Construct validity and inter-rater reliability of the Gymnastic Functional Measurement Tool in the classification of female competitive gymnasts in Canada.

OBJECTIVES: To determine the construct validity and the inter-rater reliability of the Gymnastic Functional Measurement Tool (GFMT) within the parameters of the Canadian classification of female competitive gymnasts. DESIGN: Validity and Reliability study. SETTING: The GFMT was administered by evaluators who had no previous knowledge of the competing level of the gymnasts. To determine the construct validity, a multiple linear regression analysis was carried out between the GFMT scores and the gymnasts' competition level to obtain the coefficient of determination. To estimate the inter-rater reliability, gymnasts were simultaneously evaluated by two evaluators. Intraclass correlation coefficient (ICC) analysis was carried out for the individual score of each item as well as for the total score of the GFMT. PARTICIPANTS: Ninety (90) female gymnasts aged between the ages of 8 and 18 years old. MAIN OUTCOME: GFMT total score and individual score of each item. RESULTS: The study demonstrated an excellent relationship between the total GFMT scores and the gymnasts' competition level (r2 = 0.97). The inter-rater reliability analysis of the GFMT total score was excellent with an ICC of 0.98. CONCLUSION: Construct validity and inter-rater reliability of the GFMT in the classification of female competitive gymnasts in Canada has been demonstrated.

Can We Quickly and Thoroughly Assess Pain with the PACSLAC-II? A Convergent Validity Study in Long-Term Care Residents Suffering from Dementia.

A previous study found that the modified version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-II) is a valid tool to assess pain in elderly individuals suffering from dementia and who are unable to communicate verbally. The primary objective of this study was to confirm the convergent validity of the PACSLAC-II using direct evaluation of long-term care residents in real-life situations, using two other well-validated pain assessment scales (i.e., PACSLAC and Pain Assessment in Advanced Dementia [PAINAD]). A secondary objective was to document and compare the time required to complete and score each assessment scale. During two potentially painful procedures (i.e., transfer/mobilization), 46 long-term care residents (mean age = 83 ± 10 years) suffering from dementia were observed by three independent evaluators, each using one of the assessment scales (randomly assigned). Correlational analyses and analysis of variance were used to evaluate the association between each scale and to compare scoring time. The PACSLAC (r = 0.61) and the PAINAD (r = 0.65) were both moderately associated with the PACSLAC-II (all p values < .001). The PAINAD's average scoring time (63 ± 19 seconds) was lower than the PACSLAC-II's (96 ± 2 seconds), which was lower than the PACSLAC's (135 ± 53 seconds) (all p values < .001). These results suggest that the PACSLAC-II is a valid tool for assessing pain in individuals with dementia. The time required to complete and score the PACSLAC-II was reasonable, supporting its usefulness in clinical settings.

Can adding a standardized observational tool to interdisciplinary evaluation enhance the detection of pain in older adults with cognitive impairments?

OBJECTIVE: The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities, and it is especially high among older adults who are unable to communicate due to cognitive impairments. Although validated assessment tools exist, pain detection in this population is often done by interdisciplinary evaluation (IE), which largely relies on the subjective impression of health care providers. The aim of this study was to examine the agreement between the IE and validated observational pain tools. SETTING: We recruited 59 residents with limited ability to communicate. The pain behaviors of each participant were assessed with two validated tools, the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and the Pain Assessment in Advanced Dementia (PAINAD), during transfer or mobilization. The results were then compared with the findings of the IE. RESULTS: The correlation between the PACSLAC and PAINAD was high (r = 0.79 [95% CI: 0.67-0.87]). However, we found a low to moderate association between the PACSLAC and the IE (r = 0.34 [95% CI: 0.09-0.55]), and a weaker association was observed between the PAINAD and the IE (r = 0.25 [95% CI: -0.02-0.48]). When the IE concluded that there was an absence of pain behavior, the PAINAD and the PACSLAC detected the presence of pain in 13.6% and 27.1% of the cases respectively. CONCLUSION: These results may be explained by an inability of IE to assess pain correctly or by instruments providing false positive results. Nevertheless, as detection of pain is difficult in this population, our research supports the use of validated tools to complement assessment of pain by the IE and make sure that no pain goes undetected.