Validity and reliability of the Pain Assessment in Impaired Cognition 15 (PAIC15) observation scale in persons with aphasia

Abstract

Background The use of self-report pain scales in persons with aphasia can be challenging due to communication and cognitive problems. An observational scale may be used as an alternative. The aim of this study is to examine the validity and reliability of the observational Pain Assessment in Impaired Cognition (PAIC15) scale that was developed for people with dementia, in persons with aphasia. Methods In 14 Dutch nursing homes, persons with aphasia were observed during rest and transfer by two observers using the PAIC15. The PAIC15 comprises 15 items covering the three domains of facial expressions, body movements, and vocalizations. When able, the person completed four self-report pain scales after each observation. The observations were repeated within one week. For criterion validity, correlations between the PAIC15 and self-report pain scales were calculated and for construct validity, three hypotheses were tested. Reliability was determined by assessing internal consistency, and intra- and interobserver agreement. Results PAIC15 observations were obtained for 71 persons (mean age 75.5 years) with aphasia. Fair positive correlations (rest: 0.35–0.50; transfer: 0.38–0.43) were reported between PAIC15 and almost all self-report pain scales and, one of the three construct validity hypotheses was confirmed. Results showed acceptable internal consistency. Intraobserver agreement was high during transfer but not during rest, interobserver agreement was high on the three PAIC15 domains during transfer but not during rest. Conclusions Recognition of pain in persons aphasia using the PAIC15 observational scale showed mixed yet promising results in this clinical study.