Validity of observation tools for patients hospitalized with osteoporotic vertebral fractures

Osteoporotic vertebral fractures in older patients impair activities of daily living because of low back pain and abnormal posture. Assessing pain using self-reported assessment tools is difficult, especially in patients with moderate-to-severe cognitive impairment. In recent years, observational assessment tools have been used when self-reported assessment tools were difficult to implement. However, no reports have investigated the usefulness of observational assessment tools in patients with acute-phase orthopedic disorders without comorbidities. This study examined the validity of observational tools for pain assessment in patients with lumbar vertebral fractures. Patients admitted to our hospital with acute-phase vertebral fractures were enrolled in this prospective study. Pain was assessed using Japanese versions of the Abbey Pain Scale and Doloplus-2 observational assessment tools, in addition to the Numerical Rating Scale, a self-reported assessment tool. To verify the validity of each pain assessment tool, we examined whether each tool correlated with the activities of daily living and ambulatory status. Activities of daily livings were assessed using the Barthel Index. Ambulatory status was assessed using the Functional Ambulation Categories and the 10-m walking test. Similar to the Numerical Rating Scale scores, assessments with the Abbey Pain Scale and Doloplus-2 showed significant decreases in scores over time. In addition, a significant positive correlation was observed between the self-reported and observational assessment tools. Each pain assessment tool was significantly negatively correlated with activities of daily livings and ambulatory status. Our results indicated when self-reported assessment with the Numerical Rating Scale was difficult for patients with cognitive impairment, pain could be estimated using the Abbey Pain Scale and Doloplus-2 observational assessment tools.