The Rotterdam Elderly Pain Observation Scale (REPOS) is reliable and valid for non-communicative end-of-life patients

Abstract

BackgroundIn palliative care, administration of opioids is often indispensable for pain treatment. Pain assessment may help recognize pain and guide treatment in non-communicative patients. In the Netherlands the Rotterdam Elderly Pain Observation Scale (REPOS) is recommended to this aim, but not yet validated. Therefore the objective of this study was to validate the REPOS in non-communicative or unconscious end-of-life patients.MethodsIn this observational study, the primary researcher applied the REPOS, while both the researcher and a nurse applied the Numeric Rating Scale (NRS). If possible, the patient in question applied the NRS as well. The NRS scores were compared with the REPOS scores to determine concurrent validity. REPOS scores obtained before and after a pain-reducing intervention were analysed to establish the scale’s sensitivity to change.ResultsA total of 183 REPOS observations in 100 patients were analysed. Almost 90% of patients had an advanced malignancy; observations were done a median of 3 days (IQR 1 to 13) before death. Internal consistency of the REPOS was 0.73. The Pearson product moment correlation coefficient ranged from 0.64 to 0.80 between REPOS and NRS scores. REPOS scores declined with median 2 points (IQR 1 to 4) after a pain-reducing intervention (p < 0.001). Optimal sensitivity (0.81) and specificity (0.62) were found at cut-off score 3.ConclusionsThis study demonstrates that the REPOS has promising psychometric properties for pain assessment in non-communicative end-of-life patients. Its application may be of additional value to relieve suffering, including pain, in palliative care.Electronic supplementary materialThe online version of this article (10.1186/s12904-018-0280-x) contains supplementary material, which is available to authorized users.

Validation of the Rotterdam Elderly Pain Observation Scale in the Hospital Setting

“…This study confirmed that the REPOS is valid and reliable for the assessment of pain in oral communication–limited nursing home residents and palliative care patients as well as for noncommunicative hospital patients.…”

Validity of the Rotterdam Elderly Pain Observation Scale for institutionalised cognitively impaired Dutch adults

“…A REPOS score of 3 or higher combined with an observer NRS rating of 4 or higher suggests moderate to severe pain (Van Herk et al 2009). Two further studies confirmed good validity of the REPOS for palliative care patients (Masman et al 2018) and for non-communicative hospital patients (Boerlage et al 2019).…”

“…ROC curve analysis confirmed that a REPOS score of 3 or higher indicates the presence of pain. The cut-off value of 3 also holds for nursing home residents, hospital patients and palliative care patients alike (Van Herk et al 2009;Masman et al 2018;Boerlage et al 2019).…”

The role of cancer nurses in cancer-related pain management in Europe

“…For patients who are unresponsive or otherwise limited, there are many other tools available, such as Face, Legs, Activity, Cry, Consolability (FLACC) Scale or the Rotterdam Elderly Pain Observation Scale (REPOS). 26,27 Once pain management is initiated, patients’ pain should be reassessed at appropriate intervals to confirm adequate pain control and to monitor for adverse events. 22 However, as unidimensional tools do not capture psychological or social components, a more detailed assessment using a multi-dimensional tool should be carried out once pain has been identified by regular monitoring.…”