title: Validity of pain behaviors in persons with mild to moderate cognitive impairment.
abstract: OBJECTIVE
  To evaluate the validity of traditional pain behaviors (guarding, bracing, rubbing, grimacing, and sighing) in persons with and without cognitive impairment and chronic low back pain (CLBP).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Outpatient clinics.
  
  
  METHODS
  Thirty-seven cognitively intact and 40 cognitively impaired participants with and without CLBP.
  
  
  METHODS
  Frequency of traditional pain behaviors.
  
  
  RESULTS
  Forty-six of the participants were pain free, and 31 had CLBP. The internal consistency reliability coefficient of the five pain behaviors was 0.32, suggesting that a unidimensional scale did not exist. Multivariate analysis of variance analysis according to the independent variables pain status (pain free vs CLBP) and cognitive status (intact vs impaired) with the dependent variable frequency of pain behaviors found significant differences according to pain status (F[5,61]=3.06, P=.02) and cognitive status (F[5,61]=5.41, P<.001) but without evidence of an interaction (F[5,61]=1.14, P=.35). Participants with CLBP exhibited significantly higher levels of grimacing (P<.001) and guarding (P=.02) than pain-free participants. Intact subjects exhibited fewer guarding (P=.02) and rubbing behaviors (P<.001) but a higher number of bracing behaviors (P=.03) than cognitively impaired participants.
  
  
  CONCLUSIONS
  These results support the utility of facial grimacing in assessing pain in patients with mild to moderate cognitive impairment and call into question the validity of guarding and rubbing in assessing pain in persons with mild to moderate cognitive impairment.
authors.affiliation: Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, Illinois 60611, USA. shega@northwestern.edu
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Shega
authors.forename: Thomas
authors.initials: T
authors.lastname: Rudy
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: Lisa Caitlin
authors.initials: LC
authors.lastname: Perri
authors.forename: Olga Telgarska
authors.initials: OT
authors.lastname: Mengin
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology*; D003072:Cognition Disorders / Q000523:psychology*; D005149:Facial Expression; D005260:Female; D006801:Humans; D055809:Illness Behavior; D017116:Low Back Pain / Q000523:psychology*; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D009633:Nonverbal Communication; D015588:Observer Variation; D010147:Pain Measurement / Q000379:methods* / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results