Reliability and Validity of the Thai Version of the PAINAD Scale: An Extended Application of Pain Assessment in the Moderately Severe Stage of Dementia

Natthapapath Boonsawat; Patumporn Suraarunsumrit; Sutisa Pitiyarn; Napaporn Pengsorn; Varalak Srinonprasert; Sahatsa Mandee; Titima Wongviriyawong

doi:10.33192/smj.v77i1.271644

Authors

Natthapapath Boonsawat Division of Geriatric Medicine, Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand; Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Patumporn Suraarunsumrit Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Sutisa Pitiyarn Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Napaporn Pengsorn Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Varalak Srinonprasert Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Sahatsa Mandee Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Titima Wongviriyawong Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v77i1.271644

Keywords:

Pain, Dementia, Reproducibility of Results

Abstract

Objective: To evaluate the reliability and validity of the Thai version of the PAINAD (PAINAD-Th) scale for assessing pain in people with dementia (PwD).

Materials and methods: A cross-cultural translation of the PAINAD scale involving forward and back-translation to and from Thai was conducted, and then the content validity index (CVI) of semantic equivalence was evaluated. The PAINAD-Th was tested on 120 videos of PwD. Each participant was recorded in two videos: one during an activity and the other at rest. Subsequently, two trained nurses independently observed the videos and rated the PAINAD-Th to assess inter-rater reliability. The rating process was repeated in one week to investigate the test-retest reliability. The concurrent validity was assessed against the Visual Analogue Scale rated by the expert committee.

Results: The CVI of PAINAD-Th was 1.00 for forward translation and 0.93 for back translation. The PAINAD-Th showed strong correlations with the reference standard (rs=0.854–0.943, p-value <0.001). The inter-rater agreement for the total scores was 0.937 and 0.955, and the test-retest reliabilities were 0.914 to 0.964 for the activity stage and 0.880 for the resting stage, respectively. The concurrent validity index did not vary significantly across different stages of dementia; the findings remained consistent in the delirium subgroup analysis.

Conclusions: The PAINAD-Th is a valuable tool for evaluating pain in PwD, not only in severe dementia but also in moderately severe stage, regardless of concurrent delirium. It also demonstrated good-to-excellent concurrent validity, inter-rater reliability, and test-retest reliability.

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