Reliability and utility of the Abbey Pain Scale-SWE for pain assessment among people with dementia

The relevance of this research project is placed in the field of geriatric care and care of people with dementia. Pain assessment in people with cognitive impairment to the degree that make self rating or interview impossible require development and the use of complementing further instruments to assist in assessment of pain.  

Pain is frequent among older persons and has a negative impact on quality of life (Gibson & Lussier, 2012). It is well known that older persons with dementia is vulnerable and exposed to the risk of having their pain underdiagnosed due to their decreased intellectual and verbal capacity to describe pain. Additionally, prior research have reported about nurses' uncertainty to interpret and understand indications of pain in people with dementia (Gilmore-Bykovskyi & Bowers, 2013).

Pain assessment and dementia is an urgent issue in need of improvement, where observational behavioural pain assessment scales may be useful tools (Hadjistavropoulos et al, 2014; Herr et al, 2010; Socialstyrelsen, 2013). However, up to this date Swedish evaluation studies of such scales are missing.

This research project is a prospective descriptive observational study, where the observational- behavioural pain assessment scale Abbey Pain Scale-SWE is used for systematic assessment and registration of pain. Data are collected by observation, systematical data registration of pain and follow-up documentation of interventions of pain treatment. Survey along with focus group interviews with care staff is used to evaluate utility of the Abbey Pain Scale-SWE for pain assessment.

Abbey Pain Scale-SWE is designed to assist in pain assessment in people who are unable to clearly articulate pain problems. Based on observation and knowledge of the person's usual function and medical history, the person is rated on a four-point word descriptor scale (abscent=0, mild=1, moderate=2, severe=3) across six domains of pain-related behaviour (vocalisation, facial expression, change in body language, change in behaviour, physiological change, physical change). Scores are summarised to provide an overall score of pain intensity ranging from 0 to 14+ (0-2 indicates no pain, 3-7 indicates mild pain, 8-13 indicates moderate pain, and 14+ indicates severe pain).The scorer is also required to indicate the type of pain - acute or chronic and to repeat the assessment no more than one hour later if any pain-relieving intervention has occurred.

The Abbey Pain Scale-SWE is the first Swedish version of the original Abbey Pain Scale (Abbey et al, 2004), developed to be used in people with dementia and who have diminished capacity to self-report pain. In a previous study, the Abbey Pain Scale-SWE was tested and evaluated for the first time (submitted by Christina Karlsson). Further studies are needed to strengthen reliability and utility of the Abbey Pain scale-SWE for pain assessment.

Keywords: Abbey Pain Scale-SWE, Dementia, Pain assessment.