The Norwegian Doloplus-2, a tool for behavioural pain assessment: translation and pilot-validation in nursing home patients with cognitive impairment.
BACKGROUND
Pain assessment is challenging in cognitively impaired (CI) patients due to inadequate self-report skills and observational ratings are an alternative. The Doloplus-2 is developed for pain assessment in the CI and rates somatic, psychomotor and psychosocial behaviours as indicators of pain.


OBJECTIVE
To translate the Doloplus-2 into Norwegian, to test the Doloplus-2 with regard to criterion validity and to obtain the administrators' evaluation of the clinical performance of the Doloplus-2.


METHODS
Nurses at three nursing homes, in collaboration with two research assistants, administered the Doloplus-2 to 59 patients with dementia. The results were compared against experienced clinicians' pain ratings. Regression analyses were performed to explore each different item's contribution to the total pain score. The administrators also completed a debriefing questionnaire.


RESULTS
The instrument was translated according to international guidelines. Regression analyses demonstrate that the Doloplus-2 score accounts for 62% (R2) of the expert score and that the four most informative items could explain 68% of the expert score. Analyses of the different Doloplus-2 items indicate that facial expressions explain most and social life least of the expert's pain ratings. The administrators reported that Doloplus-2 was helpful and easy to administer, but questioned the validity of the psychosocial domain.


CONCLUSIONS
The Norwegian Doloplus-2 demonstrates satisfactory criterion validity and clinical value in this pilot study. However, the content of the instrument needs a general re-evaluation, especially with regard to the psychosocial items.
Hølen
Jacob C
JC
Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, N-7006 Trondheim, Norway. jacob.chr.holen@medisin.ntnu.no
Saltvedt
Ingvild
I
Fayers
Peter M
PM
Bjørnnes
Marit
M
Stenseth
Guri
G
Hval
Bjørn
B
Filbet
Marilène
M
Loge
Jon Håvard
JH
Kaasa
Stein
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000451:nursing / Q000523:psychology*; D003704:Dementia / Q000451:nursing / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D010146:Pain / Q000175:diagnosis* / Q000451:nursing / Q000523:psychology; D010147:Pain Measurement / Q000379:methods* / Q000451:nursing; D010166:Palliative Care / Q000379:methods; D010349:Patient Compliance / Q000523:psychology; D010865:Pilot Projects; D012044:Regression Analysis; D015203:Reproducibility of Results