Doloplus-2, a valid tool for behavioural pain assessment?

Jacob C Holen, Ingvild Saltvedt, Peter M Fayers, Marianne J Hjermstad, Jon H Loge, Stein Kaasa

Research output: Contribution to journalArticle

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Abstract

Background
The Doloplus-2 is used for behavioural pain assessment in cognitively impaired patients. Little data exists on the psychometric properties of the Doloplus-2. Our objectives were to test the criterion validity and inter-rater reliability of the Doloplus-2, and to explore a design for validations of behavioural pain assessment tools.

Methods
Fifty-one nursing home patients and 22 patients admitted to a geriatric hospital ward were included. All were cognitively impaired and unable to self-report pain. Each patient was examined by an expert in pain evaluation and treatment, who rated the pain on a numerical rating scale. The ratings were based on information from the medical record, reports from nurses and patients (if possible) about pain during the past 24 hours, and a clinical examination. These ratings were used as pain criterion. The Doloplus-2 was administered by the attending nurse. Regression analyses were used to estimate the ability of the Doloplus-2 to explain the expert's ratings. The inter-rater reliability of the Doloplus-2 was evaluated in 16 patients by comparing the ratings of two nurses administrating the Doloplus-2.

Results
There was no association between the Doloplus-2 and the expert's pain ratings (R2 = 0.02). There was an association (R2 = 0.54) between the expert's ratings and the Doloplus-2 scores in a subgroup of 16 patients assessed by a geriatric expert nurse (the most experienced Doloplus-2 administrator). The inter-rater reliability between the Doloplus-2 administrators assessed by the intra-class coefficient was 0.77. The pain expert's ratings were compared with ratings of two independent geriatricians in a sub sample of 15, and were found satisfactory (intra-class correlation 0.74).

Conclusion
It was challenging to conduct such a study in patients with cognitive impairment and the study has several limitations. The results do not support the validity of the Doloplus-2 in its present version and they indicate that it demands specific administration skills.
Original languageEnglish
Article number29
Number of pages9
JournalBMC Geriatrics
Volume7
DOIs
Publication statusPublished - 19 Dec 2007

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Pain Measurement
Pain
Nurses
Administrative Personnel
Geriatrics
Aptitude
Nursing Homes
Psychometrics
Self Report
Medical Records
Regression Analysis

Cite this

Holen, J. C., Saltvedt, I., Fayers, P. M., Hjermstad, M. J., Loge, J. H., & Kaasa, S. (2007). Doloplus-2, a valid tool for behavioural pain assessment? BMC Geriatrics, 7, [29]. https://doi.org/10.1186/1471-2318-7-29

Doloplus-2, a valid tool for behavioural pain assessment? / Holen, Jacob C; Saltvedt, Ingvild; Fayers, Peter M; Hjermstad, Marianne J; Loge, Jon H; Kaasa, Stein.

In: BMC Geriatrics, Vol. 7, 29, 19.12.2007.

Research output: Contribution to journalArticle

Holen, JC, Saltvedt, I, Fayers, PM, Hjermstad, MJ, Loge, JH & Kaasa, S 2007, 'Doloplus-2, a valid tool for behavioural pain assessment?', BMC Geriatrics, vol. 7, 29. https://doi.org/10.1186/1471-2318-7-29
Holen, Jacob C ; Saltvedt, Ingvild ; Fayers, Peter M ; Hjermstad, Marianne J ; Loge, Jon H ; Kaasa, Stein. / Doloplus-2, a valid tool for behavioural pain assessment?. In: BMC Geriatrics. 2007 ; Vol. 7.
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title = "Doloplus-2, a valid tool for behavioural pain assessment?",
abstract = "BackgroundThe Doloplus-2 is used for behavioural pain assessment in cognitively impaired patients. Little data exists on the psychometric properties of the Doloplus-2. Our objectives were to test the criterion validity and inter-rater reliability of the Doloplus-2, and to explore a design for validations of behavioural pain assessment tools.MethodsFifty-one nursing home patients and 22 patients admitted to a geriatric hospital ward were included. All were cognitively impaired and unable to self-report pain. Each patient was examined by an expert in pain evaluation and treatment, who rated the pain on a numerical rating scale. The ratings were based on information from the medical record, reports from nurses and patients (if possible) about pain during the past 24 hours, and a clinical examination. These ratings were used as pain criterion. The Doloplus-2 was administered by the attending nurse. Regression analyses were used to estimate the ability of the Doloplus-2 to explain the expert's ratings. The inter-rater reliability of the Doloplus-2 was evaluated in 16 patients by comparing the ratings of two nurses administrating the Doloplus-2.ResultsThere was no association between the Doloplus-2 and the expert's pain ratings (R2 = 0.02). There was an association (R2 = 0.54) between the expert's ratings and the Doloplus-2 scores in a subgroup of 16 patients assessed by a geriatric expert nurse (the most experienced Doloplus-2 administrator). The inter-rater reliability between the Doloplus-2 administrators assessed by the intra-class coefficient was 0.77. The pain expert's ratings were compared with ratings of two independent geriatricians in a sub sample of 15, and were found satisfactory (intra-class correlation 0.74).ConclusionIt was challenging to conduct such a study in patients with cognitive impairment and the study has several limitations. The results do not support the validity of the Doloplus-2 in its present version and they indicate that it demands specific administration skills.",
author = "Holen, {Jacob C} and Ingvild Saltvedt and Fayers, {Peter M} and Hjermstad, {Marianne J} and Loge, {Jon H} and Stein Kaasa",
note = "Acknowledgements The authors wish to thank Bj{\o}rn Hval, RN, Department of Anaesthesiology, St. Olav's Hospital, Trondheim, Norway for his work as the pain expert. We also wish to thank the patients and the staff of Trondheim Hospital and Ilsvika nursing homes, and The Geriatric Ward at St. Olav's University Hospital for their enthusiastic participation, and Elin Einarson RN, Astri Huseby MD, and Silje Songe-M{\o}ller medical student, for their invaluable contributions. This work was financed by The Research Council of Norway",
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AU - Holen, Jacob C

