Validity of observation tools for patients hospitalized with osteoporotic vertebral fractures

Osteoporotic vertebral fractures in older patients impair activities of daily living because of low back pain and abnormal posture. Assessing pain using self-reported assessment tools is difficult, especially in patients with moderate-to-severe cognitive impairment. In recent years, observational assessment tools have been used when self-reported assessment tools were difficult to implement. However, no reports have investigated the usefulness of observational assessment tools in patients with acute-phase orthopedic disorders without comorbidities. This study examined the validity of observational tools for pain assessment in patients with lumbar vertebral fractures. Patients admitted to our hospital with acute-phase vertebral fractures were enrolled in this prospective study. Pain was assessed using Japanese versions of the Abbey Pain Scale and Doloplus-2 observational assessment tools, in addition to the Numerical Rating Scale, a self-reported assessment tool. To verify the validity of each pain assessment tool, we examined whether each tool correlated with the activities of daily living and ambulatory status. Activities of daily livings were assessed using the Barthel Index. Ambulatory status was assessed using the Functional Ambulation Categories and the 10-m walking test. Similar to the Numerical Rating Scale scores, assessments with the Abbey Pain Scale and Doloplus-2 showed significant decreases in scores over time. In addition, a significant positive correlation was observed between the self-reported and observational assessment tools. Each pain assessment tool was significantly negatively correlated with activities of daily livings and ambulatory status. Our results indicated when self-reported assessment with the Numerical Rating Scale was difficult for patients with cognitive impairment, pain could be estimated using the Abbey Pain Scale and Doloplus-2 observational assessment tools. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial the ethical review board of the Moji Medical Center (approval no: 02-01) ### Funding Statement This work was supported by research grants from the Japan Organization of Occupational Health and Safety and JSPS KAKENHI Grant Number JP 120K18079. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the ethical review board of the Moji Medical Center (approval no: 02-01) and was conducted in compliance with the Declaration of Helsinki. We disclosed this information to the subjects and provided them with the opportunity to refuse consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors