RESEARCH IN BRIEF
The reliability and validity of the pain items of the Hong Kong version interRAI community health assessment for communitydwelling elders in Hong Kong Justina YW Liu, Iris Chi, Kin-Sun Chan, Claudia KY Lai and Angela YM Leung Accepted for publication: 16 April 2015
Background Ample evidence suggested that pain among older adults is often under-detected and as a result pain was poorly treated. (Won et al. 2004) It is believed that one of the major reasons for under-treated pain is due to the unavailability of accurate, reliable and valid pain instrument for elders who are relatively healthier and lived in community. InterRAI CHA is a modular instrument that could efficiently assess healthy elder individuals who do not need to receive formal personal care services. Except for the pain items under the health conditions domain in the interRAI CHA, other domains in the interRAI CHA have been evaluated and obtained acceptable levels of psychometric properties in Hong Kong (Chou et al. 2001).
Aim The aim of this study was to assess the reliability and validity of the pain items and scale of the Hong Kong version interRAI Community Health Assessment (CHA) among community-dwelling older adults in Hong Kong.
Design This study is part of a project that validated the Hong Kong Version of interRAI CHA as applied to communityAuthors: Justina YW Liu, PhD, RN, Assistant Professor, School of Nursing, Centre for Gerontological Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China; Iris Chi, DSW, Professor, School of Social Work, University of Southern California, Los Angeles, CA, USA and Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, Hong Kong SAR; Kin-Sun Chan, PhD, Assistant Professor, Faculty of Social Sciences, University of Macau, Macau; Claudia KY Lai, PhD, RN, Professor, School of Nursing, Centre for Gerontological Nursing, The Hong
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dwelling older adults. A cross-sectional face-to-face interview design was used in this study.
Methods Participants Prior to initiating the research, approval to conduct the study was obtained by the Ethics Review Committee of The Hong Kong Polytechnic University. All eligible participants were asked for their informed consent. The recruitment took place in a community clinic operated by one of the nongovernmental organisation in Hong Kong. A purposive sampling method was employed and the selection criteria were communitydwelling adults aged 50+ years of age, of either gender, and able to communicate in Cantonese. The criterions used for sample size calculation were 5% type I error and 90% statistical power. A total of 136 community-dwelling elders were recruited and a random subsample of 30 elders was selected to be re-assessed by the same rater about four weeks after the initial assessment for assessing test–retest reliability.
Instruments Pain assessment items of the interRAI CHA (Hong Kong version) InterRAI CHA has a total of four pain assessment items (i.e. pain frequency, pain intensity, pain consistency and experiKong Polytechnic University, Hung Hom, Hong Kong SAR; Angela YM Leung, PhD, RN, Assistant Professor, Sau Po Centre on Ageing, The University of Hong Kong and School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China Correspondence: Justina YW Liu, Assistant Professor, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China. Telephone: +852 2766 4097. E-mail: [email protected]
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2352–2354, doi: 10.1111/jocn.12885
Research in brief
ence in sudden/acute flare-ups of pain). To facilitate data transformation to other interRAI instruments (i.e. other interRAI instruments may contain only two pain assessment items which include pain frequency and intensity), two of the four pain assessment items (i.e. pain frequency and intensity) create the Pain Scale score (Fries et al. 2001). Brief Pain Inventory-Chinese version (BPI-C) The BPI –C is a multidimensional pain assessment tool. The BPI-C consists of 14 items. Evidence shows that the BPI-C is a valid and reliable multidimensional pain assessment tool (Ger et al. 1999). Five-point verbal rating scale (VRS) The five-point VRS consists of a list of adjectives describing different levels of pain intensity. There is good evidence of their reliability and construct validity (Turk & Melzack 2011).
Procedure All participants were assessed by the two nurses who worked in the community clinic. Prior to data collection, a three-day intensive training course was provided to the two nurses to ensure their competence in using the Hong Kong version of interRAI CHA. The inter-rater reliability of the two nurses was 964%. A trained independent research assistant conducted the concurrent validity criterion measurements (i.e. the BPI-C and VRS).
