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Evidence-based Development and Initial Validation of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate-II (PACSLAC-II)

Chan, Sarah MA*; Hadjistavropoulos, Thomas PhD*; Williams, Jaime PhD*; Lints-Martindale, Amanda PhD

doi: 10.1097/AJP.0000000000000039
Original Articles

Objectives: Our goal was to develop and validate, based on theoretical and empirical knowledge, the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-II), a shorter tool that would improve on the PACSLAC, while addressing limitations of the original version.

Methods: The PACSLAC was revised based on the relevant clinical and theoretical literature. Psychometric properties and clinical utility of the resulting 31-item PACSLAC-II were examined. Specifically, the PACSLAC-II was used to assess pain based on video footage of long-term care (LTC) residents with dementia undergoing painful procedures as part of routine care. Its ability to discriminate pain from non–pain-related states was compared with that of preexisting pain assessment tools using archival data. A second phase involved the use of the PACSLAC and PACSLAC-II by LTC staff to solicit feedback from health care providers. Mixed-methods analysis of this feedback was conducted.

Results: The PACSLAC-II demonstrated satisfactory reliability, excellent validity, and ability to differentiate between pain and nonpain states. The PACSLAC-II also accounted for unique variance in differentiating between pain and nonpain states, even after controlling for the preexisting tools combined, including the PACSLAC. The PACSLAC-II was also preferred by many LTC nurses and care aides, because of its length and condensed nature, which was thought to facilitate documentation and greater efficiency in pain management.

Discussion: Findings indicate that the empirical and theoretically driven revisions to the PACSLAC led to improved ability to differentiate between pain and nonpain states, while retaining its clinical utility.

*Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK

Department of Clinical Health Psychology, Faculty of Medicine, University of Manitoba, MB, Canada

Supported, in part, through a grant from the Saskatchewan Health Research Foundation, Saskatoon, Saskatchewan. S.C. was supported through a research fellowship from the Alzheimer Society of Canada, Toronto, Ontario. The remaining authors declare no conflict of interest and have no financial interest in the PACSLAC-II.

Reprints: Thomas Hadjistavropoulos, PhD, Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada S4S 0A2 (e-mail:

Received May 13, 2013

Received in revised form November 27, 2013

Accepted September 16, 2013

© 2014 by Lippincott Williams & Wilkins