Psychometric Evaluation of a Pain Intensity Measure for Persons with Dementia

Ersek, Mary; Neradilek, Moni B.; Herr, Keela; Hilgeman, Michelle M.; Nash, Princess; Polissar, Nayak L.; Nelson, Francis

doi:10.1093/pm/pny166

Cited by 15 publications

(28 citation statements)

References 44 publications

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“…13 In addition to expert ratings, we used two observational validated tools, the MOBID and the PIMD, to measure pain. 21,22,28 For both tools, raters observe pain-related behaviors during movement, which generally leads to higher scores than when observations occur during rest. 22,39 The tools differ in that the PIMD has raters judge the intensity of pain-related behaviors and sums the score on all items.…”

Section: Discussionmentioning

confidence: 99%

“…25 Four experts, three experienced geriatric nurse practitioners and one doctorally prepared nurse, were trained in the protocol and made evaluations on all study participants. 21,22…”

Section: Expert Clinician Pain Intensity Ratingmentioning

confidence: 99%

“…This article describes secondary analyses using data collected as part of a parent study to develop and test a pain observation tool for persons with dementia using items from existing measures. 21,22 We employed a comprehensive pain evaluation conducted by an expert clinician as the "gold standard" pain measure. We also collected proxy pain reports from licensed staff nurses and certified nursing assistants, as well as observational pain measures that were completed by trained research staff.…”

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confidence: 99%

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Pain Patterns and Treatment Among Nursing Home Residents With Moderate‐Severe Cognitive Impairment

Ersek

Nash

Hilgeman

et al. 2019

J American Geriatrics Society

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OBJECTIVES To examine the frequency and severity of pain and use of pain therapies among long‐term care residents with moderate to severe dementia and to explore the factors associated with increased pain severity. DESIGN Prospective individual data were collected over 1 to 3 days for each participant. SETTING Sixteen long‐term care facilities in Alabama, Georgia, Pennsylvania, and New Jersey. PARTICIPANTS Residents with moderate to severe cognitive impairment residing in a long‐term care facility for at least 7 days were enrolled (N = 205). Residents were 47% female, predominantly white (69%), and 84 years old, on average (SD = 10 years). MEASUREMENTS A comprehensive pain assessment protocol was used to evaluate pain severity and characteristics through medical record review, interviews with nursing home staff, physical examinations, as well as pain observation tools (Mobilization‐Observation‐Behavior‐Intensity‐Dementia Pain Scale and Pain Intensity Measure for Persons With Dementia). Known correlates were also assessed (agitation, depression, and sleep). RESULTS Experts' pain evaluations indicated that residents' usual pain was mild (mean = 1.6/10), and most experienced only intermittent pain (70%). However, 45% of residents experienced moderate to severe worst pain. Of residents, 90% received a pain therapy, with acetaminophen (87%) and opioids (32%) commonly utilized. Only 3% had a nondrug therapy documented in the medical record. The only resident characteristic that was significantly associated with pain severity was receipt of an opioid in the past week. CONCLUSION Using a comprehensive pain assessment protocol, we found that most nursing home residents with moderate to severe dementia had mild usual, intermittent pain and the vast majority received at least one pain therapy in the previous week. Although these findings reflect improvements in pain management compared with older studies, there is still room for improvement in that 45% of the sample experienced moderate to severe pain at some point in the previous week. J Am Geriatr Soc 68:794–802, 2020

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Section: Discussionmentioning

confidence: 99%

“…25 Four experts, three experienced geriatric nurse practitioners and one doctorally prepared nurse, were trained in the protocol and made evaluations on all study participants. 21,22…”

Section: Expert Clinician Pain Intensity Ratingmentioning

confidence: 99%

mentioning

confidence: 99%

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Pain Patterns and Treatment Among Nursing Home Residents With Moderate‐Severe Cognitive Impairment

Ersek

Nash

Hilgeman

et al. 2019

J American Geriatrics Society

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“…Although all items have seemingly proven their utility in assessing pain in other scales already, 50–70% of items were only present twice or less across all conditions. This great number of apparently useless items supports the approach of the COST initiative (Corbett et al, ; de Waal et al ; Kunz et al, ) and other research groups (Chang, Versloot, Fashler, McCrystal, & Craig, ; Ersek et al, ) that it is absolutely crucial to evaluate psychometric quality at the level of single items.…”

Section: Discussionmentioning

confidence: 65%

“…Although all items have seemingly proven their utility in assessing pain in other scales already, 50-70% of items were only present twice or less across all conditions. This great number of apparently useless items supports the approach of the COST initiative de Waal et al 2019;Kunz et al, 2020) and other research groups (Chang, Versloot, Fashler, McCrystal, & Craig, 2015;Ersek et al, 2018) that it is absolutely crucial to evaluate psychometric quality at the level of single items. Items occurring three times or more were explored further by applying two additional criteria: (a) items' specificity, that is their ability to differentiate between pain and reference condition and (b) items' convergent validity, that is their association with self-reported pain in the ischaemic pain condition.…”

Section: Observer Ratings By Use Of Pain-related Behaviour and Relamentioning

confidence: 75%

Pain assessment for cognitively impaired older adults: Do items of available observer tools reflect pain‐specific responses?

Kappesser

Voit

Lautenbacher

et al. 2020

European Journal of Pain

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Background A number of observational tools are available to assess pain in cognitively impaired older adults, however, none of them can yet be regarded as a “gold standard”. An international research initiative has created a meta‐tool compiling the facial, vocalization and body movement items of the majority of available tools. Objective of this study was to investigate the pain specificity and the validity of these items. Method N = 34 older adults with or without cognitive impairment were videotaped in three different conditions (one reference, two painful conditions) in their nursing homes. They were further asked to self‐report their pain in each condition. The occurrence of non‐verbal behaviours was coded as present or absent using the items of the meta‐tool. Results The majority of non‐verbal behaviours was not pain sensitive as they occurred less than three times across participants and conditions. Of the remaining items, two facial items (“pained expression” and “raising upper lip”), one vocalization item (“using pain‐related words”) and one body movement item (“guarding”) were found to be pain specific and valid. One additional item, the vocalization item “gasping”, was pain specific, but not associated with pain self‐report, and three additional items, the facial items “frowning” and “narrowing eyes” and the vocalization item “mumbling” were correlated with pain self‐report but did not help to separate pain from non‐pain conditions. Conclusions Systematic evaluation of items of existing observational pain assessment tools under naturalistic conditions seems a promising approach in the process of further investigating and improving tools. Significance Only few items stemming from observational pain assessment tools were found to be pain sensitive and specific as well as valid in this study. The investigation of existing tools not only on tool but additionally on item‐level can provide helpful insights and thereby can help to improve the original tools and establish a gold standard for nonverbal pain assessment in older adults with cognitive impairments.

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Perception, behavior and experience of nursing assistants towards pain of older adults with dementia: A qualitative study

Yang,

Yi,

Wang

et al. 2024

Geriatric Nursing

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Psychometric Evaluation of a Pain Intensity Measure for Persons with Dementia

Abstract: Initial evaluation of the PIMD supports its validity and reliability. Additional testing is needed to evaluate the tool's sensitivity to changes in pain intensity.

Cited by 15 publications

References 44 publications

Pain Patterns and Treatment Among Nursing Home Residents With Moderate‐Severe Cognitive Impairment

Pain Patterns and Treatment Among Nursing Home Residents With Moderate‐Severe Cognitive Impairment

Pain assessment for cognitively impaired older adults: Do items of available observer tools reflect pain‐specific responses?

Perception, behavior and experience of nursing assistants towards pain of older adults with dementia: A qualitative study

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