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Semin Respir Crit Care Med 2013; 34(02): 153-168
DOI: 10.1055/s-0033-1342970
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Validated Approach to Evaluating Psychometric Properties of Pain Assessment Tools for Use in Nonverbal Critically Ill Adults

Céline Gélinas
1   Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
2   Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
,
Kathleen A. Puntillo
3   Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
,
Aaron M. Joffe
4   Department of Anesthesiology and Pain Medicine, University of Washington/Harborview Medical Center, Seattle, Washington
,
Juliana Barr
5   Anesthesiology Service, VA Palo Alto Health Care System, Palo Alto, California
6   Department of Anesthesia, Stanford University School of Medicine, Stanford, California
› Author Affiliations
Further Information

Publication History

Publication Date:
28 May 2013 (online)

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Abstract

A valid pain assessment is the foundation of adequate pain management. Pain assessment can be challenging, especially in adult intensive care unit (ICU) patients who are unable to self-report. In such situations, relying on observational assessment tools is an alternative strategy. This review describes and analyzes the development and psychometric properties of pain assessment tools developed for use with nonverbal critically ill adults. A total of 32 relevant papers that described the psychometric properties of eight pain assessment tools were included. The scale development process, psychometric properties (i.e., reliability and validity), and feasibility of pain assessment tools were analyzed using a 0 to 20 scoring system. Each pain assessment tool was scored independently by two reviewers. Of the eight behavioral pain scales developed for use in adult ICU patients, the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) are considered to be the most valid and reliable for this purpose, according to the available evidence. Behavioral pain scales may be viable alternatives to assessing pain in ICU patients who are unable to self-report, but only valid, reliable, and feasible scales should be used for this purpose.

Keywords

pain assessment tools - reliability - validity - intensive care unit - nonverbal adult
 

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    • Selected Reading Selected papers included in the psychometric analysis of pain assessment tools developed for use in nonverbal critically ill adults
      BPS

    • Ahlers SJ, van der Veen AM, van Dijk M, Tibboel D, Knibbe CA. The use of the Behavioral Pain Scale to assess pain in conscious sedated patients. Anesth Analg 2010; 110 (1) 127-133
      CrossrefPubMedGoogle Scholar
    • Ahlers SJ, van Gulik L, van der Veen AM , et al. Comparison of different pain scoring systems in critically ill patients in a general ICU. Crit Care 2008; 12 (1) R15
      CrossrefPubMedGoogle Scholar
    • Aïssaoui Y, Zeggwagh AA, Zekraoui A, Abidi K, Abouqal R. Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients. Anesth Analg 2005; 101 (5) 1470-1476
      CrossrefPubMedGoogle Scholar
    • Chanques G, Jaber S, Barbotte E , et al. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 2006; 34 (6) 1691-1699
      CrossrefPubMedGoogle Scholar
    • Chen Y-Y, Lai Y-H, Shun S-C, Chi N-H, Tsai P-S, Liao Y-M. The Chinese Behavior Pain Scale for critically ill patients: translation and psychometric testing. Int J Nurs Stud 2011; 48 (4) 438-448
      CrossrefPubMedGoogle Scholar
    • Juarez P, Bach A, Baker M , et al. Comparison of two pain scales for the assessment of pain in the ventilated adult patient. Dimens Crit Care Nurs 2010; 29 (6) 307-315
      CrossrefPubMedGoogle Scholar
    • Payen JF, Bru O, Bosson JL , et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001; 29 (12) 2258-2263
      Google Scholar
    • Young J, Siffleet J, Nikoletti S, Shaw T. Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients. Intensive Crit Care Nurs 2006; 22 (1) 32-39
      CrossrefPubMedGoogle Scholar

      • BPS-NI

      • Chanques G, Payen J-F, Mercier G , et al. Assessing pain in non-intubated critically ill patients unable to self report: an adaptation of the Behavioral Pain Scale. Intensive Care Med 2009; 35 (12) 2060-2067
        CrossrefPubMedGoogle Scholar

