J Korean Med Sci.  2017 Nov;32(11):1852-1856. 10.3346/jkms.2017.32.11.1852.

Validity of the Korean Version of the Face, Legs, Activity, Cry, and Consolability Scale for Assessment of Pain in Dementia Patients

Affiliations
  • 1Department of Neurology, Konkuk University Medical Center, Seoul, Korea. alzdoc@kuh.ac.kr
  • 2Department of Quality Improvement, Konkuk University Medical Center, Seoul, Korea.
  • 3Department of Rehabilitation Medicines, Konkuk University Medical Center, Seoul, Korea.
  • 4Center for Geriatric Neuroscience Research, Institute of Biomedical Science, Konkuk University, Seoul, Korea.

Abstract

Pain is often associated with a more rapid progression of cognitive and functional decline, and behavioral disturbance in dementia. Therefore, it is essential to accurately assesses pain for proper intervention in patients with dementia. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale is an excellent behaviour scale which includes most of the domains that are recommended by the American Geriatrics Society to evaluate when assessing pain in patients with dementia. The purpose of this study was to develop the Korean version of the FLACC (K-FLACC) and to verify its reliability and validity in assessing pain of elderly patients with dementia. We developed the K-FLACC to consist of the five domains (face, legs, activity, cry, and consolability) with scores of 0, 1, and 2 for each domain and a total score ranging from 0 to 10 as in the original FLACC. Eighty-eight patients with dementia who visited Konkuk University Medical Center were evaluated. The K-FLACC revealed good validity as compared to the Numeric Rating Scale (NRS; r = 0.617, P < 0.001) and the Face Pain Scale (FPS; r = 0.350, P = 0.001). All of the five domains of the K-FLACC were related to the NRS and FPS, in which the activity domain showed the highest correlation. Test-retest reliability was excellent, as the intra-class correlation coefficient comparing the retest to test was 0.73 (95% confidence interval, 0.59-0.82). Our results show that the K-FLACC is a suitable and valuable scale to assess pain in patients with dementia in Korea.

Keyword

Pain; Dementia; Screening; Scale

MeSH Terms

Academic Medical Centers
Aged
Dementia*
Facial Pain
Geriatrics
Humans
Korea
Leg*
Mass Screening
Reproducibility of Results

