Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools

BMC Geriatrics

Michelle Briggs¹  Anne Corbett²  Andrew F Long⁴  S José Closs⁴  Philip Esterhuizen⁴  Dawn Dowding³  Valentina Lichtner⁴ 

[1] Institute of Health and Wellbeing, Leeds Beckett University, Leeds, UK;Wolfson Centre for Age-Related Diseases, King’s College London, London SE1 1UL, UK;Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, New York, NY 10001, USA;School of Healthcare, University of Leeds, Leeds, UK

关键词: Meta-review;    Dementia;    Aged;    Pain scales;    Pain assessment;   

Others  :  1089789
DOI  :  10.1186/1471-2318-14-138

 received in 2014-07-29, accepted in 2014-12-11,  发布年份 2014

【 摘 要 】

Background

There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment.

Methods

We searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach.

Results

We retrieved 441 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. The lack of a ‘gold standard’ significantly hinders the evaluation of tools’ validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations.

Conclusions

There are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence.

【 授权许可】

   
2014 Lichtner et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]ADI: Dementia statistics. http://www.alz.co.uk/research/statistics webcite
• [2]Shega JW, Ersek M, Herr K, Paice JA, Rockwood K, Weiner DK, Dale W: The multidimensional experience of noncancer pain: does cognitive status matter? Pain Med 2010, 11(11):1680-1687.
• [3]Achterberg WP, Pieper MJ, van Dalen-Kok AH, de Waal MW, Husebo BS, Lautenbacher S, Kunz M, Scherder EJ, Corbett A: Pain management in patients with dementia. Clin Interv Aging 2013, 8:1471.
• [4]Grimby C, Fastbom J, Forsell Y, Thorslund M, Claesson CB, Winblad B: Musculoskeletal pain and analgesic therapy in a very old population. Arch Gerontol Geriatr 1999, 29(1):29-43.
• [5]Black BS, Finucane T, Baker A, Loreck D, Blass D, Fogarty L, Phillips H, Hovanec L, Steele C, Rabins PV: Health problems and correlates of pain in nursing home residents with advanced dementia. Alzheimer Dis Assoc Disord 2006, 20(4):283-290.
• [6]Ballard C, Creese B, Corbett A, Aarsland D: Atypical antipsychotics for the treatment of behavioral and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opin Drug Saf 2011, 10(1):35-43.
• [7]Closs SJ, Barr B, Briggs M: Cognitive status and analgesic provision in nursing home residents. Brit J Gen Pract 2004, 54(509):919-921.
• [8]Maclean W: Identifying and managing pain in people with dementia. Nursing Research Care 2003, 5:428-430.
• [9]Cook AKR, Niven CA MD: Assessing the pain of people with cognitive impairment. Int J Geriatr Psychiatry 1999, 14:421-425.
• [10]Archibald C: People With Dementia in Acute Hospital Settings. Stirling: University of Stirling, Dementia Services Development Centre; 2002.
• [11]Closs SJ, Barr B, Briggs M, Cash K, Seers K: A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment. J Pain Symptom Manage 2004, 27(3):196-205.
• [12]Sampson EL, Gould V, Lee D, Blanchard MR: Differences in care received by patients with and without dementia who died during acute hospital admission: a retrospective case note study. Age Ageing 2006, 35:187-189.
• [13]American Geriatrics Society (AGS) Panel on Persistent Pain in Older persons: The management of persistent pain in older persons. J Am Geriatr Soc 2002, 50:S2-5-S224.
• [14]Jordan AI, Regnard C, Hughes JC: Hidden pain or hidden evidence? J Pain Symptom Manage 2007, 33:658-660.
• [15]Higgins J, Green S: Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [Updated March 2011]. UK: The Cochrane Collaboration; 2011. http://www.cochrane-handbook.org webcite
• [16]The Joanna Briggs Institute: Joanna Briggs Institute Reviewers’ Manual 2008 Edition. Australia: The Joanna Briggs Institute; 2008. http://joannabriggs.org/ webcite