        • CPOT

        • Gélinas C. Nurses' evaluations of the feasibility and the clinical utility of the Critical-Care Pain Observation Tool. Pain Manag Nurs 2010; 11 (2) 115-125
          CrossrefPubMedGoogle Scholar
        • Gélinas C, Arbour C. Behavioral and physiologic indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: similar or different?. J Crit Care 2009; 24 (4) e7-e17
          CrossrefPubMedGoogle Scholar
        • Gélinas C, Arbour C, Michaud C, Vaillant F, Desjardins S. Implementation of the critical-care pain observation tool on pain assessment/management nursing practices in an intensive care unit with nonverbal critically ill adults: a before and after study. Int J Nurs Stud 2011; 48 (12) 1495-1504
          CrossrefPubMedGoogle Scholar
        • Gélinas C, Fillion L, Puntillo KA. Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adults. J Adv Nurs 2009; 65 (1) 203-216
          CrossrefPubMedGoogle Scholar
        • Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care 2006; 15 (4) 420-427
          CrossrefPubMedGoogle Scholar
        • Gélinas C, Harel F, Fillion L, Puntillo KA, Johnston CC. Sensitivity and specificity of the critical-care pain observation tool for the detection of pain in intubated adults after cardiac surgery. J Pain Symptom Manage 2009; 37 (1) 58-67
          CrossrefPubMedGoogle Scholar
        • Gélinas C, Johnston C. Pain assessment in the critically ill ventilated adult: validation of the Critical-Care Pain Observation Tool and physiologic indicators. Clin J Pain 2007; 23 (6) 497-505
          CrossrefPubMedGoogle Scholar
        • Lee KI, Oh HS, Suh YO, Seo WS. Patterns and clinical correlates of pain among brain injured patients in critical care assessed with the critical care pain observation tool. Pain Manag Nurs . In press
          PubMedGoogle Scholar
        • Nürnberg Damström D, Saboonchi F, Sackey PV, Björling G. A preliminary validation of the Swedish version of the critical-care pain observation tool in adults. Acta Anaesthesiol Scand 2011; 55 (4) 379-386
          CrossrefPubMedGoogle Scholar
        • Paulson-Conger M, Leske J, Maidl C, Hanson A, Dziadulewicz L. Comparison of two pain assessment tools in nonverbal critical care patients. Pain Manag Nurs 2011; 12 (4) 218-224
          CrossrefPubMedGoogle Scholar
        • Vázquez M, Pardavila MI, Lucia M, Aguado Y, Margall MA, Asiain MC. Pain assessment in turning procedures for patients with invasive mechanical ventilation. Nurs Crit Care 2011; 16 (4) 178-185
          CrossrefPubMedGoogle Scholar

          • FLACC

          • Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs 2000; 1 (1) 13-21
            CrossrefPubMedGoogle Scholar
          • Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 1997; 23 (3) 293-297
            PubMedGoogle Scholar
          • Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care 2010; 19 (1) 55-61 , quiz 62
            CrossrefPubMedGoogle Scholar

            • NPAT

            • Klein DG, Dumpe M, Katz E, Bena J. Pain assessment in the intensive care unit: Development and psychometric testing of the nonverbal pain assessment tool. Heart Lung 2010; 39 (6) 521-528
              PubMedGoogle Scholar

              • NVPS

              • Juarez P, Bach A, Baker M , et al. Comparison of two pain scales for the assessment of pain in the ventilated adult patient. Dimens Crit Care Nurs 2010; 29 (6) 307-315
                CrossrefPubMedGoogle Scholar
              • Kabes AM, Graves JK, Norris J. Further validation of the nonverbal pain scale in intensive care patients. Crit Care Nurse 2009; 29 (1) 59-66
                CrossrefPubMedGoogle Scholar
              • Odhner M, Wegman D, Freeland N, Steinmetz A, Ingersoll GL. Assessing pain control in nonverbal critically ill adults. Dimens Crit Care Nurs 2003; 22 (6) 260-267
                CrossrefPubMedGoogle Scholar
              • Topolovec-Vranic J, Canzian S, Innis J, Pollmann-Mudryj MA, McFarlan AW, Baker AJ. Patient satisfaction and documentation of pain assessments and management after implementing the adult nonverbal pain scale. Am J Crit Care 2010; 19 (4) 345-354 , quiz 355
                CrossrefPubMedGoogle Scholar

                • PAIN

                • Puntillo KA, Miaskowski C, Kehrle K, Stannard D, Gleeson S, Nye P. Relationship between behavioral and physiological indicators of pain, critical care patients' self-reports of pain, and opioid administration. Crit Care Med 1997; 25 (7) 1159-1166
                  CrossrefPubMedGoogle Scholar
                • Puntillo KA, Stannard D, Miaskowski C, Kehrle K, Gleeson S. Use of a pain assessment and intervention notation (P.A.I.N.) tool in critical care nursing practice: nurses' evaluations. Heart Lung 2002; 31 (4) 303-314
                  CrossrefPubMedGoogle Scholar

                  • PBAT

                  • Li D, Miaskowski C, Burkhardt D, Puntillo K. Evaluations of physiologic reactivity and reflexive behaviors during noxious procedures in sedated critically ill patients. J Crit Care 2009; 24 (3) e9-e13
                    PubMedGoogle Scholar
                  • McGrath PJ, Johnson GI, Goodman JT, Schillinger J, Dunn J, Chapman J. CHEOPS: A behavioral scale for rating postoperative pain in children. In: Fields HL, Dubner R, Cervero F, , eds. Pain Research and Therapy. Vol 9. New York: Raven; 1985: 395-402
                    Google Scholar
                  • Puntillo KA, Morris AB, Thompson CL, Stanik-Hutt J, White CA, Wild LR. Pain behaviors observed during six common procedures: results from Thunder Project II. Crit Care Med 2004; 32 (2) 421-427
                    CrossrefPubMedGoogle Scholar