Docstoc

Pain Behavior Observation Scales for …

Document Sample
Pain Behavior Observation Scales for … Powered By Docstoc
					     Pain Behavior Observation Scales Papers
             – A Systematic Review




               Agnes Mitchell RN, MN
                  Clinical Specialist
             The CAPITAL CARE Group
       14225-94 St. Edmonton, Alberta, T5E 6C6
                Phone: 780 496 3344
                Fax: 780 476 4585
        E-mail: agnesmitchell@capitalcare.net




                      Advisors:

         Dr. Duncan Saunders, SEARCH Faculty
                           &
Betty Thompson, Administrator, CAPITAL CARE Norwood


                   March 6, 2007
Acknowledgements

Betty Thompson as my immediate supervisor at The CAPITAL CARE Group provides constant
opportunities to grow and learn. Betty’s continuous support and guidance to me during the
SEARCH Classic Program and in my role as a Clinical Nurse Specialist is unbeatable.

Dr. Duncan Saunders has been an excellent mentor in this systematic review. He provided
exceptional guidance and wisdom for this project to be meaningfully applied to a front line
clinical question.

I would also like to thank the Capital Health Continuing Care Best Practice Pain Sub-Committee.
We have worked very hard to review, critique and sort out the evidence to determine what would
be practical and doable for frontline professionals to implement and guide their practices. It was
no easy task. I believe the Continuing Care Interdisciplinary Pain Assessment & Management
Standard will guide and enhance clinical practice to improve the quality of life for residents.

Finally, I would like to thank The CAPITAL CARE Group Administration and Capital Health
for supporting the SEARCH Canada Classic program and myself as a participant. It was a great
opportunity to renew my research skills and to learn how computer technology makes it possible
to be part of a virtual community. I cannot imagine life without memory sticks, lap tops and the
ability to SKYPE and web conference with colleagues across the province.




Pain Behavior Observation Scales                                                                2
                                   Table of Contents


Abstract: Pain Behavior Observation Scale Papers ………………………………...           Page 4

Background, Purpose, Methods ………………………………………………..                          Page 5

Results ………………………………………………………………………………                                     Page 6

Discussion ………………………………………………………………………….                                   Page 7

Limitations and Strengths ………………………………………………………….                          Page 8

References …………………………………………………………………………..                                  Page 9 – 11

Elevator Speech/Dissemination Plans/Written Reflection …………………………. Page 12

Appendix A – Search Review Process ……………………………………………... Page 13

Appendix B – Quality of Study Design Using a Yes/No Table ……………………. Page 14

Appendix C – Relevant Results of the Two Best Quality PBOS Papers ………...   Page 15

Appendix D – Clinical Feasibility of PBOS ………………………………………..                Page 16

Poster                                                                     Page 17




Pain Behavior Observation Scales                                                     3
                                           ABSTRACT

