中文版晚期老年痴呆症疼痛评估量表的初步评价

Initial validation of Chinese Pain Assessment in Advanced Dementia Scale (C-PAINAD)

目的对中文版晚期老年痴呆症疼痛评估量表(C-PAINAD)作出初步的评价,探讨其在中国应用的可行性。方法通过反复对照评核,将量表翻译成中文版,然后对11例认知能力严重受损的老年痴呆患者进行观察评估。评估工具包括C-PAINAD、不舒服视觉模拟量表(DVA)及费城老年学中心情感量表(PGCAR)。采用相关性分析、单因素方差检验及因子分析检验C-PAINAD的可靠性及有效性。结果C-PAINAD的评分集中于0分附近。其与DVA及负面情感均有良好及显著的相关性,但与正面情感的相关程度较差,能够有效测评不同状态下的疼痛程度。因子分析的贡献率是51.20%(CronbachUs α=0.66),显示PAINAD具有良好的可靠性及有效性。结论C-PAINAD能够可靠并有效地评估晚期老年痴呆症患者的疼痛程度。建议在进行进一步信度及效度分析研究时,可给予止痛药进行前后对照比较,以确定C-PAINAD在临床及研究上的应用价值。

Objective To validate the translated Chinese version of Pain Assessment in Advanced Dementia Scale （C-PAINAD） for its clinical application in assessing the discomfort level of severely cognitive impaired patients. Methods In developing the C-PAINAD, both clinical and academic experts were engaged in an iterative translation process for ensuring its semantic equivalence with its original language as well as it comprehensibility for clinical application. In establishing C-PAINAD＇s interrater reliability, its applicability for clinical use is further assessed in 11 severely cognitive impaired patients. The assessment tools included C-PAINAD, Discomfort Visual Analog Scale （DVA）, and Philadelphia Geriatric Center Affect Rating Scale （PGCAR）. Correlations, ANOVA and factor analysis were undertaken to examine the reliability and validity of C-PAINAD. Results The scores of C-PAINAD were not in normal distribution but clustered around Zero. C-PAINAD was positively correlated with DVA and negative affect but mildly and negatively correlated with positive affect. It was able to detect different pain level under different condition. One factor was extracted and the percentage of variance was 51.20%. C-PAINAD was proved to have satisfactory reliability and validity （Cronbach＇s α=0.66）. Conclusions C-PAINAD was a simple, reliable and effective pain assessment instrument for measuring pain level of non-communicative patients like advanced dementia. Further research is deemed necessary to conduct with pre-and post-test of analgesic prescriptions prior to wider clinical application.