Faces of Pain during Dental Procedures: Reliability of Scoring Facial Expressions in Print Art.

Frank Lobbezoo,Savannah De La Mar,Xuan Mai Lam,Liza J M Van De Rijt,Maurits K A Van Selms,Miriam Kunz

doi:10.3390/brainsci11091207

Abstract

Background: Observational tools have been developed to assess pain in cognitively impaired individuals. It is not known, however, whether these tools are universal enough so that even pain depicted in print art can be assessed reliably. Therefore, the aim of this study was to assess the reliability in scoring facial expressions of pain in dental print art from the 17th, 18th, and 19th century, using a Short Form of the 15-item Pain Assessment in Impaired Cognition (PAIC15-SF) tool. Methods: Seventeen prints of patients undergoing dental procedures were scored twice by two inexperienced observers and an expert and once by a Gold Standard observer. Results: All observers achieved high intra-observer reliability for all four items of the category “facial expressions” and for three items of the category “body movements” (ICC: 0.748–0.991). The remaining two items of the category “body movements”, viz., “rubbing” and “restlessness”, were excluded from further research because it was not possible to calculate a reliable ICC. Overall, the intra-observer reliability of the expert was higher than that of the inexperienced observers. The inter-observer reliability scores varied from poor to excellent (ICC: 0.000–0.970). In comparison to the Gold Standard, the inter-observer reliability of the expert was higher than that of the inexperienced observers. Conclusion: The PAIC15-SF tool is universal enough even to allow reliable assessment of facial expressions of pain depicted in dental print art.

Highlights

Pain, and especially orofacial pain, is a common condition among the general population [1]
All test-retest reliability scores, quantified as ICC, were determined for the nine different items of the PAIC15-SF. It can be gathered from this table that both inexperienced observers showed a fair-to-good to excellent intra-observer reliability (ICC 0.748–0.991) for all items, except for the body movements “rubbing” and “restlessness”
Due to the fact that the expert’s ICC scores for the inter-observer reliability in comparison with those of the Gold Standard were overall higher than those of the inexperienced observers (Obs. 1 vs. Gold Standard; Obs. 2 vs. Gold Standard), it can be assumed that the expert is more reliable in establishing facial expressions of orofacial pain in print artwork compared to the inexperienced observers

Summary

Introduction

Especially orofacial pain, is a common condition among the general population [1]. The presence of pain will be addressed verbally in order to receive a proper diagnosis and cure. For those persons who suffer from pain but are at the same time limited in their communicative abilities, pain can become undetected. When a patient is cognitively impaired or has dementia, the assessment of pain becomes increasingly challenging due to the loss of communication abilities [3,4]. In such cases, healthcare providers have to rely on observations and intuition to assess when more or different care is needed [5]. Research has shown good psychometric properties of the PAIC15; the tool can be considered reliable, valid, and ready to be used in everyday clinical settings [8]

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Conclusion