|
|
|
|
Practical Information
|
Instrument Name:
|
Abbey Pain Scale
|
Instrument Description:
|
The Abbey Pain scale is used to measure pain in people with late-stage dementia who cannot verbally communicate. The scale is made up of six behavior attributes (items) considered to be markers of pain. The attributes are: vocalization, facial expression, change in body language, behavioral change, physiological change, and physical changes. The scale was developed and tested in two stages: (1) internal reliability was assessed by Cronbach’s alpha and test-retest reliability was assessed when a summative scale was developed (2) validity was assessed by (a) comparing the scale score with the holistic impression of pain using the measure of association Gamma; and (b) examining the change in pain score pre and post intervention using a paired t-test. (Ref: 1)
|
Price:
|
Free (available in the public domain). Please contact author for permission to use.
|
Administration Time:
|
One minute. (Ref: 1)
|
Publication Year:
|
2002
|
Item Readability:
|
Flesch-Kincaid Grade Level score indicates that a subject with a 7th grade reading level could comprehend the scale. Most items included ten words or less. (Ref: 1) Since the clinician reads the items, training/experience in pain evaluation and palliative care would be appropriate.
|
Scale Format:
|
Each of the six attributes is rated using 0 (absent) to 2 (constantly present) and for level of severity, using 0 (absent) to 3 (severe). Lastly, the administrator gives a holistic impression of pain using the scale 1 (no pain) to 5 (severe). (Ref: 1)
|
Administration Technique:
|
Observations made by a staff member (i.e. registered nurse). (Ref: 1) The items are read by the clinician--during observations-- therefore training/experience in pain evaluation and palliative care would be appropriate.
|
Scoring and Interpretation:
|
Items range from 0 to 3, for a total possible score of 18 (the total score is the sum of scores for the six “degree” items). If the total score is less than 7, then heat, massage, or movement should be tried to reduce pain. If the total score is greater than 7, then an RN or the resident’s GP should be contacted. (Ref: 1)
|
Forms:
|
No information found.
|
|
|
Research Contacts
|
Instrument Developers:
|
Jennifer Ann Abbey, Anita De Bellis, Adrian Esterman, Deborah Parker, Lynne Giles, Belinda Lowcay
|
Instrument Development Location:
|
Advanced Healthcare Management PO Box 703, Bribie Island, Qld, 4507
|
Instrument Developer Email:
|
j.abbey@qut.edu.au
|
Instrument Developer Website:
|
No information found.
|
|
|
Annotated Bibliography
|
1. Abbey J, Piller N, De Bellis A, Esterman A, Parker D, Giles L, Lowcay B. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs. 2004 Jan;10(1):6-13. [PMID: 14966439]
Purpose:
To validate an easy-to-use scale that would measure pain experienced by aged care facility residents with late-stage dementia since the detection and diagnosis of pain in the institutionalized older population is often poorly achieved.
Sample:
Eligible residents were those diagnosed by a senior staff registered nurse as having late-stage dementia and at one point during the project perceived by caregivers in the facility as experiencing pain. Data were available for 770 pain episodes from 52 residents in the first stage of the study. In the second stage, there were 51 residents with 236 documented pain episodes. Forty-three of the residents (70%) were assessed by one staff member whereas the remaining 18 residents (30%) were assessed by two staff members in order to measure inter-rater reliability. Most of the residents (66%) in the study were female and the age range of all residents was 60-97 years of age and a median of 83 years. The staff that administered the scale consisted of 61 staff members, 45 (74%) were Registered Nurses, 7 (12%) were Enrolled Nurses, and 9 (14%) were other members of staff not specified.
Methods:
The research was conducted in two stages between 1997 and 2002 in 24 aged care residential facilities in four Australian states: South Australia, New South Wales, Queensland, and Victoria. A draft scale was used to record pain observations before and after intervention, the summative score was added in the second stage.
Implications:
The pain scale score has been shown to be a reliable indicator of pain in late-stage dementia residents. Since the scale is so simple to use it can be used by all levels of staff. As related to the Abbey pain scale score results, the most common pain relieving intervention was analgesics followed by repositioning.
|
|
top
|
Factors and Norms
|
Factor Analysis Work:
|
No information found.
|
Normative Information Availability:
|
No information found.
|
|
|
Reliability Evidence
|
Test-retest:
|
Observations of each attribute were made before pain intervention and forty-five minutes after pain intervention. No values were provided. (Ref: 1)
|
Inter-rater:
|
Inter-reliability was assessed by the intra-class correlation coefficient (ICC). For pre-intervention scores, the ICC was 0.63 (p=0.02) and for post-intervention the ICC was 0.44 (p=0.12). (Ref: 1)
|
Internal Consistency:
|
Cronbach’s alpha coefficient for internal consistency was 0.81. (Ref: 1)
|
Alternate Forms:
|
No information found.
|
|
|
Validity Evidence
|
Construct/ Convergent/ Discriminant:
|
No information found.
|
Criterion-related/ Concurrent/ Predictive:
|
Validity was assessed by comparing the summative pain score with the holistic impression of pain using the measure of association Gamma, whereby the nurses’ perception of pain severity served as the gold standard. Regression analysis determined that all items were significant predictors of pain severity (with questions about degree of pain being more significant than those asking about the presence or absence of pain), predicting 42% of variability in the pain gold standard. Including only the 6 items concerning degree of pain, the regression model still accounted for 41% of the variance. The “physical changes” item was the only non-significant predictor. (Ref: 1)
The authors also purport examining validity by use of the change in pain score before and after intervention using a paired t-test. Gamma was found to be 0.586 (p=<0.001), signifying a “reasonable degree” of validity. The pre-intervention scale mean was 9.02 (SE=0.48) and post-intervention scale mean was 4.21 (SE=0.41). (Ref: 1)
|
Content:
|
The items were based on expertise of other collaborators and were previously tested in other studies. The authors used the Delphi method with gerontological and pain experts to modify the items, then finally focus groups were held with practitioners in the field. (Ref: 1)
|
Responsiveness Evidence:
|
No information found.
|
Scale Application in VA Populations:
|
No information found.
|
Scale Application in non-VA Populations:
|
Yes. (Ref: 1)
|
|
|
Comments
|
The Abbey Pain Scale is a recently developed, very brief instrument for the assessment of pain in patients with late-stage dementia. The instrument is based on clinician observation of six indicators of pain.
Overall Usefulness for a Certain Population: Only the developmental article was available for this review, so use of this scale among different populations is unknown. It appears very promising for use with patients who cannot communicate their pain severity.
Advantages: Extremely brief; some initial evidence of good validity; internal consistency adequate for group comparisons.
Disadvantages: As the Abbey is very recently developed, there is little work documenting psychometric properties among different groups, required training, and possible refinement of scoring. Inter-rater reliability was low.
Recommendation: This tool will be very useful in the assessment of pain among patients who cannot communicate, a clearly important area, and has implications for treatment. As with all new instruments, more research is required as to the instrument’s properties among diverse groups (i.e. the Abbey was developed based on an Australian sample; generalizability to the U.S. population is unknown).
|
|
|
