Abbey Pain Scale

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Objective

For caregivers to assess the pain experience of people with end-stage dementia who are non-verbal.  

Background 

Pain assessment can be extremely complex in individuals with dementia, particularly toward the end
stages of dementia when an individual may become nonverbal. Pain is a  significant experience for
those with dementia and it is widely believed to be under reported in the dementia population. In the
absence of self-reported pain, caregivers and clinicians must rely on their observation and the
knowledge they have of the person in questions usual behaviours. 

As a result, the Abbey Pain Scale (APS) was designed to assist in the assessment of pain in the
nonverbal individual suffering from end-stage dementia [1].

Like many pain scales for use with people with dementia, there is not a lot of evidence regarding the
APS. This is probably because of the nature of the group the scale is designed for. However, the APS
has been incorporated into Australian pain guidelines and is recommended by researchers [2][3] 

It is easy to use and no training is required [2]. It is easily accessible online  and provides some sort
of formalised pain assessment for this complex group of dementia sufferers. 

Intended Population

Individuals with progressed dementia where they are unable to verbalise pain, and their caregivers.

Methods of Use

The APS requires the caregiver or clinician to observe the individual with dementia for signs of pain.  
 The Australian Pain Society recommends using this as a movement-based assessment [4], i.e. that
observations are made when the individual is moving for daily cares e.g.  dressing or pressure area care.
Pain may become more obvious on movement, compared to at rest. 

The Australian Pain Society also recommends that the scale is completed again one hour post any
intervention [4]. If pain appears to persist then a comprehensive assessment of the person’s care must be
done to identify causes of pain and any corresponding treatments to ease pain. If pain appears to persist
beyond 24 hours medical help should be sought. 

Each item is rated and rate the following six items on a scale of absent=0, mild=1, moderate=2 or
severe=3. 

The six items to be observed are: 

1. Vocalisation
2. Facial expression
3. Change in body language 
4. Behavioural change 
5. Physiological change 
6. Physical changes 

Scores are then added to create a total score which can then be compared to the following to give an
overall description of the person’s perceived pain experience. 

0-2  = No pain 

3-7 = Mild pain 

8-13 = Moderate pain 

>14 = Severe pain 

Versions

Swedish[5] 
Danish[6] 

Japanese [7][8] 

Evidence

Reliability

The original authors [1] reported satisfactory reliability of the APS. The Danish version showed good
inter-rater reliability [6] and the Japanese version reported good reliability [7].

Validity

Discriminant validity: significant differences observed pre/post treatment [2][6].  

The Australian Pain Society notes that the APS does not discriminate between pain and distress so
careful observation after pain relief is also needed [4]. 

