Pain Assessment in Impaired Cognition: Observer Agreement in a Long-Term Care Setting in Patients with Dementia

Abstract

Aim: To study the application of the meta-tool Pain Assessment in Impaired Cognition (PAIC) in a clinical setting in patients with moderate to severe dementia. Materials & methods: Observational study in five Dutch nursing homes, where residents were observed by nurses or nurse-assistants during rest and movement. Prevalence and observer agreement of individual items were examined. Results: An observer agreement of ≥70% was found for most items of the body movement domain and vocalization domain, although prevalence of these behaviors was low (especially during rest). Items of the facial expression domain had a percentage agreement <70%, especially during movement, but with high prevalence of behaviors. Conclusion: The pain assessment in impaired cognition items show promising interobserver and intraobserver agreement in a clinical setting.

Keywords::

• dementia
• interobserver agreement
• intraobserver agreement
• nursing home
• observational measurement instrument
• pain
• pain assessment
• reliability

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/pmt-2019-0025

Acknowledgments

The authors thank the nursing home organizations: Florence, Topaz, Woonzorgcentrum Haaglanden, and Saffier de Residentie for participating in this study. The authors also thank all the residents, physicians and nurses for their collaboration and participation.

Financial & competing interests disclosure

This study was supported by the SBOH (employer of elderly care medicine/general practitioner trainees). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval and have followed the principles outlined in the Declaration of Helsinki for all human investigations. The Medical Ethics Committee of the Leiden University Medical Centre approved this study and gave a waiver of consent. Due to the cognitive impairment of the included residents, written informed consent was obtained from the patient’s legal representative. When possible, written informed consent was also obtained from the residents themselves.

Additional information

Funding

This study was supported by the SBOH (employer of elderly care medicine/general practitioner trainees). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.