These criteria identified 10 behaviourally-based pain assessment tools for use with older adults with dementia. The tools were evaluated in each of the areas of “conceptualization, subjects, administration, reliability, and validity.” The authors independently critiqued each tool and applied a score from 0-3 for each of the five evaluation categories, with a score of 3 indicating strong evidence for each construct to 0 for no evidence.

Studies that described the implementation and evaluation of the 10 tools were analysed and the strengths and limitations noted to arrive at a total score for each tool. This process revealed that only one #find more keyword# tool has been tested with older adults in acute care settings (the Abbey Pain Scale)[27]. The authors concluded that, while some tools are potentially useful, weaknesses in the tools Inhibitors,research,lifescience,medical evaluated mean that there is currently “no standardized tool based Inhibitors,research,lifescience,medical on nonverbal behavioural pain indicators in English that may be recommended for broad adoption in clinical practice”[26]. One reason given for this conclusion was the acknowledgment that the ability

to recognise pain and rate pain severity on the basis of behavioural cues is limited by significant inter-patient variability in pain-related behaviours that may Inhibitors,research,lifescience,medical also be affected by co morbid conditions such as stroke and psychiatric illness. The study by Zwakhalen et al used a more comprehensive scoring method that, in addition to the categories evaluated by Herr et al, included an evaluation of study size and homogeneity of studies. The expanded range of scores for each of the constructs being evaluated produced Inhibitors,research,lifescience,medical a total possible score of 20. The authors evaluated seven of the tools reported by Herr and colleagues, and evaluated an additional five tools that were not included in the former study, before recommending

the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC)[28] and DOLOPLUS-2[29]. scales as the most appropriate scales currently available. The difference Sitaxentan in results between these two studies reflects differences in evaluation methodology. For example, the highest rating tool in the Herr et al study was the DS-DAT, but this tool was excluded from the study by Zwakhalen and colleagues as this tool attempted to rate discomfort rather than pain, and was therefore conceptually different than other tools designed to evaluate pain in this population. Differences in the study results may also reflect a lack of consensus on how to validate tools for observational assessment of pain behaviours.