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Article

Probable Pain on the Pain Assessment in Impaired Cognition (PAIC15) Instrument: Assessing Sensitivity and Specificity of Cut-Offs against Three Standards

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Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands
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Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Aafje Thuiszorg, Huizen en Zorghotels, Pietersdijk 60, 3079 TD Rotterdam, The Netherlands
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Franciscus Vlietland Hospital, Vlietlandplein 2, 3118 JH Schiedam, The Netherlands
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Stichting Voor Regionale Zorgverlening (Nursing Home), Prins Clauslaan 1, 4691 ZA Tholen, The Netherlands
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Author to whom correspondence should be addressed.
Academic Editors: Yvonne Teuschl and Anke Sambeth
Brain Sci. 2021, 11(7), 869; https://doi.org/10.3390/brainsci11070869
Received: 18 May 2021 / Revised: 16 June 2021 / Accepted: 26 June 2021 / Published: 29 June 2021
(This article belongs to the Special Issue Pain Assessment in Impaired Cognition)
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. View Full-Text
Keywords: dementia; pain measurement; behavior observation techniques; diagnostic techniques and procedures dementia; pain measurement; behavior observation techniques; diagnostic techniques and procedures
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MDPI and ACS Style

van der Steen, J.T.; Westzaan, A.; Hanemaayer, K.; Muhamad, M.; de Waal, M.W.M.; Achterberg, W.P. Probable Pain on the Pain Assessment in Impaired Cognition (PAIC15) Instrument: Assessing Sensitivity and Specificity of Cut-Offs against Three Standards. Brain Sci. 2021, 11, 869. https://doi.org/10.3390/brainsci11070869

AMA Style

van der Steen JT, Westzaan A, Hanemaayer K, Muhamad M, de Waal MWM, Achterberg WP. Probable Pain on the Pain Assessment in Impaired Cognition (PAIC15) Instrument: Assessing Sensitivity and Specificity of Cut-Offs against Three Standards. Brain Sciences. 2021; 11(7):869. https://doi.org/10.3390/brainsci11070869

Chicago/Turabian Style

van der Steen, Jenny T., Andrew Westzaan, Kimberley Hanemaayer, Muhamad Muhamad, Margot W.M. de Waal, and Wilco P. Achterberg 2021. "Probable Pain on the Pain Assessment in Impaired Cognition (PAIC15) Instrument: Assessing Sensitivity and Specificity of Cut-Offs against Three Standards" Brain Sciences 11, no. 7: 869. https://doi.org/10.3390/brainsci11070869

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