Towards the rapid assessment of pain expression: The Index of Facial Pain Expression (IFPE)
Abstract
Pain is the most common reason for seeking healthcare and one in five Canadians suffer from chronic pain. Despite high prevalence and severe consequences, pain is often poorly recognized and inadequately managed. Training observers to recognize facial expressions of pain may improve observer detection and estimation of pain. Pain is accompanied by distinct and reliable changes in four facial muscles (i.e., brow, orbital, levator, eye closure) that can be characterized as a "pain expression." The facial expression of pain communicates quantitative information that is associated with self-report of pain. Observers do not fully utilize evidence for pain conveyed by the face and rely on salient indicators at the expense of subtle signs. This dissertation described the development, reliability, and validity of the Index of Facial Pain Expression (IFPE) - an abbreviated system for quantifying facial pain expression. This work consisted of three steps. First, we developed the IFPE which is an online environment designed to quantify pain through the use of an abbreviated Facial Action Coding System (FACS). This training environment included a manual, three online learning modules, and a final test containing 25 video-clips. Second, four comparable Sensitivity To Expressions of Pain (STEP) tests were designed to evaluate observer sensitivity and response bias to evidence of clinical pain. Participants (n=101) completed questionnaires, watched four STEP tests, and evaluated patient pain. Results indicated that observer characteristics were associated with evaluation of pain. Third, a controlled investigation was performed to evaluate the impact of training in the IFPE on observer sensitivity and response bias to clinical pain. Participants attended two laboratory testing sessions separated by an intervention period where they were assigned to complete the IFPE (n = 34) or a no contact control (n = 20). Participants completed questionnaires during the first testing session and watched parallel versions of the STEP test during laboratory sessions. Training in the IFPE resulted in reliable coding of facial muscle movements associated with pain, and improvement in sensitivity to evidence of clinical pain. Collectively, this work provides initial support for the IFPE as a tool to improve observer detection of facial pain expression.
Description
Keywords
Psychology--Behavioral, Psychology--Clinical, Psychometrics
Citation
Rash, J. (2017). Towards the rapid assessment of pain expression: The Index of Facial Pain Expression (IFPE) (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/28490