Background
Method
Data sources and search strategy
Eligibility criteria
Process of study selection
Quality assessment
Data abstraction
Results
Quality assessment
Characteristics of included studies
First author, year, country [reference] | Aim | Setting | Sample size N
(n = number assessed with Doloplus-2) | Mean (SD)/Median (range) age, years | % women | Type of cognitive impairment and stage | Defined by authors as non-verbal/not able to self-report |
---|---|---|---|---|---|---|---|
Akbarzadeh, 2007, Sweden [33] | To psychometrically test the Swedish version of the Doloplus-2 instrument for its use among older people | Three acute and one psycho-geriatric ward in a hospital |
N = 48 | NR, sample > 65 | NR | NR†
| Yes |
Ando, 2010, Japan [23]* | To develop a Japanese version of the Doloplus-2 and to apply it to elderly patients with Alzheimer’s disease (AD) | General hospital, surgical and psychiatric ward |
N = 6 | Mean 78.4 (4.7) | 50% | Moderate to severe AD Mean MMSE 7.6 (5.5) and HDS-R 6.4 (5.6) | Yes |
Ando, 2016, Japan [54] | To assess whether the Japanese Doloplus-2 scale could effectively identify pain in elderly individuals with moderate-to-severe dementia | Geriatric hospital |
N = 39 (n = 19) | Mean 84.5 (6.6) experimental group Mean 87.5 (7.1) control group | 79% (experimental group) 90% (control group) | Moderate to severe dementia Mean MMSE in experimental group 10.9 (SD 6.5), not reported for control group | The participants had to have the ability to say that they were currently in pain |
Bauer, 2007, France [44] | To investigate the tolerability of equimolar mix in very elderly patients undergoing painful procedures | Hospital, geriatric short-stay unit |
N = 62 (n = 43 procedures) | Mean 87 (5) | 62.9% | 54.8% of the participants were reported to have mild to moderate cognitive disorders | NR |
Chen, 2010a, Taiwan [22]** a
| To translate the French version of the Doloplus-2 scale into Chinese and to evaluate the psychometric properties and the clinical feasibility of the translated instrument | LTC, five dementia special care units |
N = 241 | Mean 79.3 (9.4) | 49% | Moderate to severe dementia Mean MMSE 5.26 (SD 5.46) | Yes |
Chen, 2010b, Taiwan [38]a
| To validate RNs’ and NAs’ report in assessing present pain and to investigate the potential influencing factors of institutionalized older people with dementia | LTC, six dementia special care units |
N = 304 | Mean 79.9 (8.8) | 42% | Dementia 66% had a MMSE ≤10 | The participant were asked about pain presences, intensity and location |
Chen, 2014, Taiwan [45] | To test a causal model of the predictors of agitation | LTC, 11 dementia special care units |
N = 405 | Mean 80.6 (7.9) | 33% | Varying stages of dementia 59.5% had a MMSE ≤10. Mean MMSE 8.9 (SD 6.8; range 0–26) | NR |
Couilliot, 2013, France [55] | To investigate the acceptability and feasibility of an acupuncture intervention on persistent musculoskeletal pain in a geriatric population | Geriatric hospital |
N = 60 (varying for the different time points n = 43 to n = 57) | Mean 83 (range 67–105) | 80% | 55.0% was diagnosed with dementia 62% were able to answer MMSE; mean 18.8 (SD 5.4) | 63% of the participant diagnosed with dementia were able to self-rate their pain at the time of inclusion |
Hadjistavropolous, 2008, Canada [46] | To examine the extent to which each of Doloplus-2’s items were predictive of delirium, depression, and dementia severity | Three LTC homes and a LTC unit within a large regional hospital |
N = 160 | Mean 86.3 (6.9) | 70.6% | Varying stages of dementia Mean HDS 91.0 (SD 49.2) | NR |
Hølen, 2005, Norway [21] | To translate the Doloplus-2 into Norwegian, to test the Doloplus-2 with regard to criterion validity and to obtain the administrators’ evaluation of the clinical performance of the Doloplus-2 | NHs, three special units for dementia |
N = 59 | Median 82 (range 39) | 80% | Dementia 88% had a MMSE <24; median 9 (Q1 = 3, Q3 = 18) | Yes |
Hølen, 2007, Norway [47] | To test the criterion validity and inter-rater reliability of the Doloplus-2, and to explore a design for validations of behavioral pain assessment tools | Two NHs and a geriatric hospital unit |
N = 41 | Mean 84 | 74% | Cognitively impaired Median MMSE 10. 50% scored 0–10; 36% scored 11–20; 14% scored 21–30 on the MMSE. | Yes |
