title: A scale to measure pain in non-verbally communicating older patients: the EPCA-2 Study of its psychometric properties.
abstract: We have constructed and validated the Elderly Pain Caring Assessment 2 (EPCA-2) an 8 items behavioural scale to rate the intensity of pain in non-verbally communicating older (age 65 years) patients (NVC-OP). It was postulated that the assessed pain had two dimensions (signs outside and during caregiving). The first version of the scale was constructed on the basis of the results of a survey among 48 experienced nurses and caregivers and of a review of the literature. After testing of three intermediate versions, the psychometrics properties of the final version were studied on 340 NVC-OP. The face and content validities were good. Convergent validity: the total score was well correlated both with a pain global clinical score given by two highly experienced observers (r(s)=0.846) and with the opioid dose prescribed in a sub-group of patients (r(s)=0.698). The discriminant and divergent validities were satisfactory. After factor analysis, the internal structure of the scale was consistent with the postulated two-dimensional structure of the construct. The inter-rater reliability was very good (ICC=0.877) and is always equally good irrespective of the status (doctor, nurse and caregiver) of the raters. The internal consistency was highly satisfactory (alpha=0.79). The responsiveness evaluated in 4 ways was always very good. EPCA-2 may provided nurses, caregivers and doctors with a validated instrument for pain assessment in NVC-OP.
authors.affiliation: Centre Hospitalier Universitaire, Unite de Biostatistique et Recherche Clinique, Avenue de la Cote de Nacre, 14000 Caen, France. morello-r@chu-caen.fr
authors.forename: Remy
authors.initials: R
authors.lastname: Morello
authors.forename: Alain
authors.initials: A
authors.lastname: Jean
authors.forename: Michel
authors.initials: M
authors.lastname: Alix
authors.forename: Dominique
authors.initials: D
authors.lastname: Sellin-Peres
authors.forename: Jacques
authors.initials: J
authors.lastname: Fermanian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005163:Factor Analysis, Statistical; D005260:Female; D005853:Geriatrics; D006801:Humans; D008297:Male; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology*; D010147:Pain Measurement / Q000379:methods*; D011594:Psychometrics; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity