O39 Unidimensional and functional pain assessment tools in postoperative adult patients: a systematic review of their development and utility

Abstract Introduction The Visual Analogue Scale (VAS), Numeric Rating Scale (NRS), Verbal descriptor scale, and faces pain scale are used to measure postoperative pain in adults. However, their utility in this population has not been reviewed systematically. We aimed to summarise and appraise the evidence relating to the measurement properties of unidimensional tools when used for this population and to identify available tools assessing the impact of pain on the restoration of function. Method Four databases (MEDLINE, EMBASE, CINAHL, PsycINFO) were searched up to August 2020 for relevant studies. Two reviewers independently screened articles and assessed risk of bias using the COensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Result Thirty-one studies were included. Only one study included an objective pain score; a tool assessing pain interference with function and reported low-quality evidence for construct validity. Studies looked at unidimensional tools were underpinned by low or very low-quality evidence for reliability, and all displayed a low quality of evidence of indeterminate responsiveness. Measurement error was only reported for VAS in one study of moderate quality. Interpretability results were available only for VAS and NRS. Feasibility results varied based on the included population. Conclusion Despite the extensive use of unidimensional tools, there is no evidence to suggest that any of these tools has superior measurement properties for postoperative pain. Therefore, future studies should be prioritised to assess their validity, measurement error and responsiveness. Validation studies of pain assessment tools that promote function are needed. Take-home Message Take home message: Functional pain scores should be assessed and validated for postoperative pain.

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The evaluation of smartphone versions of the visual analogue scale and numeric rating scale as postoperative pain assessment tools: a prospective randomized trial

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/s12630-019-01324-9 ◽

2019 ◽

Vol 66 (6) ◽

pp. 706-715 ◽

Cited By ~ 4

Author(s):

Lily Y. L. Chiu ◽

Terri Sun ◽

Ronald Ree ◽

Dustin Dunsmuir ◽

Alexander Dotto ◽

...

Keyword(s):

Postoperative Pain ◽

Visual Analogue Scale ◽

Randomized Trial ◽

Pain Assessment ◽

Analogue Scale ◽

Rating Scale ◽

Numeric Rating Scale ◽

Assessment Tools ◽

Prospective Randomized Trial ◽

Numeric Rating

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Apathy Measures in Older Adults and People with Dementia: A Systematic Review of Measurement Properties Using the COSMIN Methodology

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000515678 ◽

2021 ◽

pp. 1-13

Author(s):

Clare Burgon ◽

Sarah Elizabeth Goldberg ◽

Veronika van der Wardt ◽

Catherine Brewin ◽

Rowan H. Harwood

Keyword(s):

Systematic Review ◽

Older Adults ◽

Rating Scale ◽

Measurement Properties ◽

Evaluation Procedure ◽

Measurement Instruments ◽

Health Measurement ◽

Eligibility Criteria ◽

People With Dementia ◽

Patient Reported

Background: Apathy is highly prevalent in dementia and is also seen in mild cognitive impairment and the general population. Apathy contributes to failure to undertake daily activities and can lead to health problems or crises. It is therefore important to assess apathy. However, there is currently no gold standard measure of apathy. A comprehensive systematic review of the measurement properties of apathy scales is required. Methods: A systematic review was registered with PROSPERO (ID: CRD42018094390). MEDLINE, Embase, PsycINFO, and CINAHL were searched for studies that aimed to develop or assess the validity or reliability of an apathy scale in participants over 65 years, living in the community. A systematic review was conducted in line with the COnsensus-based Standards for the selection of health Measurement INstruments procedure for reviewing patient-reported outcome measures. The studies’ risk of bias was assessed, and all relevant measurement properties were assessed for quality. Results were pooled and rated using a modified Grading of Recommendations Assessment, Development, and Evaluation procedure. Results: Fifty-seven publications regarding 18 measures and 39 variations met the eligibility criteria. The methodological quality of individual studies ranged from inadequate to very good and measurement properties ranged from insufficient to sufficient. Similarly, the overall evidence for measurement properties ranged from very low to high quality. The Apathy Evaluation Scale (AES) and Lille Apathy Rating Scale (LARS) had sufficient content validity, reliability, construct validity, and where applicable, structural validity and internal consistency. Conclusion: Numerous scales are available to assess apathy, with varying psychometric properties. The AES and LARS are recommended for measuring apathy in older adults and people living with dementia. The apathy dimension of the commonly used Neuropsychiatric Inventory should be limited to screening for apathy.

