Development of the Japanese DOLOPLUS-2: A pain assessment scale for the elderly with Alzheimer's disease

Background: Pain assessment in non‐communicative patients relies primarily on observation scales. The DOLOPLUS‐2 is a behavioral pain assessment scale for the elderly with impaired verbal communication. It rates five somatic items, two psychomotor items, and three psychosocial items as indicators of pain. The aims of the present study were to develop a Japanese version of the DOLOPLUS‐2 and to apply it to elderly patients with Alzheimer's disease (AD). Methods: The translated instrument was evaluated with reference to Japanese patients with AD experiencing pain during post‐surgery rehabilitation for hip fractures and who were unable to use any self‐reported pain measures. After translation and back‐translation, 21 registered nurses tested ‘Version 1’ of the pain assessment scale on three patients. The ratings of the nurses and researcher were compared and the number of matching scores determined. Semistructured interviews were conducted with the nurses and patient case studies were recorded. The results of the interviews provided the basis for the development of ‘Version 2’ of the scale, which was then tested with six patients and 31 nurses using the same procedures as for the testing of Version 1. Results: The intraclass correlation coefficient for inter‐rater reliability for the Version 2 administrators was 0.90 (P < 0.001), with a 95% confidence interval of 0.88–0.92; the degree of agreement by items (0.67–0.90) was excellent. Nurses' comments for Version 1 revealed that it was ‘difficult to use’ and that ‘some Japanese expressions and explanations needed improvement’. In contrast, the nurses' comments on Version 2 indicated that there were no problems. Analysis of patient case studies in Version 2 indicated that pain scores were high only when the patients clearly would have had pain, such as when they started with full weight bearing. On the basis of these results, we developed a final version of the Japanese DOLOPLUS‐2. Conclusion: The findings of the present study suggest that Version 2 of the Japanese DOLOPLUS‐2 can be used reliably in clinical settings to measure the pain AD patients may be experiencing. However, the final version of the Japanese DOLOPLUS‐2 needs to be validated in a larger patient cohort in future studies.