                    PAIN BEHAVIOR OBSERVATION SCALE PAPERS -
                              A SYSTEMATIC REVIEW

Background: Pain is extremely difficult to recognize, assess and manage in an older adult with
advanced dementia (AD). Older adults with AD are particularly difficult to assess because they
gradually lose the cognitive, physical and verbal capacity to use a self report pain intensity scale.
The research question is “What pain behavior observation scales (PBOS) for the older adult with
AD who live in a continuing care facility are valid, reliable, clinically responsive and feasible?”
Methods:         A search strategy was completed in December of 2005. PubMed, EBSCO and
OVID data bases were searched with the following terms: pain scales, elderly, pain
measurement, frail elderly, aged, and cognitive impairment. As well, relevant websites and
reference lists from two systematic reviews on PBOS were reviewed. Sixty abstracts were
identified, and 15 potentially eligible papers were reviewed by two blinded reviewers. Eight
papers met the following inclusion criteria: primary study of a PBOS; study reported on validity
or reliability or clinical responsiveness or clinical feasibility; PBOS developed for older adults
with AD, over the age of 65 years who lived in a continuing care facility and English language
sources only. The eight papers were examined against four quality factors: validity, reliability;
clinical feasibility and clinical responsiveness with the use of a yes/no table. The relevant results
of the two papers that met all four quality factors were compared. The PBOS of the two papers
that reported on all four quality factors (Abbey et al., 2004; Warden, Hurley, & Volicer, 2003)
were further examined for clinical feasibility.
Results:         Five studies were conducted in a clinical setting and three of these studies
addressed clinical responsiveness with a pain intervention. The results of the two studies that
met all four quality measures had almost equivalent validity and reliability psychometric
measures (Abbey et al., 2004; Warden et al., 2003). Both studies demonstrated clinical
responsiveness with a pain intervention using the respective PBOS. Warden’s PBOS appears to
be the most clinically feasible because behaviors were well defined, summation of the scale was
one step, and total numerical value is out of ten.
Conclusion and Clinical Application:             Abbey’s and Warden's PBOS study reported
preliminary reliability and validity statistics and clinical responsiveness. Warden’s PBOS
appears to be the most clinical feasible for use in clinical practice at this time. From clinical
experience, it is better to use a PBOS than not using one at all. In conclusion, Warden’s PBOS
called the PAINAD was recommended to the Capital Health Continuing Care Best Practice Pain
Sub-Committee to include in Capital Health’s Continuing Care Pain Assessment Tool.




Pain Behavior Observation Scales                                                                    4
                                          Background

Pain is a complex phenomenon. The most widely accepted definition of pain for clinical practice
is by Margo McCaffery: “Pain is whatever the experiencing person says it is, existing whenever
he/she says it does.” (McCaffery & Pasero, 1999; pg 17). The prevalence of older adults
residing in long term care who experience intermittent pain is 47% and those with constant pain
is 24% (Ferrell, 1995). Stein, (2001) reports up to 80% of older adults in long term care
experience chronic pain. The CAPITAL CARE Group (TCCG) in Edmonton, Alberta operates
approximately 1100 long term care beds. Approximately 70 % of the older adults living in these
facilities have some degree of cognitive impairment.

Pain is extremely difficult to recognize, assess and manage in older adults with advanced
dementia (AD). Older adults with AD are particularly difficult to assess because they eventually
lose the cognitive, physical and verbal capacity to use a self report pain intensity scale. Pain
assessment of the older adult with AD is based on their medical history, a physical assessment,
the individual’s behaviors and the perceptions of long term care staff and family members who
are familiar with the individual on a daily basis. Behaviors of the older adult with AD need
careful assessment as the behaviors may exist for other physical and psychosocial reasons.

Pain assessment and management is a standard that has been added to The Canadian Council of
Health Services Accreditation in 2005 and part of the new Alberta Health and Wellness, 2006
Continuing Care Health Service Standards. The Capital Health Regional Continuing Care Best
Practice Committee struck a sub-committee to address pain in 2004. A systematic review to
support the identification of a reliable and valid pain behavior observation scale (PBOS) for
older adults with AD was needed.

                                            Purpose

The purpose of this project was to determine a PBOS that could be used with older adults with
AD who lived in a continuing care facility. The research question that guided this project was:
What PBOS for the older adult with AD who live in a continuing care facility is valid, reliable,
clinically responsive and feasible?


                                               Methods
Search Strategies
The search strategies included on-line computer searches of a number of data bases, hand
searches of key pain articles and reference lists of two published systematic reviews on pain
scales, and grey literature. Pubmed, EBSCO and Ovid were the data bases searched
systematically in the month of December 2005 using the following search terms: pain scales,
elderly, pain measurement, frail elderly, aged, cognitive impairment. In addition the author spent
more than a year prior to entering the SEARCH Classic program, reading and collecting pain
articles without using any particular systematic approach. When colleagues learned of the
subject area of interest to the author; they often sent articles from a variety of web sites and
electronic journals. Key articles were not documented and the author learned who the most




Pain Behavior Observation Scales                                                                   5
frequently published researchers in pain were in the last ten years. A few of these authors
included: Ferrel, Kovach, Hurley, and Herr to name a few.