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Study of Pain Level Control Targets After Arthroscopic Surgery

10.21203/rs.3.rs-253532/v2 ◽

2021 ◽

Author(s):

Wang Xin ◽

Liu Congying ◽

Zhang Xiaole ◽

Wang Hong ◽

Xu Yan ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Score ◽

Pain Control ◽

Rating Scale ◽

Numerical Rating Scale ◽

Arthroscopic Surgery ◽

Daily Activities ◽

Pain Level ◽

Convenience Sampling ◽

The Impact

Abstract Objective: To explore the goal of pain control in patients after arthroscopic surgery.Design: Investigation. Postoperative pain, pain control satisfaction and the effect of pain on daily activities were investigated and evaluated.Setting: Department of Sports Medicine,Peking University 3rd Hospital,Beijing, P.R.ChinaSubjects: 514 patients selected by convenience sampling from patients hospitalized in a level A hospital in Beijing from 2020.06-2020.11. The patient inclusion criteria were an age of at least 18 years, no history of diagnosis of mental illness, the ability to clearly express his or her pain and an agreement to voluntarily cooperate with the investigators. The exclusion criteria were patients who were unable to complete follow-up.Methods: Postoperative pain, pain control satisfaction and the effect of pain on daily activities were investigated and evaluated by administering a homemade questionnaire to 514 patients selected by convenience sampling from patients hospitalized in a level A hospital in Beijing from 2020.06-2020.11. Pain was assessed using a digital pain numerical rating scale (NRS) (0-10), and a digital score ranging from 0 to 10 was used for satisfaction with pain control and the impact of pain on aspects of daily living.Results: The pain level was most severe in patients 6-24 hours after arthroscopic surgery, during which pain control satisfaction was at its worst. The pain score was significantly related to the effects of pain on aspects of daily life, and the degree of these effects changed significantly for pain scores greater than 2 points.Conclusion: Pain control 6 to 24 hours after surgery is not satisfactory. It is recommended that a pain score of 2 points is used as the goal for pain control after arthroscopic surgery to guide both doctors and patients to effectively control postoperative pain.

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COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: a Delphi study

BMC Medical Research Methodology ◽

10.1186/s12874-020-01179-5 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

L. B. Mokkink ◽

M. Boers ◽

C. P. M. van der Vleuten ◽

L. M. Bouter ◽

J. Alonso ◽

...

Keyword(s):

Measurement Error ◽

Delphi Study ◽

Outcome Measurement ◽

Research Question ◽

Measurement Instrument ◽

Measurement Properties ◽

Measurement Instruments ◽

Sources Of Variation ◽

The Impact

Abstract Background Scores on an outcome measurement instrument depend on the type and settings of the instrument used, how instructions are given to patients, how professionals administer and score the instrument, etc. The impact of all these sources of variation on scores can be assessed in studies on reliability and measurement error, if properly designed and analyzed. The aim of this study was to develop standards to assess the quality of studies on reliability and measurement error of clinician-reported outcome measurement instruments, performance-based outcome measurement instrument, and laboratory values. Methods We conducted a 3-round Delphi study involving 52 panelists. Results Consensus was reached on how a comprehensive research question can be deduced from the design of a reliability study to determine how the results of a study inform us about the quality of the outcome measurement instrument at issue. Consensus was reached on components of outcome measurement instruments, i.e. the potential sources of variation. Next, we reached consensus on standards on design requirements (n = 5), standards on preferred statistical methods for reliability (n = 3) and measurement error (n = 2), and their ratings on a four-point scale. There was one term for a component and one rating of one standard on which no consensus was reached, and therefore required a decision by the steering committee. Conclusion We developed a tool that enables researchers with and without thorough knowledge on measurement properties to assess the quality of a study on reliability and measurement error of outcome measurement instruments.