Monacelli, 2013, Italy [53] | To re-assess pain after 1 year in a group of elderly NH residents with dementia | One NH |
N = 23 | Mean 88.1 (2.4) | 78% | Moderate to severe dementia Mean MMSE 10.3 (SD 2.2) | Yes |
Neville, 2014, Australia [48] | To evaluate the relative psychometric merits of the APS, the Doloplus-2 Scale, and the CNPI | Three residential aged care facilities |
N = 126 | Mean 85.2 (6.6; range 69–96) | 83% | Moderate to severe dementia Mean GDS 5.7 (SD 1.5; range 0–7) | NR |
Pautex, 2007, Switzerland [49] | To report the psychometric properties of the observational Doloplus-2 scale using the VAS pain score as a gold standard and evaluate its performance | A geriatric hospital and a department of psychiatry |
N = 180 | Mean 83.7 (6.5) | 73% | 74% had dementia (the remaining 26% had no cognitive decline). AD: 39%; Mixed: 34%; Vascular: 20%; Other causes: 5% Median MMSE 18.0 (±7.7). CDR score of 1 (mild dementia): 37%; score of 2 (moderate): 41%; score of 3 (severe): 33% | The participants had to have the ability to reliably use the VAS |
Pickering, 2010, multinational [50] | To evaluate the translation of the Doloplus-2 scale in five languages, as regards test–retest and inter-rater reliability | Multicenter; NHs, LTC settings, rehabilitation, home dwelling, acute care, other |
N = 341 | Mean 82 ± 2 | 70% | Different incapacities; dementia, aphasia, behavioral disorders, ‘other’ MMSE range 0–12 | Yes |
Rodríguez-Mansilla, 2015, Spain [56] | To assess the effectiveness of ear acupressure and massage vs. control in the improvement of pain, anxiety and depression in persons diagnosed with dementia | Residential homes |
N = 120 | Range 67–91 | 77.4% | Dementia MMSE 0–20 was one of the inclusion criteria | NR |
Sheu, 2011, Canada [51] | To examine the validity of facial expression components of 6 widely used pain assessment scales developed for elders with dementia | Hospital |
N = 30 | NR, sample > 65 | NR | The majority had cognitive impairment | All patients had capacity to comprehend and communicate in English, so as to cooperate with instructions |
Stacpoole, 2014, UK [52] | To evaluate the effects of the Namaste Care program on the behavioral symptoms of residents with advanced dementia in care homes and their pain management | Five dementia care homes |
N = 37 | Mean 78.5 | 59.4% | Severe dementia AD: 46%; Vascular: 19%; Mixed: 5.3%; Fronto-temporal: 2.7%; Unspecified: 27% BANS-S score ranged 17–28. | NR |
Torvik, 2009, Norway [43]b
| To describe the pain and use of pain medication in nursing home patients and examine which variables that were associated with pain | Seven NHs | Data abstracted is on the not self-reporting/proxy-rated group N = 86 (n = 77) | Mean 86 (6) | 77% | MMSE was not scored because of cognitive impairment or lack of language | Yes |
Torvik, 2010, Norway [42]b
| To examine the use of Doloplus-2 in a nonverbal nursing home population, and to evaluate its reliability and validity by comparing registered nurses’ estimation of pain with Doloplus-2 scores | Seven NHs |
N = 77 | Mean 86 (6.6) | 75% | None of the patients could complete the MMSE due to severe cognitive impairment, even though the majority had not been given any dementia diagnosis | Yes |
Voyer, 2008, Canada [41]c
| To determine detection rates of delirium and delirium symptoms by nurses among elderly residents with dementia and to identify factors associated with undetected cases of delirium | Three LTC facilities and one LTC unit of a large hospital |
N = 156 (n = 109) | Mean 86.3 (6.9) | 73.7% | Dementia Early: 3.1%; Middle:; 72.1%; Late: 24.8% according to FAST score AD: 34.2%; Vascular: 18.1%; Mixed: 14.2%; Subcortical: 4.5%; Unspecified: 29.1% | NR |
Voyer, 2009, Canada [39]c
| To investigate predisposing factors associated with delirium among demented long-term-care residents and to assess the cumulative effect of these factors on the likelihood of having delirium | Three LTC facilities and one LTC unit of a large regional hospital |
N = 155 | Mean 86.3 (6.9) | 73.6% | Dementia Mean HDS 91.1 (SD 48.9) | NR |
Voyer, 2011, Canada [40]c
| To investigate individual and environmental factors associated with delirium severity among older persons with delirium superimposed on dementia | Three LTC facilities and one LTC unit of a large regional hospital |
N = 71 | Mean 87.7 (7.4) | 71.8% | Dementia Mean HDS 79.6 (SD 43.5) | NR |
