title: The mouth care item of the MOBID pain scale: secondary analyses of unique video uptakes by dental professionals.
abstract: OBJECTIVE
  The Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale has been developed for the assessment of pain in elderly individuals with severe dementia. From the initial draft of the MOBID, the teeth/mouth care item was removed due to its low correlation with the total score. However, the observation of this item was done by non-dental professionals only. The aim was to revisit the unique teeth/mouth care video uptake fragments with a group of experienced elderly care dentists, as to establish the reliability of this item.
  
  
  METHODS
  Using the Orofacial MOBID Pain Scale, 11 fragments were assessed by 12 specialists during two sessions with a 4-week interval. The specialists scored whether or not they observed orofacial pain/discomfort-related behaviours (pain noises, facial expressions and/or defence) and/or dementia-related behaviours (anxiety, aggression and/or confusion). The threshold for agreement in scoring was arbitrarily set at 66.6%. As a next step, reliability was quantified using Cohen's kappa.
  
  
  RESULTS
  For only two video fragments, substantial agreement was obtained during both sessions, while for three fragments, the agreement was substantial during one session only. In addition, only three observers were able to provide consistent scores. For two of those, the various kappa values could be qualified as moderate to good. Notably, all consistent scores pertained to dementia-related behaviours; not to orofacial pain/disability-related behaviours.
  
  
  CONCLUSIONS
  Teeth/mouth care, as displayed on video uptakes, cannot be interpreted reliably by experienced elderly care dentists in terms of orofacial pain/discomfort-related behaviour or dementia-related behaviour with the Orofacial MOBID Pain Scale.
authors.affiliation: Department of Oral Function, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Research Institute MOVE Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anne H
authors.initials: AH
authors.lastname: Toxopeus
authors.affiliation: Department of Global Public Health and Primary Care, Center for Elderly- and Nursing Home Medicine, University of Bergen, Bergen, Norway.|Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Bettina S
authors.initials: BS
authors.lastname: Husebo
authors.affiliation: Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Bergen, Norway.
authors.forename: Liv Inger
authors.initials: LI
authors.lastname: Strand
authors.affiliation: Department of Oral Function, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Research Institute MOVE Amsterdam, Amsterdam, The Netherlands.|Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Delwel
authors.affiliation: Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Arjen J
authors.initials: AJ
authors.lastname: van Wijk
authors.affiliation: Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Erik J A
authors.initials: EJ
authors.lastname: Scherder
authors.affiliation: Department of Oral Function, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Research Institute MOVE Amsterdam, Amsterdam, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Lobbezoo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression; D001007:Anxiety; D060825:Cognitive Dysfunction; D003221:Confusion; D003704:Dementia / Q000503:physiopathology; D003815:Dentists; D005157:Facial Pain; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000503:physiopathology* / Q000534:rehabilitation; D010147:Pain Measurement / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results; D012107:Research Design; D012720:Severity of Illness Index; D014743:Videotape Recording
keywords: dementia; non-verbal; nursing home care; orofacial pain