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

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

• References

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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
• 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
• 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
• 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
• 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
• 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
• 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
• 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

• 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

• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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

• FLACC

• Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs 2000; 1 (1) 13-21
• 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
• 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

• 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

• 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
• 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
• 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
• 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

• 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
• 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

• 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
• 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
• 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