Zwakhalen, 2006, the Netherlands [24] | To evaluate the psychometric properties of translated versions of the PAINAD, PACSLAC, and Doloplus-2 scales | NHs, 12 psycho-geriatric wards and a somatic NH ward |
N = 128 (assessed at rest T1 n = 89, at specific moment T3 n = 26) | Mean 82.4 (6.8) | 78% | Dementia AD: 32.0%; Vascular: 18.8%; Other (e.g. Parkinson’s disease, frontal lobe): 5.5%; Mixed: 3.9%; Unknown: 8% Mild: 21.9%; Moderate to moderately severe: 28.1%; Severe to very severe: 47.7%; Unknown/missing: 2.3% according to CPS score | Patients were questioned about their current pain intensity using self-report scales |
Feasibility and clinical utility
First author, year, country [reference] | Assessment completed by | Cut-off, % who scored ≥ cut-off | Number of items used | Mean (SD) /Median (range) score, total and subscales | Time needed to complete the assessment | Training given on Doloplus-2 | Raters’ knowledge of the patients’ normal behavior | Other information about feasibility and/or clinical utility |
---|---|---|---|---|---|---|---|---|
Akbarzadeh, 2007, Sweden [33] | RNs and NAs | ≥5*
| 10 | Mean total score 11.9 (6.5) for rater 1 and 12.6 (6.8) for rater 2 Median total score 12 (0–25) for rater 1 and rater 2 | NR | NR | NR | NR |
Ando, 2010, Japan [23] | First author and authors (CA) and RNs | ≥5*
| 10 | NR | NR | All nurses were provided with in-depth instructions regarding scoring of the Doloplus-2 | At admission to hospital, nurses observed the patients’ behavior in an attempt to learn their habits and usual condition by talking with family or health care workers who were familiar with the patient | Nurses’ (N = 14) were interviewed and the scale was said to be feasible |
Ando, 2016, Japan [54] | RNs | ≥5, 79% | 10 | Mean total score Pre-test 7.5 (3.2) Post-test 2.9 (2.1) | NR | One of the authors held meetings with the RNs to provide in-depth instructions regarding scoring of the Doloplus-2 | NR | |
Bauer, 2007, France [44] | NR | NR | 5; Somatic complaints, Protection of sore areas, Expression, Communication and Problems of behavior | NR | NR | NR | NR | NR |
Chen, 2010a, Taiwan [22] | RNs and RAs | ≥5, 39.8% | 10 | Mean score Total 4.5 (4.1); Somatic 1.3 (2.1); Psychomotor 2.1 (1.9); Psychosocial 1.1 (1.9) | NR | RNs in each institution received intensive training from the researcher in the use of the C-Doloplus-2, following the user manual | RNs must have worked in their dementia special care unit at least one month before data collection began To ensure RAs familiarity with residents, they were asked to observe and record resident’s painful conditions at rest and after pain-provoked motion every day for one week | Nurses (N = 14) asked to rate on a 5-point Likert-type scale (5 = strongly agree to 1 = strongly disagree) “Do you think the C-Doloplus-2 is appropriate for assessing pain in cognitively impaired older people with communication difficulty?” Mean score 4.1 (SD 0.8; range 3–5) The RNs indicated it was difficult to distinguish whether there are behavioral changes in sleep pattern, communication and social life of older people with end-stage of dementia, but most agreed that the C-Doloplus-2 scale has clinical potential to detect pain in this group |
Chen, 2010b, Taiwan [38] | RNs and NAs from the units and RAs with a Bachelor of Science or higher degrees and majors in psychology or nursing | ≥5, 34% (RNs); 48% (NAs); 38% (RAs) | 10 | NR | NR | RAs underwent a series of training courses; five hours of instruction about pain in older people with dementia and two weeks of clinical practice training about performing self-report and observational instruments to assess pain in older people with dementia | RNs and NAs must have worked in their dementia special care unit at least one month before data collection began RAs observed resident’s painful conditions at rest and after pain-provoked motion and interviewed residents about their pain every day for one week prior to assessment with Doloplus-2 | NR |
Chen, 2014, Taiwan [45] | RAs with Bachelor of Science or higher degrees and majors in psychology or nursing | ≥5, 33.8% | 10 | Mean total score 3.5 (3.2; range 0–15) | NR | The RAs received 6 h of instruction pertaining to pain, depression and agitation in dementia, and two weeks of skills training in observing and recording in clinical settings | For one week, the RAs observed the residents’ behavior directly as they performed ADL, noting pain behaviors | NR |
