Validation of an acute pain‐behavior scale for older persons with inability to communicate verbally: Algoplus®

Abstract

To compensate for poor acute pain detection in elderly inpatients with inability to communicate verbally (ICV), the Doloplus Collective team devised the 5-item Algoplus behavior-assessment scale specifically aimed at quickly detecting acute pain in these individuals. Algoplus was developed in three successive phases, including expert opinions, caregivers interviews, patient video recordings and statistical procedures. Among the 1500 recorded primary pain behaviors, 48 were selected and clustered into a 5-item scale. This version was validated based on 349 old inpatients (204 with acute pain and 145 without) from different care settings and hospitals. Comparators were objective acute pain clinical situations, experts' clinical judgment on acute pain presence, and self-rating scales (Visual Analog Scale, Numeric Rating Scale and Verbal Descriptor Scale) for a communicative subsample (n=134). Algoplus showed good discriminant validity with adequate internal consistency (Kuder-Richardson-20, 0.712), excellent interrater reliability (intraclass coefficient, 0.812) and high sensitivity to change during specific pain situations and after starting pain management. Excellent correlations were observed between Algoplus and experts' clinical judgment, acute pain clinical situations or each comparator self-rating-pain score. For patients with acute pain conditions, a score ⩾2 out of 5 on the Algoplus scale was retained as the threshold for the presence of acute pain in elderly ICV inpatients, with 87% sensitivity and 80% specificity. In addition, the very brief rating time of ∼1min is particularly relevant in acute-care settings, where repetitive pain-monitoring is required.

An Algorithm for Neuropathic Pain Management in Older People

“…Among the behavioral scales, Doloplus—one of the first published scales—and Algoplus have been validated for pain evaluation in elderly patients with communication disorders [21, 22]. Doloplus has three dimensions (somatic, psychomotor, and psychosocial reactions) each comprising ten items (rated from 0 to 3).…”

Erfassung des Schmerzverhaltens von Menschen mit schwerer Demenz

“…Mehrere Studien sprechen von der Problematik, dass Schmerzen bei dementen Menschen oft unentdeckt bleiben und somit nur insu zient therapiert werden können [7,9,11,15,19,23]. Ebenfalls zeigt sich in der Literatur, dass sowohl Ärzte und P egepersonal als auch P egehilfskräfte dazu neigen, die beobachteten Schmerzen zu unterschätzen und dass somit keine adäquate erapie statt ndet [8].…”

Pain Assessment with Cognitively Impaired Older People in the Acute Hospital Setting

“…As the ability to recall and/or verbalise a self-report of pain diminishes, behavioural pain scales may offer a mechanism to assess and measure pain effectively. There are a number of behavioural indicator pain assessment scales available (18)(19)(20)(21)(22)(23). However, the evidence for using these scales in the acute postoperative setting remains contradictory (20,24,25).…”

“…In a further development, the Doloplus collective team have recently introduced a five-item Algoplus® behaviour-assessment scale, devised specifically to detect acute pain in patients who have an inability to communicate verbally (23). This scale was developed using a multi-centred cross-sectional approach and was utilised in several different care settings and hospitals.…”