphasia.
Persons with aphasia were observed during rest and transfer by two observers using the PAIC15. The PAIC15 comprises 15 items covering the three domains of facial expressions, body movements, and vocalizations. When able, the participant completed four self-report pain scales after each observation. The observations were repeated within one week. For criterion validity, correlations between the PAIC15 and self-report pain scales were calculated and for construct validity, three hypotheses were tested. Reliability was determined by assessing internal consistency, and intra- and interobserver agreement.
PAIC15 observations were obtained for 71 persons (mean age 75.5 years) with aphasia. Fair positive correlations (rest: 0.35-0.50; transfer: 0.38-0.43) were reported between PAIC15 and almost all self-report pain scales. Results show that significantly more pain was observed in persons with aphasia during transfer than during rest. No differences were found for observed pain between persons with aphasia who use pain medication and those without, or persons who have joint diseases compared to those without. Results showed acceptable internal consistency. Intra- and interobserver agreement was high for most PAIC15 items, particularly for the domains body movements and vocalizations during rest and transfer.
Recognition of pain in persons aphasia using the PAIC15 showed mixed yet promising results.
由于沟通和认知问题，使用自我报告疼痛量表评估失语症患者的疼痛可能具有挑战性，而自我报告疼痛被认为是评估疼痛的金标准（Harrison RA，Field TS。中风后疼痛：识别、评估和治疗。脑血管疾病。2015；39（3-4）：190-201.）。可以使用观察量表作为替代方法。本研究旨在检验 PAIC15 量表在评估失语症患者疼痛方面的有效性和可靠性。
在休息和转移期间，由两名观察者使用 PAIC15 对失语症患者进行观察。PAIC15 包括 15 个项目，涵盖面部表情、身体动作和发声三个领域。当患者能够完成时，在每次观察后完成四项自我报告疼痛量表。观察在一周内重复进行。为了评估效标效度，计算了 PAIC15 与自我报告疼痛量表之间的相关性，为了评估结构效度，检验了三个假设。通过评估内部一致性以及观察者内和观察者间的一致性来确定可靠性。
共对 71 名（平均年龄 75.5 岁）失语症患者进行了 PAIC15 观察。在休息和转移期间，PAIC15 与几乎所有自我报告疼痛量表之间均报告了适度的正相关（休息时为 0.35-0.50；转移时为 0.38-0.43）。结果表明，在转移期间，与休息期间相比，观察到失语症患者的疼痛明显更多。在使用疼痛药物和不使用疼痛药物的失语症患者之间，以及在患有关节疾病和没有关节疾病的患者之间，观察到的疼痛没有差异。结果表明，内部一致性可接受。在休息和转移期间，大多数 PAIC15 项目的观察者内和观察者间一致性较高，尤其是身体动作和发声领域。
使用 PAIC15 识别失语症患者的疼痛表现出混合但有希望的结果。