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The revised FLACC score: Reliability and validation for pain assessment in children with cerebral palsy

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2015.06.007 ◽

2015 ◽

Vol 9 (1) ◽

pp. 57-61 ◽

Cited By ~ 9

Author(s):

Line Kjeldgaard Pedersen ◽

Ole Rahbek ◽

Lone Nikolajsen ◽

Bjarne Møller-Madsen

Keyword(s):

Cerebral Palsy ◽

Pain Management ◽

Postoperative Pain ◽

Pain Score ◽

Pain Assessment ◽

Reliability And Validity ◽

Measurement Properties ◽

Cosmin Checklist ◽

Children With Cerebral Palsy

AbstractBackground and aimsPain in children with cerebral palsy (CP) is difficult to assess and is therefore not sufficiently recognized and treated. Children with severe cognitive impairments have an increased risk of neglected postoperative, procedural and chronic pain resulting in decreased quality of life. The r-FLACC (revised Face, Legs, Activity, Cry and Consol ability) pain score is an internationally acclaimed tool for assessing pain in children with CP because of its ease to use and its use of core pain behaviours. In addition the r-FLACC pain score may be superior to other pain assessment tools since it includes an open- ended descriptor for incorporation of individual pain behaviours. The COSMIN group has set up three quality domains, which describe the quality of Health-Related Patient-Reported Outcomes (HR-PROs). These are reliability (internal consistency, reliability and measurement error), validity (content validity, construct validity and criterion validity) and responsiveness. The r-FLACC score has only been assessed for reliability and validity in the original English version by the developers of the score. The aim of this study is to assess reliability and validity of the r-FLACC pain score for use in Danish children with CP.MethodsTwenty-seven children aged 3–15 years old with CP were included after orthopaedic surgery. Two methods for assessment of postoperative pain were used. Pain intensity was assessed by r-FLACC, with a 2 min standardized video recording of the child, and the Observational Visual Analogue Score (VAS-OBS) assessed by the parents. The COSMIN checklist was used as a guideline in the reliability and validity testing of the r-FLACC score.ResultsReliability was supported by three measurement properties. Internal consistency was excellent with a Cronbachs alpha of 0.9023 and 0.9758 (two raters). A factor analysis of the subgroups in the r-FLACC score showed unidimensionality. A test-retest showed excellent intra-rater reliability with an intraclass correlation (ICC) of 0.97530. Inter-rater reliability was acceptable with an ICC of 0.74576. Validity was supported by three measurement properties. Content validity was tested by the originators of the r-FLACC. Construct validity was supported by a significant increase in r-FLACC scores following surgery (n = 17; difference 2.23; p = 0.0397). Criterion validity was acceptable with Pearson’s correlation coefficients of 0.76 and 0.59 when comparing r-FLACC scores and VAS-OBS scores.Conclusions and implicationsThis study benefits from a systematical approach to the validation and reliability parameters by using the COSMIN checklist as a guideline. It is evident that the r-FLACC pain score maintains its psychometric properties after translation. In conclusion, the r-FLACC pain score is valid and reliable in assessing postoperative pain in children with CP not able to self-report pain. With the r-FLACC pain score clinicians have a valid tool for assessing postoperative pain, hence increasing the quality of pain management in children with CP. In addition the validated r-FLACC score has the potential for use in interventional research regarding pain management in this vulnerable group of patients. Future perspectives include validation of the r-FLACC score for procedural and chronic everyday pain and implementation into daily practice.

