Resum

The OBJECTIVE of this study was to develop a way of evaluating pain levels among patients with advanced senile dementia who have no way of communicating. The method had to display adequate psychometric properties.

The METHODS followed and the RESULTS obtained were as follows. There were four different phases in the process. PHASE 1. The items to be observed were selected by taking the opinion of clinical experts into account and by gathering together previous studies found in scientific literature. 24 items were proposed which were evaluated by 112 professionals from clinics who offered their opinion on whether or not the propositions were adequate in order to measure pain. PHASE 2. A pilot study was carried out in order to determine the validity of the 24 items when applied to 30 Alzheimer patients and 30 elderly people without cognitive deficiency whose dependency was moderate. Nine of the propositions were seen to possess higher psychometric properties. This scale displayed an internal consistency of 0.77 once measured by Cronbach's Alpha coefficient; its validity, compared to the results of other scales for measuring pain, showed a significant correlation with the EVA (r=0.44; p<0.05), the Verbal Scale for Pain Intensity (r=0.42; p<0.05) and the MPQ-SV (r=0.41; p<0.05), for the group without cognitive deficiency; reliability between observers was deemed adequate given that there was an interclass correlation of between 0.36 and 0.96 (p<0.05 to p<0.001) for all the items and the different pairs of observers. PHASE 3. The evaluation of the behaviour of the Experimental Scale (9 items) was carried out on 126 people with advanced dementia. The exploratory and confirmatory factorial analyses were compatible for 8 of the items and three factors (Emotional Expression of Pain; Pain during care, and Spontaneous Pain Behaviour). Reliability (internal consistency), measured using Cronbach's Alpha coefficient, was 0.66. Its concurrent validity, determined through the opinion of the professionals, showed that patients considered as 'no pain' by the professionals had significantly lower scores on the total scale as well as in the three factors of the scale. In order to determine the cut-off point of the scale, an analysis of the ROC curve was carried out and a value of 3 was found to be the indicator of the presence of pain. A user manual was developed, which was subject to the evaluation of the clinical professionals. Its use resulted in an interclass correlation of the same response for the same observation for different pairs of observers which ranged between 0.51 y 0.97 (p<0.05 and p<0.001). PHASE 4. A study was carried out in order to determine the sensitivity of the scale in cases of acute pain (blood test). This showed differences between the pain levels of the group who had had EMLA cream applied compared to the control group (p<0.01). A second study of the sensitivity of the scale for cases of chronic pain (treatment of bedsores) was carried out. In this case, there was a significantly lower score (p<0.05) for patients who had received subcutaneous morphine compared to the control group.

La difusió d'aquesta tesi per mitjà del servei TDX ha estat autoritzada pels titulars dels drets de propietat intel.lectual únicament per a usos privats emmarcats en activitats d'investigació i docència. No s'autoritza la seva reproducció amb finalitats de lucre ni la seva difusió i posada a disposició des d'un lloc aliè al servei TDX. No s'autoritza la presentació del seu contingut en una finestra o marc aliè a TDX (framing).

Aquesta reserva de drets afecta tant al resum de presentació de la tesi com als seus continguts. En la utilització o cita de parts de la tesi és obligat indicar el nom de la persona autora.