Dementia care These initial studies with the prototype
demonstrated excellent validity and reliability of the tool, and were repeated with the commercial version of PainChek, which includes the app and the Web Admin Portal. Prior to the development of the app, a preliminary patent application was submitted. Data from the validation studies was used to support regulatory clearance for PainChek as a Class 1 medical device in Australia (TGA) and Europe (CE), which was granted in July 2017. To date, four studies about the
PainChek app have been published: l Study 1:Pain Assessment in Dementia: Evaluation of a Point-of- Care Technological Solution (Atee, et al., 2017a). In this study, Atee et al. provide an account of the description, content, and conceptual synthesis as well as the psychometric properties of PainChek. The app was tested in 40 residents, who underwent 353 paired assessments during rest (n = 209) and movement (n = 144). PainChek was demonstrated to have excellent concurrent validity and internal consistency, together with good interrater reliability and discriminant validity.
l Study 2: A novel pain assessment tool incorporating automated facial analysis: interrater reliability in advanced dementia(Atee, et al., 2018) In this study, Atee et al. examined the interrater reliability of the Electronic Pain Assessment Tool (ePAT) among raters when assessing pain in residents with moderate-to- severe dementia, as well as the relationship between total instrument scores and facial scores. A total of 76 assessments were conducted, which indicated that the tool had good reliability properties, and further supported its appropriateness for use
in residents with advanced dementia.
l Study 3:Psychometric evaluation of the Electronic Pain Assessment Tool (ePAT): An Innovative Instrument for Individuals with Moderate-to-Severe Dementia (Atee, et al., 2017b) Based on 400 paired assessments, the psychometric properties of the tool were further examined in 34 geriatric residents. Again, the app demonstrated strong psychometric properties: excellent concurrent validity, interrater reliability, internal consistency, and excellent test-retest reliability. Discriminant validity and predictive validity were both good.
l Study 4: Clinimetric Properties of the Electronic Pain Assessment Tool (ePAT) for Aged-Care Residents with Moderate to Severe Dementia(Hoti et al., 2018). Hoti et al. further analysed Study 3 data to confirm the cut-off scores, and predictive validity of the tool, whilst also reporting on its clinical utility. Using the ROC curve methodology, the cut-off points for presence of pain was confirmed to be ≥ 7. The study demonstrated the high accuracy, sensitivity and specificity of the app in detecting pain in individuals with dementia. It also demonstrated the excellent clinical utility of the app for pain screening and case finding.
Behind the technology PainChek uses facial analysis technology to detect the presence of facial micro- expressions (action units or AUs) indicative of the presence of pain. Utilising the computation power and the built-in cameras of smart devices (phones and tablets), the app uses technology that detects the presence of a face, maps the facial features, and applies a series of algorithms to detect pain-related AUs in real-time using images from a short three-second video.
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This data is then combined with non-
facial features observed by the app user and input via a series of digital checklists, which together allows automatic calculation of a total pain score and the assignment of a pain intensity level. The system allows point-of-care assessment of pain using the app on either iOS or Android mobile devices, without the need for an internet connection, meaning it can be used across a broad range of clinical settings. Data synchronisation to a cloud-
based repository takes place when the device is connected to the internet, providing data security and data sharing across multiple users linked to the same software licence. The PainChek Web Admin Portal can monitor app usage and track assessment results at a patient, user, facility and provider level. The open application programming
interface (API) allows integration of PainChek with client management systems, reducing data entry duplication and enabling two-way data flow, as well as enabling real-time communication of pain assessment results to all those involved in the care of the patient or resident, freeing up staff to engage in direct resident care.
System training A wide variety of training resources have been developed to assist users with the operation of PainChek, including face-to- face training, and web-based materials. The face-to-face training is available for institutional users, and comprises of four sessions: (1) pain associated behaviours in people with dementia, (2) pain assessment in people with dementia, (3) PainChek (e.g., contents, scoring, and administration), and (4) practical training and clinical shadowing. Video clips used in training
demonstrate the AUs typically displayed 37
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