• [17]National Library of Medicine: Medical Subject Headings, 2014 MeSH Descriptor Data - Dementia - Tree Number C10.228.140.380 and F03.087.400 - Unique ID D003704. http://www.nlm.nih.gov/cgi/mesh/2014/MB_cgi?mode=&term=Dementia&field=entry webcite
• [18]National Library of Medicine: Medical Subject Headings, 2014 MeSH Descriptor Data - Cognition Disorders - Tree Number F03.087.250 - Unique ID D003072. http://www.nlm.nih.gov/cgi/mesh/2014/MB_cgi?mode=&term=Cognition+Disorders&field=entry webcite
• [19]National Library of Medicine: Medical Subject Headings, 2014 MeSH Descriptor Data - Learning Disorders- Tree Number C10.597.606.150.550, C23.888.592.604.150.550, F03.550.350.500 and F03.550.450 - Unique ID D007859. http://www.nlm.nih.gov/cgi/mesh/2014/MB_cgi?mode=&term=Learning+Disorders&field=entry webcite
• [20]Powell RA, Downing J, Ddungu H, Mwangi-Powell F: Pain History and Pain Assessment. In Guide to Pain Management in Low-Resource Settings. Edited by Kopf A, Patel NB. Seattle, USA: IASP; 2010:67-78.
• [21]Zwakhalen S, Hamers J, Abu-Saad H, Berger M: Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr 2006, 6(1):3. BioMed Central Full Text
• [22]Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine 2009, 6(7):e1000100.
• [23]Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC: The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 2010, 63(7):737-745.
• [24]van Herk R, van Dijk M, Baar FP, Tibboel D, de Wit R: Observation scales for pain assessment in older adults with cognitive impairments or communication difficulties. Nurs Res 2007, 56(1):34-43.
• [25]Corbett A, Husebo B, Malcangio M, Staniland A, Cohen-Mansfield J, Aarsland D, Ballard C: Assessment and treatment of pain in people with dementia. Nat Rev Neurol 2012, 8(5):264-274.
• [26]Liu JL, Wyatt JC, Deeks JJ, Clamp S, Keen J, Verde P, Ohmann C, Wellwood J, Dawes M, Altman DG: Systematic reviews of clinical decision tools for acute abdominal pain. Health Technol Assess 2006, 10(47):1-167. iii-iv
• [27]Montori VM, Wilczynski NL, Morgan D, Haynes RB, Hedges T: Optimal search strategies for retrieving systematic reviews from Medline: analytical survey. Bmj 2005, 330(7482):68.
• [28]Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM: Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007, 7:10. BioMed Central Full Text
• [29]Long AF, Dixon P: Monitoring outcomes in routine practice: defining appropriate measurement criteria. J Eval Clin Pract 1996, 2(1):71-78.
• [30]Schofield P, Clarke A, Faulkner M, Ryan T, Dunham M, Howarth A: Assessment of pain in adults with cognitive impairment: a review of the tools. Int J Disabil Hum De 2005, 4(2):59-66.
• [31]Schofield P: Assessment and management of pain in older adults with dementia: a review of current practice and future directions. Curr Opin Support Palliat Care 2008, 2(2):128-132.
• [32]Schofield P, Clarke A, Faulkner M, Ryan T, Dunham M, Howarth A: Assessment of pain in older people. Where are we now and what needs to be done? Int J Disabil Hum De 2006, 5(1):3-8.
• [33]Herr K, Bjoro K, Decker S: Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage 2006, 31(2):170-192.
• [34]Smith M: Pain assessment in nonverbal older adults with advanced dementia. Perspect Psychiatr Care 2005, 41(3):99-113.
• [35]Qi NS, Brammer JD, Creedy DK: The psychometric properties, feasibility and utility of behavioural-observation methods in pain assessment of cognitively impaired elderly people in acute and long-term care: a systematic review. JBI Library of Systematic Reviews [S1] 2012., 10(17)
• [36]Juyoung P, Castellanos-Brown K, Belcher J: A review of observational pain scales in nonverbal elderly with cognitive impairments. Res Soc Work Pract 2010, 20(6):651-664.