Related articles

Fatigue Severity Scale - PhysiopediaObjective The Fatigue Severity Scale is a 9-item scale which
measures the severity of fatigue and its effect on a person's activities and lifestyle in patients with a
variety of disorders. It was originally devised for people with Multiple Sclerosis or systemic lupus
erythematosus[1]. [2] Intended Population Those with a variety of diagnoses including arthritis,
fibromyalgia, Multiple sclerosis, Parkinson’s disease and stroke. Method of Use A self-report scale of
nine items about fatigue, its severity and how it affects certain activities. Answers are scored on a
seven point scale where 1 = strongly disagree and 7 = strongly agree. This means the minimum score
possible is nine and the highest is 63. The higher the score, the more severe the fatigue is and the more
it affects the person's activities. It is simple to understand and takes an average of eight minutes to
answer[3]. Evidence Reliability Test-retest Reliability One study reported excellent test-retest
reliability (ICC = 0.91) in a Brazilian-Portuguese version for people with Parkinson's (n = 30, mean
age = 62 (11) years, mean time post- Parkinson's = 7.6 (6.5) years)[4]. Similar results were found in a
study of cirrhotic patients[3]. Validity Able to discriminate between groups (with and without fatigue)
in a study of people with cirrhosis[3]. Correlates with depressive symptomology (Beck Depression
Inventory) and quality of life (SF-36)[3]. Parkinson’s Disease Excellent (r = -0.77) negative correlation
with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale[5] Excellent (r =
0.62) correlation with Nottingham Health Profile (NHP-EN) scale[5] Excellent (r = 0.84) correlation
with Parkinson’s Fatigue (PFS) scale [6] Poor-adequate (r = 0.22-0.47) correlation with Parkinson’s
Disease Questionnaire-39 (PDQ-39) scale; n = 66, mean age = 70.8 (9.9) years, time since Parkinson's
= 70.2 (56.1) months) [7] Responsiveness No significant changes observed with the scale pre and post
liver transplant[3]. The FSS has been reported to have low floor and moderate ceiling effects[8].
Versions Brazilian-Portuguese[4] Finnish[9]Pain Catastrophizing Scale - PhysiopediaSummary Pain
catastrophizing is characterized by the tendency to magnify the threat value of a pain stimulus and to
feel helpless in the presence of pain, as well as by a relative inability to prevent or inhibit pain-related
thoughts in anticipation of, during, or following a painful event.[1] Pain catastrophizing affects how
individuals experience pain. Sullivan et al 1995 state that people who catastrophize tend to do three
things, all of which are measured by this questionnaire. They ruminate about their pain (e.g. "I can´t
stop thinking about how much it hurts") They magnify their pain (e.g. "I´m afraid that something
serious might happen") They feel helpless to manage their pain (e.g. "There is nothing I can do to
reduce the intensity of my pain") As such, the PCS was developed to help quantify an individual's pain
experience, asking about how they feel and what they think about when they are in pain. Compared to
other ways of measuring pain-related thoughts, this questionnaire is unique in that the individual does
not need to be in pain while completing it. It is one of the most widely used instruments for measuring
catastrophic thinking related to pain, and is used extensively in clinical practice and in research.[2] The
Adult Version is available in English and 20 other languages. Intended Population For adolescents and
adults dealing with pain as the result of various pathology/disease.[3] Method of Use People are asked
to indicate the degree to which they have the above thoughts and feelings when they are experiencing
pain using the 0 (not at all) to 4 (all the time) scale. A total score is yielded (ranging from 0-52), along
with three subscale scores assessing rumination, magnification and helplessness. Evidence Reliability
The PCS has been shown to have adequate to excellent internal consistency (coefficient alphas stated
below):[3][4] Total PCS = .87-.93 Rumination = .85-.91 Magnification = .66-.75 Helplessness = .
78-.87 Validity The PCS total and subscales correlated moderately and significantly with the INTRP,
the Inventory of Negative Thoughts in Response to Pain, (p < .01) providing further evidence of
concurrent validity for the PCS. Controlling for general psychological disturbance (MASQGeneral
Disturbance) did not substantially change the magnitudes of the correlations between the PCS
subscales (.43-.48) or the total PCS (partial r = .56, p < .001) and the INTRP.[4] Responsiveness A
total PCS score of 30 represents clinically relevant level of catastrophizing. A total PCS score of 30
corresponds to the 75th percentile of the distribution of PCS scores in clinic samples of chronic pain
patients.[3] Gender Differences Osman et al found a significant difference between men and women.
These authors found that women had higher scores on the Rumination [F(286) = 3.91, p < .05] and
Helplessness, [F(286) = 5.99, p < .01] subscales than did men. Also, women had higher scores on the
total PCS score [F(286) = 5.55, p < .01] than did men. There was no significant difference between
