Comparison of Self-Reported Pain and the PAINAD Scale in Hospitalized Cognitively Impaired and Intact Older Adults After Hip Fracture Surgery

DeWaters, Trudy; Faut-Callahan, Margaret; McCann, Judith J.; Paice, Judith A.; Fogg, Louis; Hollinger-Smith, Linda; Sikorski, Kai; Stanaitis, H.

doi:10.1097/01.nor.0000310607.62624.74

Cited by 76 publications

(79 citation statements)

References 27 publications

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“…However, PAINAD is quick and simple to use (<1 min), is a reliable indicator of pain intensity (0–10 pain score), assesses physiological and psychological pain symptoms13 and is usable in the ED. This was supported by a substudy by our team involving emergency nurse focus groups (n=36), which identified that PAINAD was preferred when compared with The Abbey Pain Scale, Doloplus-2 and Pain Assessment Checklist for Seniors with Limited Ability to Communicate 6…”

Section: Discussionmentioning

confidence: 99%

Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial

2017

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Objective The primary objective of the study was to measure the impact of an observational pain assessment dementia tool on time from ED arrival to first dose of analgesic medicine. Methods A multisite cluster randomised controlled trial was conducted to test the Pain Assessment in Advanced Dementia (PAINAD) tool. Patients aged 65 years or older suspected of a long bone fracture were screened for cognitive impairment using the Six-Item Screening (SIS) tool. Patients scoring 4 or less on SIS (intervention sites) were assessed for pain using PAINAD. Control sites, assessed pain using standard methods. The primary outcome was time to first dose of analgesia and was analysed on an intention-to-treat basis with a sensitivity analysis. results We enrolled 602 patients, of which 323 (54%) were at intervention sites (n=4). The median time to analgesia was 82 min (IQR 45-151 min). There was no statistically significant difference in median time to analgesia for intervention 83 (IQR 48-158 min) and nonintervention 82 min (IQR 41-147 min) sites (p=0.414). After adjusting for age, fracture type, arrival mode and triage category, there remained no significant difference in time to analgesia (HR 0.97, 95% CI 0.80 to 1.17, p=0.74). Of the 602 patients enrolled, 273 actually had cognitive impairment. A sensitivity analysis demonstrated patients at intervention sites received analgesia 13 min sooner (90 vs 103 min, p=0.91). conclusion Use of the PAINAD was not associated with a shorter time to analgesia, although there was a clinically important but non-significant improvement in the cognitively impaired patient group. Further research is needed to address this clinically important and complex issue.

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Section: Discussionmentioning

confidence: 99%

Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial

2017

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“…A Swedish version of the instrument was available, but no published data on validity were found. PAINAD has also been tested in hospitalized cognitively intact and impaired post-orthopaedic surgical older adults and a positive correlation was found between a self-report pain scale and the PAINAD [31]. The internal consistency was satisfactory in the dataset as evidenced by a Cronbach’s alpha of 0.75.…”

Section: Methodsmentioning

confidence: 99%

Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes; a cross-sectional study

et al. 2016

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BackgroundEarlier studies in nursing homes show a high prevalence of cognitive impairment, dependency in activities of daily living (ADL), pain, and neuropsychiatric symptoms among residents. The aim of this study was to explore the prevalence of the above among residents in a nationally representative sample of Swedish nursing homes, and to investigate whether pain and neuropsychiatric symptoms differ in relation to gender, cognitive function, ADL-capacity, type of nursing-home unit and length of stay.MethodsCross-sectional data from 188 randomly selected nursing homes were collected. A total of 4831 residents were assessed for cognitive and ADL function, pain and neuropsychiatric symptoms. Data were analysed using descriptive statistics and the chi-square test.ResultsThe results show the following: the prevalence of cognitive impairment was 67 %, 56 % of residents were ADL-dependent, 48 % exhibited pain and 92 % exhibited neuropsychiatric symptoms. The prevalence of pain did not differ significantly between male and female residents, but pain was more prevalent among cognitively impaired and ADL-dependent residents. Pain prevalence was not significantly different between residents in special care units for people with dementia (SCU) and general units, or between shorter-and longer-stay residents. Furthermore, the prevalence of neuropsychiatric symptoms did not differ significantly between male and female residents, between ADL capacities or in relation to length of stay. However, residents with cognitive impairment and residents in SCUs had a significantly higher prevalence of neuropsychiatric symptoms than residents without cognitive impairment and residents in general units.ConclusionsThe prevalence rates ascertained in this study could contribute to a greater understanding of the needs of nursing-home residents, and may provide nursing home staff and managers with trustworthy assessment scales and benchmark values for further quality assessment purposes, clinical development work and initiating future nursing assessments.

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“…15,[39][40][41] PAINAD has been shown to correlate well with observer pain ratings and other observational pain tools (r = 0.81 to 0.85), 15 and poorly with the CSDD. Observers rate each behavior on a scale of 0 to 2, where 0 represents normal functioning and 2 represents behaviors hypothesized to indicate pain (eg, noisy labored breathing, loud moaning or groaning, facial grimacing, rigid, or unable to console).…”

Section: Painad 12mentioning

confidence: 99%

Evidence-based Development and Initial Validation of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate-II (PACSLAC-II)

Chan

Hadjistavropoulos

Williams

et al. 2014

The Clinical Journal of Pain

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Comparison of Self-Reported Pain and the PAINAD Scale in Hospitalized Cognitively Impaired and Intact Older Adults After Hip Fracture Surgery

Cited by 76 publications

References 27 publications

Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial

Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial

Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes; a cross-sectional study

Evidence-based Development and Initial Validation of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate-II (PACSLAC-II)

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