title: Pain Assessment Scale for Patients With Disorders of Consciousness: A Preliminary Validation Study.
abstract: BACKGROUND
  Patients with acquired brain injury undergoing rehabilitation are often unable to verbalize pain because of disorders of consciousness. Hence, observational pain assessment instruments are warranted for these patients.
  
  
  OBJECTIVE
  The aim of this study was to study interrater agreement and sensitivity to change over time of an assessment scale developed for the evaluation of pain in severely brain-injured patients with disorders of consciousness.
  
  
  METHODS
  We developed a pain assessment scale based on scientific literature and clinical experience with severely brain-injured patients. It consists of four domains: physiological/autonomic, body language, verbal communication, and behavior. The domains consist of 27 items. Interrater reliability was tested through three experienced nurses who rated 26 patients with acquired brain injury. The patients were rated in two different situations: before and after repositioning in bed and before and after administration of analgesics. We used Cohen's kappa test for interrater reliability. Sensitivity to change was tested by Wilcoxon signed rank test.
  
  
  RESULTS
  Cohen's kappa for the presence or absence of each item was above 0.8 for 13 items, between 0.6 and 0.8 for eight items, and less than 0.6 for only three items. The sensitivity test showed a significant change from before to after repositioning (p = .004).
  
  
  CONCLUSIONS
  It appeared that many of the pain assessment scale items held potential for inclusion in a new, more comprehensively developed and validated scale for the assessment of pain in patients with disorders of consciousness.
authors.affiliation: Questions or comments about this article may be directed to Ingrid Poulsen, PhD, at ingrid.poulsen@regionh.dk. She is a Research Manager, RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Clinic of Neurorehabilitation, Traumatic Brain Unit, Rigshospitalet, Denmark. Pia Brix, RN, is a Clinician, Clinic of Neurointensive Care, Rigshospitalet, Denmark. Sylvia Andersen, RN, is a Clinician, Clinic of Neurointensive Care, Rigshospitalet, Denmark. Lars Westergaard, MD, is a Consultant, RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Clinic of Neurorehabilitation, Traumatic Brain Unit, Rigshospitalet, Denmark. Rikke Guldager, MSc, is a Clinical Nurse Specialist, RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Clinic of Neurorehabilitation, Traumatic Brain Unit, Rigshospitalet, Denmark.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Poulsen
authors.forename: Pia
authors.initials: P
authors.lastname: Brix
authors.forename: Sylvia
authors.initials: S
authors.lastname: Andersen
authors.forename: Lars
authors.initials: L
authors.lastname: Westergaard
authors.forename: Rikke
authors.initials: R
authors.lastname: Guldager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications*; D003244:Consciousness Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods*; D011594:Psychometrics; D015203:Reproducibility of Results