The Norwegian Dolorplus-2, a tool for behavioural pain assessment: translation and pilot-validation in nursing home patients with cognitive impairment.

J. C. Hølen, I. Saltvedt, Peter Fayers, M. Bjørnnes, G. Stenseth, Bjorn Hval, Marilene Filbert, Jon Håvard Loge, S. Kaasa

Research output: Contribution to journalArticlepeer-review

42 Citations (Scopus)


Background: Pain assessment is challenging in cognitively impaired (CI) patients due to inadequate self-report skills and observational ratings are an alternative. The Doloplus-2 is developed for pain assessment in the Cl and rates somatic, psychomotor and psychosocial behaviours as indicators of pain. Aims: To translate the Doloplus-2 into Norwegian, to test the Doloplus-2 with regard to criterion validity and to obtain the administrators' evaluation of the clinical performance of the Doloplus-2. Methods: Nurses at three nursing homes, in collaboration with two research assistants, administered the Doloplus-2 to 59 patients with dementia. The results were compared against experienced clinicians' pain ratings. Regression analyses were performed to explore each different item's contribution to the total pain score. The administrators also completed a debriefing questionnaire. Results: The instrument was translated according to international guidelines. Regression analyses demonstrate that the Doloplus-2 score accounts for 62% (R-2) of the expert score and that the four most informative items could explain 68% of the expert score. Analyses of the different Doloplus-2 items indicate that facial expressions explain most and social life least of the expert's pain ratings. The administrators reported that Doloplus-2 was helpful and easy to administer, but questioned the validity of the psychosocial domain. Conclusions: The Norwegian Doloplus-2 demonstrates satisfactory criterion validity and clinical value in this pilot study. However, the content of the instrument needs a general re-evaluation, especially with regard to the psychosocial items.

Original languageEnglish
Pages (from-to)411-417
Number of pages7
JournalPalliative Medicine
Issue number5
Publication statusPublished - 2005

Bibliographical note

The authors wish to thank Torgeir Fjermestad, Michael Ulvan and Nils Lystad, who worked as pain experts. In addition, the authors would like to thank the staff and patients of Persaunet wards 2 and 3, Furuveien and Bromstadekra nursing homes for their willingness and enthusiasm that made this study possible.


  • dementia
  • geriatrics
  • measurement
  • observational assessment
  • pain
  • palliative patients


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