Seven-Item Pain Intensity Measure Reliable in Individuals With Dementia

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The behaviors assessed by the PMID are bracing, rigid or stiff body part, sighing, complaining, grimacing, frowning, and expressive eyes.
The behaviors assessed by the PMID are bracing, rigid or stiff body part, sighing, complaining, grimacing, frowning, and expressive eyes.

A 7-item pain intensity measure for persons with dementia (PIMD) has shown initial validity and reliability, according to a study published in Pain Medicine.

The PIMD was developed using items from existing pain observational measures. Further testing will evaluate its sensitivity to changes in pain intensity. The PIMD evaluates 7 behaviors, and the intensity of those behaviors is rated on a scale of 0 (absent) to 3 (severe). The behaviors assessed are bracing, rigid or stiff body part, sighing, complaining, grimacing, frowning, and expressive eyes.

A total of 190 individuals with dementia and moderate to severe cognitive impairment (mean age, 84 years; 50.5% men; 70% white) who were living in nursing homes were included in the study. PIMD scores were evaluated at rest and during movement. Correlations between the PMID and the expert clinician pain intensity rating and the Mobilization Observation Behaviour Intensity Dementia, which evaluates pain-related behaviors (eg, facial expressions), were used to assess the validity of this tool. Internal consistency of the 7 PMID items was evaluated with Cronbach α, and interrater reliability of PMID scores measured by 2 investigators was examined using intraclass correlations.

PIMD scores during movement were found to correlate highly with both expert clinician pain intensity rating and Mobilization Observation Behaviour Intensity Dementia scores, and significant differences were found between PIMD scores at rest and during movement. Cronbach α was 0.18 at rest and 0.72 during movement, indicating “acceptable” internal consistency. Interrated intraclass correlation was 0.82 during movement, indicating good interrater agreement.

“Because of its brevity, the PIMD may be a more clinically useful tool than existing pain observation tools that contain greater numbers of items,” the researchers wrote. “Additional research is needed to evaluate the use of this tool by clinical staff and among persons with higher pain intensity.”

Reference

Ersek M, Neradilek MB, Herr K, et al. Psychometric evaluation of a pain intensity measure for persons with dementia. [published online September 10, 2018]. Pain Med. doi:10.1093/pm/pny166


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