Properties of Pain Assessment Tools for Use in People Living With Stroke: Systematic Review

Abstract

Background: Pain is a common problem after stroke and is associated with poor outcomes. There is no consensus on the optimal method of pain assessment in stroke. A review of the properties of tools should allow an evidence based approach to assessment. Objectives: We aimed to systematically review published data on pain assessment tools used in stroke, with particular focus on classical test properties of: validity, reliability, feasibility, responsiveness. Methods: We searched multiple, cross-disciplinary databases for studies evaluating properties of pain assessment tools used in stroke. We assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool. We used a modified harvest plot to visually represent psychometric properties across tests. Results: The search yielded 12 relevant articles, describing 10 different tools (n = 1,106 participants). There was substantial heterogeneity and an overall high risk of bias. The most commonly assessed property was validity (eight studies) and responsiveness the least (one study). There were no studies with a neuropathic or headache focus. Included tools were either scales or questionnaires. The most commonly assessed tool was the Faces Pain Scale (FPS) (6 studies). The limited number of papers precluded meaningful meta-analysis at level of pain assessment tool or pain syndrome. Even where common data were available across papers, results were conflicting e.g., two papers described FPS as feasible and two described the scale as having feasibility issues. Conclusion: Robust data on the properties of pain assessment tools for stroke are limited. Our review highlights specific areas where evidence is lacking and could guide further research to identify the best tool(s) for assessing post-stroke pain. Improving feasibility of assessment in stroke survivors should be a future research target.

Predictors of death within 6 months of stroke onset: A model with Barthel index, platelet/lymphocyte ratio and serum albumin

“…Among pain intensity assessment tools, the most commonly used assessment tool is the Faces Pain Scale, which has the most supporting evidence demonstrating that it is an effective means to assess patients’ pain (Edwards et al., 2020). In this study, we used schematic facial depictions to show varying degrees of discomfort in stroke patients and different facial images constitute the Wong‐Baker FACES Pain Rating Scale (WBS).…”

Pain tolerance after stroke: The Tromsø study

“…The possible clinical implications of lower pain tolerance have particular importance in stroke patients, considering the co‐occurrence of aphasia and cognitive decline that render many of these patients with limited ability to communicate their pain (Edwards et al, 2020). If stroke patients are more sensitive to pain, or have more difficulty coping with it, this calls for awareness in health professionals.…”

Assessment instruments used for self-report of pain in hospitalized stroke patients with communication problems: a scoping review

“…One was the above-mentioned systematic review by de Vries et al 9 and the other was a systematic review by Edwards et al 14 However, the focus of these reports differs from our scoping review. Of the various communication problems, de Vries et al 9 focused solely on aphasia, while Edwards et al 14 did not focus on any communication problems. Further, de Vries et al 9 included studies with proxy pain ratings, whereas our scoping review focuses solely on patient self-report.…”

“…A preliminary search of PROSPERO, MEDLINE, CINAHL, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis was conducted, and while no scoping reviews were identified, the search yielded two systematic reviews regarding pain assessment instruments for the diagnosis of pain in people who have had a stroke. One was the above-mentioned systematic review by de Vries et al 9 and the other was a systematic review by Edwards et al 14 However, the focus of these reports differs from our scoping review. Of the various communication problems, de Vries et al 9 focused solely on aphasia, while Edwards et al 14 did not focus on any communication problems.…”