A Validated Approach to Evaluating Psychometric Properties of Pain Assessment Tools for Use in Nonverbal Critically Ill Adults

Gélinas, Céline; Puntillo, Kathleen; Joffe, Aaron M.; Barr, Juliana

doi:10.1055/s-0033-1342970

Cited by 92 publications

(44 citation statements)

References 37 publications

(83 reference statements)

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“…Psychometric properties related to the use of pain tools were assessed using the new terminology [ 32 ] as recommended by recent Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit [ 16 ]. Inter-rater reliability Inter-rater reliability of the three tools (primary endpoint) was tested by the weighted kappa coefficient.…”

Section: Methodsmentioning

confidence: 99%

Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report

et al. 2014

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IntroductionPain assessment is associated with important outcomes in ICU patients but remains challenging, particularly in non-communicative patients. Use of a reliable tool is paramount to allow any implementation of sedation/analgesia protocols in a multidisciplinary team. This study compared psychometric properties (inter-rater agreement primarily; validity, responsiveness and feasibility secondarily) of three pain scales: Behavioural Pain Scale (BPS/BPS-NI, that is BPS for Non-Intubated patients), Critical Care Pain Observation Tool (CPOT) and Non-verbal Pain Scale (NVPS), the pain tool routinely used in this 16-bed medical ICU.MethodsPain was assessed by at least one of four investigators and one of the 20 bedside nurses before, during and 10 minutes after routine care procedures in non-comatose patients (Richmond Agitation Sedation Scale ≥ -3) who were unable to self-report their pain intensity. The Confusion Assessment Method for the ICU was used to assess delirium. Non-parametric tests were used for statistical analysis. Quantitative data are presented as median (25th to 75th).ResultsA total of 258 paired assessments of pain were performed in 30 patients (43% lightly sedated, 57% with delirium, 63% mechanically ventilated). All three scales demonstrated good psychometric properties. However, BPS and CPOT exhibited the best inter-rater reliability (weighted-κ 0.81 for BPS and CPOT) and the best internal consistency (Cronbach-α 0.80 for BPS, 0.81 for CPOT), which were higher than for NVPS (weighted-κ 0.71, P <0.05; Cronbach-α 0.76, P <0.01). Responsiveness was significantly higher for BPS compared to CPOT and for CPOT compared to NVPS. For feasibility, BPS was rated as the easiest scale to remember but there was no significant difference in regards to users’ preference.ConclusionsBPS and CPOT demonstrate similar psychometric properties in non-communicative intubated and non-intubated ICU patients.Electronic supplementary materialThe online version of this article (doi:10.1186/cc14000) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report

et al. 2014

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“…The numerous factors that should be considered in this decision process in any setting 4,13,73 are shown in Box 1 , with a few factors discussed in more detail because they are especially germane to successful implementation of any pain assessment tool.…”

Section: Key Factors In Selecting Pain Assessment Toolsmentioning

confidence: 99%

“…Of particular relevance in the selection of a tool is a review of not only of the original articles, but of comparison studies since they may offer useful information on how tools performed in a specific setting when compared to one another 27,73 . In addition, if clinicians are looking for a tool that can be used across several clinical settings, for example, in an acute care setting followed by inpatient rehabilitation or hospice, they need to determine in what settings a tool was used and how it performed.…”

Section: Key Factors In Selecting Pain Assessment Toolsmentioning

confidence: 99%

Pain Assessment in Noncommunicative Adult Palliative Care Patients

McGuire

Kaiser

Haisfield-Wolfe

et al. 2016

Nursing Clinics of North America

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Synopsis Palliative care patients who have pain are often unable to self-report their pain placing them at increased risk for under-recognized and under-treated pain. Use of appropriate pain assessment tools significantly enhances the likelihood of effective pain management and improved pain-related outcomes. This paper reviews selected tools and provides palliative care clinicians with a practical approach to selecting a pain assessment tool for non-communicative adult patients.

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“…A CPOT score of > 2 indicates the presence of pain; the sensitivity of the test is 86% while its specificity is 78% for the assessment of severe post-surgical pain [42,43]. The cut-off value suggested for BPS is >5 [44,45].…”

Section: Assessment Of Pain In Critically Ill Patientsmentioning

confidence: 99%

Metody oceny natężenia bólu u dorosłych pacjentów oddziałów intensywnej terapii —polska wersja językowa narzędzia CPOT (Critical Care Pain Observation Tool) i BPS (Behavioral Pain Scale)

Kotfis

Zegan-Barańska

Szydłowski

et al. 2017

Anaesthesiol Intensive Ther

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Many patients treated in the intensive care unit (ICU) experience pain that is a source of suffering and leaves a longterm imprint (chronic pain, post-traumatic stress disorder). Nearly 30% of patients experience pain at rest, while the percentage increases to 50% during nursing procedures. Pain in ICU patients can be divided into four categories: continuous ICU treatment-related pain/discomfort, acute illness-related pain, intermittent procedural pain and pre-existing chronic pain present before ICU admission. As daily nursing procedures and interventions performed in the ICU may be a potential source of pain, it is crucial to use simple pain monitoring tools. The assessment of pain intensity in ICU patients remains an everyday challenge for clinicians, especially in sedated, intubated and mechanically ventilated patients. Regular assessment of pain intensity leads to improved outcome and better quality of life of patients in the ICU and after discharge from ICU. The gold standard in pain evaluation is patient self-reporting, which is not always possible. Current research shows that the two tools best validated for patients unable to self-report pain are the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT). Although international guidelines recommend the use of validated tools for pain evaluation, they underline the need for translation into a given language. The authors of this publication obtained an official agreement from the authors of the two behavioral scales -CPOT and BPS -for translation into Polish. Validation of these tools in the Polish population will aid their wider use in pain assessment in ICUs in Poland.

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A Validated Approach to Evaluating Psychometric Properties of Pain Assessment Tools for Use in Nonverbal Critically Ill Adults

Cited by 92 publications

References 37 publications

Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report

Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report

Pain Assessment in Noncommunicative Adult Palliative Care Patients

Metody oceny natężenia bólu u dorosłych pacjentów oddziałów intensywnej terapii —polska wersja językowa narzędzia CPOT (Critical Care Pain Observation Tool) i BPS (Behavioral Pain Scale)

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