men and women on the Magnification subscale (p > .05).[4] Other Versions Cano et al (2005) went on
to develop the Spouse/Significant Other Version of the PCS, known as the PCS-S. These authors
figured that since pain catastrophizing appears to have a social function, then pain catastrophizing of
their significant others may also have an influence on those individuals with chronic pain (ICP's).[5] It
was found that spouse catastrophizing was indeed related to ICP pain severity and interference as well
as both spouses’ depressive symptoms. ICP's were also at a greater risk for psychological distress when
both spouses had higher levels of catastrophizing. As such, these authors suggested that the PCS-S has
the potential to be a useful and valid measure of pain catastrophizing in the spouse/significant others of
ICP's.[5] Resources PCS English Version (Adult) PCS English Version Manual (Adult) PCS English
Version (Child)Brief Pain Inventory - Short Form - PhysiopediaSummary The Brief Pain Inventory -
Short Form (BPI-sf) is a 9 item self-administered questionnaire used to evaluate the severity of a
patient's pain and the impact of this pain on the patient's daily functioning. The patient is asked to rate
their worst, least, average, and current pain intensity, list current treatments and their perceived
effectiveness, and rate the degree that pain interferes with general activity, mood, walking ability,
normal work, relations with other persons, sleep, and enjoyment of life on a 10 point scale. The BPI-sf
is a modification of the Brief Pain Inventory - Long Form, which includes additional questions on
demographics (date of birth, marital status, education, employment), pain history, aggravating and
easing factors, treatment and medication, pain quality, and response to treatment. The brevity of the
BPI-sf makes it suitable for settings in which pain is assessed on a daily basis (e.g. in a randomized
control trial), whereas the long-form may be more appropriate as a baseline measure. The questionnaire
exists within the biopsychosocial model of pain, as it addresses sensory, emotional, and functional
aspects of the pain experience[1]. Thus, the tool is responsive to changes in pain associated with both
pharmacological, physical, and psychological interventions[2]. Intended Population Originally
intended for use in epidemiological studies and clinical trials involving patients with cancer-related
pain, the BPI-sf is now widely used in a range of chronic cancer-related and non-malignant pain
conditions, including HIV/AIDS, phantom limb pain, critical limb ischemia, neuropathy, low back
pain, and osteoarthritis. The tool has also been used to assess individuals experiencing acute pain, for
example post-operatively. The questionnaire has been translated into numerous languages including
Vietnamese, Chinese, Italian, German, Taiwanese, Greek, Norwegian, French, Hindi, Japanese, and
Spanish[3]. Method of Use The questionnaire can be completed via self-report or interview. The short
form version takes 5 minutes for the patient to complete. Evidence Reliability The psychometric
properties of the tool have been analyzed in a range of populations with cancer and non-cancer related
pain. Acceptable reliability has been reported in studies of patients with advanced cancer pain[4],
osteoarthritis pain[5][6], and chronic pain in neuropathic and nociceptive pain patients (Turkish
translation)[7]. Validity Kumar reports that the BPI has been validated in patient populations with bone
metastases, breast cancer and postoperative cancer patients and in a variety of languages including
Brazilian, Chinese, Greek, Hindi, Italian, Japanese, Korean, Malay, Norwegian, Polish, Russian,
Spanish, Taiwanese and Thai[8]. A number of studies have utilized a confirmatory factor approach
(CFA) to determine the construct validity of the BPI. A three factor representation (pain intensity,
activity interference, and affective interference) was compared with a two factor (pain intensity,
activity interference) and one-factor (pain intensity) approach. Research by Atkinson and colleagues
supports both two- and three-factor representations in the HIV/AIDS and cancer populations[9].
Lapane and colleagues and Tan and colleagues report that a two-factor model has greater validity for
patients with non-cancer pain (including arthritis, back/neck pain, injury-/trauma-related pain,
neuropathic pain, and fibromyalgia-related pain)[10][3]. Responsiveness Studies have reported on the
responsiveness of the BPI with respect to change in patient's self-reported pain over time and change
with treatment[3]. The tool was able to detect change in pain and impact of pain in patients with hip
osteoarthritis up to one year following total hip replacement[5]. No minimum clinically important
change (MCIC) has been reported in the literature regarding patients with cancer-related pain[8].
Kumar suggests future studies employ a patient-rated global impression of change as a criterion
measure to determine an MCIC in this population. Miscellaneous Other Versions The BPI has been
modified to reflect more inclusive language for individuals experiencing disability related pain. In this