Reference

1. Ammaturo DA, Hadjistavropoulos T, Williams J. Pain in dementia: use of observational pain assessment tools by people who are not health professionals. Pain Med. Forthcoming. 2016.
2. Echávarri C, Burgmans S, Uylings H, Cuesta MJ, Peralta V, Kamphorst W, Rozemuller AJ, Verhey FR. Neuropsychiatric symptoms in Alzheimer’s disease and vascular dementia. J Alzheimers Dis. 2013; 33:715–721.
3. Finkel SI. Behavioral and psychological symptoms of dementia: a current focus for clinicians, researchers, and caregivers. J Clin Psychiatry. 2001; 62:Suppl 21. 3–6.
4. Pieper MJ, van Dalen-Kok AH, Francke AL, van der Steen JT, Scherder EJ, Husebø BS, Achterberg WP. Interventions targeting pain or behaviour in dementia: a systematic review. Ageing Res Rev. 2013; 12:1042–1055.
5. Balfour JE, O'Rourke N. Older adults with Alzheimer disease, comorbid arthritis and prescription of psychotropic medications. Pain Res Manag. 2003; 8:198–204.
6. Cohen-Mansfield J, Thein K, Marx MS, Dakheel-Ali M. What are the barriers to performing nonpharmacological interventions for behavioral symptoms in the nursing home? J Am Med Dir Assoc. 2012; 13:400–405.
7. Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K, Gill R, Juszczak E, Yu LM, Jacoby R, et al. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol. 2009; 8:151–157.
8. Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Manag Nurs. 2011; 12:230–250.
9. Koller D, Goldman RD. Distraction techniques for children undergoing procedures: a critical review of pediatric research. J Pediatr Nurs. 2012; 27:652–681.
10. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978; 37:378–381.
11. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988; 14:9–17.
12. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997; 23:293–297.
13. Abbey J, Piller N, De Bellis A, Esterman A, Parker D, Giles L, Lowcay B. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs. 2004; 10:6–13.
14. Husebo BS, Strand LI, Moe-Nilssen R, Husebo SB, Ljunggren AE. Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting. Scand J Caring Sci. 2010; 24:380–391.
15. Pautex S, Herrmann FR, Michon A, Giannakopoulos P, Gold G. Psychometric properties of the Doloplus-2 observational pain assessment scale and comparison to self-assessment in hospitalized elderly. Clin J Pain. 2007; 23:774–779.
16. Fuchs-Lacelle S, Hadjistavropoulos T. Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC). Pain Manag Nurs. 2004; 5:37–49.
17. Cohen-Mansfield J. Pain assessment in noncommunicative elderly persons--PAINE. Clin J Pain. 2006; 22:569–575.
18. Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. J Am Med Dir Assoc. 2003; 4:9–15.
19. Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999; 340:669–676.
20. Jordan A, Hughes J, Pakresi M, Hepburn S, O'Brien JT. The utility of PAINAD in assessing pain in a UK population with severe dementia. Int J Geriatr Psychiatry. 2011; 26:118–126.
21. von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain. 2007; 127:140–150.
22. Shen J, Giles SA, Kurtovic K, Fabia R, Besner GE, Wheeler KK, Xiang H, Groner JI. Evaluation of nurse accuracy in rating procedural pain among pediatric burn patients using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. Burns. 2017; 43:114–120.
23. AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002; 50:S205–S224.
24. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken). 2011; 63:Suppl 11. S240–S252.
25. Kim EJ, Buschmann MT. Reliability and validity of the Faces Pain Scale with older adults. Int J Nurs Stud. 2006; 43:447–456.
26. Fleiss JL, Chilton NW. The measurement of interexaminer agreement on periodontal disease. J Periodontal Res. 1983; 18:601–606.
27. Marmo L, Fowler S. Pain assessment tool in the critically ill post-open heart surgery patient population. Pain Manag Nurs. 2010; 11:134–140.
28. Jensen MP, McFarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain. 1993; 55:195–203.
29. Rodriguez CS. Pain measurement in the elderly: a review. Pain Manag Nurs. 2001; 2:38–46.
30. Shega J, Emanuel L, Vargish L, Levine SK, Bursch H, Herr K, Karp JF, Weiner DK. Pain in persons with dementia: complex, common, and challenging. J Pain. 2007; 8:373–378.
31. Rajkumar AP, Ballard C, Fossey J, Orrell M, Moniz-Cook E, Woods RT, Murray J, Whitaker R, Stafford J, Knapp M, et al. Epidemiology of pain in people with dementia living in care homes: longitudinal course, prevalence, and treatment implications. J Am Med Dir Assoc. 2017; 18:453.e1–453.e6.
32. Achterberg WP, Pieper MJ, van Dalen-Kok AH, de Waal MW, Husebo BS, Lautenbacher S, Kunz M, Scherder EJ, Corbett A. Pain management in patients with dementia. Clin Interv Aging. 2013; 8:1471–1482.
33. Eslami V, Katz MJ, White RS, Sundermann E, Jiang JM, Ezzati A, Lipton RB. Pain intensity and pain interference in older adults: role of gender, obesity and high-sensitivity C-reactive protein. Gerontology. 2017; 63:3–12.
34. Hunt LJ, Covinsky KE, Yaffe K, Stephens CE, Miao Y, Boscardin WJ, Smith AK. Pain in community-dwelling older adults with dementia: results from the national health and aging trends study. J Am Geriatr Soc. 2015; 63:1503–1511.
35. Leveille SG, Zhang Y, McMullen W, Kelly-Hayes M, Felson DT. Sex differences in musculoskeletal pain in older adults. Pain. 2005; 116:332–338.
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr