Characteristic Behaviors of Pain During Movement in the Older Individuals with Dementia

Abstract

Purpose

This study assessed the pain associated with movement and exercise in older individuals with cognitive decline, using the Abbey Pain Scale (APS) to identify the sub-items that effectively reflect pain during such activities.

Patients and Methods

A cross-sectional study was conducted in 225 older patients with musculoskeletal disorders and cognitive decline at the Ikeda Rehabilitation Hospital in Toyama, Japan. Pain during walking or transferring was assessed using the verbal rating scale (VRS) and the APS. Item response theory (IRT) was used to identify the APS sub-items that most accurately reflected the presence and degree of pain.

Results

Pain associated with movement scored 1.3 ± 1.1 on the VRS and 2.5 ± 2.6 on the APS. The IRT analysis extracted “vocalization”, “facial expression”, and “change in body language” as the most reliable indicators of pain. These extracted items showed good internal consistency (Cronbach’s α = 0.72), were significantly positively related to changes in the VRS (rs = 0.370, p < 0.001), and showed significant differences between patients with and without subjective pain.

Conclusion

Our study suggests that the APS sub-items “vocalization”, “facial expression”, and “change in body language” may be the most effective indicators of pain during movement and exercise in older individuals with cognitive decline. This approach may enhance the reliability of pain assessments and management during exercise therapy.

Keywords:

• behavior observation assessments
• pain assessment
• pain behavior
• item response theory

Abbreviations

APS, Abbey Pain Scale; ICCs, item characteristic curves; IRT, item response theory; MMSE, Mini-Mental State Examination; PRO, patient-reported outcome; VRS, visual rating scale.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Acknowledgments

The authors thank all the subjects examined in this study and the staff at the Department of Rehabilitation, Ikeda Rehabilitation Hospital for their support with data collection. We would like to thank Editage for English language editing. We also thank the first author’s current affiliation, Department of Rehabilitation, Toyama University Hospital, Toyama, Japan. No funding was received for this study.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.