• [37]Thuathail AN, Welford C: Pain assessment tools for older people with cognitive impairment. Nurs Stand 2011, 26(6):39-46.
• [38]Lord B: Paramedic assessment of pain in the cognitively impaired adult patient. BMC Emerg Med 2009, 9:20. BioMed Central Full Text
• [39]While C, Jocelyn A: Observational pain assessment scales for people with dementia: a review. Br J Community Nurs 2009, 14(10):438. 439–442
• [40]Rutledge DN, Donaldson NE, Pravikoff DS: Update. Pain assessment and documentation. Special populations of adults. OJCI 2002, 5(2):1-49.
• [41]Rutledge DR, Donaldson NE: Pain assessment and documentation. Part II - special populations of adults. OJCI 1998, 1(6):1-29.
• [42]Andrade DCD, Faria JWVD, Caramelli P, Alvarenga L, Galhardoni R, Siqueira SRD, Yeng LT, Teixeira MJ: The assessment and management of pain in the demented and non-demented elderly patient. Arq Neuropsiquiatr 2011, 69(2B):387-394.
• [43]Scherder E, Oosterman J, Swaab D, Herr K, Ooms M, Ribbe M, Sergeant J, Pickering G, Benedetti F: Recent developments in pain in dementia. Bmj 2005, 330(7489):461-464.
• [44]Lobbezoo F, Weijenberg RAF, Scherder EJA: Topical review: orofacial pain in dementia patients. A diagnostic challenge. J Orofac Pain 2011, 25(1):6-14.
• [45]Herr K, Bursch H, Ersek M, Miller LL, Swafford K: Use of pain-behavioral assessment tools in the nursing home: expert consensus recommendations for practice. J Gerontol Nurs 2010, 36(3):18-29. quiz 30–11
• [46]McAuliffe L, Nay R, O’Donnell M, Fetherstonhaugh D: Pain assessment in older people with dementia: literature review. J Adv Nurs 2009, 65(1):2-10.
• [47]Miller LL, Talerico KA: Pain in older adults. Annu Rev Nurs Res 2002, 20:63-88.
• [48]Helfand M, Freeman M: Assessment and management of acute pain in adult medical inpatients: a systematic review. Pain Med 2009, 10(7):1183-1199.
• [49]Stolee P, Hillier LM, Esbaugh J, Bol N, McKellar L, Gauthier N: Instruments for the assessment of pain in older persons with cognitive impairment. J Am Geriatr Soc 2005, 53(2):319-326.
• [50]State of the Art review of tools for assessment of pain in nonverbal older adults http://prc.coh.org/pain-noa.htm webcite
• [51]Lorenz KA, Sherbourne CD, Shugarman LR, Rubenstein LV, Wen L, Cohen A, Goebel JR, Hagenmeier E, Simon B, Lanto A, Asch SM: How reliable is pain as the fifth vital sign? J Am Board Fam Med 2009, 22(3):291-298.
• [52]Collins A: Measuring what matters to patients at the frontline [Video/webinar]. http://www.health.org.uk/multimedia/video/measuring-what-matters-to-patients-at-the-frontline/ webcite
• [53]Roland M, Campbell S: Successes and failures of Pay for performance in the United Kingdom. N Engl J Med 2014, 370(20):1944-1949.
• [54]Hurley AC, Volicer BJ, Hanrahan PA, Houde S, Volicer L: Assessment of discomfort in advanced Alzheimer patients. Res Nurs Health 1992, 15(5):369-377.
• [55]Mularski R, White-Chu F, Overbay D, Miller L, Asch S, Ganzini L: Measuring pain as the 5th vital sign does not improve quality of pain management. J Gen Intern Med 2006, 21(6):607-612.
• [56]Dixon P, Long A: Broadening the criteria for selecting and developing health status instruments. Outcomes Briefing 1995, 6:4-14.
• [57]Greenhalgh J, Long AF, Brettle AJ, Grant MJ: Reviewing and selecting outcome measures for use in routine practice. J Eval Clin Pract 1998, 4(4):339-350.
• [58]Closs SJ, Cash K, Barr B, Briggs M: Cues for the identification of pain in nursing home residents. Int J Nurs Stud 2005, 42(1):3-12.
• [59]Ratl P, Jouvel E, Pickeringl G, Donnarell L, Nguyenl L, Michell M, Capriz-Ribièrel F, Lefebvre-Chapirol S, Gauquelinl F, Bonin-Guillaumel S: Validation of an acute pain-behavior scale for older persons with inability to communicate verbally: Algoplus®. Eur J Pain 2011, 15(2):198.e191-198.e110.