title: Effects on pain of a stepwise multidisciplinary intervention (STA OP!) that targets pain and behavior in advanced dementia: A cluster randomized controlled trial.
abstract: Pain in nursing home residents with advanced dementia remains a major challenge; it is difficult to detect and may be expressed as challenging behavior. STA OP! aims to identify physical and other needs as causes of behavioral changes and uses a stepwise approach for psychosocial and pharmacological management which was effective in improving challenging behavior.
  
  
  
  To assess whether implementation of the stepwise multidisciplinary intervention also reduces pain and improves pain management.
  
  
  
  In a cluster randomized controlled trial (Netherlands National Trial Register NTR1967), healthcare professionals of intervention units received the stepwise training, while training of the control group focused on knowledge and skills without the stepwise component. Observed and estimated pain was assessed at baseline and at 3 and 6 months post-intervention. Logistic generalized estimating equations were used to test treatment and time effects.
  
  
  
  A total of 21 clusters (single nursing home units) in 12 Dutch nursing homes included 288 residents with advanced dementia (Global Deterioration Scale score 5, 6, or 7): 148 in the intervention and 140 in the control condition.
  
  
  
  The multilevel modeling showed an overall effect of the intervention on observed pain but not on estimated pain; Pain Assessment Checklist for Seniors with Limited Ability to Communicate-Dutch version, mean difference: -1.21 points (95% confidence interval: -2.35 to -0.06); Minimum Dataset of the Resident Assessment Instrument pain scale, mean difference: -0.01 points (95% confidence interval: -0.36 to 0.35). Opioid use increased (odds ratio = 3.08; 95% confidence interval: 1.08-8.74); paracetamol use did not (odds ratio = 1.38; 95% confidence interval: 0.71-2.68).
  
  
  
  STA OP! was found to decrease "observed" pain but not estimated pain. Observing pain-related behavior might help improve pain management in dementia.
authors.affiliation: 1 EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.|2 Department of General Practice & Elderly Care Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.|3 Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marjoleine J C
authors.initials: MJC
authors.lastname: Pieper
authors.affiliation: 3 Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jenny T
authors.initials: JT
authors.lastname: van der Steen
authors.affiliation: 1 EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.|4 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.|5 Department of Public and Occupational Health, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
authors.affiliation: 6 Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Erik J A
authors.initials: EJA
authors.lastname: Scherder
authors.affiliation: 7 Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jos W R
authors.initials: JWR
authors.lastname: Twisk
authors.affiliation: 1 EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.|3 Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Wilco P
authors.initials: WP
authors.lastname: Achterberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003704:Dementia / Q000628:therapy*; D005260:Female; D064946:Hospice and Palliative Care Nursing / Q000379:methods*; D006801:Humans; D008297:Male; D009426:Netherlands; D009735:Nursing Homes; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D011568:Psychiatric Nursing / Q000379:methods*
keywords: Pain; dementia; nursing homes; pain management; randomized controlled trial