Screening for pain in patients with cognitive and communication difficulties: evaluation of the SPIN-screen

ABSTRACT - The scale of pain intensity (SPIN)-screen is a simple visual tool for the screening and measurement of pain intensity, which is designed to be accessible by patients with cognitive and communication problems. It was applied prospectively in a consecutive cohort of 79 patients admitted to a tertiary specialist neurorehabilitation unit, of which 86% had significant cognitive/communicative disabilities. In all, 71 patients (90%) responded to the SPIN. Concurrent validation against a standard numbered graphic rating scale (NGRS) showed a strong overall correlation (rho 0.94 p < 0.0001). When the NGRS was converted to an equivalent six-point scale, weighted Kappa tests demonstrated 'almost perfect' agreement (K = 0.81, SE 0.083) between the two sets of ratings. Repeat testing after 24 hours provided preliminary evidence for the stability and responsiveness of the SPIN-screen, but these require further evaluation. Of those who expressed a preference for one tool over the other, 70% preferred the SPIN. The study provides support for application of the SPIN-screen as a routine screening tool in this group of patients.