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. 2014 Dec 17:14:138.
doi: 10.1186/1471-2318-14-138.

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools

Valentina Lichtner  1 , Dawn Dowding, Philip Esterhuizen, S José Closs, Andrew F Long, Anne Corbett, Michelle Briggs
Affiliations

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools

Valentina Lichtner et al. BMC Geriatr. .

Abstract

Background: There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment.

Methods: We searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach.

Results: We retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a 'gold standard' significantly hinders the evaluation of tools' validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations.

Conclusions: There are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence.

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Figures

Figure 1
Figure 1
Algorithm for inclusion/exclusion of reviews. Screening algorithm (based on inclusion criteria as per Table 1). Each decision point has the three options for promoting records to the next stage of the winnowing process: ‘yes’ (inclusion), ‘no’ (exclusion), ‘maybe’. Depending on the stage of the reviewing process (on title and abstract only, or full text), the latter option may require retrieving the full text, discussion between reviewers, and/or referral to a third reviewer.
Figure 2
Figure 2
Flow chart of retrieved sources and screening process. Overview of the review process and number of retrieved, included and excluded records.
See this image and copyright information in PMC

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2318/14/138/prepub

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