Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake

Scand J Caring Sci; 2009; 23; 180–189Pain behaviour and pain intensity in older persons withsevere dementia: reliability of the MOBID Pain Scale byvideo uptakeAdvancing age is associated with high prevalence ofdementia, often combined with under-diagnosed and un-der-treated pain. A nurse-administered assessment tool hasbeen developed to unmask pain during standardised, gui-ded movements, called Mobilisation–Observation–Behav-iour–Intensity–Dementia (MOBID) Pain Scale. The aimwas to examine intra- and inter-rater reliability of painbehaviour indicators, inferred pain intensity, and theoverall MOBID Pain Score. Twenty-six nursing home pa-tients with severe dementia and chronic pain, 11 primarycaregivers and three external raters at the Red CrossNursing Home, Bergen were included. During videouptake the patients were guided by their primary care-givers to standardised movements of different body parts.Pain behaviour indicators (pain noises, facial expressionand defence) were registered for each movement withsubsequent rating of pain intensity by external raters, whoassessed and scored the videos concurrently and inde-pendently at day 1, 4 and 8. Facial expression was mostcommonly observed, followed by pain noises and defence.Repeated assessments increased the number of observedpain behaviours, but did not improve reliability. Inter-raterreliability was highest for noises, followed by defence andfacial expression (j = 0.44–0.92, j = 0.10–0.76 andj = 0.05–0.76 respectively, at day 8). Mobilisation of armsand legs were rated most painful. Intra- and inter-raterreliability of overall pain were very good [intraclass cor-relation coefficient (1,1) ranging 0.92–0.97 and 0.94–0.96respectively, at day 8]. Reliability of pain intensity scorestended to increase by repeated assessment. Using videouptake, MOBID Pain Scale was shown to be sufficientlyreliable to assess pain in older persons with severedementia.Keywords: instrument development, statistics, researchmethods, dementia, pain, nursing home care, gerontology,musculoskeletal, quality of care.Submitted 13 September 2007, Accepted 18 January 2008