Couilliot, 2013, France [55] | The hospital’s caregivers | NR | 10 | Baseline mean scores Total 8.7 (4.7); Somatic 4.7 (2.6); Psychomotor 2.3 (1.3); Psychosocial 1.6 (2.2) | NR | The hospital’s caregivers had been previously trained and were competent in assessment with the scale | NR | NR |
Hadjistavropolous, 2008, Canada [46] | Research nurses | NR | 10 | Mean total score 4.5 (4.4) | NR | Research nurses completed 15 h of instruction on delirium, dementia, and depression from a member of the research team. Instruction on the research procedures as well as direct supervision in the data collection for 15 participants were also provided | NR | NR |
Hølen, 2005, Norway [21] | Nurse in co-operation with a RA | ≥5, 49% | 10 | Mean total score 5.2 (5.2) | NR | Nurses and RAs trained in accordance with the Doloplus-2 standard recommendations | The nurses administering the scale worked close to the patients and were familiar with their habits and regular condition | A debriefing questionnaire was completed by the administrators of the Doloplus-2 (N = 11): - The standardized format makes the discussion of a patient more solid - Small enough administrative burden and usable in routine care situations - Items eight to ten (psychosocial reactions), should be cautiously scored because changes in these behavior can be a result of dementia, and not necessarily pain. Therefore, it is important to know the patient’s habits and regular behavioral patterns - Training and reading of the instruction manual are important for using the scale correctly |
Hølen, 2007, Norway [47] | RNs | 5 out of 30*
| 10 | Mean total score 7.5 (5.1; range 0–22) | NR | Nurses who used the Dolplus-2 were trained, but no details provided | RNs administering the scale cared for the patients regularly and were familiar with their behavior | NR |
Monacelli, 2013, Italy [53] | A nurse working in the NH | Higher than 5/30, 96% | 10 | NR | Average 8–10 min per patient | Adequate professional training with reference to Pickering, 2010 [54] | NR | Collection of professional comments on the administration of the scale defined it as handy and easy for clinical application and mostly suitable for a residential setting were professionals are engaged with a daily care of patients After assessing with Doloplus-2 for 1 year: - Reduced mean score below the pain threshold: Chi square = 14.8; p < 0.0001. - Increased analgesic therapy: At the initial assessment, analgesic therapy was of 30% with only 1 level WHO group. After 1 year, the analgesic treatment was of 100% with 1 level WHO group of 15%, 2 level WHO group of 75% and 3 level WHO group of 10% |
Neville, 2014, Australia [48] | RNs, enrolled nurses and assistants-in-nursing | 5*
| 10 | Mean total score First testing occasion: 9.0 (6.5) for rater 1 and 7.4 (6.2) for rater 2. Second testing occasion: 7.1 (6.0) for rater 1 and 6.8 (5.9) for rater 2 | NR | The nurses as rater of the Doloplus-2 scale, received training from a project team member, but no more details provided | The nurses were well aware of the person they were assessing | Nurse qualification was significantly associated with Doloplus-2 score at the first testing occasions (R2 = 0.1; p = .004). More highly qualified nurse raters tended to assign higher pain ratings. The scale may initially be susceptible to rater qualification, but this effect disappears with repeated use There was no significant effect from different nurse raters producing pain ratings, over and above the effects of rater demographics (all p > 0.12), indicating that multiple raters does not bias pain scores |
Pautex, 2007, Switzerland [49] | Nurses | ≥5, 19% | 10 | Median total scale 4 (interquartile range 7) | Average 10 (6 to 12) minutes per patient | A nurse at each unit received extensive training to complete Doloplus-2 and had the responsibility to train other nurses in the unit for at least 1 h and supervised their use of the scale | NR | Constructed and tested a shortened version of the Doloplus-2 (5 items). Internal consistency and correlation with VAS was similar to the complete Doloplus-2 Of the 88 patients who reported pain using VAS, 50 got a score lower than 5 and 21 got a score equal to 0 on the Dolplus-2. Patients report more pain using self-report (VAS) than nurses uncover with the Doloplus-2 |
