Pain assessment tool for dementia

A test cannot be valid if it is not reliable, i. The inter-rater reliability of the APS was found to be moderately good 0. Lints-Martindale et al. Employing an influenza vaccination as the painful stimulus, they found that agreement between the tools ranged from substantial i.

Assessors assign 1 if a behavior is present and 0 if it is absent. As there are six categories namely: non-verbal vocalizations [e. One major strength of this study was that it is the first study of its kind as far as we know to evaluate a pain assessment tool linked to automated facial recognition technology and built into a smart device for people with moderate to severe dementia.

Compared to other existing tools, this offers the advantage of minimizing rater subjectivity in one of the key AGS pain assessment domains, i. Another strength is that pain scores were obtained while participants were receiving their standard care. The latter was provided during the study at all times and with minimal or no interruption.

Standard care is believed to elicit nociceptive pain and also offers a real world context as encountered in the residential aged care setting, and with less potential for recall bias from raters.

Residents had various types of dementias and pain diagnoses covered a wide spectrum of medical conditions. Also, pain measurements were performed on a weekly basis for a period of 13 consecutive weeks to portray a clearer clinical picture about the frequency and status of pain symptoms in these subjects. Our study design is observational in nature where no intervention e. Hence unless an adequately powered, tightly controlled clinical trial is employed with an intervention targeted towards these behavioral problems, the confounding effect is inevitable to occur.

Rater-related limitations also include the fact that only a small number of raters completed the assessments, and there were a number of novice raters. The impact of the latter was evaluated by comparing the results with and without the inclusion of their assessments, this had a negligible impact on the results.

Although it is also desirable to conduct an additional multivariate analysis, we consider the current analysis of variables provides sufficient information to meet the objectives of the study. This study demonstrates that ePAT has psychometric properties which make it suitable for use in people with moderate to severe dementia.

It has proven validity and reliability compared to APS, which is the current gold standard for pain assessment in people with dementia who cannot self-report pain in Australia.

We believe it offers a significant advantage in that the facial expression assessment is automated, providing an objective and reproducible evidence of the presence of pain, in conjunction with non-facial features. Lastly, it has been designed for use by healthcare professionals and lay carers alike. The authors want to thank aged care staff, residents, and their families for their involvement in the project. National Center for Biotechnology Information , U.

Journal of Alzheimer's Disease. J Alzheimers Dis. Published online Aug Prepublished online Aug 9. Hughes a. Jeffery D. Alba Malara, Handling Associate Editor. Author information Article notes Copyright and License information Disclaimer.

Accepted Jun All rights reserved. This article has been cited by other articles in PMC. Abstract Pain is common among people with moderate to severe dementia, but inability of patients to self-report means it often goes undetected and untreated.

Keywords: Automated, dementia, ePAT, facial recognition technology, FACS, older people, pain assessment, psychometric evaluation, reliability, validation.

Open in a separate window. The electronic Pain Assessment Tool ePAT new tool Purpose: The ePAT is a multimodal pain scale designed to assist clinicians and health care workers assess pain in people with moderate to severe dementia at the point of care. Image 1. Face detection and tracking in the ePAT App during a clinical encounter.

Image 6. Total score screen of the ePAT App depicting to pain intensity score. Image 2. Image 3. Image 4. Image 5. Design and setting The study was a prospective observational study which involved residents from three metropolitan aged care homes ACHs in Perth, Western Australia. Protocol plan The study was conducted over a week period in each of the three participating ACHs.

Statistical analysis Standard descriptive statistics were used to summarize the study participants and number of assessments conducted frequencies and percentages for categorical variables, means, standard deviations, and ranges for continuous variables. Table 2 Resident demographics and pain characteristics.

Pain assessment data Pain assessments for residents were undertaken during routine care while at rest or with movement. Table 3 Pain assessment data for the three participating aged care homes. Table 4 Number of assessments completed by each assessor.

Discriminant validity Discriminant validity was assessed by comparing ePAT scores to APS for the same resident at rest and then after movement, e. Table 5 Numbers shown in the cells are the number of assessments percentage of the APS category.

Clin Interv Aging 8 , — Pain , — J Am Med Dir Assoc 7 , — J Am Med Dir Assoc 13 , — Medical Care 43 , — Pain Res Manag 12 , — Clin J Pain 27 , — Nurs Res 56 , 34— Analysis of the data was carried out collaboratively.

The reviews were synthesised using a narrative synthesis approach. Results: We retrieved potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment.

The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. When to Use. Why Use. Patients with advanced dementia who may potentially be in pain. It can be used in both nonverbal and verbal patients.

Valid in varying levels of cognitive impairment from mild to severe. Assessing pain in advanced dementia is intuitively difficult; a validated scale can help. Breathing independent of vocalization. Occasional labored breathing or short periods of hyperventilation. Noisy labored breathing, long periods of hyperventilation or Cheyne-Stokes respirations. Negative vocalization. Facial expression. Smiling or inexpressive.

Facial grimacing. Body language. No need to console. Unable to console, distract or reassure. Result: Please fill out required fields. Next Steps. Creator Insights.