AU - Saltvedt, Ingvild

AU - Fayers, Peter M

AU - Hjermstad, Marianne J

AU - Loge, Jon H

AU - Kaasa, Stein

N1 - Acknowledgements The authors wish to thank Bjørn Hval, RN, Department of Anaesthesiology, St. Olav's Hospital, Trondheim, Norway for his work as the pain expert. We also wish to thank the patients and the staff of Trondheim Hospital and Ilsvika nursing homes, and The Geriatric Ward at St. Olav's University Hospital for their enthusiastic participation, and Elin Einarson RN, Astri Huseby MD, and Silje Songe-Møller medical student, for their invaluable contributions. This work was financed by The Research Council of Norway

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Y1 - 2007/12/19

N2 - BackgroundThe Doloplus-2 is used for behavioural pain assessment in cognitively impaired patients. Little data exists on the psychometric properties of the Doloplus-2. Our objectives were to test the criterion validity and inter-rater reliability of the Doloplus-2, and to explore a design for validations of behavioural pain assessment tools.MethodsFifty-one nursing home patients and 22 patients admitted to a geriatric hospital ward were included. All were cognitively impaired and unable to self-report pain. Each patient was examined by an expert in pain evaluation and treatment, who rated the pain on a numerical rating scale. The ratings were based on information from the medical record, reports from nurses and patients (if possible) about pain during the past 24 hours, and a clinical examination. These ratings were used as pain criterion. The Doloplus-2 was administered by the attending nurse. Regression analyses were used to estimate the ability of the Doloplus-2 to explain the expert's ratings. The inter-rater reliability of the Doloplus-2 was evaluated in 16 patients by comparing the ratings of two nurses administrating the Doloplus-2.ResultsThere was no association between the Doloplus-2 and the expert's pain ratings (R2 = 0.02). There was an association (R2 = 0.54) between the expert's ratings and the Doloplus-2 scores in a subgroup of 16 patients assessed by a geriatric expert nurse (the most experienced Doloplus-2 administrator). The inter-rater reliability between the Doloplus-2 administrators assessed by the intra-class coefficient was 0.77. The pain expert's ratings were compared with ratings of two independent geriatricians in a sub sample of 15, and were found satisfactory (intra-class correlation 0.74).ConclusionIt was challenging to conduct such a study in patients with cognitive impairment and the study has several limitations. The results do not support the validity of the Doloplus-2 in its present version and they indicate that it demands specific administration skills.

AB - BackgroundThe Doloplus-2 is used for behavioural pain assessment in cognitively impaired patients. Little data exists on the psychometric properties of the Doloplus-2. Our objectives were to test the criterion validity and inter-rater reliability of the Doloplus-2, and to explore a design for validations of behavioural pain assessment tools.MethodsFifty-one nursing home patients and 22 patients admitted to a geriatric hospital ward were included. All were cognitively impaired and unable to self-report pain. Each patient was examined by an expert in pain evaluation and treatment, who rated the pain on a numerical rating scale. The ratings were based on information from the medical record, reports from nurses and patients (if possible) about pain during the past 24 hours, and a clinical examination. These ratings were used as pain criterion. The Doloplus-2 was administered by the attending nurse. Regression analyses were used to estimate the ability of the Doloplus-2 to explain the expert's ratings. The inter-rater reliability of the Doloplus-2 was evaluated in 16 patients by comparing the ratings of two nurses administrating the Doloplus-2.ResultsThere was no association between the Doloplus-2 and the expert's pain ratings (R2 = 0.02). There was an association (R2 = 0.54) between the expert's ratings and the Doloplus-2 scores in a subgroup of 16 patients assessed by a geriatric expert nurse (the most experienced Doloplus-2 administrator). The inter-rater reliability between the Doloplus-2 administrators assessed by the intra-class coefficient was 0.77. The pain expert's ratings were compared with ratings of two independent geriatricians in a sub sample of 15, and were found satisfactory (intra-class correlation 0.74).ConclusionIt was challenging to conduct such a study in patients with cognitive impairment and the study has several limitations. The results do not support the validity of the Doloplus-2 in its present version and they indicate that it demands specific administration skills.

U2 - 10.1186/1471-2318-7-29

DO - 10.1186/1471-2318-7-29

M3 - Article

VL - 7

JO - BMC Geriatrics

JF - BMC Geriatrics

SN - 1471-2318

M1 - 29

ER -