Body movements as pain indicators in older people with cognitive impairment: A systematic review

Abstract

Background and objective Pain assessment tools for cognitively impaired older people, unable to self‐report pain, are commonly founded upon observation of pain behaviour, such as facial expressions, vocalizations and body movements. The scientific basis for claiming that body movements may indicate pain has not formerly been investigated in a systematic review. The objective was to explore research evidence for body movements being pain indicators in older people with cognitive impairment. Data bases and data treatment MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Library were searched systematically. Two researchers independently identified and consented on studies to be included. PRISMA statement for reporting systematic reviews was followed. Mixed Methods Appraisal Tool was used for critical evaluation of study quality. Results A total of 2,096 records from the literature searches were identified, and 17 quantitative and eight qualitative studies were included in the review, the studies mainly related to older people with dementia. Quality scores ranged from 50% to 100%. We combined 62 items of body movements into 13 similar or synonymous items, and criteria for evidence were defined. Strong evidence was found for restlessness (agitation), rubbing, guarding, rigidity and physical aggression as the behaviours frequently responded (increased or decreased) to pain provoking activities, painful procedures and/or pain medication. Conclusions Among 13 categories of body movements, we found five with strong and five with moderate evidence of validity. As few items were typically included in many studies reflecting criterion validity, all should be included in future studies of patients with different characteristics, location and duration of pain. Significance Pain assessment tools for older people with cognitive impairment or dementia should include valid pain behaviour items. Our review shows strong scientific evidence for the following body movements indicating pain: restlessness (agitation), rubbing, guarding, rigidity and physical aggression.

The Pain Assessment in Impaired Cognition scale (PAIC15): A multidisciplinary and international approach to develop and test a meta‐tool for pain assessment in impaired cognition, especially dementia

“…With regard to the five body movement items, we also find strong agreement with previous findings (Keefe & Block, ; Prkachi, Schultz, & Hughes, ; Strand et al, ). A recent systematic review article (Strand et al in press) on pain‐indicative body movements in older people with cognitive impairment found strong (restlessness, rubbing, guarding) or moderate criterion validity for all five items included in the PAIC15.…”

A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain

“…The internal consistency (Cronbach's alpha) of the CPS was 0.70 in a validation study. 41 The CFS classifies residents as intact (able to complete BIMS and scored [13][14][15], mildly impaired (8-12 BIMS score or 0-2 CPS score), moderately impaired (0-7 BIMS score or 3-4 CPS score, or severely impaired (could not complete BIMS and 5-6 CPS score). The scale has four items total and a score range of 0-6, but we created a dichotomized variable that indicated change in cognitive impairment from admission to 6 months.…”

“… 13 Restlessness, rubbing, guarding, rigidity, and physical aggression show strong evidence as body movement indicators for pain while bracing, decreased mobility, flinching, and pacing show moderate evidence. 14 The assessment of pain in those with dementia is further complicated by the well-documented relationships between pain and depression 15 and dementia and depression. 16 Among those who are unable to self-report pain, disentangling pain and depression can be challenging.…”

A Study of Patient’s Pain Assessment Based on Facial Expression: Issues and Challenges

“…[25,27,30] Body Movement Assessed as a reaction of any action that affects the body, especially pain like rigid, guarding, and tense, physical aggression, fidgeting, increased pacing/rocking, and mobility changes such as inactivity or motor restlessness. [24,31,40] Vocalization When we are in a bad situation, we shout for help as the same when babies feel in distress or pain, they would cry, so our voices in a different pattern (Moaning, crying, groaning, sighing, and gasping). Voice nature can noticed in verbal self-report.…”