Impact of a Training Intervention on the Pain Assessment in Advanced Dementia (PAINAD) Scale in Noncommunicative Inpatients

Validity and reliability of the Italian version of painad for postoperative pain assessment in geriatric patients with proximal femur fractures

BACKGROUND

Pain assessment is essential in nursing care. The Numerical Rating Scale (NRS) is widely used but may not fully capture pain's multidimensional nature. The Pain Assessment in Advanced Dementia (PAINAD) scale is reliable for assessing pain in cognitively impaired patients. This study aims to evaluate the validity of the Italian version of PAINAD (PAINAD-IT) for postoperative pain assessment in geriatric patients with femur fractures.

METHODS

This study employs the PAINAD-IT, which was translated and validated for the Italian context by Costardi et al. (2007). Face and content validity (I-CVI and S-CVI) for non-cognitively impaired patients were evaluated by experts. Pain assessments were conducted at rest (T0) and during movement (T1). Convergent validity was tested using Spearman correlation, discriminant validity with the Wilcoxon test, and inter-rater reliability with Cohen's kappa. Sensitivity and specificity were calculated.

RESULTS

I-CVIs were ≥0.90 and S-CVI was 0.96. 75 patients were included. Cohen's kappa was 0.918 at T0 and 0.881 at T1. Both PAINAD and NRS detected a significant increase in pain from T0 to T1 (Wilcoxon p < 0.001). Sensitivity was 26 % and specificity was 99 % for PAINAD-IT scores ≥3.

CONCLUSION

PAINAD showed strong reliability and correlation with NRS, effectively distinguishing between rest and pain stages, these results suggest that PAINAD-IT may be a useful tool for pain assessment in geriatric patients operated for femur fracture. PAINAD-IT scores ≥3 may suggest severe pain. Further multi-centre studies with larger sample sizes are needed to fully validate PAINAD-IT for postoperative pain assessment in geriatric patients with.

Correlation between Biomarkers of Pain in Saliva and PAINAD Scale in Elderly People with Cognitive Impairment and Inability to Communicate

The pain assessment in advanced dementia (PAINAD) appears to be a clinically useful tool. However, the salivary determination of tumor necrosis factor receptor type II (sTNF-RII) and secretory IgA (sIgA) as pain biomarkers is still incipient. The aim was to correlate the PAINAD score with sTNF-RII and sIgA biomarker levels in the saliva of patients with advanced dementia. In this regard, a cross-sectional study was conducted. The sample consisted of 75 elderly patients with a clinical diagnosis of dementia and a global deterioration scale (GDS) score of 5 to 7. The PAINAD scale was determined by a previously trained professional and the collection of salivary samples was performed using the passive secretion method. Human sTNF-RII and sIgA using ELISA kits. The results showed a correlation between the PAINAD scale (numeric, binary, and recoded) and sTNF-RII and sIgA (p < 0.001). No association between the sociodemographic and clinical variables and the PAINAD scale was found (p > 0.05). Between 97.3% and 96.2% of patients with pain on the PAINAD scale also showed pain based on the sTNF-RII levels; in all of them, sIgA levels did not fit the logistic models. Therefore, the correlation highlights the usefulness of this scale and confirms the usefulness of sTNF-RII and sIgA as biomarkers of pain.

Reliability and Feasibility of the Pain Assessment in Advanced Dementia Scale-Korean Version (PAINAD-K)

BACKGROUND

There is currently no observational instrument for assessing pain in aged patients who are unable to provide self-report in long-term care hospitals in Korea.

AIMS

The goal of this research was to culturally adapt and test the validity, reliability, and feasibility of the Korean version of the Pain Assessment in Advanced Dementia Scale.

DESIGN

This was a methodologic study aiming to translate the Pain Assessment in Advanced Dementia Scale.

PARTICIPANTS/SUBJECTS

The inpatients in a 270-bed LTC hospital in D metropolitan city were assessed pain levels.

METHODS

The Pain Assessment in Advanced Dementia (PAINAD) Scale was used as an observation scale to assess 192 long-term care hospital patients, with observation durations of 1 and 5 minutes.

RESULTS

The interrater reliability (1 minute) for the scale showed substantial kappa agreement of .62, and scores for the 1- and 5-minute observations showed almost perfect agreement of .95. The criterion validity of the scale (1 minute) was high relative to the Face-Legs-Activity-Cry-Consolability (FLACC) Scale, and low compared with the numeric rating scale (NRS). Discriminant validity was established between patients with and without pain. The feasibility of the Pain Assessment in Advanced Dementia Scale-Korean Version (PAINAD-K) (1 minute) indicated low sensitivity of 41.3% and high specificity of 92.6%.

CONCLUSIONS

Therefore, the PAINAD-K is a valid and reliable tool to determine the absence of pain in non-verbal aged patients.