Data analysis All analyses were conducted using SPSS version 19.0 (IBM Corp., Released 2010., Armonk, New York). Test–retest reliability was assessed by percentage of agreement. Internal consistency was assessed by Cronbach’s alpha coefficient. The concurrent validity of the pain assessment by the interRAI CHA was assessed by Pearson correlation coefficients between the Pain Scale and four pain items of the interRAI CHA vs. the BPI-T and the five-point VRS.
Results Sample characteristics One hundred and thirty-six participants’ age ranged between 51–91 with a mean age of 707 (SD = 78). 97 (713%) were female and 39 (287%) male.
Test–retest reliability Good test–retest reliability was observed for the pain items of interRAI CHA. The percentage agreement of the pain © 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2352–2354
scale items of interRAI CHA between the initial test and the retest was 867%.
Internal consistency The Cronbach’s alpha calculated based on all four pain items was 077, indicating that the pain items had adequate levels of internal consistency. All pain items were measuring a similar characteristic.
Concurrent validity Concurrent validity analysis was summarised in Table 1. The correlation coefficients of the Pain Scale, the four pain items of the interRAI CHA to the BPI-C were 052 and 066 respectively. The correlation coefficient of the Pain Scale and the four pain items of the interRAI CHA to the five-point VRS were 047 and 067 respectively. The results showed significant correlations with acceptable levels of concurrent validity.
Conclusion To our knowledge this was the first study to evaluate the psychometric properties of the pain assessment items of the Hong Kong version of interRAI CHA among communitydwelling elders in Hong Kong. The findings demonstrated that the pain items of the interRAI CHA have good test– retest reliability and acceptable levels of concurrent validity when used among community-dwelling older people. We conclude that the interRAI CHA contained a valid pain assessment for community-dwelling older adults in Hong Kong.
Relevance to clinical practice The result of this study showed that the pain items of the Hong Kong version interRAI CHA is a reliable and valid pain assessment tool for community-dwelling elders in Hong Kong. It provides a simple to use pain assessment tool which can be easily integrated as part of a comprehensive assessment (i.e. interRAI CHA), so that it will be more Table 1 Concurrent validity of the pain scale and four pain items of Hong Kong version interRAI CHA (n = 136)
Criteria pain scale BPI–C VRS
InterRAI CHA pain scale
InterRAI CHA four pain items
052** 047**
066** 067**
BPI–C, Brief Pain Inventory–Chinese version; VRS, Verbal rating scale. **p < 005.
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Research in Brief
readily used by clinicians and be a less burden for the seniors to complete an evaluation.
Funding
Key words: community-dwelling elders, interRAI, pain,
This project was funded by Charities and Foundation Fund from Hong Kong Christian Service (Project code: 5-ZH85).
psychometric properties, reliability, validity
Conflict of interest Contributions
The authors declare no conflict of interest.
Study design: LYWJ, CI; data analysis: LYWJ, CK; data collection: LYWJ, LA and manuscript preparation: LYWJ, CI, LKYC.
References Chou KL, Chi I, Leung AC, Wu YM & Liu CP (2001) Validation of Minimum Data set for nursing home in Hong Kong Chinese elders. Clinical Gerontologist 23, 43–54. Fries BE, Simon SE, Morris JN, Flodstrom C & Bookstein FL (2001) Pain in US nursing homes validating a pain scale for the minimum data set. The Gerontologist 41, 173–179.
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Ger LP, Ho ST, Sun WZ, Wang MS & Cleeland CS (1999) Validation of the Brief Pain Inventory in a Taiwanese population. Journal of Pain and Symptom Management 18, 316– 322. Turk DC & Melzack R (2011) Handbook of Pain Assessment. Guilford Press, New York.
Won AB, Lapane KL, Vallow S, Schein J, Morris JN & Lipsitz LA (2004) Persistent nonmalignant pain and analgesic prescribing patterns in elderly nursing home residents. Journal of the American Geriatrics Society 52, 867–874.
