{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T23:06:07Z","timestamp":1790463967833,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T00:00:00Z","timestamp":1707436800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To identify specific facial expressions associated with pain behaviors using the PainChek application in residents with dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This is a secondary analysis from a study exploring the feasibility of PainChek to evaluate the effectiveness of a social robot (PARO) intervention on pain for residents with dementia from June to November 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants experienced PARO individually five days per week for 15\u2009min (once or twice) per day for three consecutive weeks. The PainChek app assessed each resident's pain levels before and after each session. The association between nine facial expressions and the adjusted PainChek scores was analyzed using a linear mixed model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1820 assessments were completed with 46 residents. Six facial expressions were significantly associated with a higher adjusted PainChek score. Horizontal mouth stretch showed the strongest association with the score, followed by brow lowering parting lips, wrinkling of the nose, raising of the upper lip and closing eyes. However, the presence of cheek raising, tightening of eyelids and pulling at the corner lip were not significantly associated with the score. Limitations of using the PainChek app were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Six specific facial expressions were associated with observational pain scores in residents with dementia. Results indicate that automated real\u2010time facial analysis is a promising approach to assessing pain in people with dementia. However, it requires further validation by human observers before it can be used for decision\u2010making in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>Pain is common in people with dementia, while assessing pain is challenging in this group. This study generated new evidence of facial expressions of pain in residents with dementia. Results will inform the development of valid artificial intelligence\u2010based algorithms that will support healthcare professionals in identifying pain in people with dementia in clinical situations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>The study adheres to the CONSORT reporting guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>One resident with dementia and two family members of people with dementia were consulted and involved in the study design, where they provided advice on the protocol, information sheets and consent forms, and offered valuable insights to ensure research quality and relevance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jan.16063","type":"journal-article","created":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T07:49:45Z","timestamp":1707464985000},"page":"3846-3855","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Associations between facial expressions and observational pain in residents with dementia and chronic pain"],"prefix":"10.1111","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0136-0940","authenticated-orcid":false,"given":"Lihui","family":"Pu","sequence":"first","affiliation":[{"name":"Menzies Health Institute Queensland Griffith University  Brisbane Queensland Australia"},{"name":"School of Nursing and Midwifery Griffith University  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3958-4408","authenticated-orcid":false,"given":"Michel W.","family":"Coppieters","sequence":"additional","affiliation":[{"name":"Menzies Health Institute Queensland Griffith University  Brisbane Queensland Australia"},{"name":"School of Health Sciences and Social Work Griffith University  Brisbane Queensland Australia"},{"name":"Amsterdam Movement Sciences \u2013 Program Musculoskeletal Health, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0538-4843","authenticated-orcid":false,"given":"Martin","family":"Smalbrugge","sequence":"additional","affiliation":[{"name":"Department of Medicine for Older People Amsterdam UMC, Vrije Universiteit Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Public Health Research Institute, Aging &amp; Later Life  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7249-2580","authenticated-orcid":false,"given":"Cindy","family":"Jones","sequence":"additional","affiliation":[{"name":"Menzies Health Institute Queensland Griffith University  Brisbane Queensland Australia"},{"name":"Faculty of Health Sciences &amp; Medicine Bond University  Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6562-711X","authenticated-orcid":false,"given":"Joshua","family":"Byrnes","sequence":"additional","affiliation":[{"name":"Menzies Health Institute Queensland Griffith University  Brisbane Queensland Australia"},{"name":"Centre for Applied Health Economics, School of Medicine and Dentistry Griffith University  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0806-5610","authenticated-orcid":false,"given":"Michael","family":"Todorovic","sequence":"additional","affiliation":[{"name":"Menzies Health Institute Queensland Griffith University  Brisbane Queensland Australia"},{"name":"School of Nursing and Midwifery Griffith University  Brisbane Queensland Australia"},{"name":"Faculty of Health Sciences &amp; Medicine Bond University  Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3004-9019","authenticated-orcid":false,"given":"Wendy","family":"Moyle","sequence":"additional","affiliation":[{"name":"Menzies Health Institute Queensland Griffith University  Brisbane Queensland Australia"},{"name":"School of Nursing and Midwifery Griffith University  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.12968\/ijpn.2004.10.1.12013"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532\u20105415.50.6s.1.x"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmn.2020.06.005"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpain.2022.827551"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2018.00117"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2020.10.011"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.12204"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2021.06.009"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2012.53"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/7576292"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000195"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001593"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1322355111"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmn.2015.03.003"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2019.01.156"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.1477"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1532\u20102149.2013.00421.x"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001424"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.1691"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2007.09.007"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/6635496"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.2174\/1567205013666160603010455"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010018\u20100773\u20108"},{"key":"e_1_2_13_25_1","doi-asserted-by":"crossref","unstructured":"Martinez D. Ognjen R. O. &Picard R.(2017).Personalized Automatic Estimation of Self\u2010Reported Pain Intensity from Facial Expressions2017 IEEE Conference on Computer Vision and Pattern Recognition Workshops (CVPRW) Honolulu HI USA 2017 (pp. 2318\u20132327).","DOI":"10.1109\/CVPRW.2017.286"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10433\u2010012\u20100234\u20108"},{"key":"e_1_2_13_27_1","doi-asserted-by":"crossref","unstructured":"Prajod P. Huber T. &Andr\u00e9 E.(2022).Using Explainable AI to Identify Differences Between Clinical and Experimental Pain Detection Models Based on Facial Expressions. MultiMedia Modeling Cham.","DOI":"10.1007\/978-3-030-98358-1_25"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpain.2021.788606"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2008.04.010"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15106"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228\u2010020\u201002995\u2010w"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.3390\/su132011502"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2019.2900022"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S144651"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2016.12.078"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2021.05.010"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/00019442\u2010200002000\u201000010"},{"key":"e_1_2_13_38_1","doi-asserted-by":"crossref","unstructured":"Xu X. &Sa V. R. d.(2021).Personalized Pain Detection in Facial Video with Uncertainty Estimation. 2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC) (pp. 4163\u20134168).https:\/\/doi.org\/10.1109\/EMBC46164.2021.9631056","DOI":"10.1109\/EMBC46164.2021.9631056"}],"container-title":["Journal of Advanced Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jan.16063","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T02:40:30Z","timestamp":1723171230000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jan.16063"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,9]]},"references-count":37,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1111\/jan.16063"],"URL":"https:\/\/doi.org\/10.1111\/jan.16063","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1111\/JAN.16063\/v3\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JAN.16063\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JAN.16063\/v4\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JAN.16063\/v1\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JAN.16063\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JAN.16063\/v2\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JAN.16063\/v2\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JAN.16063\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JAN.16063\/v4\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/JAN.16063\/v3\/decision1","asserted-by":"object"}]},"ISSN":["0309-2402","1365-2648"],"issn-type":[{"value":"0309-2402","type":"print"},{"value":"1365-2648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,9]]},"assertion":[{"value":"2023-05-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}