The psychometric assessment of the older adult in pain: A systematic review of assessment instruments
Andrew I. G. McLennan, Emily Winters, Michelle M. Gagnon, Thomas Hadjistavropoulos
Abstract
We conducted a systematic review of pain assessment tools suitable for community-dwelling older adults. For this work, we conceptualized existing psychometric tools as falling under the following domains: a) pain intensity/characteristics; b) pain-related interference/disability; c) coping strategies; d) pain beliefs/attitudes/cognitions; e) pain-related fear and anxiety; and f) pain-specific emotional distress. Multi-dimensional and condition-specific tools were also considered. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology for systematic reviews of patient-reported outcome measures guided the evaluation of measurement properties, quality of evidence ratings, and recommendations for each measure. A search of Medline, PsycINFO, Web of Science, and the Cumulative Index of Nursing and Allied Health Literature, yielded a total of 21,755 records. Of these, 120 studies, focusing on 57 psychometric tools, were included in this review and categorized into the aforementioned pain assessment domains. The availability of psychometric studies with older adult populations was insufficient for most tools and the quality of evidence ranged from very low to high. Only a small number of tools met the criteria for a strong or tentative recommendation favoring their use. We identified gaps that should be addressed in future research. • Pain assessment tools were classified into domains (e.g., intensity, coping). • Quality of evidence and measurement properties vary across assessment domains. • Only few tools have undergone adequate psychometric evaluation with older adults. • Tools assessing pain intensity had the strongest psychometric support. • More research is needed in this area.