title: Doloplus-2, a valid tool for behavioural pain assessment?
abstract: BACKGROUND
  The Doloplus-2 is used for behavioural pain assessment in cognitively impaired patients. Little data exists on the psychometric properties of the Doloplus-2. Our objectives were to test the criterion validity and inter-rater reliability of the Doloplus-2, and to explore a design for validations of behavioural pain assessment tools.
  
  
  METHODS
  Fifty-one nursing home patients and 22 patients admitted to a geriatric hospital ward were included. All were cognitively impaired and unable to self-report pain. Each patient was examined by an expert in pain evaluation and treatment, who rated the pain on a numerical rating scale. The ratings were based on information from the medical record, reports from nurses and patients (if possible) about pain during the past 24 hours, and a clinical examination. These ratings were used as pain criterion. The Doloplus-2 was administered by the attending nurse. Regression analyses were used to estimate the ability of the Doloplus-2 to explain the expert's ratings. The inter-rater reliability of the Doloplus-2 was evaluated in 16 patients by comparing the ratings of two nurses administrating the Doloplus-2.
  
  
  RESULTS
  There was no association between the Doloplus-2 and the expert's pain ratings (R2 = 0.02). There was an association (R2 = 0.54) between the expert's ratings and the Doloplus-2 scores in a subgroup of 16 patients assessed by a geriatric expert nurse (the most experienced Doloplus-2 administrator). The inter-rater reliability between the Doloplus-2 administrators assessed by the intra-class coefficient was 0.77. The pain expert's ratings were compared with ratings of two independent geriatricians in a sub sample of 15, and were found satisfactory (intra-class correlation 0.74).
  
  
  CONCLUSIONS
  It was challenging to conduct such a study in patients with cognitive impairment and the study has several limitations. The results do not support the validity of the Doloplus-2 in its present version and they indicate that it demands specific administration skills.
authors: Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. jacob.chr.holen@medisin.ntnu.no
authors: Jacob C
authors: JC
authors: Hølen
authors: Ingvild
authors: I
authors: Saltvedt
authors: Peter M
authors: PM
authors: Fayers
authors: Marianne J
authors: MJ
authors: Hjermstad
authors: Jon H
authors: JH
authors: Loge
authors: Stein
authors: S
authors: Kaasa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001519:Behavior; D003072:Cognition Disorders; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D010147:Pain Measurement / Q000379:methods*; D011594:Psychometrics; D015203:Reproducibility of Results