Reference lists of two published systematic reviews on pain scales were reviewed for journal
articles that met the internal criteria (Stolee et al., 2005) (Herr et al., 2006). The grey literature
included the following:
Textbooks
              Managing Pain: The Canadian Healthcare Professional’s Reference (2002)
                 (Jovey, 2002)
              Pain: Clinical Manual (1999) 2nd Edition. McCaffery, M. & Pasero, C. Mosby:
                 Harcourt Health Sciences Company.
Organizations Websites
              The Canadian Pain Society
              University of Iowa – Gerontology
              http://www.cityofhope.org/prc/elderly.asp
              Registered Nurses Association of Ontario: www.rnao.org
Sixty abstracts were reviewed. Fifteen potential papers were identified and blindly reviewed by
a SEARCH Faculty member and the author using the following inclusion criteria:
         Primary study of a PBOS
         Reported on validity or reliability or clinical responsiveness or clinical feasibility
         Developed for older adults with AD, over the age of 65 years who live in a continuing
             care facility
         English language sources
Eight primary study papers of a PBOS met the eligibility criteria. Appendix A provides a brief
summary of the search review process.
Quality Measures of Study Design
The eight papers were examined against four quality factors: validity, reliability; clinical
responsiveness and clinical feasibility. Appendix B displays a yes/no table to look at the quality
factors of the studies.
Comparison of Study Results
Relevant results were pulled from the two papers that met all four quality measures (Abbey et al.,
2004; Warden et al., 2003). The gold standard for pain behaviors of older adults with AD has
been determined by American Geriatric Society Panel on Persistent Pain in Older Persons,
(2002). See Appendix C for details.
Clinical Feasibility of PBOS Examined
Clinical feasibility of two PBOS was addressed by asking five questions applied to the Abbey
Pain Scale by Abbey et al., (2004) and the PAINAD by Warden et al. (2003). See Appendix D
for details.

                                               Results
Generally, all eight papers were at some stage in development of a PBOS for older adults with
AD for reliability and validity measures. Five studies were conducted in a clinical setting. Of
the five studies conducted in a clinical setting only three addressed clinical responsiveness by
using the PBOS after a pain intervention. No study actually measured the clinical feasibility of a
PBOS. Two of the eight papers (Abbey et al., 2004; Warden et al., 2003) reported on all four
quality measures.


Pain Behavior Observation Scales                                                                    6
Relevant results were examined from the two papers that met all four quality measures (Abbey et
al., 2004; Warden et al., 2003) (Please see Appendix C). The study designs of these papers were
very different and therefore challenging to compare results. Both of these papers had reasonable
preliminary reliability and validity psychometric properties and demonstrated clinical
responsiveness. The strengths of (Abbey et al., 2004) study was a larger sample size, used many
facilities and many kinds of staff. (Abbey et al., 2004) reported reasonable validity statistics;
strong intra-reliability statistics, modest correlations for inter-reliability and demonstrated
clinical responsiveness. No comparison PBOS was used in the (Abbey et al., 2004) study
design.

The strengths of (Warden et al., 2003)study included a comparison of their PBOS to two other
researched based PBOSs, significant correlations for inter-reliability, modest intra-reliability
scores were reported and demonstrated clinical responsiveness. Good construct validity was
determined by detecting differences in pain associated with different conditions and analgesic
use. The limitation of Warden et al., (2003) study was a small sample size and the limited results
on intra-reliability scores.

