The Verbal Rating Scale Is Reliable for Assessment of Postoperative Pain in Hip Fracture Patients

Rune Dueholm Bech, Jens Lauritsen, Ole Ovesen, Søren Overgaard, Rune Dueholm Bech, Jens Lauritsen, Ole Ovesen, Søren Overgaard

Abstract

Background. Hip fracture patients represent a challenge to pain rating due to the high prevalence of cognitive impairment. Methods. Patients prospectively rated pain on the VRS. Furthermore, patients described the changes in pain after raising their leg, with one of five descriptors. Agreement between paired measures on the VRS at rest and by passive straight leg raise with a one-minute interval between ratings at rest and three-minute interval for straight leg raise was expressed by kappa coefficients. Reliability of this assessment of pain using the VRS was compared to the validity of assessing possible change in pain from the selected descriptors. Cognitive status was quantified by the short Orientation-Memory-Concentration Test. Results. 110 patients were included. Paired scores with maximum disagreement of one scale point reached 97% at rest and 95% at straight leg raise. Linear weighted kappa coefficients ranged from 0.68 (95% CI = 0.59-0.77) at leg raise to 0.75 (95% CI = 0.65-0.85) at rest. Unweighted kappa coefficients of agreement in recalled pain compared to agreement of paired VRS scores ranged from 0.57 (95% CI = 0.49-0.65) to 0.36 (95% CI = 0.31-0.41). Interpretation. The VRS is reliable for assessment of pain after hip fracture. The validity of intermittent questioning about possible change in pain intensity is poor.

Figures

Figure 1
Figure 1
Flowchart of patients. 107 paired measures were assessed at rest. 103 patients completed paired measures at straight leg raise.
Figure 2
Figure 2
Diagram of pain rating.
Figure 3
Figure 3
VRS at rest. The bars and percentages show disagreement of 0, 1, and 2 scale points between the paired scores. Maximum disagreement was 2 scale points.
Figure 4
Figure 4
VRS at straight leg raise. The bars and percentages show disagreement of 0–3 scale points between the paired scores. Maximum disagreement was 3 scale points.

