Original Article
Psychometric Assessment of Physiologic and Behavioral Pain Indicators in Polish Versions of the Pain Assessment Scales

https://doi.org/10.1016/j.pmn.2018.07.006Get rights and content

Abstract

Background

There is an urgent need to prepare a reliable and accurate tool for pain assessment in patients who are unable to self-report. Translating pain assessment scales into foreign languages requires further validation testing.

Aim

The aim of the study was to carry out psychometric assessment of behavioral and physiological indicators of pain included in two Polish versions of pain assessment scales, the Behavioral Pain Scale (BPS) and the original Adult Non-Verbal Pain Scale (NVPS).

Design

A prospective repeated-measure descriptive study was conducted.

Settings and participants

Twenty-eight adult non-communicative mechanically ventilated ICU patients were included in the study. The study took place in five hospitals in Poland, one 15-bed general ICU of a university teaching hospital and four 6-bed medical ICUs of district hospitals.

Methods

Pain assessment was conducted at rest, during non-painful and painful procedures independently by two observers.

Results

Internal consistency of the Polish version of the scales was below the expected 0.7 value (Cronbach’s alpha for the BPS 0.6883 and NVPS 0.6697). Principal component analysis showed that for the Polish version of the BPS, all three domains formed one separate factor (63.9%), while in the case of the NVPS two separate factors were found, one covering four domains of the NVPS (47.1%) and the other exclusively covering the category of Vital sign (20.2%). There was a significant difference between the pain scores with the NVPS (χ2 = 228.95 p < .001) and the BPS (χ2 = 236.46 p < .001) during three observation phases. There were no significant differences between scores obtained by different raters. The analysis of variance demonstrated a statistically significant difference in the values of physiological indicators of pain (SBP, DBP, MAP) between observation phases.

Conclusions

The Polish version of the BPS has better psychometric properties than the Polish version of the NVPS. It is necessary to define precisely the descriptors used in the scales and to implement a staff training program.

Section snippets

Aim

The aim of the study was to carry out a psychometric assessment and evaluation of behavioral and physiologic indicators of pain in nonverbal patients. Behavioral and physiologic descriptors included in two pain assessment scales (the BPS and the NVPS) as well as other parameters established by competent assessors were analyzed in the study. The study also aimed to establish which of the scales has the most favorable psychometric properties and should be recommended for use in intensive care

Materials and Methods

A prospective repeated-measure descriptive study of mechanically ventilated patients hospitalized in intensive therapy units was conducted in five hospitals in Poland, one 15-bed general ICU of a university teaching hospital and four 6-bed medical ICUs of district hospitals. The authors of both scales have agreed to their adaptation and use in Poland.

The study protocol was approved by the Bioethical Commission of the University of Warmia and Mazury in Olsztyn, Poland (approval no. 13/2011) and

Pain Assessment

The pain assessment in the nonpainful phase was performed with an indirect measurement of blood pressure with an arm cuff in all patients because hospital procedures limit the use of changing bandages as a non-nociceptive stimulus. The painful phase assessment was done during tracheal suctioning (n = 148, 69%) or turning the patient in bed (n = 68, 31%). Tracheal suctioning and turning the patient in bed were previously identified by Puntillo et al. (2001) as nociceptive procedures. The authors

Discussion

Although there are international guidelines for the management of pain (Barr et al., 2013, Herr et al., 2011), in many ICUs, pain assessment in adult patients unable to self-report is performed based on indicators of vital signs, observation of behavioral reactions, and the clinical experience of the staff. In Poland, using observation scales for pain assessment is not a routine practice because the relevance indicators and the reliability of the adapted foreign scales remain unknown. This

Conclusions

The evaluation of psychometric values of the Polish version of the BPS and original NVPS in adult patients does not confirm their reliability and validity. The results of the present study indicate that the Polish version of the BPS has better psychometric properties than the NVPS and that the BPS should be recommended for wide use in practice. However, the Polish version of the BPS is currently internally consistent at less than the expected level. The BPS is homogenous in terms of the domains

Acknowledgments

The authors would like to thank the Warmia and Mazury Regional Chamber of Nurses and Midwives for the cooperation and help in conducting the study. We thank Margaret Odhner and Jean-Francois Payen for permitting us to use their pain assessments scales, the original NVPS and BPS.

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    The research was financed by the Regional Chamber of Nurses and Midwives in Warmia and Mazury with its headquarters in Olsztyn bound by the contract signed on June 27, 2012.

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    © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.