The clinical feasibility was addressed by examining each PBOS with five questions (see
Appendix D). In examining the answers to the five clinical feasibility questions it became more
evident that the Abbey Pain Scale was not as easy to use as Warden’s PAINAD. The Abbey
Pain Scale did not come with instructions, items on pain scale were not clearly defined, items
were ranked on a liker scale and there were two levels of scoring to this PBOS. The total pain
score was then sub-divided again to mild, moderate and severe pain scores. The scoring of this
scale seems problematic because there are no gold standards to pain behavior scores let alone
mild, moderate, and severe pain behavior scores.

Warden’s PAINAD came with specific instructions. The behaviors on the PAINAD were clearly
defined. This PBOS appears easy to score with one step to sum the total score out of ten. The
PAINAD total score out of 10 seems reasonable to work but remains meaningless because there
is no gold standard pain behavior score. The initial weaknesses of the PAINAD scale include the
lack of sensitivity to resident’s subtle behaviors therefore the score could be very low and the
resident may still be experiencing pain. In summary, the PBOS by Warden et al., (2003) called
“PAINAD” met preliminary reliability and validity psychometric properties, demonstrated
clinical responsiveness and had more positive clinical feasibility factors then the Abbey Pain
Scale (Abbey et al., 2004).

                                              Discussion
Three systematic reviews on pain scales have been published (Herr, Bjoro, & Decker, 2006;
Stolee et al., 2005; Zwakhalen, Hamers, Abu-Saad, & Berger, 2006). All three conclude that no
PBOS is ready for clinical practice because only preliminary psychometric properties have been
achieved. The conclusion of this systematic review recommends the use of Warden’s PAINAD
scale. The preliminary evidence suggests that using a PBOS provides the clinician with a
systematic assessment to measure clinical responsiveness with those older adults with AD who
demonstrate pain behaviors. The rationale for selecting a PBOS with preliminary psychometric
properties, clinical feasibility and responsiveness was to promote a consistent way to identify the



Pain Behavior Observation Scales                                                                  7
existence of pain in older adults with AD. Therefore, the PAINAD was recommended because
of the clinically feasible features and that it is better to use a PBOS than not using one at all.
The PAINAD scale was recommended to the Capital Health Continuing Care Best Practice Pain
Sub-Committee to include in the regional pain assessment tool. The author feels confident that
the use of this PBOS will not cause harm, and will assist clinicians to begin to articulate the pain
behaviors of older adults with AD. The PAINAD could be used along with a self-report pain
intensity scale when the resident’s self report is becoming less reliable related to a decrease in
cognitive and verbal capacity. Clinicians may be frustrated with this scale because in some cases
it will not be sensitive enough to the older adults with AD pain behaviors. No PBOS will be
useful if a resident is in pain and not showing any behaviors. As well, it will be critical for staff
to know that the PAINAD score out of ten is a pain behavior score and not comparable to the
numerical self report pain intensity scale score out of ten (Pasero & McCaffery, 2005). A pain
behavior score is not equivalent to a self report pain intensity score. The real challenge is the
adoption and use of pain scales by clinicians, particularly the nurses as one part of their
assessment. A PBOS is needed to screen, identify, and assess pain in the older adult with AD
and to clinically monitor effectiveness of pain interventions.

                                    Limitations and Strengths
Replication of this study may be a limitation as some of the literature on pain was gathered prior
to the project and key documents or search strategies that led the author to a paper maybe
missing. The author identified her own biases during this process. The author tended to lean
towards papers written by nurse researchers as it was difficult to understand the orientation of
other disciplines in their approach and philosophy to the assessment and development of pain
scales.

The strengths of this project are: specificity of the research question; relevance of the research
question to the long term care sector, a small piece towards meeting the regional best practice
pain committee needs and the regional and provincial long term care accreditation standards.
Having a second reviewer evaluate the fifteen papers that met the internal criteria further
clarified and identified the author’s biases, research question, and inclusion criteria. It was
helpful to study and review already published systematic reviews on PBOS as the author learned
from studying others’ methods. The results of this project were meaningful to the region and The
CAPITAL CARE Group in determining the best published PBOS for clinicians to assess and
manage pain for residents at this time. It is hoped that further clinical research on PBOSs will
soon be conducted and published.