Pickering, 2010, multinational [50] | Two physicians per team (9 teams) | NR | 10 | Mean total sore per language version - Dutch: 5.4 (4.4) for rater 1 and 4.1 (3.8) for rater 2 - English: 8.3 (6.0) for rater 1 and 8.8 (6.5) for rater 2 - Italian: 12.7 (6.5) for rater 1 and 12.7 (6.8) for rater 2 - Portuguese: 6.1 (7.0) for rater 1 and 6.2 (7.0) for rater 2 - Spanish: 6.0 (4.9) for rater 1 and 6.3 (4.6) for rater 2 | Average 5 min per patient | The team was provided with Doloplus-2 video, instructions for use, several evaluations with paper and video backups. Implemented the scale a few days before study start to familiarize themselves with it | All physicians were familiar with the patient and provided daily medical care | All participating physicians considered Doloplus-2 to be easy to use once they were familiar with it |
Rodríguez-Mansilla, 2015, Spain [56] | An occupational therapist | Scores over 5*
| 10 | Mean total score baseline: Ear acupressure 19.0 (5.1); Massage 22.7 (6.4); Control: 21.4 (2.7) | NR | NR | NR | NR |
Sheu, 2011, Canada [51] | “Coders” over 19 years of age with healthy vision was recruited from a university campus | NR | 1, only the ‘Facial expression’ item | NR | NR | NR | NR | NR |
Stacpoole, 2014, UK [52] | Researcher with care staff | 5 or more*
| 10 | NR | NR | NR | NR | NR |
Torvik, 2009, Norway [43] | RNs | 5, 67.5% | 10 | NR | NR | The researcher trained the RNs in data collection and was available during data collection | The RNs were the patients’ primary nurses who cared for the patient regularly | NR |
Torvik, 2010, Norway [42] | RNs | 5, 68% | 10 | Mean score Total 6.9 (4.4); Somatic 3.5 (2.7); Psychomotor 1.6 (1.3); Psychosocial 2.0 (2.4) | NR | The researcher increased staff awareness of patients’ pain by teaching about pain and Doloplus-2. Staff received both oral and written information about how to use the Doloplus-2 | The RNs were the patients’ primary nurses who cared for the patient regularly | The highest congruency between Doloplus-2 score > 5 and RNs reporting ‘Don’t know’ when proxy-rating pain, was found on the Psychosocial subscale The highest congruence between the Doloplus-2 score and the proxy-rating occurred on the Psychomotor score RNs evaluated significantly more patients as experiencing pain compared with proxy-rated pain (p = 0.001) |
Voyer, 2008, Canada [41] | RAs who were nurses | 5 out of 30, 44% | 10 | NR | NR | NR | NR | NR |
Voyer, 2009, Canada [39] | Study nurses | 5 out of 30, 45.8% | 10 | NR | NR | NR | NR | NR |
Voyer, 2011, Canada [40] | Study nurses | 5 out of 30, 50.7% | 10 | NR | NR | NR | NR | NR |
Zwakhalen, 2006, the Netherlands [24] | Nurses | 5 out of 30*
| 10 | Mean total score ‘Daily pain’ group 9.8 (6.0; range 2–23). ‘No pain group’ 5.1 (3.9; range 0–16) | NR | NR | P.212: “…the Doloplus-2 cannot be used without in-depth knowledge of the patient…”, “but not specify raters’ knowledge of the patients’ normal behavior” | Nurses’ (N = 12) ratings of clinical usefulness (scored on a 10-point scale): mean 5.6 (SD 2.2) Qualitative information from nurses, p.: 217: “Doloplus-2 provides a more general view. A clear manual is provided. The scale is difficult to score and interpret. It’s questionable whether all items of the Doloplus are relevant to detect pain. The psychosocial items in particular are difficult to interpret as solid specific pain behavior. Other causes, like the dementia itself, could explain a change in psychosocial behavior.” |
Feasibility
Clinical utility
Measurement properties
First author, year, country [reference] | Reliability | Validity | Responsiveness | Interpretability |
---|---|---|---|---|
Akbarzadeh, 2007, Sweden [33] | Internal consistency Cronbach’s alpha for the total scale 0.84 for rater 1 and 0.82 for rater 2 Reliability (Inter-rater) Agreement between rater 1 and rater 2 for single items (Cohen’s Kappa coefficient) 0.31–0.69 No statistically significant difference between rater 1 and rater 2 for total score (Wilcoxon signed-rank test) p = 0.106 Spearman correlation 0.90 between rater 1 and rater 2 for total score | Criterion (Concurrent) Spearman correlation with the UAB as the ‘gold standard’ 0.70 for rater 1 and 0.72 for rater 2 Construct (Structural) EFA with the result of items loading on one factor | NR | NR |
