Behavioral pain assessment scale for the elderly presenting with verbal communication disorders, DOLOPLUS consists in an observation form consisting of 10 items divided into 3 sub-groups proportionally to the observed frequency (5 somatic items, 2 psychomotor items and 3 psychosocial items).
Each item is scored from 0 to 3 (scored using 4 exclusive and progressive levels) yielding an overall score between 0 and 30.
Pain is patent for a score greater than or equal to 5 out of 30.
DO NOT AUTOMATICALLY USE THE DOLOPLUS SCALE WITHOUT FIRST TRYING SELF-ASSESSMENT.
When the elderly person can communicate and cooperate, it makes sense to use self-assessment tools.
Combining self- and hetero-assessment will avoid underestimation.
RATING OF AN ITEM IN ISOLATION
Behaviour is iterative if it is repeated several times (therefore not continuously)
AN APPROVED SCALE
The use of a scale which has not been approved or which includes poor psychometric properties will lead to erroneous extrapolation. Thus any measuring instrument, if it is to be of any practical use, must be approved. This means checking that it provides a sensible, reproducible, reliable and specific result.
Before using a tool, the clinician must be satisfied that it has good psychometric qualities (see Hadjistravopoulos et al. 2006).
The Doloplus scale is the first hetero-assessment scale of pain in elderly people with verbal communication difficulties to have been approved in French in January 1999 and published (Lefebvre- Chapiro 2001). Fifteen French and Swiss geriatricians trained in palliative care and pain management, led by a biostatistician, studied a population of elderly subjects aged over 65 and having verbal communication or behavioural difficulties, except when studying convergent validity (in which case the ability to self-assess was required). This was a multicentre study (15 different centres with or without geriatric medicine units, palliative care departments, geriatric aftercare and long-term care centres, geriatric rehabilitation centres and care homes). It began in March 1995 and ended in January 1999.
The 510 elderly people were aged between 65 and 101, and were assessed using the Doloplus scale 1 to 3 times depending on the tests, making a total of 1000 assessments. The various statistical validation stages concentrated on the study of reproducibility (test-retest reliability and inter-rater reliability), sensitivity (by item and overall), convergent validity and internal consistency.
For more detailed numerical data, please see the following publication:
Wary B.,Serbouti S., “Doloplus: validation d’une échelle d’évaluation comportementale de la douleur chez la personne âgée.” Revue Douleurs, 2001, 2; 1: 35-38.
The days of simple estimation of pain are behind us. Today’s hetero-assessment scales have filled in the gaps which self-assessment tools were unable to fill. Validation of the Doloplus scale is just one more battle won in the fight against the inequalities to be found in pain management, particularly in elderly people with verbal communication difficulties.
Below are some of the most frequently asked questions about DOLOPLUS.
If, after exploring this site and particularly the recommendations given, you still have questions about how to use the scale, or if you would like any further information, whether it is about international development, approval of the scale, or anything else, please get in touch with the appropriate person via the “Contact us” section.
WHO SCORES, AND HOW FREQUENTLY?
CAN A SOLE CAREGIVER AT HOME USE DOLOPLUS?
Scoring by a pluridisciplinary team is preferable, but use by lone caregivers is possible (still wiser than simple estimation).
It is essential to draw on information gathered from the family and other persons involved (liaison notebook, telephone conversation, scheduled bedside meeting).
HOW LONG DOES SCORING TAKE?
IS THERE A LINK BETWEEN THE DOLOPLUS SCORE AND WHICH PAINKILLER TO PRESCRIBE?
A pain rating scale only answers one question: “Is this elderly person in pain or not?” The prescription of a painkiller should be kept separate from the assessment score; experience of pain is purely personal, and only score kinetics will tell us whether the painkilling treatment is adequate or not.
CAN THE DOLOPLUS SCALE BE USED FOR OTHER POPULATIONS?
Peut-on utiliser l'échelle DOLOPLUS pour d'autres populations ?
Non, mais… Il n’existe actuellement pas d’échelle comportementale pour évaluer la douleur chez l’adulte psychiatrique ou comateux par exemple.
Les comportements étant assez spécifiques d’une population donnée, il faudrait réserver l’échelle DOLOPLUS aux malades âgés.
Si l’absence d’outil d’hétéro-évaluation pour d’autres populations autorise l’utilisation quelque peu abusive de DOLOPLUS, elle doit surtout inciter à la recherche d’outils adaptés à chaque type de population.
DOES DOLOPLUS SCORE ACUTE PAIN?
Les cas cliniques sont classés par ordre de difficultés croissantes en fonction de l’apprentissage réalisé.
Télécharger le fichier PDF de chaque cas clinique.