version, the “walking ability” item was replaced with “mobility (ability to get around)” and three
additional domains (self-care, recreational activities, and social activities) were added to the
interference items[11]. It is unclear whether these modifications improve the psychometric properties
of the tool[3]. Resources Brief-Pain Inventory - Short Form (copy of questionnaire) Brief-Pain
Inventory - Long Form (copy of questionnaire) Brief Pain Inventory User's Guide Cleeland CS.
Measurement of pain by subjective report. In: Chapman CR, Loeser JD, editors. Issues in Pain
Measurement. New York: Raven Press; pp. 391-403, 1989 Advances in Pain Research and Therapy;
Vol. 12. Cleeland CS. Assessment of pain in cancer: measurement issues. In: Foley KM, Bonica JJ,
Ventafridda V, editors. Proceedings of the Second International Congress on Cancer Pain. New York:
Raven Press; pp. 47-55, 1990 Advances in Pain Research and Therapy; Vol. 16. Cleeland CS. Pain
assessment in cancer. In: Osoba D, editor. Effect of Cancer on Quality of Life. Boca Raton: CRC Press,
Inc.; pp. 293-305, 1991. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain
Inventory. Ann Acad Med Singapore 1994;23(2):129-138. [1] Daut RL, Cleeland CS. The prevalence
and severity of pain in cancer. Cancer 1982;50(9):1913-1918. [2] Daut RL, Cleeland CS, Flanery RC.
Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases.
Pain 1983;17(2):197- 210. [3]Neck Pain and Disability Scale - PhysiopediaObjective The most used
neck disability questionnaires are the Neck Pain and Disability scale (NPAD) and the Neck Disability
Index (NDI) [1][2][3][4]. The Neck Pain and Disability scale (NPAD) is a composite index including
20 items which measure the intensity of neck pain and related disability. Until 1999, several measures
of generalised pain and disability were available (Oswestry Disability Questionnaire and Pain
Disability Index), but there was no well-developed measure that dealt specifically with neck pain. To
provide a new measure of neck pain and disability the NPAD has been developed. It was originally
developed in the USA by Wheeler and colleagues, but there are various other translations of the scale.
Validated French, Turkish, German, Portuguese, Italian, Dutch, English, … translations are available
showing adequate validity and reliability. The 20-item scale measures problems with neck movements,
neck pain intensity, effect of neck pain on emotion and cognition, and the level of interference with
daily life activities. The NPAD is a validated measure to evaluate outcomes in patients with neck pain.
It is easy to complete for the patients themselves, and easy to score for the evaluators. Its interference
with vocational,recreational, social, and functional aspects of living; and the presence and extent of
associated emotional factors. Intended Population Cervical pain syndromes. The NPAD is a 20-item
measure that was specifically developed for patients with neck pain.[2] Blozik E. et al. found that
patients who were classified to be depressed (regression coefficient 2.1, p<0.001), anxious (1.9,
p<0.001), or having deficits in social support (5.5, p=0.004) scored significantly higher NPAD scores.
[1] (level of evidence B) The NPAD is useful in chronic neck pain and C1-2 fusion patients.[5] Method
of Use Patients respond to each item by marking along a 10cm visual analog scale (VAS). Item scores
range from 0 to 5, andthe total score is a total of the item scores (possible range 0 (no pain) – 100
(maximal pain)). The NPAD score is well validated if no more than 15% of the items are missing.
Completion of the NPAD usually requires less than 5 minutes.[1][2] Evidence Martin Scherer et al.
found that the German version of the neck pain and disability scale (NPAD-d) has evidence of validity
and reliability in a general practice setting.(level of evidence B) The NPAD-d Exhibited stable internal
consistency, good construct and discriminant validity. It may be useful in the clinical assessment
process and the management of neck pain.[2] Wim Jorritsma et al. found that the Dutch language
version of the NPAD (NPAD-DLV) has a good validity.[3] (level of evidence B) Reliability The
stability of a score with repeated measurements over time is defined as test-retest reliability. It is
assessed by having an individual complete the instrument 2 or more times during a period when the
individual’s condition is expected to remain stable. Intra-class correlation coefficient and SEM values
are commonly used to estimate test-retest reliability.[6] M. Scherer et al. tested reliability using
Cronbach’s alpha. He found that the German version of the NPAD demonstrated good reliability in a
general practice setting. Chronbach’s alpha of NPAD-d was 0.94.[2] (level of evidence B) W. Jorritsma
et al. found a Cronbach’s alpha of 0.93 for the Dutch version of the NPAD.[3](level of evidence B) W.
Jorritsma et al. found that the reliability of the NPAD-DLV was acceptable for patients with CNP. The
mean test-retest interval was 18.2 days (SD 6.2, range 6-34). ICC = 0.76 (0.57-0.87) LOAs (Limits of
agreement) = +-20.9 (scale 0-100) [4](level of evidence B) Bremerich et al. found that the Cronbach’s
alpha scores for the NPAD-d whole scale and the NPAD-d sub-scales pain disability and neck specific
