Properties of Pain Assessment Tools for Use in People Living With Stroke: Systematic Review

 Really, you are that fucking stupid that you think assessment is of ANY USE to stroke survivors?  

SOLVE THE PAIN PROBLEM YOU FUCKING IDIOTS.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will ream me out for making them look bad by being truthful , I look forward to that day. 

The latest here:

Properties of Pain Assessment Tools for Use in People Living With Stroke: Systematic Review

Sophie Amelia Edwards¹, Antreas Ioannou², Gail Carin-Levy³, Eileen Cowey⁴, Marian Brady⁵, Sarah Morton⁶, Tonje A. Sande⁷, Gillian Mead⁶ and Terence J. Quinn^1*

• ¹Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
• ²Internal Medicine Department, Nicosia General Hospital, Strovolos, Cyprus
• ³School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
• ⁴School of Medicine, University of Glasgow, Glasgow, United Kingdom
• ⁵NMAHP Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
• ⁶Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
• ⁷Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom

Background: Pain is a common problem after stroke and is associated with poor outcomes. There is no consensus on the optimal method of pain assessment in stroke. A review of the properties of tools should allow an evidence based approach to assessment.

Objectives: We aimed to systematically review published data on pain assessment tools used in stroke, with particular focus on classical test properties of: validity, reliability, feasibility, responsiveness.

Methods: We searched multiple, cross-disciplinary databases for studies evaluating properties of pain assessment tools used in stroke. We assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool. We used a modified harvest plot to visually represent psychometric properties across tests.

Results: The search yielded 12 relevant articles, describing 10 different tools (n = 1,106 participants). There was substantial heterogeneity and an overall high risk of bias. The most commonly assessed property was validity (eight studies) and responsiveness the least (one study). There were no studies with a neuropathic or headache focus. Included tools were either scales or questionnaires. The most commonly assessed tool was the Faces Pain Scale (FPS) (6 studies). The limited number of papers precluded meaningful meta-analysis at level of pain assessment tool or pain syndrome. Even where common data were available across papers, results were conflicting e.g., two papers described FPS as feasible and two described the scale as having feasibility issues.

Conclusion: Robust data on the properties of pain assessment tools for stroke are limited. Our review highlights specific areas where evidence is lacking and could guide further research to identify the best tool(s) for assessing post-stroke pain. Improving feasibility of assessment in stroke survivors should be a future research target.

Systematic Review Registration Number: PROSPERO CRD42019160679

Available online at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019160679.

Introduction

Pain is a common problem after stroke (1). Estimates of the frequency of pain vary across studies, depending on the population assessed and whether the focus is incident or prevalent pain. Large cohorts of mild to moderate stroke survivors suggest pain incidence of around 10% (2), while in smaller cohorts figures range from 30% during the first months (3), to 48% at 1 year (4) and 43% at 10 years (5) after stroke.

Post-stroke pain is associated with disability and reduced quality of life (1). It is independently associated with fatigue (6), depression (7) and has been strongly linked with suicidality (8, 9). Pain after stroke can have a variety of etiologies and manifestations, including: shoulder pain, headache, neuropathic pain and exacerbation of pre-existing pain. Pain symptoms can present at any point during stroke recovery and may progress to chronic pain if not recognized and treated appropriately.

The first step in managing post-stroke pain is recognition and measurement. However, management of pain has not always been given the same priority as other aspects of stroke care such as instituting secondary prevention (10). Pain assessment is a complicated task made more challenging in the context of stroke. Since pain is a subjective experience, self-report scales and questionnaires are the most commonly employed pain assessment tools in clinical practice and pain may be part of a more general health related quality of life assessment (11). However, stroke impairments such as cognitive decline and communication issues may make it difficult for stroke survivors to communicate the presence and experience of pain using these tools (12, 13). Other impairments such as visual issues or loss of motor skills may further complicate the use of self-completion questionnaires or visual analog scales.

Accepting these caveats, there is a range of pain assessment tools available that could be used with stroke survivors. Some are generic, some are specific to a certain pain syndrome and some are developed exclusively for stroke. At present there is no consensus on the best approach to assessing post-stroke pain and no standardized tool is recommended for research or practice (14). In the absence of a gold standard pain assessment in stroke survivors and with the great variety of assessment tools available, clinicians may struggle to know the most appropriate approach for their patients. The choice of assessment tools should be guided by evidence, particularly, the psychometric properties of the pain assessment tools available. Classical test features such as validity and responsiveness have been described for certain pain tools, however, equally important are end-user evaluations such as acceptability and feasibility within the person's healthcare setting.

A summary of psychometric properties of pain assessment tools could help clinicians and researchers choose the most appropriate measure, highlighting strengths and limitations and also showing where new evidence is needed. Thus, we conducted a systematic review to compare methods of pain assessment following stroke with a particular focus on properties of validity, reliability, feasibility, and responsiveness.