| Summary: | Background: during pain assessment in persons unable to self-report, such as people living with dementia, vocalisations are
commonly used as pain indicators. However, there is a lack of evidence from clinical practice regarding their diagnostic value
and relationship with pain. We aimed to explore vocalisations and pain in people with dementia undergoing pain assessments
in clinical practice settings.
Methods: a total of 22,194 pain assessments were reviewed in people with dementia (n = 3,144) from 34 different Australian
aged care homes and two dementia specific programs. Pain assessments were conducted by 389 purposely trained health care
professionals and cares using PainChek pain assessment tool. Vocalised expressions were determined based on nine vocalisation
features included in the tool. Linear mixed models were used to examine the relationship of pain scores with vocalisation
features. Using a single pain assessment for each of the 3,144 people with dementia, additional data analysis was conducted
via Receiver Operator Characteristic (ROC) analysis and Principal Component Analysis.
Results: vocalisation scores increased with increasing pain intensity. High pain scores were more likely with the presence of
sighing and screaming (8 times). The presence of vocalisation features varied depending on the intensity of pain. The ROC
optimal criterion for the voice domain yielded a cut-off score of ≥2.0 with a Youden index of 0.637. The corresponding
sensitivity and specificity were 79.7% [confidence interval (CI): 76.8–82.4%] and 84.0% (CI: 82.5–85.5%), respectively.
Conclusion: we describe vocalisation features during presence of different levels of pain in people with dementia unable to
self-report, therefore providing evidence in regard to their diagnostic value in clinical practice.
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