Pain Behavior Observation Scales                                                                   8
                                            References

Abbey, J., Piller, N., De Bellis, A., Esterman, A., Parker, D., & Giles, L., et al. (2004). The

    abbey pain scale: A 1-minute numerical indicator for people with end-stage dementia.

    International journal of palliative nursing, 10(1), 6-13.


American Geriatric Society Panel on Persistent Pain in Older Persons. (2002). The management

    of persistent pain in older persons. Journal of the American Geriatrics Society, 50(6 Suppl),

    S205-24.


Baker, A., Bowring, L., Brignell, A., & Kafford, D. (1996). Chronic pain management in

    cognitively impaired patients: A preliminary research project. Perspectives, 20(2), 4-

    5,6,7,8.


Ferrell, B. A. (1995). Pain evaluation and management in the nursing home. Annals of internal

    medicine., 123(9), 681-687.


FuchsLacelle, S., & Hadjistavropoulos, T. (2005). A checklist for pain assessment in LTC --

    PACSLAC: Pain assessment checklist for seniors with limited ability to communicate.

    Canadian Nursing Home, 16(4), 4-7.


Fuchs-Lacelle, S., & Hadjistavropoulos, T. (2004). Development and preliminary validation of

    the pain assessment checklist for seniors with limited ability to communicate (PACSLAC).

    Pain management nursing : official journal of the American Society of Pain Management

    Nurses, 5(1), 37-49.




Pain Behavior Observation Scales                                                                  9
Herr, K., Bjoro, K., & Decker, S. (2006). Tools for assessment of pain in nonverbal older adults

    with dementia: A state-of-the-science review. Journal of pain and symptom management,

    31(2), 170-192.


Herr, K., Coyne, P. J., Key, T., Manworren, R., McCaffery, M., & Merkel, S., et al. (2006). Pain

    assessment in the nonverbal patient: Position statement with clinical practice

    recommendations. Pain management nursing : official journal of the American Society of

    Pain Management Nurses, 7(2), 44-52.


Hurley, A. C., Volicer, B. J., Hanrahan, P. A., Houde, S., & Volicer, L. (1992). Assessment of

    discomfort in advanced alzheimer patients. Research in nursing & health, 15(5), 369-377.


Jovey, R. D. (2002). (Second ed.). Toronto, Ontario: Rogers Media.


McCaffery, M., & Pasero, C. (1999). PAIN clinical manual, (Second ed.). St. Louis: Mosby.


Pasero, C., & McCaffery, M. (2005). No self-report means no pain-intensity rating. The

    American Journal of Nursing, 105(10), 50-53.


Snow, A. L., Weber, J. B., O'Malley, K. J., Cody, M., Beck, C., & Bruera, E., et al. (2004).

    NOPPAIN: A nursing assistant-administered pain assessment instrument for use in

    dementia. Dementia and geriatric cognitive disorders, 17(3), 240-246.


Stein, W. M. (2001). Pain in the nursing home. Clinics in geriatric medicine, 17(3), 575-594.


Stolee, P., Hillier, L. M., Esbaugh, J., Bol, N., McKellar, L., & Gauthier, N. (2005). Instruments

    for the assessment of pain in older persons with cognitive impairment. Journal of the

    American Geriatrics Society, 53(2), 319-326.



Pain Behavior Observation Scales                                                                 10
Villanueva, M. R., Smith, T. L., Erickson, J. S., Lee, A. C., & Singer, C. M. (2003). Pain

    assessment for the dementing elderly (PADE): Reliability and validity of a new measure.

    Journal of the American Medical Directors Association, 4(1), 1-8.


