The MOBID‐2 pain scale: Reliability and responsiveness to pain in patients with dementia

Abstract

BackgroundMobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) pain scale is a staff-administered pain tool for patients with dementia. This study explores MOBID-2's test–retest reliability, measurement error and responsiveness to change.MethodsAnalyses are based upon data from a cluster randomized trial including 352 patients with advanced dementia from 18 Norwegian nursing homes. Test–retest reliability between baseline and week 2 (n = 163), and weeks 2 and 4 (n = 159) was examined in patients not expected to change (controls), using intraclass correlation coefficient (ICC2.1), standard error of measurement (SEM) and smallest detectable change (SDC). Responsiveness was examined by testing six priori-formulated hypotheses about the association between change scores on MOBID-2 and other outcome measures.ResultsICCs of the total MOBID-2 scores were 0.81 (0–2 weeks) and 0.85 (2–4 weeks). SEM and SDC were 1.9 and 3.1 (0–2 weeks) and 1.4 and 2.3 (2–4 weeks), respectively. Five out of six hypotheses were confirmed: MOBID-2 discriminated (p < 0.001) between change in patients with and without a stepwise protocol for treatment of pain (SPTP). Moderate association (r = 0.35) was demonstrated with Cohen-Mansfield Agitation Inventory, and no association with Mini-Mental State Examination, Functional Assessment Staging and Activity of Daily Living. Expected associations between change scores of MOBID-2 and Neuropsychiatric Inventory – Nursing Home version were not confirmed.ConclusionThe SEM and SDC in connection with the MOBID-2 pain scale indicate that the instrument is responsive to a decrease in pain after a SPTP. Satisfactory test–retest reliability across test periods was demonstrated. Change scores ≥ 3 on total and subscales are clinically relevant and are beyond measurement error.

Impact of a stepwise protocol for treating pain on pain intensity in nursing home patients with dementia: A cluster randomized trial

“…Dementia affects approximately 10 million people in Europe, and this is expected to double every 20 years as the population ages (Kalaria et al, 2014). One-third of people with dementia reside in nursing homes (NHs).…”

The importance of pain management in older people with dementia

“…41 Studies also suggest that sleep problems may be a symptom indicative of pain. 29,36 There is also an increasing body of evidence around the association of depression and apathy with pain in dementia. A high degree of comorbidity between depression and pain has been identified, and is often referred to as the depression-pain dyad.…”

“…51 A more recent trial in people with dementia in care homes also reported improvements in mood and depression as well as apathy, sleep and appetite disturbances but not anxiety and irritability. 29 Finally, recent work highlights the value of measuring physical ability and function as a marker of underlying pain. Measures of activities of daily living (ADL) have been shown to be associated with pain, albeit to a lesser extent than cognitive impairment, 52 and two studies reported an indirect link between pain and ADL, mediated by BPSD and depression.…”

“…shown to be sensitive to responses to pain treatment 29 hence, it is also suitable for use in research settings. This scale is available with instructions online.…”

Pain and Psychological Well-Being Among People with Dementia in Long-Term Care

“…Under-recognized or under-treated pain represent important potential threats to QoL among people with dementia (PWD) who live in nursing homes, as pain is associated with a variety of behavioral and psychological symptoms of dementia (1, 2). Contemporary conceptual models of QoL in dementia underscore the importance of focusing on psychological well-being, noting that although the progression of most dementias is not modifiable, related factors such as control of co-morbid conditions and subjective appraisal of personal and environmental factors may be potentially modifiable influences on QoL (3).…”