Screening for pain using the SPIN (Scale of Pain Intensity) - a pain assessment tool designed for patients with cognitive / communication deficits following acquired brain injury. American Academy of Physical and Rehabilitation Medicine. 68th Annual assembly. Boston

Lynne Frances Turner-Stokes, R Disler, H. Williams

Research output: Contribution to journalPoster abstract

Abstract

Objective: To examine the validity, reliability, and utility of the Scale of Pain Intensity (SPIN) as a screening tool for pain in patients with complex neurodisability. Design: A prospective cohort analysis. Setting: A tertiary inpatient neurorehabilitation service for severely disabled younger adults. Participants: 57 of 65 consecutive admissions with a median age of 50 years (IQR, 31–55) and male to female ratio of 1:1. All had physical disability: 75% had communicative and 30% had cognitive deficits. Interventions: Screening according to a standardized protocol, which includes inquiry for pain symptoms, administration of the SPIN, and a Numbered Graphic Rating Scale (NGRS) for those (n=36) who were able. Repeat (blind) assessment of the SPIN was undetected in 24 hours (n=23). Main Outcome Measures: The SPIN (possible score range, 0–5) and converted NGRS (normative range, 0–10; divided by 2 to range, 0–5). Results: 46 of 57 (80%) patients were able to use the SPIN screen (5 unable, 6 uncertain). Of 32 (60%) patients who reported pain, the median SPIN score was 2 (range, 1–4), compared with 0 (range, 0–2) in those reporting no pain (Mann-Whitney z=5.9, P<.001). There was a strong correlation between the SPIN and NGRS (Spearman ρ=.96, P<.001). Weighted Cohen κ tests showed excellent agreement with the converted NGRS score (.94). Of those who had a repeat assessment, 14 (60.9%) indicated that their level of pain had changed since the day before and 6 (26.1%) indicated the same level of pain. These changes were reflected in their SPIN scores, with correspondingly reduced agreement (κ=.59) with the initial SPIN assessment. Conclusions: The SPIN appears to provide a valid screening instrument for the presence of pain, which was also sensitive to change. It also seemed to be more accessible to more patients with cognitive and communicative deficits than conventional pain scales such as the NGRS. Further testing is now warranted.
Original languageEnglish
JournalArchives of Physical Medicine and Rehabilitation
DOIs
Publication statusPublished - 2007

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