Psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals as a screening tool for orofacial pain in people with dementia

Suzanne Delwel; Roberto S.G.M. Perez; Andrea B. Maier; Cees M.P.M. Hertogh; Henrica C.W. de Vet; Frank Lobbezoo; Erik J.A. Scherder

doi:10.1111/ger.12339

Psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals as a screening tool for orofacial pain in people with dementia

Suzanne Delwel^*
, Roberto S.G.M. Perez
, Andrea B. Maier
, Cees M.P.M. Hertogh
, Henrica C.W. de Vet
, Frank Lobbezoo
, Erik J.A. Scherder

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

OBJECTIVE: The aim of this study was to describe the psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals (OPS-NVI) as a screening tool for orofacial pain in people with dementia.

BACKGROUND: The OPS-NVI has recently been developed and needs psychometric evaluation for clinical use in people with dementia. The pain self-report is imperative as a reference standard and can be provided by people with mild-to-moderate cognitive impairment.

METHODS: The presence of orofacial pain during rest, drinking, chewing and oral hygiene care was observed in people with mild cognitive impairment (MCI) and dementia using the OPS-NVI. Participants who were considered to present a reliable self-report were asked about pain presence, and in all participants, the oral health was examined by a dentist for the presence of potential painful conditions. After item-reduction, inter-rater reliability and criterion validity were determined.

RESULTS: The presence of orofacial pain in this population was low (0%-10%), resulting in an average Positive Agreement of 0%-100%, an average Negative Agreement of 77%-100%, a sensitivity of 0%-100% and a specificity of 66%-100% for the individual items of the OPS-NVI. At the same time, the presence of oral problems, such as ulcers, tooth root remnants and caries was high (64.5%).

CONCLUSION: The orofacial pain presence in this MCI and dementia population was low, resulting in low scores for average Positive Agreement and sensitivity and high scores for average Negative Agreement and specificity. Therefore, the OPS-NVI in its current form cannot be recommended as a screening tool for orofacial pain in people with MCI and dementia. However, the inter-rater reliability and criterion validity of the individual items in this study provide more insight for the further adjustment of the OPS-NVI for diagnostic use. Notably, oral health problems were frequently present, although no pain was reported or observed, indicating that oral health problems cannot be used as a new reference standard for orofacial pain, and a regular oral examination by care providers and oral hygiene care professionals remains indispensable.

Original language	English
Pages (from-to)	200-213
Number of pages	14
Journal	Gerodontology
Volume	35
Issue number	3
Early online date	29 Apr 2018
DOIs	https://doi.org/10.1111/ger.12339
Publication status	Published - Sept 2018

Bibliographical note

Funding

This study was supported by grants from: Alzheimer Nederland, Amstelring, Fonds NutsOhra, Roomsch Catholijk Oude Armen Kantoor (RCOAK), Stichting Beroepsopleiding Huisartsen (SBOH), and Stichting Henriëtte Hofje. The authors have no conflict of interest to declare. The authors thank the participants and their care givers for their cooperation with the study. Furthermore, they thank Tarik Binnekade of the Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam for his neuropsychological input to the study and Janine van Kooten of the Department of General Practice and Elderly Care Medicine, VU University Medical Center, for her help with the acquisition of part of the participants and the collection of the demographic data at the nursing homes. They also thank the staff at the Center of Geriatric Medicine Amsterdam (COGA), VU Medical Centre (VUmc), the staff at the Geriatric outpatient clinic (BACO), Amstelland Hospital, and at the staff at the 10 participating nursing homes of Amstelring, Cordaan, and Zonnehuisgroep Amstelland for their cooperation. Moreover, they thank the students of the Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam and the Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA) for their assistance. The authors also thank the members of the Dutch Association for Gerodontology (NVGd) for their expert input on the OPS-NVI and Annelore van Dalen - de Kok for the cooperation during the forward-backward translation of the Dutch version of the PAIC meta-tool and the OPS-NVI tool. In addition, they thank Figen Knudsen-Ay for her translational support for the PAIC and OPS-NVI tools and Irene Aartman of the Academic Centre for Dentistry Amsterdam (ACTA) for her statistical support.

Funders
Academic Centre for Dentistry Amsterdam
Amstelland Hospital
Dutch Association for Gerodontology
Irene Aartman of the Academic Centre for Dentistry Amsterdam
NVGd
OPS-NVI
Roomsch Catholijk Oude Armen Kantoor
Stichting Henriëtte Hofje
VU Medical Centre
Fonds NutsOhra
Stichting Beroepsopleiding Huisarts

Keywords

cognitive impairment
dementia
dentistry
orofacial pain
pain assessment

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10.1111/ger.12339

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@article{09be865e1dcb4ed295c7b496aa709803,

title = "Psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals as a screening tool for orofacial pain in people with dementia",

