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

Abstract

Background Over the last decades, a considerable number of observational scales have been developed to assess pain in persons with dementia. The time seems ripe now to build on the knowledge and expertize implemented in these scales to form an improved, “best‐of” meta‐tool. The EU‐COST initiative “Pain in impaired cognition, especially dementia” aimed to do this by selecting items out of existing observational scales and critically re‐assessing their suitability to detect pain in dementia. This paper reports on the final phase of this collaborative task. Methods Items from existing observational pain scales were tested for “frequency of occurrence (item difficulty),” “reliability” and “validity.” This psychometric testing was carried out in eight countries, in different healthcare settings, and included clinical as well as experimental pain conditions. Results Across all studies, 587 persons with dementia, 27 individuals with intellectual disability, 12 Huntington's disease patients and 59 cognitively healthy controls were observed during rest and movement situations or while receiving experimental pressure pain, respectively. The psychometric outcomes for each item across the different studies were evaluated within an international and multidisciplinary team of experts and led a final selection of 15 items (5x facial expressions, 5x body movements, 5x vocalizations). Conclusions The final list of 15 observational items have demonstrated psychometric quality and clinical usefulness both in their former scales and in the present international evaluation; accordingly, they qualified twice to form a new internationally agreed‐on meta‐tool for Pain Assessment in Impaired Cognition, the PAIC‐15 scale. Significance Using a meta‐tool approach by building on previous observational pain assessment scales and putting the items of these scales through rigorous empirical testing (using experimental as well as clinical pain studies in several European countries), we were able to identify the best items for pain assessment in individuals with impaired cognition. These selected items form the novel PAIC15 scale (pain assessment in impaired cognition, 15 items).

Observational pain assessment in older persons with dementia in four countries: Observer agreement of items and factor structure of the Pain Assessment in Impaired Cognition

“…This suggests that training is probably necessary for the rating of items, especially in grading pain with use of several categories of severity. The need for training was also mentioned by healthcare professionals in a survey across Europe (Zwakhalen et al, ) and is planned for the short version of the PAIC scale (Kunz et al, ) for the details of PAIC15 and the associated e‐training).…”

“…This idea was recently echoed by a US‐American research group following a similar line of methodological reasoning (Ersek et al, ). Together with results from other psychometric studies, results of the present study will be used in the item reduction process by means of a Delphi procedure, to form the final PAIC‐scale (Kunz et al, ). This is also necessary for feasibility of the measurement scale in daily practice.…”

“…The research version of the PAIC ( Pain Assessment in Impaired Cognition ) is an observational scale that includes facial expressions of pain (15 items), body movements (10 items) and vocalizations (11 items). The items were chosen following a process that included an extensive literature review of existing tools and several consultation rounds with experts—this process is described in detail elsewhere (Corbett et al, ) (Kunz et al, ).…”

“…As such, the PAIC can be considered as a “meta‐tool”. For the final PAIC scale, further reduction of number of items was anticipated, using results from various psychometric studies to enhance usability (PAIC15, see accompanying article (Kunz et al, ).…”

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

“…The final PAIC collection in its research version (for the clinical version see Kunz, et al, ) is based on items of twelve eligible pain assessment tools which were identified in a comprehensive literature search (Corbett et al, ). Each item had to represent one of three main domains of pain (facial expression, vocalization, body movements) as recommended by the American Geriatric Society (AGS Panel on Persistent Pain in Older Persons, ).…”