Ando, 2010, Japan [23] | Reliability (Inter-rater) Matching scores by RN and researcher 77.5%, p = <0.01 The ICC for the agreement between RN and researcher was 0.90 (p = 0.001). Agreement by items 0.67–0.96 | Construct (cross-cultural) Semi-structured interviews with 14 nurses. Two items, ‘Protective body postures adopted at rest’ and ‘Sleep pattern’, were changed to more appropriate Japanese explanations | NR | NR |
Ando, 2016, Japan [54] | NR | NR | Before treatment, the mean total score was 9.8 (SD 4.2) for n = 10 patients, whereas their post-treatment score significantly decreased to 2.7 (SD 1.6); net change 7.1, 95% CI: 4.4–9.7 | NR |
Bauer, 2007, France [44] | NR | NR | NR | NR |
Chen, 2010a, Taiwan [22] | Internal consistency Cronbach’s alpha for the total scale 0.74. Subscales Somatic 0.79; Psychomotor 0.87; Psychosocial 0.74. The alpha coefficients did not increase when any of the items were deleted Reliability (Inter-rater) ICC for the agreement between RNs and RAs on the total scale 0.81. For the subscales; Somatic 0.79, Psychomotor 0.84 and Psychosocial 0.60 | Construct (Hypotheses testing) Pearson correlations with known correlates of pain. In moderate dementia, significant correlation with functional ability −0.38 (p < 0.01). In severe dementia, significant correlation with functional ability −0.22 (p < 0.01) and depression 0.12 (p < 0.05) Construct (Structural) A PCA showed three factors, accounting for 65% of the total variance. Factor 1: all five items of the Somatic subscale explained 27.43% of the variance. Factor 2: all three items of the Psychosocial subscale explained 19.86% of the variance. Factor 3: both items of the Psychomotor subscale, accounting for 19.99% of the variance Item-total and item-subtotal correlations: Each item was correlated with the originally belonged subscale, ranged from 0.6 to 0.94. Each item correlation with overall scale ranged from 0.42 to 0.65 Construct (Cross-cultural) Five experts examined the content of C-Doloplus-2 and rated each item on a 4-point Likert scale from relevant (4) to irrelevant (1). Only the option ‘Insomnia, affecting morning waking time’ of item 5 ‘Sleep pattern’ was recommended to be rephrased | NR | NR |
Chen, 2010b, Taiwan [38] | Reliability (inter-rater) Paired t-test for agreement of different pairs in assessing pain. No difference between mean total scores for RA-RN pairs (t = 0.28, p > 0.05), but a statistically significant differences between the mean total scores for RA-NA pairs (t = 6.70, p < 0.01). NAs tended to report more pain cues than RAs Logistic regression to examine factors influencing the extent of agreement for the different pair. For RA-RN pairs, OR increased when residents had stayed in the institution longer (OR 1.01, p = 0.01), had less physical dependency (OR 1.02, p = 0.00), and when RNs had received pain related training (OR 2.86, p = 0.04). For RA-NA pairs, OR increased when the patients had fewer medical diagnosis (OR 0.78, p = 0.01) and less physical dependency (OR 1.01, p = 0.04) | NR | NR | NR |
Chen, 2014, Taiwan [45] | Internal consistency Cronbach’s alpha for total scale 0.73 | NR | NR | NR |
Couilliot, 2013, France [55] | NR | NR | Statistically significant reduction on total and subscales scores after five acupuncture sessions: Total score mean variation −3.27, p < 0.01, effect size 0.77. Somatic score mean variation −2.08, p < 0.01, effect size 0.89. Psychomotor score mean variation −0.61, p < 0.05, effect size 0.33 Psychosocial score mean variation −0.59 points, p < 0.05, effect size 0.30 | NR |
Hadjistavropolous, 2008, Canada [46] | NR | Construct (Hypotheses testing) Item 10 (‘Problems of Behavior’) was related to dementia severity (β = − .25, p < .003), depression (β = .31, p < .001) and presence of delirium (β = .25, p < .003) Item 6 (‘Washing and dressing’) was related to delirium severity (β = .42, p < .004) and dementia severity (β = − .39, p < .005) Other items related to depression were item 5 (‘Sleep pattern’) (β = .22, p < .003), item 9 ‘Social life’ (β = .25, p < .001) | NR | NR |
