Validity and reliability of the Italian version of painad for postoperative pain assessment in geriatric patients with proximal femur fractures

Background: Pain assessment is essential in nursing care. The Numerical Rating Scale (NRS) is widely used but may not fully capture pain’s multidimensional nature. The Pain Assessment in Advanced Dementia (PAINAD) scale is reliable for assessing pain in cognitively impaired patients. This study aims to evaluate the validity of the Italian version of PAINAD (PAINAD-IT) for postoperative pain assessment in geriatric patients with femur fractures. Methods: This study employs the PAINAD-IT, which was translated and validated for the Italian context by Costardi et al. (2007). Face and content validity (I-CVI and S-CVI) for non-cognitively impaired patients were evaluated by experts. Pain assessments were conducted at rest (T0) and during movement (T1). Convergent validity was tested using Spearman correlation, discriminant validity with the Wilcoxon test, and inter-rater reliability with Cohen’s kappa. Sensitivity and specificity were calculated. Results: I-CVIs were ≥0.90 and S-CVI was 0.96. 75 patients were included. Cohen’s kappa was 0.918 at T0 and 0.881 at T1. Both PAINAD and NRS detected a significant increase in pain from T0 to T1 (Wilcoxon p <0.001). Sensitivity was 26 % and specificity was 99 % for PAINAD-IT scores ≥3. Conclusion: PAINAD showed strong reliability and correlation with NRS, effectively distinguishing between rest and pain stages, these results suggest that PAINAD-IT may be a useful tool for pain assessment in geriatric patients operated for femur fracture. PAINAD-IT scores ≥3 may suggest severe pain. Further multi-centre studies with larger sample sizes are needed to fully validate PAINAD-IT for postoperative pain assessment in geriatric patients.