Psychometric properties of pain intensity scales comparing among postoperative adult patients, elderly patients without and with mild cognitive impairment in China

Abstract

In China, there is a lack of studies to generate pain intensity scales to the patients with CI and compare the pain scales in various age groups. Therefore, this study would compare the psychometric properties of the evidence-supported pain intensity scales consisting of the Verbal Descriptor Scale (VDS), the Numeric Rating Scale (NRS), the Faces Pain Scale (FPS), the Numeric Box-21 Scale (BS-21), and the Colored Analogue Scale (CAS) in Chinese postoperative adults varying in ages including the elderly with mild CI. This was a descriptive comparative study and 200 surgical patients were recruited purposively from a university-affiliated hospital with 50 for each group: young adults (age 20 -44 years), middle-aged adults (age 45 -59 years), elderly (age ≥ 60 years) without CI, and elderly (age ≥ 60 years) with mild CI.Participants rated the vividly remembered, current, worst, least, and average pain, and indicated scale preference and simplicity. Scale face validity, concurrent validity, convergent validity, and test-retest reliability at a 3-day interval were assessed. Fisher's exact tests were used to investigate whether face validity was related to different age iv groups and the levels of CI. One-way ANOVA and Kruskal-Wallis test were used to test the differences of concurrent validity, convergent validity, and test-retest reliability of each pain scale among the four groups. Regarding face validity, the FPS was ranked best across the subjects as nearly half of the patients selected it as both the most preferred and simplest and it had low errors; the VDS and the NRS were similar and ranked following the FPS; however, the BS-21 and the CAS were ranked last. The concurrent validity, convergent validity, and test-retest reliability of all five pain scales were supported in use with the four groups. The differences in psychometric properties among the four groups were only found in face validity. The findings support the psychometric properties of all five pain scales for pain assessment in Chinese adults including the elderly with mild CI. However, the FPS appears to be the best scale followed by the VDS and the NRS. ACKNOWLEDGEMENTSIt is impossible to finish this work without the continuous help and love from the people around me. I take this opportunity to give thanks to them for their willing to teach, guidance, help, and care during my master degree study.

Pain intensity among institutionalized elderly: a comparison between numerical scales and verbal descriptors

“…And although there was a high frequency to some degree of cognitive impairment and low or no schooling among them, the vast majority was able to judge the intensity of primary pain by NRS and VDS, similar to the findings of other studies (6)(7)(14)(15)(16)(22)(23)(24)26) . This strengthens the possibility of using these instruments to measure pain intensity in this population, a desired contribution to the evaluation process of painful experiences and respecting the elderly as an active agent in this process.…”

“…VDS and NRS are valid and reliable for measuring the intensity of pain in elderly adults, including those with moderate and mild and light levels of cognitive impairment (14)(15) . More recently, the psychometric properties of these scales were reinforced in a study of pain measurement in post-operative elderly with mild cognitive impairment, being considered the most appropriate scales to measure the intensity of that experience in this group (16) . Studies (6,15) comparing different unidimensional scales showed that even seniors with cognitive impairment were able to judge pain through these two scales, with the VDS (6) being the preferred scale.…”

What Determines Whether a Pain is Rated as Mild, Moderate, or Severe? The Importance of Pain Beliefs and Pain Interference

“…However, it may not always be appropriate to use a NRS scale in a specific setting or for a specific clinical trial. In particular, NRSs may be less useful than VRSs in research in patients who are elderly or otherwise are at risk for cognitive deficits [37, 38]; VASs are even less appropriate for these populations [5, 39, 40]. For these populations, the viable alternative measures are FACES pain rating scales or VRSs.…”

Validity and Sensitivity of 6 Pain Scales in Critically Ill, Intubated Adults

“…Both of these scales have been successfully used to evaluate pain in older adults. [12][13][14][16][17][18][19] However, data to support the efficacy of those scales compared with other pain tools in patients receiving mechanical ventilation are limited. In addition, 5 other pain tools, (ANVPS 9 ; BPS 7 ; Comfort Scale 20 ; Face, Legs, Activity, Cry, and Consolability (FLACC) 21 ; Pain Assessment Behavioral Scale [PABS] 22 ) commonly used with noncommunicative patients, were selected on the basis of variations in behavior descriptors and physiological parameters (Table 1).…”