Original study
Psychometric Properties of the German “Pain Assessment in Advanced Dementia Scale” (PAINAD-G) in Nursing Home Residents

https://doi.org/10.1016/j.jamda.2007.03.002Get rights and content

Objectives

The study aims to evaluate the psychometric properties of the German version of a scale for the assessment of pain in advanced dementia (PAINAD-G).

Design

Cross-sectional study.

Setting

Eight nursing homes.

Participants

Ninety-nine residents in 8 nursing homes diagnosed with Alzheimer’s disease (68.3%) or other types of dementia (31.7%) participated after informed consent was obtained from their proxies. Nurses in charge of the residents observed their pain behavior over a 2-minute period while performing routine nursing activities—once in the morning and once in the evening.

Measurements

PAINAD-G relies on the observation of 5 behavioral categories indicative of pain: breathing, vocalization, facial expression, body language, and consolability.

Results

Psychometric analyses revealed good internal consistency of the scale (Cronbach’s α = 0.85). Inter-rater stability amounted to r = 0.80 and retest reliability to r = 0.90. Principal component analysis allowed the extraction of one factor that accounted for 63.5% of the cumulative factor variance. Validity data shows that PAINAD-G scores were higher in residents assumed to suffer from pain in comparison to those without pain. On the other hand, the level of pain rating did not correspond with the PAINAD-G scores. Residents rated to suffer from pain showed more pain behavior with increased cognitive deterioration. Measures that indicate nonpain disorders did not correlate with the PAINAD-G scores.

Discussion

PAINAD-G is a 1-dimensional scale that demonstrates good reliability. The outcome supports the assumption that the scale actually measures pain.

Section snippets

Design and Procedure

The psychometric evaluation of the German version (PAINAD-G) was part of a research project aimed at the development and validation of an instrument to assess quality of life in individuals suffering from dementia (H.I.L.DE.).29 The study was approved by the local research ethics committee. Taking the assumed verbal restrictions of the individuals into account, quality of life outcomes were assessed without reference to verbal reports. Therefore, all the instruments in the study relied on

Participants

Eight nursing homes in different parts of Germany participated in the H.I.L.DE study. The total sample size included 149 residents meeting the inclusion criteria. Not all of them participated in the behavioral observations. Nurses provided complete data for 99 individuals. With the exception of the AES scale, the exclusion analysis showed no significant difference between the 50 individuals not incorporated into the behavioral assessment and the PAINAD-G group (Table 1). According to the

Discussion

The study aimed to assess the psychometric properties of the German version of the PAINAD observation scale. It included a large sample of noncommunicative residents with predominantly severe dementia. According to our data, the scale is 1-dimensional and displays good internal consistency with Cronbach’s α = 0.85, which is remarkable given the fact that the scale consists of only 5 items. Deletion of the item “consolability” would contribute to a minor increase in internal consistency. For the

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      These facial characteristics in the ED setting may be features of distress and not necessarily a response to pain. This contrasts with the findings of studies conducted in residential nursing homes in which the facial item has been reported to be clinically useful but the reliability of the breathing item questioned.37–39 A notable finding in our study was that the PAINAD pain intensity level of our cohort differed from other cohorts with similar injury characteristics.

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    This study was supported by a grant provided by Mundipharma, Limburg, Germany. The sponsor did not play a role for all authors in the design, methods, subject recruitment, data collection or analysis, or interpretation of the paper.

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