• Anneke A Boerlage, Joost van Rosmalen, Juanita M Cheuk-Alam-Balrak, Jeannette A Goudzwaard, Dick Tibboel, and Monique van Dijk.
• Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
• Pain Pract. 2019 Apr 1; 19 (4): 407-417.

BackgroundThe Rotterdam Elderly Pain Observation Scale (REPOS) has been proven useful to assess pain in noncommunicative and cognitively impaired nursing home residents. We evaluated whether the REPOS is also reliable and valid for pain assessment in the hospital setting.MethodsIn this prospective multicenter observational study, surgical patients were observed perioperatively at bedside and internal medicine patients were filmed during a possible painful moment and at rest. Pain behavior was assessed from the video recordings with the REPOS and the Pain Assessment Checklist for seniors with Severe Dementia-Dutch language (PACSLAC-D). Longitudinal associations between REPOS score and numeric rating scale pain ratings from observers and nurses (NRSobs and NRSproxy ) corrected for patients' gender were assessed with linear mixed models.ResultsIn total, 72 patients were included; 118 observations of surgical and 68 observations of internal medicine patients were analyzed. Interobserver reliability between the researcher and 2 other observers was good, with Cohen's kappa values of 0.71 (confidence interval [CI] 0.59 to 0.83) and 0.84 (CI 0.74 to 0.94), respectively. The intraobserver reliability of the principal investigator was good, with Cohen's kappa 0.82 (CI 0.67 to 0.91). Linear mixed modeling revealed correlation values between the REPOS and NRSobs of 0.67 and the REPOS and NRSproxy of 0.73. Optimal sensitivity (78%) and specificity (90%) for the detection of pain were found with a REPOS cutoff score of ≥3, using an NRS score of ≥4 as the reference value.ConclusionsThe REPOS is reliable and valid for the assessment of postoperative and chronic pain in hospital patients who cannot self-report pain.© 2018 World Institute of Pain.

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