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2352–2354
The reliability and validity of the pain items of the Hong Kong version interRAI community health assessment for communitydwelling elders in Hong Kong Justina YW Liu, Iris Chi, Kin-Sun Chan, Claudia KY Lai and Angela YM Leung Accepted for publication: 16 April 2015
Background Ample evidence suggested that pain among older adults is often under-detected and as a result pain was poorly treated. (Won et al. 2004) It is believed that one of the major reasons for under-treated pain is due to the unavailability of accurate, reliable and valid pain instrument for elders who are relatively healthier and lived in community. InterRAI CHA is a modular instrument that could efficiently assess healthy elder individuals who do not need to receive formal personal care services. Except for the pain items under the health conditions domain in the interRAI CHA, other domains in the interRAI CHA have been evaluated and obtained acceptable levels of psychometric properties in Hong Kong (Chou et al. 2001).
Aim The aim of this study was to assess the reliability and validity of the pain items and scale of the Hong Kong version interRAI Community Health Assessment (CHA) among community-dwelling older adults in Hong Kong.
Design This study is part of a project that validated the Hong Kong Version of interRAI CHA as applied to communityAuthors: Justina YW Liu, PhD, RN, Assistant Professor, School of Nursing, Centre for Gerontological Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China; Iris Chi, DSW, Professor, School of Social Work, University of Southern California, Los Angeles, CA, USA and Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, Hong Kong SAR; Kin-Sun Chan, PhD, Assistant Professor, Faculty of Social Sciences, University of Macau, Macau; Claudia KY Lai, PhD, RN, Professor, School of Nursing, Centre for Gerontological Nursing, The Hong
2352
dwelling older adults. A cross-sectional face-to-face interview design was used in this study.
Methods Participants Prior to initiating the research, approval to conduct the study was obtained by the Ethics Review Committee of The Hong Kong Polytechnic University. All eligible participants were asked for their informed consent. The recruitment took place in a community clinic operated by one of the nongovernmental organisation in Hong Kong. A purposive sampling method was employed and the selection criteria were communitydwelling adults aged 50+ years of age, of either gender, and able to communicate in Cantonese. The criterions used for sample size calculation were 5% type I error and 90% statistical power. A total of 136 community-dwelling elders were recruited and a random subsample of 30 elders was selected to be re-assessed by the same rater about four weeks after the initial assessment for assessing test–retest reliability.
Instruments Pain assessment items of the interRAI CHA (Hong Kong version) InterRAI CHA has a total of four pain assessment items (i.e. pain frequency, pain intensity, pain consistency and experiKong Polytechnic University, Hung Hom, Hong Kong SAR; Angela YM Leung, PhD, RN, Assistant Professor, Sau Po Centre on Ageing, The University of Hong Kong and School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China Correspondence: Justina YW Liu, Assistant Professor, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China. Telephone: +852 2766 4097. E-mail: [email protected]
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2352–2354, doi: 10.1111/jocn.12885
Research in brief
ence in sudden/acute flare-ups of pain). To facilitate data transformation to other interRAI instruments (i.e. other interRAI instruments may contain only two pain assessment items which include pain frequency and intensity), two of the four pain assessment items (i.e. pain frequency and intensity) create the Pain Scale score (Fries et al. 2001). Brief Pain Inventory-Chinese version (BPI-C) The BPI –C is a multidimensional pain assessment tool. The BPI-C consists of 14 items. Evidence shows that the BPI-C is a valid and reliable multidimensional pain assessment tool (Ger et al. 1999). Five-point verbal rating scale (VRS) The five-point VRS consists of a list of adjectives describing different levels of pain intensity. There is good evidence of their reliability and construct validity (Turk & Melzack 2011).
Procedure All participants were assessed by the two nurses who worked in the community clinic. Prior to data collection, a three-day intensive training course was provided to the two nurses to ensure their competence in using the Hong Kong version of interRAI CHA. The inter-rater reliability of the two nurses was 964%. A trained independent research assistant conducted the concurrent validity criterion measurements (i.e. the BPI-C and VRS).
