Premium
Body movements as pain indicators in older people with cognitive impairment: A systematic review
Author(s) -
Strand Liv Inger,
Gundrosen Kim Fredrik,
Lein Regina Küfner,
Laekeman Marjan,
Lobbezoo Frank,
Defrin Ruth,
Husebo Bettina S.
Publication year - 2019
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.1344
Subject(s) - cinahl , medline , systematic review , dementia , psychology , cochrane library , cognition , pain assessment , clinical psychology , physical therapy , physical medicine and rehabilitation , medicine , psychological intervention , psychiatry , alternative medicine , pain management , disease , pathology , political science , law
Background and objective Pain assessment tools for cognitively impaired older people, unable to self‐report pain, are commonly founded upon observation of pain behaviour, such as facial expressions, vocalizations and body movements. The scientific basis for claiming that body movements may indicate pain has not formerly been investigated in a systematic review. The objective was to explore research evidence for body movements being pain indicators in older people with cognitive impairment. Data bases and data treatment MEDLINE , EMBASE , CINAHL , Psyc INFO and the Cochrane Library were searched systematically. Two researchers independently identified and consented on studies to be included. PRISMA statement for reporting systematic reviews was followed. Mixed Methods Appraisal Tool was used for critical evaluation of study quality. Results A total of 2,096 records from the literature searches were identified, and 17 quantitative and eight qualitative studies were included in the review, the studies mainly related to older people with dementia. Quality scores ranged from 50% to 100%. We combined 62 items of body movements into 13 similar or synonymous items, and criteria for evidence were defined. Strong evidence was found for restlessness (agitation), rubbing, guarding, rigidity and physical aggression as the behaviours frequently responded (increased or decreased) to pain provoking activities, painful procedures and/or pain medication. Conclusions Among 13 categories of body movements, we found five with strong and five with moderate evidence of validity. As few items were typically included in many studies reflecting criterion validity, all should be included in future studies of patients with different characteristics, location and duration of pain. Significance Pain assessment tools for older people with cognitive impairment or dementia should include valid pain behaviour items. Our review shows strong scientific evidence for the following body movements indicating pain: restlessness (agitation), rubbing, guarding, rigidity and physical aggression .