Warden, V., Hurley, A. C., & Volicer, L. (2003). Development and psychometric evaluation of

    the pain assessment in advanced dementia (PAINAD) scale. Journal of the American

    Medical Directors Association, 4(1), 9-15.


Zwakhalen, S. M., Hamers, J. P., Abu-Saad, H. H., & Berger, M. P. (2006). Pain in elderly

    people with severe dementia: A systematic review of behavioural pain assessment tools.

    BMC geriatrics [electronic resource], 6, 3.




Pain Behavior Observation Scales                                                              11
                                        Elevator Speech
Context: in stairwell coming back from lunch (I walk versus ride the elevator) with two nurses:
Do you think we do a good job of assessing our residents for pain now? Do you think we could
improve? Do you have any advice for me? Say, have you heard that I am taking this research
program? Do you think it would be useful for me to study and figure out which pain tools would
be most useful to use with our population? I will keep you in touch.

                                       Dissemination Plans
Internal to The Capital Care Group:
        Corporate Best Practice Committee
        Senior Forum (Care Managers)
        Hard copy of report to each campus/program (7)
        People and Progress Conference (TCCG) poster – February 2007


External to The Capital Care Group:
       Regional Best Practice Committee
       Article in AGNA newsletter
       AGNA Provincial Conference – April 2008
       Medical Workshop – March 2006 – part of a oral presentation
       CGNA – Poster May 2007
       SEARCH Conference – June 2007
       Margaret Scott Nursing Research Day, University of Alberta, October 2007




                                         Written Reflection
The numerous published pain articles are overwhelming. From my graduate level education I
knew that narrowing the research question would take months and it did. Constantly reading and
critiquing the literature and consulting with co-workers were critical. In the search for literature
I was amazed to find in the end two published systematic review of pain scales and a third one
was found six months later after the initial search for this project. All of these systematic
reviews agreed that no PBOS was ready for clinical practice. It is obviously an emerging area of
research. I found myself consulting a nurse researcher to ensure I would not be causing harm by
recommending the PAINAD even though the psychometric properties were preliminary. She
agreed that to get the staff even to begin to use a PBOS will be the greatest challenge of the
implementation of any new pain standards. This was a great experience and I will always
attempt to approach the literature with a refined question and a systematic way to critique the
quality of the literature.




Pain Behavior Observation Scales                                                                 12
                                        Appendix A

                                   Search Review Process



    Search Terms: pain scales, elderly, pain measurement, frail elderly, aged,
                            cognitive impairment
                                        ↓

                   DATA Bases searched in December 2005:
                     132 hits from pub med, EBSCO, Ovid
       Relevant web sites; Reference lists of 3 systematic reviews on PBOS
                                         ↓

                                   60 Abstracts reviewed
                                             ↓

                                     15 potential papers
                                             ↓

                           Internal inclusion criteria applied

                 Blindly by SEARCH Faculty Member and Author-
                                      ↓

                        8 papers met internal inclusion criteria




Pain Behavior Observation Scales                                                 13
                                        Appendix B

                   Quality of Study Design Using a Yes/No Table

                       Validity         Reliability   Clinical            Clinical
                       (Masking –       (Statistics   Feasibility –       Responsiveness –
Study/Pain Behavior    two different    reported)     Was study           Was the PBOS
Observation Scale      observers are                  completed in a      used before and
(PBOS)                 blinded to the                 clinical setting?   after a pain
                       results of the                 Was time to         intervention?
                       other)                         administered
                                                      scale measured?
(Abbey et al., 2004)   Yes              Yes           Yes                 Yes
Abbey Pain Scale                                      No
(Baker, Bowring,       No               No            Yes                 Yes
Brignell, & Kafford,                                  No
1996)
Behavioral Check
list
(Snow et al., 2004)    No               Yes           No                  No
NOPAIN                                                No

