Completed Research Project

Testing the feasibility, reliability and validity of two pain assessment tools in residential aged care, refining them for future use

Investigators: Toye C, Kristjanson LJ, Goucke C, Auret K, Bruce D & Schug S.

Funding: Edith Cowan University Industry Collaborative Scheme and Sir Charles Gairdner Hospital ($44,000)

Administering institution: Edith Cowan University

Abstract: This study tested two pain assessment tools in residential aged care facilities, an observational tool and a tool obtaining (multidimensional) self reports at interview. The internal consistency reliability, stability over time, and feasibility of these tools were examined. The cognitive status of participating residents was also documented to see if selection of either a self report tool or an observational tool could be aided by reference to this status. We first tested the self report tool with 33 residents and the observational tool with 35 residents. Both tools demonstrated satisfactory internal consistency reliability and stability over time and the observational tool also demonstrated that it was feasible for use in residential aged care. The self report tool, however, was time consuming to use and a few residents who were apparently well able to report pain provided some inconsistent responses, perhaps because the wording needed simplifying or because there were problems with pain memory, the questionnaire requiring reflection over the past 24 hours. Cognitive testing was found to provide some guidance in the tool selection process in that people with severe or very severe levels of dementia were unable to provide self reports. The self report tool was then administered to 149 aged care residents to determine which items could be deleted to abbreviate the tool, using a theoretical rationale. The plan was to delete both unreliable items and items that were redundant with others that were more reliable and/or more clinically useful (because they detected greater pain severity or interference). On this basis, six items were deleted and six retained. The new version of the tool assesses pain severity now, at its least, and at its worst; and pain interference with walking, interactions, and general activities. The wording of items has been simplified. This version also has a movement protocol, to remind respondents of pain experienced on movement, and an item locating pain. The internal consistency reliability of this version of the tool is satisfactory and its stability is highly likely to be adequate, given that the stability of the individual items has already been demonstrated.