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Observational Pain Assessment Instruments for Use With Nonverbal Patients at the End-of-life: A Systematic Review

Journal of Palliative Care ◽

10.1177/0825859718816073 ◽

2019 ◽

Vol 34 (4) ◽

pp. 255-266 ◽

Cited By ~ 5

Author(s):

Diane Tapp ◽

Sara Chenacher ◽

Ngangue Patrice Alain Gérard ◽

Philippe Bérubé-Mercier ◽

Celine Gelinas ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Pain Assessment ◽

Reliability And Validity ◽

Assessment Tools ◽

Cochrane Library ◽

Severe Illness ◽

Assessment Instruments ◽

Measurement Instruments ◽

Health Measurement

Purpose: To review studies pertaining to the reliability and validity of observational pain assessment tools for use with nonverbal patients at the end-of-life, a field of research not documented by previous systematic reviews. Methods: Databases (PubMed, Embase, Epistemonikos, the Cochrane Library, and CINAHL) were systematically searched for studies from study inception to February 21, 2016 (update in May 9, 2018). Two independent reviewers screened study titles, abstracts, and full texts according to inclusion and exclusion criteria. Disagreements were resolved through consensus. Reviewers also extracted the psychometrics properties of studies of observational pain assessment instruments dedicated to a noncommunicative population in palliative care or at the end-of-life. A comprehensive quality assessment was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to derive poor, fair, good or excellent ratings for the psychometric tests reported in each study. Results: Four studies linked to 4 different tools met the inclusion criteria. Study populations included dementia, palliative care and severe illness in the context of intensive care. All the studies included in this review obtained poor COSMIN ratings overall. Conclusions: At this point, it is impossible to recommend any of the tools evaluated given the low number and quality of the studies. Other analyses and studies need to be conducted to develop, adapt, or further validate observational pain instruments for the end-of-life population, regardless of the disease.

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Measuring test-retest reliability (TRR) of AMSTAR provides moderate to perfect agreement – a contribution to the discussion of the importance of TRR in relation to the psychometric properties of assessment tools

BMC Medical Research Methodology ◽

10.1186/s12874-021-01231-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stefanie Bühn ◽

Peggy Ober ◽

Tim Mathes ◽

Uta Wegewitz ◽

Anja Jacobs ◽

...

Keyword(s):

Psychometric Properties ◽

Systematic Reviews ◽

Methodological Quality ◽

Assessment Tools ◽

Measurement Properties ◽

Perfect Agreement ◽

Retest Reliability ◽

Test Retest Reliability ◽

The Impact

Abstract Background Systematic Reviews (SRs) can build the groundwork for evidence-based health care decision-making. A sound methodological quality of SRs is crucial. AMSTAR (A Measurement Tool to Assess Systematic Reviews) is a widely used tool developed to assess the methodological quality of SRs of randomized controlled trials (RCTs). Research shows that AMSTAR seems to be valid and reliable in terms of interrater reliability (IRR), but the test retest reliability (TRR) of AMSTAR has never been investigated. In our study we investigated the TRR of AMSTAR to evaluate the importance of its measurement and contribute to the discussion of the measurement properties of AMSTAR and other quality assessment tools. Methods Seven raters at three institutions independently assessed the methodological quality of SRs in the field of occupational health with AMSTAR. Between the first and second ratings was a timespan of approximately two years. Answers were dichotomized, and we calculated the TRR of all raters and AMSTAR items using Gwet’s AC1 coefficient. To investigate the impact of variation in the ratings over time, we obtained summary scores for each review. Results AMSTAR item 4 (Was the status of publication used as an inclusion criterion?) provided the lowest median TRR of 0.53 (moderate agreement). Perfect agreement of all reviewers was detected for AMSTAR-item 1 with a Gwet’s AC1 of 1, which represented perfect agreement. The median TRR of the single raters varied between 0.69 (substantial agreement) and 0.89 (almost perfect agreement). Variation of two or more points in yes-scored AMSTAR items was observed in 65% (73/112) of all assessments. Conclusions The high variation between the first and second AMSTAR ratings suggests that consideration of the TRR is important when evaluating the psychometric properties of AMSTAR.. However, more evidence is needed to investigate this neglected issue of measurement properties. Our results may initiate discussion of the importance of considering the TRR of assessment tools. A further examination of the TRR of AMSTAR, as well as other recently established rating tools such as AMSTAR 2 and ROBIS (Risk Of Bias In Systematic reviews), would be useful.

