Characteristic Behaviors of Pain During Movement in the Older Individuals with Dementia.

Purpose: This study assessed the pain associated with movement and exercise in older individuals with cognitive decline, using the Abbey Pain Scale (APS) to identify the sub-items that effectively reflect pain during such activities. Patients and Methods: A cross-sectional study was conducted in 225 older patients with musculoskeletal disorders and cognitive decline at the Ikeda Rehabilitation Hospital in Toyama, Japan. Pain during walking or transferring was assessed using the verbal rating scale (VRS) and the APS. Item response theory (IRT) was used to identify the APS sub-items that most accurately reflected the presence and degree of pain. Results: Pain associated with movement scored 1.3 ± 1.1 on the VRS and 2.5 ± 2.6 on the APS. The IRT analysis extracted "vocalization", "facial expression", and "change in body language" as the most reliable indicators of pain. These extracted items showed good internal consistency (Cronbach's α = 0.72), were significantly positively related to changes in the VRS (rs = 0.370, p < 0.001), and showed significant differences between patients with and without subjective pain. Conclusion: Our study suggests that the APS sub-items "vocalization", "facial expression", and "change in body language" may be the most effective indicators of pain during movement and exercise in older individuals with cognitive decline. This approach may enhance the reliability of pain assessments and management during exercise therapy.