function were 0.97, 0.95, 0.97 and 0.87, respectively. The test-retest reliability of the NPAD-d was
excellent (0.97).[5] (level of evidence B) Validity The Neck Pain and Disability Scale (NPAD) has
been translated into several languages. The following versions are well validated: Turkish, French,
German, Brazilian, Portuguese, Korean, Italian, Iranian and Dutch version.[4] (level of evidence B)
Content validity: The specific items on the instrument and what they measure determine the evidence
that is based on content. The International Classification of Functioning, Disability and Health model
can be used to define item content. According to this model, items can potentially measure the domains
of (1) body structure and function and (2) activity and participation.[6] Construct validity:While
evidence for content relates directly to what the items measure, evidence for construct validity assesses
how the scores on the instrument relate to other measures of the construct.60 A strong relationship
between the scores on the instrument and other measures of the same or a related construct provides
evidence for convergent validity; little or no relationship between the scores on the instrument and
other measures of distinctly different constructs provides evidence for divergent validity.[6] M. Scherer
et al. evaluated the construct validity of the NPAD-d by simple correlation analyses (Pearson’s rho)
with social and clinical characteristics. Item-to-total correlations ranged between 0.414 - 0.829.
Correlation analysis showed high correlations with criterion variables.[2] W. Jorritsma et al. found that
the NPAD-DLV is a valid measure of self-reported neck-pain related disability. Item-to-total
correlations ranged between 0.45 - 0.73. NPAD-DLV and SF-36 correlation ranged between -0.36 -
-0.70. NPAD-DLV and VASpain correlation was 0.54. NPAD-DLV and VASdisability correlation was
0.57. Total scores of NPAD-DLV and NDI-DLV correlation was 0.77.[3] Bremerich et al. found that
the NPAD-d is a valid patient-orientated instrument for use in future studies of Neck Pain And
Disability in German speaking patients.[5] Responsiveness Evidence for responsiveness assesses the
ability of the instrument to detect changes in an individual’s status over time. The score on an outcome
instrument should increase and decrease if the individual’s condition improves and worsens,
respectively.[6] Bremerich FH, Grob D, Dvorak J, Mannion AF. The Neck Pain and Disability Scale:
cross-cultural adaptation into German and evaluation of its psychometric properties in chronic neck
pain and C1-2 fusion patients. Spine. 2008;33(9):1018-27.Quebec Back Pain Disability Scale -
PhysiopediaObjective  The Quebec back pain disability scale (QBPDS) is a condition-specific
questionnaire developed to measure the level of functional disability for patients with low back pain
(LBP) that was designed, developed and validated by Kopec et al in 1995. [1] Original versions of the
scale were developed in French and English and were reported to meet the most stringent criteria for a
health assessment instrument. Investigators and qualified colleagues translated the English version of
the QBPDS into Dutch, Iranian, Brazilian Portuguese, Turkish, Chinese, Greek, Polish, Korean and
Arabic. [2] [3] The original purpose of the questionnaire is to take into account the functional
limitations related to pain, to monitor the progress of individual patients and to compare the evolution
of LBP subjects incorporated in rehabilitation programs. [4] [2] [5] The Quebec back pain disability
scale consists of 20 daily activities that can be categorized into 6 types of activities:  [1] [2] Bed/rest
items                                      1–3 Sitting/standing items                           4–6 Ambulation items            
                     7–9 Movement items                                   10–12 Bending/stooping items                      
  13–16 Handling of large/heavy objects items    17–20. The various components of the questionnaire
were selected from a larger pool of items based on test-retest reliability, item-total correlations, and
responsiveness of individual items and by using techniques of factor analysis and item response theory.
[1] The scale exists of one central question: “Do you have trouble today with...?” followed by 20
activities of daily life. Some examples of daily activity: taking something out of the fridge, getting out
of bed... In every activity, there are 6 answer categories, measured by using a Likert scale from 0-5 (0
= no effort, 5 = not able to). If the patient suffers a lot that day, he scores that activity with a 5, if it
gives no problems a 0. [1] [6] [3] The final outcome is obtained by the sum of the scoring of the degree
of difficulty in performing the 20 daily activities. These outcomes score within the range of 0 and 100,
determents the level of functional disability, with higher numbers representing greater levels of
disability. [1][7] Intended Population The Quebec back pain disability scale has been developed for
several populations of patients with various disability levels who suffer diseases such as acute LBP,