References

    1. Foss N. B., Kristensen M. T., Kristensen B. B., Jensen P. S., Kehlet H. Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery: a randomized, double-blind, placebo-controlled trial. Anesthesiology. 2005;102(6):1197–1204. doi: 10.1097/00000542-200506000-00020.
    1. Bech R. D., Lauritsen J., Ovesen O., Emmeluth C., Lindholm P., Overgaard S. Local anaesthetic wound infiltration after internal fixation of femoral neck fractures: a randomized, double-blind clinical trial in 33 patients. HIP International. 2011;21(2):251–259. doi: 10.5301/hip.2011.6513.
    1. Closs S. J., Barr B., Briggs M., Cash K., Seers K. A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment. Journal of Pain and Symptom Management. 2004;27(3):196–205. doi: 10.1016/j.jpainsymman.2003.12.010.
    1. Jensen M. P., Karoly P., Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27(1):117–126. doi: 10.1016/0304-3959(86)90228-9.
    1. Gagliese L., Weizblit N., Ellis W., Chan V. W. S. The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients. Pain. 2005;117(3):412–420. doi: 10.1016/j.pain.2005.07.004.
    1. Wade D. T., Vergis E. The short orientation-memory-concentration test: a study of its reliability and validity. Clinical Rehabilitation. 1999;13(2):164–170. doi: 10.1191/026921599673848768.
    1. Goring H., Baldwin R., Marriott A., Pratt H., Roberts C. Validation of short screening tests for depression and cognitive impairment in older medically ill patients. International Journal of Geriatric Psychiatry. 2004;19(5):465–471. doi: 10.1002/gps.1115.
    1. Davous Lamour P. Y., Debrand E., Rondot P. A comparative evaluation of the short orientation memory concentration test of cognitive impairment. Journal of Neurology Neurosurgery and Psychiatry. 1987;50(10):1312–1317. doi: 10.1136/jnnp.50.10.1312.
    1. Lauritsen J. Simpel Funktionsmåling. 2007. (Danish)
    1. Katzman R., Brown T., Fuld P., Peck A., Schechter R., Schimmel H. Validation of a short orientation-memory-concentration test of congestive impairment. American Journal of Psychiatry. 1983;140(6):734–739. doi: 10.1176/ajp.140.6.734.
    1. Sim J., Wright C. C. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Physical Therapy. 2005;85(3):257–268.
    1. Landis J. R., Koch G. G. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174. doi: 10.2307/2529310.
    1. Feldt K. S., Ryden M. B., Miles S. Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture. Journal of the American Geriatrics Society. 1998;46(9):1079–1085. doi: 10.1111/j.1532-5415.1998.tb06644.x.
    1. Morrison R. S., Magaziner J., McLaughlin M. A., et al. The impact of post-operative pain on outcomes following hip fracture. Pain. 2003;103(3):303–311. doi: 10.1016/S0304-3959(02)00458-X.
    1. Pesonen A., Kauppila T., Tarkkila P., Sutela A., Niinisto L., Rosenberg P. H. Evaluation of easily applicable pain measurement tools for the assessment of pain in demented patients. Acta Anaesthesiologica Scandinavica. 2009;53(5):657–664. doi: 10.1111/j.1399-6576.2009.01942.x.
    1. Pesonen A., Suojaranta-Ylinen R., Tarkkila P., Rosenberg P. H. Applicability of tools to assess pain in elderly patients after cardiac surgery. Acta Anaesthesiologica Scandinavica. 2008;52(2):267–273. doi: 10.1111/j.1399-6576.2007.01480.x.
    1. Parmelee P. A. Pain in cognitively impaired older persons. Clinics in Geriatric Medicine. 1996;12(3):473–487.
    1. Harkins S. W. Geriatric pain. Pain perceptions in the old. Clinics in Geriatric Medicine. 1996;12(3):435–459.
    1. Folstein M. F., Folstein S. E., McHugh P. R. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975;12(3):189–198.
    1. Melzack R. The McGill pain questionnaire: from description to measurement. Anesthesiology. 2005;103(1):199–202. doi: 10.1097/00000542-200507000-00028.
    1. Coll A. M., Ameen J. R. M., Mead D. Postoperative pain assessment tools in day surgery: literature review. Journal of Advanced Nursing. 2004;46(2):124–133. doi: 10.1111/j.1365-2648.2003.02972.x.
    1. Rakel B., Herr K. Assessment and treatment of postoperative pain in older adults. Journal of Perianesthesia Nursing. 2004;19(3):194–208. doi: 10.1016/j.jopan.2004.03.005.
    1. Leino K. A., Kuusniemi K. S., Lertola K. K., Olkkola K. T. Comparison of four pain scales in patients with hip fracture or other lower limb trauma. Acta Anaesthesiologica Scandinavica. 2011;55(4):495–502. doi: 10.1111/j.1399-6576.2010.02373.x.
    1. Herr K. A., Spratt K., Mobily P. R., Richardson G. Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clinical Journal of Pain. 2004;20(4):207–219. doi: 10.1097/00002508-200407000-00002.
    1. Hadjistavropoulos T., Herr K., Turk D. C., et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. The Clinical Journal of Pain. 2007;23(1, supplement):S1–S43. doi: 10.1097/AJP.0b013e31802be869.
    1. Peters M. L., Patijn J., Lamé I. Pain assessment in younger and older pain patients: psychometric properties and patient preference of five commonly used measures of pain intensity. Pain Medicine. 2007;8(7):601–610. doi: 10.1111/j.1526-4637.2007.00311.x.
    1. Pautex S., Herrmann F., Le Lous P., Fabjan M., Michel J.-P., Gold G. Feasibility and reliability of four pain self-assessment scales and correlation with an observational rating scale in hospitalized elderly demented patients. Journals of Gerontology—Series A Biological Sciences and Medical Sciences. 2005;60(4):524–529. doi: 10.1093/gerona/60.4.524.
    1. Nymark T., Lauritsen J. M., Ovesen O., Röck N. D., Jeune B. Decreasing incidence of hip fracture in the Funen County, Denmark. Acta Orthopaedica. 2006;77(1):109–113. doi: 10.1080/17453670610045777.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit