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Practical Information
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Instrument Name:
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DOLOPLUS 2 Scale
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Instrument Description:
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The DOLOPLUS 2 is the revised version of an instrument (DOLOPLUS) used to assess pain in elderly with dementia; it is based upon clinician observations of patient behavior in different situations that might reveal pain. The ten situations that might possibly reveal pain are: somatic complaints, protective body postures adopted at rest, protection of sore areas, expression, investigation, washing/dressing, mobility, communication, social life, and problems of behavior. The types of behavior are categorized into three different groups: somatic reactions, psychomotor reactions, and psychosocial reactions. The DOLOPLUS 2 should be given only when the patient is non-communicative; otherwise, self-report instruments should be used. (Ref: 1)
The original DOLOPLUS scale was developed in France by Wary et al in 1993. It is based on the children’s Douleur Enfant Gustave Roussy (DEGR) and adapted for use with the elderly. Wary later formed a “DOLOPLUS” group of geriatricians in France to produce the updated version, DOLOPLUS-2. It was reported that the scale was psychometrically tested with 500 French elderly, but this information is not available in English. (Ref: 1) There is an English version of the scale available, and the current review focuses on the one available English article that describes the DOLOPLUS development. A website is available regarding the DOLOPLUS 2 scale and its background, scale description, hypothetical clinical case studies, and more related information.
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Price:
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Free; the scale may be downloaded from the website provided.
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Administration Time:
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For trained caregivers, 2 to 5 minutes at the most.
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Publication Year:
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2001
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Item Readability:
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A subject with an 8th grade reading level could comprehend the scale, according to the Flesch-Kincaid Grade Level. The items are worded with 10 or less words written in simple language. (Ref: 1) Since the clinician reads the items, training/experience in pain evaluation and palliative care would be appropriate. The DOLOPLUS 2 Scale manual provides ‘instructions for use’ as well as definitions of the scale items, which might be useful for an inexperienced caregiver.
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Scale Format:
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The DOLOPLUS 2 is an ordinal scale of ten pain behaviors; each of the ten behaviors has four sublevels scored from zero to 3: Level 1 (0), Level 2 (1), Level 3 (2), and Level 4 (3). (Ref: 1)
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Administration Technique:
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Clinician-administered. Re-assessment should be done twice daily until the pain is sedated, then at longer periods of time, depending on the situation. The developers recommend administration by several different caregivers. Do not administer non-applicable items. (Ref: 1)
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Scoring and Interpretation:
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The DOLOPLUS 2 score can range from 0 to 30. If the score is greater than or equal to 5 out of 30 it can be confirmed that pain exists. Also, consider borderline scores indicative of pain. The developers suggest that the most fundamental score is not the initial score, but the score related to the development over time and with treatment. (Ref: 1)
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Forms:
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The DOLOPLUS 1 is the original heteroevaluation scale-developed in 1993 by Wary et al--used for different caregivers to provide individual evaluations on the same patient’s pain assessment, in the elderly population. (Ref: 1) Translation of the DOLOPLUS 2 scale is available in French and English, and in the future Spanish, German and Dutch will be available. (http://www.doloplus.com)
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Research Contacts
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Instrument Developers:
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Sylvie Lefebvre-Chapiro and the DOLOPLUS group
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Instrument Development Location:
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Geriatric and Palliative Care Department, Hospital Paul Brousse, Villejuif, France
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Instrument Developer Email:
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No information found.
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Instrument Developer Website:
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www.doloplus.com
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Annotated Bibliography
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1. Lefebvre-Chapiro, S et al. The DOLOPLUS 2 scale-evaluating pain in the elderly. European Journal of Palliative Care, 2001;8(5): 191-194. [No PMID]
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Purpose:
To validate a caregiver-administered scale that is simple to use and will measure pain in elderly people afflicted with some form of dementia, who are unable to communicate. The scale will help caregivers with their observations and to facilitate an assessment as objective as possible. This article serves as a brief review of the DOLOPLUS 2 development.
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Sample:
Over 500 patients suffering from dementia were tested using the DOLOPLUS 2 scale. There was no demographic information reported. |
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Methods:
DOLOPLUS 2 is based on observations of patient behavior in ten different situations that could potentially reveal pain. The observations of several caregivers were compared to provide correct answers to different items as well as the time given to each particular patient.
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Implications:
The developers reported that the DOLOPLUS 2 scale was shown to correlate well with the Visual Analog Scale (VAS), that there was satisfactory stability on the retest, and good reliability; however, statistical values were not reported. Developers felt that these significant results should convince caregivers faced with pain of the elderly patients to use the DOLOPLUS 2 scale in patients with communication problems.
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Factors and Norms
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Factor Analysis Work:
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No information found.
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Normative Information Availability:
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No information found.
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Reliability Evidence
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Test-retest:
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No information found. Satisfactory test-retest was reported, although no statistical values were provided. (Ref: 1)
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Inter-rater:
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No information found.
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Internal Consistency:
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No information found.
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Alternate Forms:
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No information found.
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Validity Evidence
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Construct/ Convergent/ Discriminant:
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No information found. It was reported that the developers tested the correlation of the scale with the Visual Analogue Scale (VAS) among 500 French elderly, but no values were given. (Ref: 1)
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Criterion-related/ Concurrent/ Predictive:
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No information found.
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Content:
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No information found. Items were based on the children’s Douleur Enfant Gustave Roussy and adapted for use in the elderly. (Ref: 1)
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Responsiveness Evidence:
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No information found.
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Scale Application in VA Populations:
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No information found.
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Scale Application in non-VA Populations:
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Yes. (Ref: 1)
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Comments
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The DOLOPLUS 2 is a care-giver administered scale for assessment of pain in non-communicative elderly. It should be used longitudinally to assess pain levels during and after treatment.
Overall Usefulness for a Certain Population: The DOLOPLUS 2 was developed among a sample of 500 French elderly, for which no demographic information is available in English. Generalizability to other samples is unknown.
Advantages: The DOLOPLUS is brief, requiring less than 5 minutes to administer once trained.
Disadvantages: While the instrument itself is available in English, there was only one English article available for review, which did not provide any psychometric information.
Overall Recommendation: This scale is early in its English development and lacks available information regarding its usability and psychometric properties among the U.S. population. Validation among the U.S. population is required before the DOLOPLUS 2 is widely used to make treatment decisions.
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