title: Validation of an acute pain-behavior scale for older persons with inability to communicate verbally: Algoplus.
abstract: To compensate for poor acute pain detection in elderly inpatients with inability to communicate verbally (ICV), the Doloplus Collective team devised the 5-item Algoplus behavior-assessment scale specifically aimed at quickly detecting acute pain in these individuals. Algoplus was developed in three successive phases, including expert opinions, caregivers interviews, patient video recordings and statistical procedures. Among the 1500 recorded primary pain behaviors, 48 were selected and clustered into a 5-item scale. This version was validated based on 349 old inpatients (204 with acute pain and 145 without) from different care settings and hospitals. Comparators were objective acute pain clinical situations, experts' clinical judgment on acute pain presence, and self-rating scales (Visual Analog Scale, Numeric Rating Scale and Verbal Descriptor Scale) for a communicative subsample (n=134). Algoplus showed good discriminant validity with adequate internal consistency (Kuder-Richardson-20, 0.712), excellent interrater reliability (intraclass coefficient, 0.812) and high sensitivity to change during specific pain situations and after starting pain management. Excellent correlations were observed between Algoplus and experts' clinical judgment, acute pain clinical situations or each comparator self-rating-pain score. For patients with acute pain conditions, a score ⩾2 out of 5 on the Algoplus scale was retained as the threshold for the presence of acute pain in elderly ICV inpatients, with 87% sensitivity and 80% specificity. In addition, the very brief rating time of ∼1min is particularly relevant in acute-care settings, where repetitive pain-monitoring is required.
authors.affiliation: Faculté de Médecine de la Timone, Université de la Méditerranée, Marseille, France. patrice.rat@ap-hm.fr
authors.forename: Patrice
authors.initials: P
authors.lastname: Rat
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Jouve
authors.forename: Gisèle
authors.initials: G
authors.lastname: Pickering
authors.forename: Laurent
authors.initials: L
authors.lastname: Donnarel
authors.forename: Louise
authors.initials: L
authors.lastname: Nguyen
authors.forename: Micheline
authors.initials: M
authors.lastname: Michel
authors.forename: Françoise
authors.initials: F
authors.lastname: Capriz-Ribière
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lefebvre-Chapiro
authors.forename: Frédérique
authors.initials: F
authors.lastname: Gauquelin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonin-Guillaume
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods*; D011594:Psychometrics / Q000379:methods; D012680:Sensitivity and Specificity