(Fuchs-Lacelle &       No               Yes           No                  No
Hadjistavropoulos,                                    No
2004)
PACSLAC
(FuchsLacelle &        No               No            No                  No
Hadjistavropoulos,                                    No
2005)
PACSLAC
(Hurley, Volicer,      No               Yes           Yes                 No
Hanrahan, Houde, &                                    No
Volicer, 1992)
DS-DAT
(Villanueva, Smith,    Yes              Yes           Yes                 No
Erickson, Lee, &                                      No
Singer, 2003)
PADE
(Warden et al.,        Yes              Yes           Yes                 Yes
2003)                                                 No
PAINAD




Pain Behavior Observation Scales                                                         14
                                    Appendix C
              Relevant Results of the Two Best Quality PBOS Papers


  Results of Study              Abbey Pain Scale                          PAINAD
                               (Abbey et al., 2004)                  (Warden et al., 2003)

Population                    61 residents; 66% female           19 out of 96 in patient diagnosed
                                                                   with dementia
                              average age 83 years             mean age 78.1 years
                                                                25 charts of residents receiving
                                                                   pain medications as prn were
                                                                   reviewed as part of a quality
                               24 different kinds of              improvement project
                                facilities in four              multiple units; 1 site VA Medical
                                Australian states                  Center
Who used the PBOS?      45 RNs, 7 enrolled nurses and 9    3 LPNs, 2 nursing assistants, 4 RNs,
                        assistants to nurses               social worker intern,

How many times was
the PBOS
administered?           236 pain episodes recorded (18     57 observations (2 observers for each
                        residents assessed by 2 staff      observation using PAINAD & a
                        members independently, with 43     comparison pain scale. Three
                        residents assessed by a single     observations of each resident – rest,
                        staff member.                      pleasant and unpleasant activity)
Validity – AGS          3/6 of the AGS behaviors           3/6 of AGS behaviors
Behaviors as a Gold
Standard; statistics;   Gamma (measure of correlation)     - good construct validity, detected
                        = 0.586 (P<0.001)                  differences in pain associated with
                                                           different conditions & analgesic
                                                           administration

Was PBOS compared       No comparison to another PBOS      Compared to VAS & DS-DAT
to another?
Intra-Reliability       Cronbach’s alpha 0.74 pre and      Cronbach’s alpha 0.70 (lack of
Same observers,         post intervention                  distribution of scores because most fell
different times, same                                      around zero)
scale
Inter-Reliability       18 (30%) residents were assessed   significant correlations scores between:
Different observers,    by 2 staff members                 simultaneous observations:
same times, same        independently - modest                  of pain and discomfort at rest
scale                   correlation                             during pleasant and unpleasant
(Kappa scores)                                                     conditions.




Pain Behavior Observation Scales                                                             15
                                      Appendix D
                             Clinical Feasibility of PBOS

Clinical Feasibility         Abbey Pain Scale             PAINAD
Questions
How long does it take to     not measured in study        not measured in study
teach PBOS specifically?


How long does it take to     authors claim only one       authors instructions
administer PBOS?             minute; not formally         recommends 5 minutes; not
                             measured in study            formally measured in study


Were all the behaviors,      No. Terms such as mild,      Yes. All behaviors on pain
terms and scores on pain     moderate and severe pain     scale were well defined and
scale defined?               were not defined.            clearly indicate what score
                                                          to give each behavior.


Is the pain behavior score   Two levels of scoring on     Minimal interpretation of
easy to understand and       PBOS. Arbitrary numbers      behavior score. Score is out
meaningful?                  assigned to mild, moderate   of 10. Numbers easy to use
                             and severe pain scores.      but caution most be noted
                                                          that this score out of 10 is
                                                          not equivalent to the
                                                          numerical self report
                                                          intensity pain rating scale
                                                          (Pasero & McCaffery,
                                                          2005)




Pain Behavior Observation Scales                                                         16

				
DOCUMENT INFO
pptfiles pptfiles
About