Interactive computer animation pain assessment: Application with older patients in a chronic care and rehabilitation hospital.

摘要

Traditionally, pain assessment has relied on two broad approaches to measurement: behavioural techniques and self-report methods. There are many patient populations for whom these approaches are problematic, particularly geriatric patients. An experimental pain assessment device known as Interactive Computer Animation (IA) has been developed as an alternative to self-report procedures that rely on verbal communication and, therefore, are subject to certain biases of language (Swanston, Abraham, Macrae, Walker, Rushmer, Elder & Methven, 1993). IA is comprised of four animated modules (representing Throbbing, Burning, Piercing and Pressure) as well as a Visual Analogue Scale, which can be manipulated through the use of arrow keys in order to reflect the quality and quantity of the subjects' pain experience. Preliminary work comparing the results of the IA to the definitive self-report assessment tool used by clinicians today--the McGill Pain Questionnaire (Melzack, 1987) has shown good concurrent validity. The sample employed in the Swanston et al. (1993) study ;The purpose of the present study was to investigate the usefulness of IA as a measure of pain in a population of subjects who have received relatively little attention in the field of clinical pain measurement, and who present certain challenges to traditional methods of assessment, that is, older adult patients in a long-term care, rehabilitation setting. Fifty-one subjects who were identified as having pain of least one month's duration, and who consented to take part in the study, underwent a pain assessment battery that included a modified version of the Short-Form McGill Pain Questionnaire which is considered one of the "Gold Standards" of pain measurement (Forrest, 1995; Roy, 1995) and IA. The high correlations found between analogous items of the two measures is indicative of the concurrent validity of the new technique. Correlations obtained in the present study (with older adults) were comparable to data from younger subjects in the Swanson et al. (1993) study, suggesting that age does not have a major effect on the way in which IA is used. A subset of the entire sample ;Age and cognitive function (as assessed by the Standardized Mini-Mental State Examination) did not predict preference for one measure over another, the number of IA items chosen, or the difference in z-transformed Modified SF-MPQ scores from IA scores. Not only is IA a valid measure of pain in an older population, it is preferred to the paper-and-pencil assessment technique, and it holds promise for populations with even greater physical and cognitive deficits than the one studied here. This study opens the door for research into the usefulness of IA with older, institutionalized patients who may not be able to report their pain with traditional techniques like the SF-MPQ.