Doloplus 2 escala
Pain measurement in nonverbal older adults is best based on behavioural observation, e.
The purposes of this study were to examine the use of Doloplus-2 in a nonverbal nursing home population, and to evaluate its reliability and validity by comparing registered nurses' estimation of pain with Doloplus-2 scores.
In this cross-sectional study, Doloplus-2 was used to observe the pain behaviour of patients aged above 65 years who were unable to self-report their pain. Nurses also recorded their perceptions of patient pain yes, no, don't know before they used Doloplus Data on demographics, medical diagnoses, and prescribed pain treatment were collected from patient records. Daily life functioning was measured and participants were screened using the Mini Mental State Examination.
Cronbach's alpha was 0. In the present study, more patients were categorized as having pain while using Doloplus-2 compared with nurses' estimation of pain without using any tools. The fact that nurses could not report if the patients were in pain in one third of the patients supports the claim that Doloplus-2 is a useful supplement for estimating pain in this population. However, nurses must use their clinical experience in addition to the use of Doloplus-2, as behaviour can have different meaning for different patients.
Further research is still needed about the use of Doloplus-2 in patients not able to self-report their pain. Pain is a major problem in the nursing home population [ 1 - 5 ]. A recent study of Norwegian nursing homes reports pain prevalence as being highest among nonverbal patients [ 7 ]. Cognitively impaired patients are reported as receiving fewer analgesics than cognitively intact patients [ 28 ]. Studies have also shown that neuropathological changes in dementia subtypes may affect the pain experience, where both increased and decreased sensation of pain may occur [ 9 ].
In addition, those with severe cognitive impairment may have difficulty in communicating their pain to caregivers, sometimes leading to the mistaken assumption that they are not in pain [ 1 ]. Pain is a subjective and persistent phenomenon and the gold standard in pain assessment is to use scales based on the patient's self-report [ 10 ]. Several studies suggest that self-reporting scales can be used in dementia populations and that use of these scales can improve pain detection [ 21012 ].
However, many of these studies have systematically eliminated patients without the ability to self-report their pain. Given that language loss is inevitable in the most advanced stage of dementia and sometimes following stroke, valid and reliable methods for pain assessment in nonverbal older adults are needed.
In these patient populations, other methods, such as behavioural pain observation methods, become more useful and necessary. However, among patients with severe dementia, even behavioural observation methods for capturing pain can be challenging. These patients often have severe physical limitations due to rigidity and contractures that may inhibit them from expressing their pain through behaviours or body language [ 13 ].
Doloplus-2, a valid tool for behavioural pain assessment?
Facial grimaces have been reported by nursing staff as the most important behavioural expression of pain in nonverbal patients [ 17 ]. Furthermore, they relied on knowledge of a resident's habits and needs when differentiating between behaviour attributable to pain and to other factors [ 17 ].
A number of studies have focused on the development and validation of tools measuring pain in nonverbal older adults, based on behavioural observation methods. The tool rates the presence of pain behaviour indicators, pain intensity, pain localization and overall pain intensity [ 18 ].
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This is also very problematic, because the pain behaviours are not always accurate reflections of pain intensity, and will also indicate other sources of distress, such as physiological or emotional distress [ 19 ]. A systematic review in identified 12 behavioural pain assessment tools [ 16 ]. However, these tools were still under evaluation and awaiting confirmation of various aspects of their psychometric properties [ 16 ].
Herr et al. Hadjistavropoulos et al. They maintained that assessment scales were under development and consensus could not be reached regarding the definition recommendation of any particular scale [ 25 ]. The Doloplus-2 has been translated into Norwegian and tested in Norwegian nursing home populations [ 1526 ].Behavioral pain assessment scale for the elderly presenting with verbal communication disorders, DOLOPLUS consists in an observation form consisting of 10 items divided into 3 sub-groups proportionally to the observed frequency 5 somatic items, 2 psychomotor items and 3 psychosocial items.
Each item is scored from 0 to 3 scored using 4 exclusive and progressive levels yielding an overall score between 0 and When the elderly person can communicate and cooperate, it makes sense to use self-assessment tools.
Combining self- and hetero-assessment will avoid underestimation. The use of a scale which has not been approved or which includes poor psychometric properties will lead to erroneous extrapolation. Thus any measuring instrument, if it is to be of any practical use, must be approved. This means checking that it provides a sensible, reproducible, reliable and specific result.
Before using a tool, the clinician must be satisfied that it has good psychometric qualities see Hadjistravopoulos et al. The Doloplus scale is the first hetero-assessment scale of pain in elderly people with verbal communication difficulties to have been approved in French in January and published Lefebvre- Chapiro Fifteen French and Swiss geriatricians trained in palliative care and pain management, led by a biostatistician, studied a population of elderly subjects aged over 65 and having verbal communication or behavioural difficulties, except when studying convergent validity in which case the ability to self-assess was required.
This was a multicentre study 15 different centres with or without geriatric medicine units, palliative care departments, geriatric aftercare and long-term care centres, geriatric rehabilitation centres and care homes. It began in March and ended in January The elderly people were aged between 65 andand were assessed using the Doloplus scale 1 to 3 times depending on the tests, making a total of assessments.
The various statistical validation stages concentrated on the study of reproducibility test-retest reliability and inter-rater reliabilitysensitivity by item and overallconvergent validity and internal consistency. For more detailed numerical data, please see the following publication: Wary B. The days of simple estimation of pain are behind us. Validation of the Doloplus scale is just one more battle won in the fight against the inequalities to be found in pain management, particularly in elderly people with verbal communication difficulties.
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Checking for direct PDF access through Ovid. In this follow-up study, we report the psychometric properties of the observational Doloplus-2 scale using the visual analog scale VAS pain score as a gold standard and evaluate its performance.
Method Prospective clinical study of hospitalized older patients who demonstrated good comprehension and reliable use of the VAS: participants with dementia and 49 without. All participants assessed their chronic pain using the VAS.
Doloplus-2 was independently completed by the nursing team. Results Mean age of patients women, 47 men was Median mini-mental state examination of patients with diagnosis of dementia was The administration of Doloplus-2 was possible in all patients.
Doloplus-2 correlated moderately with self-assessment Spearman coefficient: 0. To shorten Doloplus-2, we constructed a version with only the 5 items that were significantly associated with the VAS score in the multiple regression models. Discussion The observational Doloplus-2 scale correlates moderately with self-assessment pain score and has adequate internal consistency.
Our data also suggest that Doloplus-2 could be substantially shortened as the brief version performed similarly to the complete Doloplus Related Topics.The high occurrence of pain among elderly subjects has now been proved by many surveys, in Europe and in North America. Whether it is acute or chronic osteoarthritic, cutaneous, neuropathic etc. Faced with that lack of interest, there is a real need for serious assessment of the symptom for medical, ethical and legal reasons, given that the dangers of a simple estimation of pain are well-known, particularly the frequent risk of underestimation.
Self-assessment tools are widely available these days, but there are many limitations to their usefulness among the elderly:. With vocabulary-based scales particularly the St Antoine Pain Questionnairesociocultural and cognitive profiles interfere a great deal. They may also use the tool to localise the pain. Conversely, there is a risk of overestimation in the event of anxiety, hypochondria or hysteria. Deficits in understanding, involvement and communication sensory problems, concentration problems, coma, aphasia, dementia, behavioural problems etc.
Indeed, the study by Pesonen et al. In elderly people, the recommendations Herr advise combining self- and hetero-assessment for elderly people to avoid the failure to recognise pain.