A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia

Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment To...

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Published inClinical interventions in aging Vol. 13; pp. 1245 - 1258
Main Authors Atee, Mustafa, Hoti, Kreshnik, Parsons, Richard, Hughes, Jeffery D
Format Journal Article
LanguageEnglish
Published New Zealand Dove Medical Press Limited 01.01.2018
Taylor & Francis Ltd
Dove Medical Press
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Abstract Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. A 2-week observational study. An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. Subjects were 10 residents (age range: 63.1-84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. A total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters' agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85-0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κ =0.72 (95% CI: 0.58-0.86) at rest and κ =0.69 (95% CI: 0.50-0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; <0.0012) and following mobilization (mean: 2.5 vs 1.7; <0.0001) compared to no pain and rest, respectively. ePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia.
AbstractList Mustafa Atee,1 Kreshnik Hoti,1,2 Richard Parsons,1 Jeffery D Hughes1 1School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia; 2Division of Pharmacy, Faculty of Medicine, University of Pristina, Prishtina, Kosovo Objectives: Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. Study design: A 2-week observational study. Setting: An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. Participants: Subjects were 10 residents (age range: 63.1-84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. Measurements: ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. Results: A total of 76 assessments (rest=38 [n=19 pairs], movement=38 [n=19 pairs]) were conducted. At rest, raters' agreement was excellent on overall total scores (coefficient of concordance=0.92 [95% CI: 0.85-0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κw=0.72 (95% CI: 0.58-0.86) at rest and κw=0.69 (95% CI: 0.50-0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; p<0.0012) and following mobilization (mean: 2.5 vs 1.7; p<0.0001) compared to no pain and rest, respectively. Conclusions: ePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia. Keywords: interrater reliability, ePAT, pain, pain assessment, PainChek®, dementia, facial action units, automated facial expression analysis, total pain scores
Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. A 2-week observational study. An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. Subjects were 10 residents (age range: 63.1-84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. A total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters' agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85-0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κ =0.72 (95% CI: 0.58-0.86) at rest and κ =0.69 (95% CI: 0.50-0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; <0.0012) and following mobilization (mean: 2.5 vs 1.7; <0.0001) compared to no pain and rest, respectively. ePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia.
Objectives: Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. Study design: A 2-week observational study. Setting: An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. Participants: Subjects were 10 residents (age range: 63.1–84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. Measurements: ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. Results: A total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters’ agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85–0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κw=0.72 (95% CI: 0.58–0.86) at rest and κw=0.69 (95% CI: 0.50–0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; p<0.0012) and following mobilization (mean: 2.5 vs 1.7; p<0.0001) compared to no pain and rest, respectively. Conclusions: ePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia.
Objectives: Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. Study design: A 2-week observational study. Setting: An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. Participants: Subjects were 10 residents (age range: 63.1-84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3[+ or -]8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1[+ or -]12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. Measurements: ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. Results: A total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters' agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85-0.96]) and broad category scores ([kappa]=1.0). Agreement was moderate ([kappa]=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave [[kappa].sub.w]=0.72 (95% CI: 0.58-0.86) at rest and [[kappa].sub.w]=0.69 (95% CI: 0.50-0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; p<0.0012) and following mobilization (mean: 2.5 vs 1.7; p<0.0001) compared to no pain and rest, respectively. Conclusions: ePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia. Keywords: interrater reliability, ePAT, pain, pain assessment, PainChek[R], dementia, facial action units, automated facial expression analysis, total pain scores
OBJECTIVESRegardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. STUDY DESIGNA 2-week observational study. SETTINGAn accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. PARTICIPANTSSubjects were 10 residents (age range: 63.1-84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. MEASUREMENTSePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. RESULTSA total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters' agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85-0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κw=0.72 (95% CI: 0.58-0.86) at rest and κw=0.69 (95% CI: 0.50-0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; p<0.0012) and following mobilization (mean: 2.5 vs 1.7; p<0.0001) compared to no pain and rest, respectively. CONCLUSIONSePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia.
Audience Academic
Author Parsons, Richard
Hoti, Kreshnik
Atee, Mustafa
Hughes, Jeffery D
AuthorAffiliation 2 Division of Pharmacy, Faculty of Medicine, University of Pristina, Prishtina, Kosovo
1 School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia, mustafa.atee@curtin.edu.au
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Keywords ePAT
pain
PainChek
automated facial expression analysis
facial action units
total pain scores
interrater reliability
pain assessment
dementia
Language English
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PublicationTitle Clinical interventions in aging
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Snippet Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because...
Objectives: Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected...
OBJECTIVESRegardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected...
Mustafa Atee,1 Kreshnik Hoti,1,2 Richard Parsons,1 Jeffery D Hughes1 1School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin...
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StartPage 1245
SubjectTerms Arthritis
automated facial expression analysis
Automation
Cognitive ability
Cognitive biases
Consent
Dementia
Digitization
Elder care
ePAT
Ethics
facial action units
Geriatrics
Health facilities
inter-rater reliability
Medical equipment
Nurses
Nursing home patients
Nursing homes
Older people
Original Research
Pain
Pain management
Pharmacy
Practical nurses
Psychotropic drugs
Quality of life
Registered nurses
total pain scores
Workers
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Title A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia
URI https://www.ncbi.nlm.nih.gov/pubmed/30038491
https://www.proquest.com/docview/2224774217
https://search.proquest.com/docview/2075543546
https://pubmed.ncbi.nlm.nih.gov/PMC6052926
https://doaj.org/article/a10978a9c3174c419d754fffc793483d
Volume 13
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