Validation of Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II) in Iranian older adults with dementia living in nursing homes

Background Some dementia patients can self-report pain although the reports are not valid in severe dementia. Observational scales have been developed for pain assessment in these patients. This study aimed to assess the psychometric properties of the Persian version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II). Methods This validation study was conducted on 138 older adults with dementia suffering from chronic pain who lived in nursing homes. The PACSLAC-II Persian version was applied through observations during activity and rest. Reliability of the PACSLAC-II was evaluated by Cronbach's alpha and intra-class correlation coefficients. Construct validity was determined by confirmatory factor analysis, divergent and convergent validity. The Spearman's rank correlation between PACSLAC-II scores and Faces Pain Scale was calculated for concurrent validity. Known-group validity during activity and rest was calculated by Wilcoxon signed ranks test. Results Cronbach's alpha coefficient for facial expression (0.82), verbalisation (0.72), and body movement (0.84) subscales indicated good internal consistency. The intra-class correlation coefficients between two raters was 0.76 and in three times evaluation, the value was 0.76. Convergent validity with Iranian Brief Pain Inventory and divergent validity with 15-item Geriatric Depression Scale confirmed the construct validity of PACSLAC-II. Three factors structure of PACSLAC-II was approved, and most of the variance was explained by facial expressions. The PACSLAC-II can discriminate between pain and non-pain events and has a moderate correlation with Faces Pain Scale (r = 0.33). Conclusions PACSLAC-II Persian version is a valid and reliable scale for pain assessment in older adults with dementia.