Data analysis All analyses were conducted using SPSS version 19.0 (IBM Corp., Released 2010., Armonk, New York). Test–retest reliability was assessed by percentage of agreement. Internal consistency was assessed by Cronbach’s alpha coefficient. The concurrent validity of the pain assessment by the interRAI CHA was assessed by Pearson correlation coefficients between the Pain Scale and four pain items of the interRAI CHA vs. the BPI-T and the five-point VRS.
Results Sample characteristics One hundred and thirty-six participants’ age ranged between 51–91 with a mean age of 707 (SD = 78). 97 (713%) were female and 39 (287%) male.
Test–retest reliability Good test–retest reliability was observed for the pain items of interRAI CHA. The percentage agreement of the pain © 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2352–2354
scale items of interRAI CHA between the initial test and the retest was 867%.
Internal consistency The Cronbach’s alpha calculated based on all four pain items was 077, indicating that the pain items had adequate levels of internal consistency. All pain items were measuring a similar characteristic.
Concurrent validity Concurrent validity analysis was summarised in Table 1. The correlation coefficients of the Pain Scale, the four pain items of the interRAI CHA to the BPI-C were 052 and 066 respectively. The correlation coefficient of the Pain Scale and the four pain items of the interRAI CHA to the five-point VRS were 047 and 067 respectively. The results showed significant correlations with acceptable levels of concurrent validity.
Conclusion To our knowledge this was the first study to evaluate the psychometric properties of the pain assessment items of the Hong Kong version of interRAI CHA among communitydwelling elders in Hong Kong. The findings demonstrated that the pain items of the interRAI CHA have good test– retest reliability and acceptable levels of concurrent validity when used among community-dwelling older people. We conclude that the interRAI CHA contained a valid pain assessment for community-dwelling older adults in Hong Kong.
Relevance to clinical practice The result of this study showed that the pain items of the Hong Kong version interRAI CHA is a reliable and valid pain assessment tool for community-dwelling elders in Hong Kong. It provides a simple to use pain assessment tool which can be easily integrated as part of a comprehensive assessment (i.e. interRAI CHA), so that it will be more Table 1 Concurrent validity of the pain scale and four pain items of Hong Kong version interRAI CHA (n = 136)
Criteria pain scale BPI–C VRS
InterRAI CHA pain scale
InterRAI CHA four pain items
052** 047**
066** 067**
BPI–C, Brief Pain Inventory–Chinese version; VRS, Verbal rating scale. **p < 005.
2353
Research in Brief
readily used by clinicians and be a less burden for the seniors to complete an evaluation.
Funding
Key words: community-dwelling elders, interRAI, pain,
This project was funded by Charities and Foundation Fund from Hong Kong Christian Service (Project code: 5-ZH85).
psychometric properties, reliability, validity
Conflict of interest Contributions
The authors declare no conflict of interest.
Study design: LYWJ, CI; data analysis: LYWJ, CK; data collection: LYWJ, LA and manuscript preparation: LYWJ, CI, LKYC.
References Chou KL, Chi I, Leung AC, Wu YM & Liu CP (2001) Validation of Minimum Data set for nursing home in Hong Kong Chinese elders. Clinical Gerontologist 23, 43–54. Fries BE, Simon SE, Morris JN, Flodstrom C & Bookstein FL (2001) Pain in US nursing homes validating a pain scale for the minimum data set. The Gerontologist 41, 173–179.
2354
Ger LP, Ho ST, Sun WZ, Wang MS & Cleeland CS (1999) Validation of the Brief Pain Inventory in a Taiwanese population. Journal of Pain and Symptom Management 18, 316– 322. Turk DC & Melzack R (2011) Handbook of Pain Assessment. Guilford Press, New York.
Won AB, Lapane KL, Vallow S, Schein J, Morris JN & Lipsitz LA (2004) Persistent nonmalignant pain and analgesic prescribing patterns in elderly nursing home residents. Journal of the American Geriatrics Society 52, 867–874.
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 2352–2354
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