{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:15:30Z","timestamp":1785402930199,"version":"3.56.0"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,10,22]],"date-time":"2019-10-22T00:00:00Z","timestamp":1571702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000921","name":"European Cooperation in Science and Technology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000921","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recognition of pain in people with dementia is challenging. Observational scales have been developed, but there is a need to harmonize and improve the assessment process. In EU initiative COST\u2010Action TD1005, 36 promising items were selected from existing scales to be tested further. We aimed to study the observer agreement of each item, and to analyse the factor structure of the complete set.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>One hundred and ninety older persons with dementia were recruited in four different countries (Italy, Serbia, Spain and The Netherlands) from different types of healthcare facilities. Patients represented a convenience sample, with no pre\u2010selection on presence of (suspected) pain. The <jats:italic>Pain Assessment in Impaired Cognition<\/jats:italic> (PAIC, research version) item pool includes facial expressions of pain (15 items), body movements (10 items) and vocalizations (11 items). Participants were observed by health professionals in two situations, at rest and during movement. Intrarater and interrater reliability was analysed by percentage agreement. The factor structure was examined with principal component analysis with orthogonal rotation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Health professionals performed observations in 40\u201357 patients in each country. Intrarater and interrater agreement was generally high (\u226570%). However, for some facial expression items, agreement was sometimes below 70%. Factor analyses showed a six\u2010component solution, which were named as follows: Vocal pain expression, Face anatomical descriptors, Protective body movements, Vocal defence, Tension and Lack of affect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Observation of PAIC items can be done reliably in healthcare settings. Observer agreement is quite promising already without extensive training.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>In this international project, promising items from existing observational pain scales were identified and evaluated regarding their reliability as an alternative to pain self\u2010report in people with dementia. Analysis on factor structure helped to understand the character of the items. Health professionals from four countries using four different European languages were able to rate items reliably. The results contributed to an informed reduction of items for a clinical observer scale (<jats:italic>Pain Assessment in Impaired Cognition<\/jats:italic> scale with 15 items: PAIC15).<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.1484","type":"journal-article","created":{"date-parts":[[2019,9,14]],"date-time":"2019-09-14T04:53:55Z","timestamp":1568436835000},"page":"279-296","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Observational pain assessment in older persons with dementia in four countries: Observer agreement of items and factor structure of the <i>Pain Assessment in Impaired Cognition<\/i>"],"prefix":"10.1002","volume":"24","author":[{"given":"Margot W. M.","family":"de Waal","sequence":"first","affiliation":[{"name":"Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelore H.","family":"van Dalen\u2010Kok","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrica C. W.","family":"de Vet","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Amsterdam UMC location VU University Amsterdam Public Health research institute Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Gimenez\u2010Llort","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Forensic Medicine Medical Psychology Unit &amp; Institut de Neuroci\u00e8ncies Universitat Aut\u00f2noma de Barcelona Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ljubica","family":"Konstantinovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Belgrade Clinic for Rehabilitation \"Dr Miroslav Zotovic\" Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"de Tommaso","sequence":"additional","affiliation":[{"name":"Applied Neurophysiopathologist and Pain Unit University Aldo Moro of Bari Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fischer","sequence":"additional","affiliation":[{"name":"Evangelische Hochschule Dresden Pflegewissenschaft Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Lukas","sequence":"additional","affiliation":[{"name":"Malteser Hospital Bonn Geriatric Centre, academic teaching hospital University of Bonn Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Kunz","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology and Sociology University of Augsburg Augsburg Germany"},{"name":"Department of General practice\u2010Geriatrics Faculty of Medical Sciences University of Groningen Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Lautenbacher","sequence":"additional","affiliation":[{"name":"Physiological Psychology University of Bamberg Bamberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Lobbezoo","sequence":"additional","affiliation":[{"name":"Department of Orofacial Pain &amp; Dysfunction Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian E.","family":"McGuire","sequence":"additional","affiliation":[{"name":"School of Psychology and Centre for Pain Research National University of Ireland Galway Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny T.","family":"van der Steen","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilco P.","family":"Achterberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S36739"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-014-0229-5"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2012.53"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000185"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2125"},{"key":"e_1_2_8_7_1","volume-title":"Measurement in medicine: A practical guide","author":"Vet Terwee C. 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