Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake

Abstract

Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed and under-treated pain. A nurse-administered assessment tool has been developed to unmask pain during standardised, guided movements, called Mobilisation-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale. The aim was to examine intra- and inter-rater reliability of pain behaviour indicators, inferred pain intensity, and the overall MOBID Pain Score. Twenty-six nursing home patients with severe dementia and chronic pain, 11 primary caregivers and three external raters at the Red Cross Nursing Home, Bergen were included. During video uptake the patients were guided by their primary caregivers to standardised movements of different body parts. Pain behaviour indicators (pain noises, facial expression and defence) were registered for each movement with subsequent rating of pain intensity by external raters, who assessed and scored the videos concurrently and independently at day 1, 4 and 8. Facial expression was most commonly observed, followed by pain noises and defence. Repeated assessments increased the number of observed pain behaviours, but did not improve reliability. Inter-rater reliability was highest for noises, followed by defence and facial expression (kappa = 0.44-0.92, kappa = 0.10-0.76 and kappa = 0.05-0.76 respectively, at day 8). Mobilisation of arms and legs were rated most painful. Intra- and inter-rater reliability of overall pain were very good [intraclass correlation coefficient (1,1) ranging 0.92-0.97 and 0.94-0.96 respectively, at day 8]. Reliability of pain intensity scores tended to increase by repeated assessment. Using video uptake, MOBID Pain Scale was shown to be sufficiently reliable to assess pain in older persons with severe dementia.

Får bedre smertebehandling

“…Kartlegging av smerteatferd har sine begrensninger fordi det er lett å tolke atferd feil (9, 12). Typisk smerteatferd er samtidig symptom på demens, og ved langtkommen demens avtar ansiktsmimikk og øyekontakt, noe som ytterligere vanskeliggjør smertekartlegging (13). Den enkelte pasient har sitt unike smerteuttrykk, forskjellig fra alle andres (7,15).…”

“…Undersøkelser viser at demente ofte er underbehandlet for smerte (1,2,(7)(8)(9)(10)(11)(12)(13). Årsaker til dette kan vaere utilstrekkelig smertekartlegging eller manglende bevissthet på at demente kan ha vondt (12).…”

“…Der er utarbeidet en rekke verktøy til kartlegging av smerter hos demente (1,13,14,17). Noen av disse er oversatt og prøvd ut i sykehjem i Norge (2,12,13).…”

“…Der er utarbeidet en rekke verktøy til kartlegging av smerter hos demente (1,13,14,17). Noen av disse er oversatt og prøvd ut i sykehjem i Norge (2,12,13). I denne artikkelen ønsker vi i å belyse hvorfor systematisk kartlegging av smerter hos demente kan vaere nyttig, og beskrive de kartleggingsverktøy som er prøvd ut i norske sykehjem.…”

Pain Experience and Expression in Patients with Dementia

“…Fronidini et al (2007) emphasize neuropsychological aspects of pain experiencing by the elderly -it intensifies short and delayed memory deficits, restricts mental flexibility and may be conducive to language impairments occurrence. In dementia pain manifestation may assume a subtle form (Husebo et al, 2009). According to Weiner et al, (1999) in case of individuals with explicit cognitive impairments such as in advanced Alzheimer's disease it comes to regression to infantile ways of self-expression because their pain, as a result of an inability to cognitively conceptualize it, loses its context.…”