Hølen, 2005, Norway [21] | NR | Content (Face) Results from a questionnaire, completed by the 11 administrators of the Doloplus-2, was the Doloplus-2 was instructive regarding observation indicating pain, and includes important pain clues Construct (cross-cultural) The translation was approved by all administrators. No item was pointed out as confusing, difficult to understand or elsewhere problematic Criterion (concurrent) Experts’ pain rating with NRS-11 was used as a pain criterion. The experts rated 25 patients as pain free where the Doloplus-2 made five false positive with scores of 5 and 6. Of the 59 cases, the Doloplus-2 made false negatives on 10 occasions: a Doloplus-2 ≥ 5 at the same time as the expert rated above 0 on the NRS-11. In five of these cases, the expert’s score was one half (usually 0 at rest and 1 in movement), three had a score of 1 and the remaining two were rated with 2 and 3 on the NRS-11 The Doloplus-2 explained 62% (R2) of the pain distribution. For 85% of the assessments, the Doloplus-2 score (0–30) multiplied by 0.25 (beta) corresponded to the expert score ± 1 unit on the 0–10 NRS scale Facial expression explained 48% (R2 = 0.48) of the experts scores alone. When including items Protective body postures at rest, Communication and Somatic complaints, these four items explained 68% of the total variability in the experts’ scores | NR | NR |
Hølen, 2007, Norway [47] | Reliability (inter-rater) Agreement between a geriatric specialist nurse and an enrolled nurse on the total score was 0.77 (ICC), with a 95% CI of 0.47–0.92. Assessed in the 16 patients included at the geriatric hospital unit | Criterion (concurrent) The pain criterion was the specialist nurse (pain expert) who made a single evaluation of each patient’s pain level on NRS-11. Doloplus-2 scores against the expert scores produced an R2 = 0.023, implying poor criterion validity of the Doloplus-2 when compared to pain experts evaluation. Association was found between the pain expert and the geriatric expert nurse who administered the Doloplus-2 in 16 patients in the Hospital, R2 = 0.54 | NR | NR |
Monacelli, 2013, Italy [53] | NR | NR | Reduction of total mean score between the first assessment and after 1 year of follow up (Wilcoxon rank test) R2 = 0.216, p < 0.001 | NR |
Neville, 2014, Australia [48] | Internal consistency Cronbach’s alpha for the two rater groups on the two assessment occasion was 0.86 and 0.87 Reliability (test–retest) Agreement for the two testing occasions occurring two weeks apart. Pearson correlation 0.71 for both rater groups Reliability (inter-rater) ICC for the agreement between nurse raters for the total score at first 0.73 and second testing occasion 0.81. Weighted Kappa to compare pain level categorizations (no pain, mild, moderate, severe pain) across raters at first 0.42 and second testing occasion 0.50 | Criterion (concurrent) Pain criterion was RNs initial yes/no rating of the residents’ pain. Pearson correlation for each rater group at the first testing occasion showed moderate correlations at 0.43 (rater group 1) and 0.45 (rater group 2) Construct (Structural) EFA showed a 1-factor solution was the best description of the factor structure of the Doloplus-2 EFA showed a single factor model best described the correlation among all the total scale scores for the Doloplus-2, CNPI and APS, each score loading highly (>0.60) on that single factor, indicating that all of the scales measures essentially the same single construct | ||
Pautex, 2007, Switzerland [49] | Internal consistency Cronbach’s alpha was adequate for all items, lower in patients with dementia (0.67) compared to cognitively intact patients (0.84). The lowest internal consistency scores were found for the items ‘Expression’ (0.82) and ‘Mobility’ (0.82) Reliability (test-retest) Performed in a subsample of 20 patients hospitalized in the same units with the same characteristics and stable chronic pain. The second testing occasion happened the day after the first one. ICC indicated excellent agreement at 0.96 | Criterion (concurrent) Spearman 0.46 indicated a moderate correlation with the pain criterion; patients’ self-assessment (VAS). The correlation was better in patients without dementia compared to patients with dementia (0.68 vs. 0.38) Doloplus-2 predicted 41% of the variability of pain intensity measured by VAS. The somatic dimension explained 36% of the variability, the psychomotor and psychosocial dimension 5% each. The intensity of pain (VAS) was mainly associated with the somatic dimension of Doloplus-2. Two items of the psychosocial reaction were also statistically significant (p < 0.05) | NR | NR |
