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Probable Pain on the Pain Assessment in Impaired Cognition (PAIC15) Instrument: Assessing Sensitivity and Specificity of Cut-Offs against Three Standards.
van der Steen, Jenny T; Westzaan, Andrew; Hanemaayer, Kimberley; Muhamad, Muhamad; de Waal, Margot W M; Achterberg, Wilco P.
  • van der Steen JT; Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands.
  • Westzaan A; Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
  • Hanemaayer K; Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands.
  • Muhamad M; Aafje Thuiszorg, Huizen en Zorghotels, Pietersdijk 60, 3079 TD Rotterdam, The Netherlands.
  • de Waal MWM; Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands.
  • Achterberg WP; Franciscus Vlietland Hospital, Vlietlandplein 2, 3118 JH Schiedam, The Netherlands.
Brain Sci ; 11(7)2021 Jun 29.
Article in English | MEDLINE | ID: covidwho-1325601
ABSTRACT
Observational pain scales can help to identify pain in persons with dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) covers 15 items that indicate pain, but it is unclear how probable pain is, for each summed score (range 0-45). We aimed to determine sensitivity and specificity of cut-offs for probable pain on the PAIC15 against three standards (1) self-report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut-off of 2, and (3) observer's overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with re-assessment after 2 months in 137 residents. The area under the ROC curve was excellent against the PAINAD cut-off (≥0.8) but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, PAIC15 scores of 3 and higher represent possible pain for screening in practice, with sensitivity and specificity against self-report in the 0.5 to 0.7 range. While sensitivity for screening in practice may be too low, a cut-off of 4 is reasonable to indicate probable pain in research.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Diagnostic study / Observational study / Prognostic study / Systematic review/Meta Analysis Language: English Year: 2021 Document Type: Article Affiliation country: Brainsci11070869

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Diagnostic study / Observational study / Prognostic study / Systematic review/Meta Analysis Language: English Year: 2021 Document Type: Article Affiliation country: Brainsci11070869