chronic disabling pain, sacroiliac joint dysfunction, lumbar spinal stenosis, disc surgery, and posterior
surgical decompression and settings. (level of evidence: 2 ) [2] The QBPDS is a useful instrument
when someone wants to get an overall impression on the improvement in Pelvic girdle pain. (level of
evidence: 2B ) [8] Method of Use Patients are asked to answer the QBPDS according to the difficulty
they have to perform the activities the current day. The QBPDS examines how the lower back pain
affects your daily life. It is very important that the patient gives a score for every activity; it is not
allowed to skip an activity. (level of evidence: 2A) [2] The scoring is done by count every digit, circled
by the patient. The end score will be between 0 (no limitation) and 100 (totally limited). [4] [2] It is a
very easy questionnaire and takes only five minutes. The QBPDS can be completed by patients by
using paper and pen, mail or telephone. [4] Evidence The evidence has been extensively examined.
(Grade of recommendation: B) [4] Reliability The ICC is 0,55 (95% CI = 0,20-0,78) in acute
occupational low back pain over a period of four weeks. [1] There is a high internal consistency for the
6-point Likert-scale in other languages (Chronbach's a > 0,90). Davidson and Keating examined the
test-retest reliability at patients with low back pain who reported no change during six weeks. They
found an ICC of 0,85 ([95% CI] 0,73-0,91). This margin of detection is lower in chronic low back pain
patients compared with acute low back pain patients. For patients older than 62 years, who suffer acute
low back pain, an ICC of 0,94 and a minimal detectable change of 11,04 over a period of 11 days is
established. [2] The English, French and Dutch versions have a good test–retest reliability. (Grade of
recommendation: B) [9] Validity Construct validity: Construct validity investigates whether the correct
variables were measured in relation to the predefined variables. The Quebec back pain disability scale
is able to distinguish the difference between patients’ disability level and the self-rated health. (Grade
of recommendation: B) [2] The construct validity of the English, French and Dutch version is good.
(Grade of recommendation: B) [9] ⁃ Internal construct validity: Kopec, the author of the Quebec back
pain disability scale, found an inter-item correlation (r) between 0,24 and 0,87 (a relatively high
correlation) and an item-total correlation (r) ranged from 0,59 to 0,86 (a relatively very high
correlation). The research, after Kopec’s results were published, reported an inter-item correlation
lower than 0,80. (Grade of recommendation: B) [2] ⁃ External construct/convergent validity: There is a
moderate to strong correlation between the Quebec back pain disability scale (QBPDS) and other
disability questionnaires (Grade of recommendation: B):              - QBPDS and Roland-Morris
disability questionnaire: r= 0,77-0,81              - QBPDS and Oswestry disability index: r= 0,80- 0,83    
         - QBPDS and physical function subscale of SF-36: r=0,67- 0,77 [4] The correlation between the
QBPDS and pain (r=0,54- 0,74), psychosocial variables and direct measures of physical function is
weak to moderate. (Grade of recommendation: A) [2][4] Content and face validity: The questionnaire
contains various domains of activities which patients and care providers deem important. Because of
this and the good measurement properties, the content and face validity is good. (Grade of
recommendation: B) [2] Responsiveness The responsiveness of the QBPDS is similar to the
responsiveness of the Roland-Morris disability questionnaire, modified Oswestry disability
questionnaire, Waddell disability index and the physical function subscale of SF-36. (Grade of
recommendation: C) [10] The QBPDS is highly sensitive to change for the score of the individual
domains as for the total score (SRM= 0,80 and effect size= 0,62). [11] In addition, the scale is able to
recognize small changes in level of disability over time. (Grade of recommendation: B) [2] Davidson
and Keating found a minimal detectable change of 19 (95% CI 14-24) at patients with low back pain
who reported no change during six weeks. For patients with chronic low back pain is the minimal
detectable change 15,8. (Grade of recommendation: B) [2] The area under the curve (AUC) can be used
as a quantitative method to differ patients who improved or deteriorated from the patients who stayed
stable. [1] The AUC for the detection of change in patients with chronic low back pain is 0,856. This
means that in 85,60 % of the cases the test correctly recognize a change in chronic low back pain.
(Grade of recommendation: B) [2] Miscellaneous The patients and the clinicians both accept the use of
the QBPDS. Researchers (Kopec et al.) declare a low item default (range 0,7-1,8%) [12].
Questionnaires sent by mail had a higher rate of incomplete questionnaires (10.8%). Some patients
remarked that a couple of items were not precise enough and the choice between score 0 and 1 and
between 4 and 5 wasn’t always convenient. The researchers didn’t found ceiling or floor effects in the
answers. (Grade of recommendation: B) [2] Resources - The Quebec back pain disability scale website

