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Updated: Sep 13, 2025

Author Spotlight: Quantifying Pain Experience – An Illustrative Approach Using the Pain Body Diagram
Published on: July 7, 2023
Construct validity of an adult pain observation scale for people with profound intellectual and multiple
Annemieke Enninga1, Wendy J Post1, Aly Waninge2,3
1Department of Inclusive and Special Needs Education, University of Groningen, Groningen, The Netherlands.
Background:
Objective assessment of pain-related behaviours is crucial in adults with profound intellectual and multiple disabilities. No standardised pain observation instrument that specifically focuses on this target group is currently available. A previous study identified 12 pain-related behaviours in these persons. This study aimed to develop a valid and reliable instrument based on these 12 pain-related behaviours to assess pain in these adults in daily situations.
Method:
Videos of 91 adults with profound intellectual and multiple disabilities in potentially painful daily situations were scored using the 12 pain-related behaviour items. Mokken scale analysis was used to determine the construct validity of these items.
Results:
Analysis resulted in a 9-item scale (H = .46, Rho = .70), which appeared to be sample independent for the variables of sex, age and level of motor functioning.
Conclusion:
A scale containing 9 items (APOS-PIMD) with reasonable construct validity and sufficient reliability was developed, which can be used to measure pain in adults with profound intellectual and multiple disabilities in daily situations.
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