Associations between facial expressions and observational pain in residents with dementia and chronic pain

Author:

Pu Lihui12ORCID,Coppieters Michel W.134ORCID,Smalbrugge Martin56ORCID,Jones Cindy17ORCID,Byrnes Joshua18ORCID,Todorovic Michael127ORCID,Moyle Wendy12ORCID

Affiliation:

1. Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia

2. School of Nursing and Midwifery Griffith University Brisbane Queensland Australia

3. School of Health Sciences and Social Work Griffith University Brisbane Queensland Australia

4. Amsterdam Movement Sciences – Program Musculoskeletal Health, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam Amsterdam The Netherlands

5. Department of Medicine for Older People Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands

6. Amsterdam Public Health Research Institute, Aging & Later Life Amsterdam The Netherlands

7. Faculty of Health Sciences & Medicine Bond University Gold Coast Queensland Australia

8. Centre for Applied Health Economics, School of Medicine and Dentistry Griffith University Brisbane Queensland Australia

Abstract

AbstractAimTo identify specific facial expressions associated with pain behaviors using the PainChek application in residents with dementia.DesignThis is a secondary analysis from a study exploring the feasibility of PainChek to evaluate the effectiveness of a social robot (PARO) intervention on pain for residents with dementia from June to November 2021.MethodsParticipants experienced PARO individually five days per week for 15 min (once or twice) per day for three consecutive weeks. The PainChek app assessed each resident's pain levels before and after each session. The association between nine facial expressions and the adjusted PainChek scores was analyzed using a linear mixed model.ResultsA total of 1820 assessments were completed with 46 residents. Six facial expressions were significantly associated with a higher adjusted PainChek score. Horizontal mouth stretch showed the strongest association with the score, followed by brow lowering parting lips, wrinkling of the nose, raising of the upper lip and closing eyes. However, the presence of cheek raising, tightening of eyelids and pulling at the corner lip were not significantly associated with the score. Limitations of using the PainChek app were identified.ConclusionSix specific facial expressions were associated with observational pain scores in residents with dementia. Results indicate that automated real‐time facial analysis is a promising approach to assessing pain in people with dementia. However, it requires further validation by human observers before it can be used for decision‐making in clinical practice.ImpactPain is common in people with dementia, while assessing pain is challenging in this group. This study generated new evidence of facial expressions of pain in residents with dementia. Results will inform the development of valid artificial intelligence‐based algorithms that will support healthcare professionals in identifying pain in people with dementia in clinical situations.Reporting MethodThe study adheres to the CONSORT reporting guidelines.Patient or Public ContributionOne resident with dementia and two family members of people with dementia were consulted and involved in the study design, where they provided advice on the protocol, information sheets and consent forms, and offered valuable insights to ensure research quality and relevance.Trial RegistrationAustralian and New Zealand Clinical Trials Registry number (ACTRN12621000837820).

Publisher

Wiley

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