References
1. ↑ Jump up to:1.0 1.1
   Abbey J, Piller N, De Bellis A, Esterman A, Parker D, Giles L, Lowcay B. The
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Nurs. 2004; 10: 1: 6-13. Accessed 11 January 2019.
2. ↑ Jump up to:2.0 2.1 2.2 Lichtner V, Dowding D, Esterhuizen P, Closs SJ, Long AF, Corbett A, Briggs
M. Pain assessment for people with dementia: a systematic review of systematic reviews of pain
assessment tools . BMC Geriatr. 2014; 14: 138. Accessed 10 January 2019.
3. Jump up↑ Schofield P. The Assessment of Pain in Older People: UK National Guidelines . Age
Ageing. 2018; 47(Suppl 1): i1–i22. Accessed 10 January 2019.
4. ↑ Jump up to:4.0 4.1 4.2
     The Australian Pain Society. Abbey Pain Scale. Available
from https://apsoc.org.au/PDF/Publications/Abbey_Pain_Scale.pdf . Accessed 10 January 2019.
5. Jump up↑ Karlson C. Reliability and utility of the Abbey Pain Scale-SWE for pain assessment
among people with dementia (in progress). Available
from https://www.oru.se/english/research/research-projects/rp/?rdb=p1701 . Accessed 10 January 2019.
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     Gregersen M, Melin AS, Nygaard IS, Nielsen CH, Beedholm-Ebsen M.
Reliability of the Danish Abbey Pain Scale in severely demented and non-communicative older
patients. Int J Palliat Nurs. 2016. 22;10:482-488.
7. ↑ Jump up to:7.0 7.1
   Takai Y, Yamamoto-Mitani N, Chiba Y, Nishikawa Y, Hayashi K, Sugai Y.
Abbey Pain Scale: development and validation of the Japanese version. Geriatr Gerontol
Int. 2010.10;2:145-53.
8. Jump up↑ Takai Y, Yamamoto-Mitani N, Chiba Y, Kato A. Feasibility and clinical utility of the
Japanese version of the Abbey pain scale in Japanese aged care. Pain Manag Nurs. 2014;15: 2:439-48.