A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia

Mustafa Atee,1 Kreshnik Hoti,1,2 Richard Parsons,1 Jeffery D Hughes1 1School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia; 2Division of Pharmacy, Faculty of Medicine, University of Pristina, Prishtina, Kosovo Objectives: Regardless of i...

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Autores principales:	Atee M, Hoti K, Parsons R, Hughes JD
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	inter-rater reliability ePAT pain dementia facial action units automated facial expression analysis total pain scores Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/a10978a9c3174c419d754fffc793483d
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spelling	oai:doaj.org-article:a10978a9c3174c419d754fffc793483d2021-12-02T09:07:57ZA novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia1178-1998https://doaj.org/article/a10978a9c3174c419d754fffc793483d2018-07-01T00:00:00Zhttps://www.dovepress.com/a-novel-pain-assessment-tool-incorporating-automated-facial-analysis-i-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Mustafa Atee,1 Kreshnik Hoti,1,2 Richard Parsons,1 Jeffery D Hughes1 1School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia; 2Division of Pharmacy, Faculty of Medicine, University of Pristina, Prishtina, Kosovo Objectives: Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. Study design: A 2-week observational study. Setting: An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. Participants: Subjects were 10 residents (age range: 63.1–84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. Measurements: ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. Results: A total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters’ agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85–0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κw=0.72 (95% CI: 0.58–0.86) at rest and κw=0.69 (95% CI: 0.50–0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; p<0.0012) and following mobilization (mean: 2.5 vs 1.7; p<0.0001) compared to no pain and rest, respectively. Conclusions: ePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia. Keywords: interrater reliability, ePAT, pain, pain assessment, PainChek®, dementia, facial action units, automated facial expression analysis, total pain scoresAtee MHoti KParsons RHughes JDDove Medical Pressarticleinter-rater reliabilityePATpaindementiafacial action unitsautomated facial expression analysistotal pain scoresGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 13, Pp 1245-1258 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	inter-rater reliability ePAT pain dementia facial action units automated facial expression analysis total pain scores Geriatrics RC952-954.6
spellingShingle	inter-rater reliability ePAT pain dementia facial action units automated facial expression analysis total pain scores Geriatrics RC952-954.6 Atee M Hoti K Parsons R Hughes JD A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia
description	Mustafa Atee,1 Kreshnik Hoti,1,2 Richard Parsons,1 Jeffery D Hughes1 1School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia; 2Division of Pharmacy, Faculty of Medicine, University of Pristina, Prishtina, Kosovo Objectives: Regardless of its severity, dementia does not negate the experience of pain. Rather, dementia hinders self-reporting mechanisms in affected individuals because they lose the ability to do so. The primary aim of this study was to examine the interrater reliability of the electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to-severe dementia. Secondly, it sought to examine the relationship between total instrument scores and facial scores, as determined by automated facial expression analysis. Study design: A 2-week observational study. Setting: An accredited, high-care, and dementia-specific residential aged care facility in Perth, Western Australia. Participants: Subjects were 10 residents (age range: 63.1–84.4 years old) predominantly with severe dementia (Dementia Severity Rating Scale score: 46.3±8.4) rated for pain by 11 aged care staff. Raters (female: 82%; mean age: 44.1±12.6 years) consisted of one clinical nurse, four registered nurses, five enrolled nurses, and one care worker. Measurements: ePAT measured pain using automated detection of facial action codes and recordings of pain behaviors. Results: A total of 76 assessments (rest =38 [n=19 pairs], movement =38 [n=19 pairs]) were conducted. At rest, raters’ agreement was excellent on overall total scores (coefficient of concordance =0.92 [95% CI: 0.85–0.96]) and broad category scores (κ=1.0). Agreement was moderate (κ=0.59) on categorical scores upon movement, while it was exact in 68.4% of the cases. Agreement in actual pain category scores gave κw=0.72 (95% CI: 0.58–0.86) at rest and κw=0.69 (95% CI: 0.50–0.87) with movement. All raters scored residents with higher total scores post-mobilization compared to rest. More facial action unit codes were also detected during pain (mean: 2.5 vs 1.9; p<0.0012) and following mobilization (mean: 2.5 vs 1.7; p<0.0001) compared to no pain and rest, respectively. Conclusions: ePAT, which combines automated facial expression analysis and clinical behavioral indicators in a single observational pain assessment tool, demonstrates good reliability properties, which supports its appropriateness for use in residents with advanced dementia. Keywords: interrater reliability, ePAT, pain, pain assessment, PainChek®, dementia, facial action units, automated facial expression analysis, total pain scores
format	article
author	Atee M Hoti K Parsons R Hughes JD
author_facet	Atee M Hoti K Parsons R Hughes JD
author_sort	Atee M
title	A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia
title_short	A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia
title_full	A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia
title_fullStr	A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia
title_full_unstemmed	A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia
title_sort	novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/a10978a9c3174c419d754fffc793483d
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A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia

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