abstract = "OBJECTIVE: The aim of this study was to describe the psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals (OPS-NVI) as a screening tool for orofacial pain in people with dementia.BACKGROUND: The OPS-NVI has recently been developed and needs psychometric evaluation for clinical use in people with dementia. The pain self-report is imperative as a reference standard and can be provided by people with mild-to-moderate cognitive impairment.METHODS: The presence of orofacial pain during rest, drinking, chewing and oral hygiene care was observed in people with mild cognitive impairment (MCI) and dementia using the OPS-NVI. Participants who were considered to present a reliable self-report were asked about pain presence, and in all participants, the oral health was examined by a dentist for the presence of potential painful conditions. After item-reduction, inter-rater reliability and criterion validity were determined.RESULTS: The presence of orofacial pain in this population was low (0\%-10\%), resulting in an average Positive Agreement of 0\%-100\%, an average Negative Agreement of 77\%-100\%, a sensitivity of 0\%-100\% and a specificity of 66\%-100\% for the individual items of the OPS-NVI. At the same time, the presence of oral problems, such as ulcers, tooth root remnants and caries was high (64.5\%).CONCLUSION: The orofacial pain presence in this MCI and dementia population was low, resulting in low scores for average Positive Agreement and sensitivity and high scores for average Negative Agreement and specificity. Therefore, the OPS-NVI in its current form cannot be recommended as a screening tool for orofacial pain in people with MCI and dementia. However, the inter-rater reliability and criterion validity of the individual items in this study provide more insight for the further adjustment of the OPS-NVI for diagnostic use. Notably, oral health problems were frequently present, although no pain was reported or observed, indicating that oral health problems cannot be used as a new reference standard for orofacial pain, and a regular oral examination by care providers and oral hygiene care professionals remains indispensable.",

keywords = "cognitive impairment, dementia, dentistry, orofacial pain, pain assessment",

author = "Suzanne Delwel and Perez, \{Roberto S.G.M.\} and Maier, \{Andrea B.\} and Hertogh, \{Cees M.P.M.\} and \{de Vet\}, \{Henrica C.W.\} and Frank Lobbezoo and Scherder, \{Erik J.A.\}",

note = "{\textcopyright} 2018 The Authors Gerodontology published by British Society of Gerodontology, European College of Gerodontology and Geriatric Oral Research Group and John Wiley \& Sons Ltd.",

year = "2018",

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doi = "10.1111/ger.12339",

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AU - Delwel, Suzanne

AU - Perez, Roberto S.G.M.

AU - Maier, Andrea B.

AU - Hertogh, Cees M.P.M.

AU - de Vet, Henrica C.W.

AU - Lobbezoo, Frank

AU - Scherder, Erik J.A.

PY - 2018/9

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N2 - OBJECTIVE: The aim of this study was to describe the psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals (OPS-NVI) as a screening tool for orofacial pain in people with dementia.BACKGROUND: The OPS-NVI has recently been developed and needs psychometric evaluation for clinical use in people with dementia. The pain self-report is imperative as a reference standard and can be provided by people with mild-to-moderate cognitive impairment.METHODS: The presence of orofacial pain during rest, drinking, chewing and oral hygiene care was observed in people with mild cognitive impairment (MCI) and dementia using the OPS-NVI. Participants who were considered to present a reliable self-report were asked about pain presence, and in all participants, the oral health was examined by a dentist for the presence of potential painful conditions. After item-reduction, inter-rater reliability and criterion validity were determined.RESULTS: The presence of orofacial pain in this population was low (0%-10%), resulting in an average Positive Agreement of 0%-100%, an average Negative Agreement of 77%-100%, a sensitivity of 0%-100% and a specificity of 66%-100% for the individual items of the OPS-NVI. At the same time, the presence of oral problems, such as ulcers, tooth root remnants and caries was high (64.5%).CONCLUSION: The orofacial pain presence in this MCI and dementia population was low, resulting in low scores for average Positive Agreement and sensitivity and high scores for average Negative Agreement and specificity. Therefore, the OPS-NVI in its current form cannot be recommended as a screening tool for orofacial pain in people with MCI and dementia. However, the inter-rater reliability and criterion validity of the individual items in this study provide more insight for the further adjustment of the OPS-NVI for diagnostic use. Notably, oral health problems were frequently present, although no pain was reported or observed, indicating that oral health problems cannot be used as a new reference standard for orofacial pain, and a regular oral examination by care providers and oral hygiene care professionals remains indispensable.

AB - OBJECTIVE: The aim of this study was to describe the psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals (OPS-NVI) as a screening tool for orofacial pain in people with dementia.BACKGROUND: The OPS-NVI has recently been developed and needs psychometric evaluation for clinical use in people with dementia. The pain self-report is imperative as a reference standard and can be provided by people with mild-to-moderate cognitive impairment.METHODS: The presence of orofacial pain during rest, drinking, chewing and oral hygiene care was observed in people with mild cognitive impairment (MCI) and dementia using the OPS-NVI. Participants who were considered to present a reliable self-report were asked about pain presence, and in all participants, the oral health was examined by a dentist for the presence of potential painful conditions. After item-reduction, inter-rater reliability and criterion validity were determined.RESULTS: The presence of orofacial pain in this population was low (0%-10%), resulting in an average Positive Agreement of 0%-100%, an average Negative Agreement of 77%-100%, a sensitivity of 0%-100% and a specificity of 66%-100% for the individual items of the OPS-NVI. At the same time, the presence of oral problems, such as ulcers, tooth root remnants and caries was high (64.5%).CONCLUSION: The orofacial pain presence in this MCI and dementia population was low, resulting in low scores for average Positive Agreement and sensitivity and high scores for average Negative Agreement and specificity. Therefore, the OPS-NVI in its current form cannot be recommended as a screening tool for orofacial pain in people with MCI and dementia. However, the inter-rater reliability and criterion validity of the individual items in this study provide more insight for the further adjustment of the OPS-NVI for diagnostic use. Notably, oral health problems were frequently present, although no pain was reported or observed, indicating that oral health problems cannot be used as a new reference standard for orofacial pain, and a regular oral examination by care providers and oral hygiene care professionals remains indispensable.

KW - cognitive impairment

KW - dementia

KW - dentistry

KW - orofacial pain

KW - pain assessment

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Psychometric evaluation of the Orofacial Pain Scale for Non-Verbal Individuals as a screening tool for orofacial pain in people with dementia

Abstract

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