Pickering, 2010, multinational [50] | Reliability (test-retest) Patients was assess at initial contact and again 4 h later. When evaluated with ICC, agreement ranged from 0.62 for the Dutch version to 0.98 for the Italian version (0.98). Evaluated with Pearson correlation, the results ranged from 0.57 for the Dutch version to 0.99 for the Portuguese version Reliability (inter-rater) ICC for the agreement between physicians for the total score ranged from 0.75 (Dutch version) to 0.97 (Italian version) Pearson correlation indicated excellent agreement ranging from 0.75 (Dutch version) to 0.97 (Italian and Portuguese version) Kappa was used to compare agreement for each of the 10 items across language version. The agreement ranged from fair to excellent (0.51–0.84) for the English version, excellent (0.79–0.96) for the Italian version, good to excellent (0.65–0.82) for the Portuguese version, fair to excellent (0.47–0.87) for the Spanish version and poor to excellent (0.19–1) for the Dutch version | NR | NR | NR |
Rodríguez-Mansilla, 2015, Spain [56] | NR | NR | The best improvement in the mean total score was reached in the last (third) month of ear acupressure. The average improvement was 8.55 points (SD 4.39), 95% CI: 7.14–9.95 | NR |
Sheu, 2011, Canada [51] | Reliability (inter-rater) Three clips indicative of mild, moderate and severe pain intensities were selected for study for each participant. The mean of criterionvalues for each intensity level was 0.04 (−0.20–0.38) for mild pain, 0.20 (−0.07–0.46), for moderate pain, and 0.38 (0.11–0 .68) for severe pain | Criterion (concurrent) Pain criterion used was FACS-scores. No significant correlations were observed with the FACS at any of the pain intensities. Pearson correlation for mild pain was −0.13 (an inverse relationship between scores), 0.16 for moderate pain, and 0.10 for severe pain Construct (Hypotheses testing) Examined whether the scale differentiated the 3 levels of facial expression of pain by a pairwise comparison of the mean between each intensity level of the scale. The Doloplus-2 did not distinguish the 3 levels of pain: Mild-moderate: 0.37, p = 0.488 Mild-severe: 0.03, p = 0.955 Moderate-severe: 0.40, p = 0.481 | NR | NR |
Stacpoole, 2014, UK [52] | NR | NR | NR | NR |
Torvik, 2009, Norway [43] | NR | NR | NR | NR |
Torvik, 2010, Norway [42] | Internal consistency Cronbach’s alpha for the total scale was 0.71, and 0.60 (Somatic) 0.80 (Psychomotor) and 0.78 (Psychosocial) for the subscales. After excluding individual items, the alpha values for the subscales were comparable to alpha for the overall scale, except for the Somatic subscale where the alpha score decreased from 0.60 to 0.47 when item ‘Somatic complaint’ deleted | Criterion (concurrent) Pain criterion used was RNs proxy assessment answering the question ‘Do you believe that this patient is experiencing pain?’ Response options were ‘no’, ‘yes’ or ‘don’t know’. Nursing staff evaluated significantly more patients as experiencing pain when using Doloplus-2 compared with proxy-rated pain (p = 0.01) When pain was proxy rated, 36 of 40 (90%) cases where the RNs assessed ‘yes, pain’, scored ≥5 on Doloplus-2. 11 of 15 (73.3%) assessed as ‘no pain’ by RNs scored <5 on Doloplus-2 | NR | NR |
Voyer, 2008, Canada [41] | NR | NR | NR | NR |
Voyer, 2009, Canada [39] | NR | NR | NR | NR |
Voyer, 2011, Canada [40] | NR | NR | NR | NR |
Zwakhalen, 2006, the Netherlands [24] | Internal consistency Internal consistency for the total and subscales at different assessment points (T1 and T3). Cronbach’s alpha was 0.75 for the total scale, 0.70 for Somatic reactions, 0.80 for Psychomotor reactions, and 0.63 for Psychosocial reactions at T1 At T3, Cronbach’s alpha was 0.74 for the total scale, 0.63 for Somatic reactions, 0.77 for Psychomotor reactions, and 0.58 for Psychosocial reactions | Construct (Hypotheses testing) Used the known-groups technique by comparing Doloplus-2 scores between a ‘non-pain’ group’ and a ‘daily pain’ group. The mean score in the ‘Daily pain’ (mean 9.8; SD 6.0; range 2–23) was obviously higher compared to mean score in ‘no pain group’ (mean 5.1; SD 3.9; range 0–16) Pearson correlation was 0.29 for VAS by rater 1, 0.33 for VAS by nurse, 0.36 for the VRS, 0.29 for the PACSLAC and 0.34 for the PAINAD | NR |