Spanish adaptation and validation of the Pain Assessment Scale in Advanced Dementia (PAINAD) in patients with dementia and impaired verbal communication: cross-sectional study

Abstract

ObjectivesThe aim of this study was to adapt and validate the Pain Assessment in Advanced Dementia (PAINAD) scale in Spanish.DesignCross-sectional observational study.SettingTwo health districts of Andalusian provinces, located in the south of Spain, through the Andalusian network of Primary Healthcare centres and four institutions dedicated to the care of patients with dementia.ParticipantsA total of 100 older people, with a medical diagnosis of dementia and a score on the Global Deterioration Scale between 5 and 7 were assessed using the PAINAD scale.Primary and secondary outcome measuresPsychometric properties including content validity, construct validity and reliability of the scale have been tested.ResultsThe overall Item Content Validity Index was excellent (0.95). Regarding construct validity, it was confirmed that a lower use of analgesics implied a lower score on the PAINAD scale (p<0.05). The internal consistency of the scale was 0.76 and it increases to 0.81 if we remove the breathing item. Furthermore, the intraclass correlation coefficient (ICC) used to assess interobserver reliability was 0.94, whereas the ICC used to assess temporary stability was 0.55.ConclusionsThe Spanish version of the PAINAD scale is a valid tool to assess pain in patients with dementia and inability to communicate verbally.

Psychometric evaluation of the Pain Assessment in Advanced Dementia scale in an acute general hospital setting

“…Further evaluation of the internal consistency during movement found the Cronbach α coefficient increased to α 0.82 on elimination of the breathing item. This is consistent with other studies 31 ; thus, this item may require modification. There are challenges in assessing whether changes in intensity of breathing are in response to pain or dyspnea.…”

“…For pain experienced during an activity, 96/131 (73%) reported pain at baseline; however, for 34/131 (26%) of the participants, pain was present after the first assessment 33 . This is lower than in the Chinese version of the PAINAD which found an ICC of 0.80–0.86 36 but similar to the Spanish version with an ICC of 0.55, despite their retest being performed after a longer 30‐day interval 31 . People with dementia in acute general hospitals are more likely to experience intense episodic acute pain which reduces over time, compared to chronic pain, seen more commonly in community and nursing homes 8 .…”

“… 33 This is lower than in the Chinese version of the PAINAD which found an ICC of 0.80–0.86 36 but similar to the Spanish version with an ICC of 0.55, despite their retest being performed after a longer 30‐day interval. 31 People with dementia in acute general hospitals are more likely to experience intense episodic acute pain which reduces over time, compared to chronic pain, seen more commonly in community and nursing homes. 8 As our study focused on acute general hospitals, pain experience was more liable to fluctuate.…”

Psychometric properties of pain measurements for people living with dementia: a COSMIN systematic review

“…Twelve studies assessed the PAINAD [ 16 , 20 – 24 , 40 , 44 – 47 , 65 ]. Overall, the level of evidence for the PAINAD tool was limited (Table 3 ).…”

The Challenges of Pain Assessment in Geriatric Patients With Dementia: A Review

“…Due to the cognitive and communicative impairments associated with dementia, assessing pain in these patients is often challenging. Many tools for the assessment of pain have been developed such as the Pain Assessment in Advanced Dementia (PAINAD) and Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC); however, they mostly rely on observing the behavior of the patient [6]. The aim of this review is to highlight the challenges of pain assessment in geriatric patients with dementia.…”