Clinimetric properties of the electronic Pain Assessment Tool (ePAT) for aged-care residents with moderate to severe dementia

Journal of Pain Research, Jun 2018

Clinimetric properties of the electronic Pain Assessment Tool (ePAT) for aged-care residents with moderate to severe dementia Kreshnik Hoti,1,2 Mustafa Atee,1 Jeffery D Hughes1 1School of Pharmacy, Curtin University, Perth, Australia; 2Division of Pharmacy, Faculty of Medicine, University of Prishtina, Pristina, Kosovo Purpose: Accurate pain assessment is critical to detect pain and facilitate effective pain management in dementia patients. The electronic Pain Assessment Tool (ePAT) is a point-of-care solution that uses automated facial analysis in conjunction with other clinical indicators to evaluate the presence and intensity of pain in patients with dementia. This study aimed to examine clinimetric properties (clinical utility and predictive validity) of the ePAT in this population group. Methods: Data were extracted from a prospective validation (observational) study of the ePAT in dementia patients who were ≥65 years of age, living in a facility for ≥3 months, and had Psychogeriatric Assessment Scales – cognitive scores ≥10. The study was conducted in two residential aged-care facilities in Perth, Western Australia, where residents were sampled using purposive convenience strategy. Predictive validity was measured using accuracy statistics (sensitivity, specificity, positive predictive value, and negative predictive value). Positive and negative clinical utility index (CUI) scores were calculated using Mitchell’s formula. Calculations were based on comparison with the Abbey Pain Scale, which was used as a criterion reference. Results: A total of 400 paired pain assessments for 34 residents (mean age 85.5±6.3 years, range 68.0–93.2 years) with moderate–severe dementia (Psychogeriatric Assessment Scales – cognitive score 11–21) were included in the analysis. Of those, 303 episodes were classified as pain by the ePAT based on a cutoff score of 7. Unadjusted prevalence findings were sensitivity 96.1% (95% CI 93.9%–98.3%), specificity 91.4% (95% CI 85.7%–97.1%), accuracy 95.0% (95% CI 92.9%–97.1%), positive predictive value 97.4% (95% CI 95.6%–99.2%), negative predictive value 87.6% (95% CI 81.1%–94.2%), CUI+ 0.936 (95% CI 0.911–0.960), CUI– 0.801 (95% CI 0.748–0.854). Conclusion: The clinimetric properties demonstrated were excellent, thus supporting the clinical usefulness of the ePAT when identifying pain in patients with moderate–severe dementia. Keywords: ePAT, PainChek, pain assessment, dementia, predictive validity, clinical utility, automated facial analysis

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Clinimetric properties of the electronic Pain Assessment Tool (ePAT) for aged-care residents with moderate to severe dementia

Journal of Pain Research Clinimetric properties of the electronic Pain Assessment Tool (ePAT) for aged-care residents with moderate to severe dementia Kreshnik Hoti 0 1 Mustafa Atee 1 Jeffer y D Hughes 1 0 Division of Pharmacy, Faculty of Medicine, University of Prishtina , Pristina, Kosovo 1 School of Pharmacy, Curtin University , Perth , Australia 8 1 0 2 - l u J - 2 1 n o 2 7 1 . 3 6 1 . 7 3 . 4 5 y b / m o c . s rsvpee l.yon PowerdbyTCPDF(ww.tcpdf.org) Purpose: Accurate pain assessment is critical to detect pain and facilitate effective pain management in dementia patients. The electronic Pain Assessment Tool (ePAT) is a point-of-care solution that uses automated facial analysis in conjunction with other clinical indicators to evaluate the presence and intensity of pain in patients with dementia. This study aimed to examine clinimetric properties (clinical utility and predictive validity) of the ePAT in this population group. Methods: Data were extracted from a prospective validation (observational) study of the ePAT in dementia patients who were ≥65 years of age, living in a facility for ≥3 months, and had Psychogeriatric Assessment Scales - cognitive scores ≥10. The study was conducted in two residential aged-care facilities in Perth, Western Australia, where residents were sampled using purposive convenience strategy. Predictive validity was measured using accuracy statistics (sensitivity, specificity, positive predictive value, and negative predictive value). Positive and negative clinical utility index (CUI) scores were calculated using Mitchell's formula. Calculations were based on comparison with the Abbey Pain Scale, which was used as a criterion reference. Results: A total of 400 paired pain assessments for 34 residents (mean age 85.5±6.3 years, range 68.0-93.2 years) with moderate-severe dementia (Psychogeriatric Assessment Scales - cognitive score 11-21) were included in the analysis. Of those, 303 episodes were classified as pain by the ePAT based on a cutoff score of 7. Unadjusted prevalence findings were sensitivity 96.1% (95% CI 93.9%-98.3%), specificity 91.4% (95% CI 85.7%-97.1%), accuracy 95.0% (95% CI 92.9%-97.1%), positive predictive value 97.4% (95% CI 95.6%-99.2%), negative predictive value 87.6% (95% CI 81.1%-94.2%), CUI+ 0.936 (95% CI 0.911-0.960), CUI- 0.801 (95% CI 0.748-0.854). Conclusion: The clinimetric properties demonstrated were excellent, thus supporting the clinical usefulness of the ePAT when identifying pain in patients with moderate-severe dementia. - with dementia and constitute a significant burden for their families and carers.1–3 In order to improve the current situation, the electronic Pain Assessment Tool [ePAT; also known as PainChek] was developed, which is a point-of-care smart device-enabled application that uses automated facial (video) analysis in conjunction with clinical indicators to evaluate the presence and intensity of pain in those with communication difficulties, including dementia.4 This application was 8 021 designed to improve the objectivity and accuracy of assessing l--Ju pain in patients with dementia, ultimately leading to effective 21n pain management for this disadvantaged group. o2 In July 2017, the ePAT application was approved as a .173 Class I medical device by the Therapeutic Goods Administra.671 tion in Australia and received the CE mark in Europe “. . . to .354 assess and monitor pain in people who cannot verbalise such /yb as people with dementia or communication difficulties.”5 com To date, the application has been validated in a total of 74 .s residents aged 60–98 years across five residential aged-care rsvpee l.yon facilities in Western Australia.4,6 In this setting, it has shown .dow lsue strong psychometric properties, including concurrent validity, /ww ano discriminant validity, and interrater reliability.4,6 :/tsp rspe Clinimetric properties, such as predictive validity and th ro clinical utility (CU), are also important criteria in evaluatfrom F ing new pain-assessment tools, because they determine dde the usefulness and applicability of the tool in the clinical lano setting.7 Literature data indicate that a large number of odw psychometric evaluation studies of pain-assessment tools rcha have neglected this aspect.2,8,9 Zwakhalen et al point out that see further research should test validity, reliability, and CU of inR existing pain-assessment tools with the view of improving faP them.8 Furthermore, a more recent systematic review by o lna Lichtner et al concluded that no single pain-assessment tool rJou can be currently recommended in patients with dementia on the basis of lack of evidence concerning validity and CU to assess pain in patients with cognitive impairment.2 The CU of a pain-assessment tool is an essential clinimetric parameter that goes beyond the analytical, technical, or even diagnostic accuracy performance of the tool.10 Testing CU in fact provides more insight into potential health benefits and out (...truncated)


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Kreshnik Hoti, Mustafa Atee, Jeffery D Hughes. Clinimetric properties of the electronic Pain Assessment Tool (ePAT) for aged-care residents with moderate to severe dementia, Journal of Pain Research, 2018, pp. 1037-1044, DOI: 10.2147/JPR.S158793