Evaluation of two observational pain assessment scales during the anaesthesia recovery period in Chinese surgical older adults

Abstract

Aims and objectives: To evaluate the reliability and validity of the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators in Chinese older adults post surgery during the anaesthesia recovery period.

Background: Pain assessment in older surgical patients is complicated by factors such as anaesthesia and opioid administration. Although observational pain behavioural assessment tools have been validated for those unable to self-report, research on their application during the anaesthesia recovery period is limited.

Design: A prospective correlational design.

Methods: Ninety-three older patients admitted for scheduled abdominal surgery were recruited in a university-affiliated hospital. The two observational scales were used to conduct pain assessments during the anaesthesia recovery period. On the first and the third postoperative day, participants recalled their pain intensity during the recovery period using the Numeric Rating Scale or the Faces Pain Scale-Revised.

Results: The internal consistency reliability of the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators was 0·81 and 0·69 respectively. The correlation between scores of the two observational scales was 0·95. The recalled self-reports of pain intensity were significantly correlated. The correlation of the Pain Assessment in Advanced Dementia scale and patients' recalled self-reports was 0·55, 0·54, and the correlation between the Checklist of Nonverbal Pain Indicators and the two recalled pain scores was both 0·60.

Conclusions: Both the two observational scales had good reliability and validity when used to assess pain in Chinese surgical older adults during the anaesthesia recovery period.

Relevance to clinical practice: Observational pain scales can be useful as a tool for patients unable to self-report. Accurate use of one of the observational pain tools can help identify pain during the anaesthesia recovery period, when patients are unable to self-report, to support effective pain management during this period.

Keywords: Checklist of Nonverbal Pain Indicators; Pain Assessment in Advanced Dementia scale; anaesthesia recovery period; observational pain assessment tools; older adults; pain assessment.