title: Pain assessment in nursing home residents with dementia: psychometric properties and clinical utility of the CNA Pain Assessment Tool (CPAT).
abstract: OBJECTIVE
  To examine the psychometric properties and clinical utility of the CPAT, an instrument to assess pain in nursing home residents with dementia.
  
  
  METHODS
  Instrument development and testing.
  
  
  METHODS
  Three regional skilled nursing facilities.
  
  
  METHODS
  One hundred forty-five residents of 3 skilled nursing facilities.
  
  
  METHODS
  The inter-rater reliability, test-retest reliability, construct validity, and criterion validity of the CPAT was measured after initial CNA training. Measurement of inter-rater reliability and test-retest reliability was repeated after modified CNA training. Internal consistency (Cronbach's alpha) was calculated for all reliability measures. The clinical utility/feasibility of the CPAT was measured by means of a practicality survey.
  
  
  RESULTS
  The CPAT was found to have acceptable levels of both interrater reliability (ICC=0.71) and test-retest reliability (ICC=0.67). Construct validity as measured by a paired t test was statistically significant (P=.043). Criterion validity as measured by Spearman's rank correlation coefficient was also statistically significant (P=.048). Internal consistency was acceptable for all measures as calculated by Cronbach's alpha, which ranged from 0.72 to 0.84. As determined by a practicality survey, the CPAT was shown to be a clinically useful and feasible instrument.
  
  
  CONCLUSIONS
  This study provides evidence that the CPAT is a reliable and valid pain assessment instrument when used in nursing home residents with dementia. It has also been shown to be a tool with suitable clinical utility and feasibility. Further study is warranted to ascertain if its use will lead to improved resident function and quality of life and whether the results of this study are reproducible in other dementia populations. The CPAT's ability to quantify pain and measure treatment response has not been determined.
authors.affiliation: Long Island State Veterans Home, Stony Brook, NY 11790, USA. fcervo@notes.cc.sunysb.edu
authors.forename: Frank A
authors.initials: FA
authors.lastname: Cervo
authors.forename: Patricia
authors.initials: P
authors.lastname: Bruckenthal
authors.forename: John J
authors.initials: JJ
authors.lastname: Chen
authors.forename: Lory E
authors.initials: LE
authors.lastname: Bright-Long
authors.forename: Suzanne
authors.initials: S
authors.lastname: Fields
authors.forename: Guangxiang
authors.initials: G
authors.lastname: Zhang
authors.forename: Ian
authors.initials: I
authors.lastname: Strongwater
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000295:instrumentation*; D011594:Psychometrics; D012866:Skilled Nursing Facilities