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Effectiveness of postoperative pain therapy in children assessed by their parents – is inadequate analgesia potentially dangerous?

Ból ◽

10.5604/01.3001.0013.4579 ◽

2019 ◽

Vol 20 (1) ◽

pp. 17-24

Author(s):

Michał Zięba ◽

Artur Baranowski ◽

Magdalena Mierzewska-Schmidt

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Postoperative Analgesia ◽

Sleep Disturbances ◽

Parental Education ◽

Pain Therapy ◽

Rating Scale ◽

Likert Scale ◽

Assessment Tools ◽

University Hospital

Inadequate pain therapy can lead to negative physical and psychological consequences, increase complications and even mortality. We aimed to assess effectiveness of postoperative analgesia in children from their parents’ point of view. We also wanted to evaluate their degree of satisfaction of postoperative analgesia and to identify areas for improvement. Patients’ parents (n = 85) from Paediatric University Hospital in Warsaw, Poland, took part in our survey. They evaluated pain intensity on five-point Likert Scale and on numerical rating scale (NRS). Mean value of pain on NRS was 4.22 (SD±2,53). On Likert scale the majority of parents described pain intensity as moderate. High percentage (38.82%) of children were in pain while their parents took the survey and only 19% of children did not feel pain at all. In 36 children (42.36%) pain caused sleep disturbances. In same cases non-pharmacological methods of analgesia were effective. Due to inadequate pain relief one of the parents arbitrarily administered a formulation containing paracetamol and codeine. The study revealed low efficacy of analgesia among children of surveyed parents. Their level of satisfaction was inadequately high (91% of them were „very satisfied” or “rather satisfied”). The survey confirmed the need for systematic pain assessment tools. Parental education seems necessary to make them aware that postoperative pain can be treated effectively. Administration of drugs without consulting medical staff is dangerous. It may result in the use of contraindicated agents (as in the case described), drug overdose or unexpected interactions.

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The Elicited Verbal Pain Language of Childbirth: A Closer Look at Pain Assessment Through a Critical and Interpretive Review of the Literature

International Journal of Childbirth ◽

10.1891/2156-5287.6.3.134 ◽

2016 ◽

Vol 6 (3) ◽

pp. 134-148 ◽

Cited By ~ 2

Author(s):

Stephanie Power ◽

Fiona E. Bogossian ◽

Jenny Strong ◽

Roland Sussex

Keyword(s):

Pain Assessment ◽

Pain Perception ◽

Cross Cultural ◽

Assessment Tools ◽

Review Of The Literature ◽

Pain Experience ◽

Electronic Search ◽

Dimensions Of Pain ◽

The Impact ◽

Affective Dimensions

OBJECTIVE:To provide a critical and interpretive review of the literature to investigate examples of pain assessment tools used in a childbirth context. Through these examples of pain assessment, the concept of elicited verbal pain language is introduced and explored.METHODS:Electronic search strategies were used to identify primary research regarding maternal reports of pain (during labor, postpartum and retrospectively), which were captured by standardized pain assessment tools.FINDINGS:The review revealed the physiological (the sensory and affective dimensions of pain, the intensity of pain, and the influence of parity on pain perception), psychological (the influence of maternal attitude, mood, and memory on pain perception), and ethnocultural (the impact of the ethnocultural context on pain perception) components of the pain experience. The strengths and limitations of pain assessment tools are highlighted. There were similarities in the reviewed studies’ approaches to pain assessment despite the cross-cultural representation of birth. Possible implications for cross-cultural pain assessment and communication are outlined.CONCLUSION:The question remains regarding the appropriateness of implementing standardized pain assessment tools across birth context. An ongoing critique of pain assessment may inform the provision of better care overall for birthing women in multicultural societies.

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