2004 - 2007 - Cicely Saunders Institute - King's College London

ICP for assessment and management
of hemiplegic shoulder pain:
• The ShoulderQ, which we have developed to assess
shoulder pain in this context, was shown to provide a
specific and sensitive assessment of response to
treatment 252 .
• The Scale of Pain Intensity (SPIN) was developed as
a simple and accessible tool for assessing pain in
people who are unable to complete the ShoulderQ.
Preliminary evaluation suggests that it has potential
for use in this context, and further evaluation is now
underway 234 . (see In Focus 2.2)
ICP for assessment and management of
depression:
• National clinical guidelines on the assessment and
management of depression in patients following
stroke and acquired brain injury have been modelled
on the ICP 189 .
ICP for the management of spasticity
• Our on-going evaluation of the functional benefits of
botulinum toxin in the management of spasticity was
a significant factor in the successful achievement of
a UK licence for its use in the management of upper
limb spasticity 5 .
• Our first successful use of goal attainment scaling
(GAS) to measure meaningful change in this context
is now being taken up in other studies 209 .
• The Depression Intensity Scale Circles (DISCs) is an
equivalent scale to the SPIN. Evaluation using the ICP
showed it to provide a valid and reliable assessment
of depression in the context of brain injury
(see In Focus) 164 .
In focus 2.2
Assessment Of Pain & Depression
Assessing symptoms in people with cognitive
and communication problems:
A novel approach to a difficult problem
Assessing symptoms is essential for the successful
management of medical conditions. However, people
with cognitive or communication problems, for example
due to acquired brain injury, confusion or other severe
illness, may have difficulty in using traditional measures.
As visual cues may help communication, we have
developed and evaluated a pictorial measure that can
help patients report on their symptoms.
This work has been carried out in the context of
developing Integrated Care Pathways (ICPs) for the
management of depression and pain respectively, in
which regular symptom assessment plays an integral part.
The Depression Intensity Scale Circles (DISCs)
The concept of increasing depression is represented by
a sequence of five dark grey circles increasing in size.
The mode of administration is adapted to suit the
individual’s cognitive and communicative abilities. Their
ability to make reliable ‘yes/no’ responses is established
using a screening questionnaire, the AbilityQ, and is
followed by a verbal explanation of the scale reinforced
by gesture or pictures as appropriate.
The DISCs has been shown to have acceptable
convergent validity, reliability and responsiveness as a
simple graded tool for the screening and assessment of
depression in patients with complex disabilities following
acquired brain injury and is now one of the
recommended tools for assessing depression in the
Royal College of Physicians guidelines for depression
following brain injury 164 .
The Scale of Pain Intensity (SPIN)
The SPIN uses the same idea as the DISCs, except that
the circles are coloured red to convey the concept of
pain. To reinforce its meaning, the colour red is also
used on separate body drawings to indicate the region
of the body where pain may be a problem.
A preliminary study to validate
the SPIN in a general
population with pain has
found that it could quantify
pain as well as the current
preferred tool, a 0-10 numeric
rating scale. Subsequent
observation of verbal and
non-verbal interaction
between speech and
language therapists and
patients with severe
dysphasia, together with the
experience of clinicians in
using the SPIN, has informed
its administration 280;234 . This
tool is now an integral part of
the multidisciplinary ICP for
managing shoulder pain in
stroke patients in daily use on
our regional rehabilitation unit.
Figure 2.7 The Depression
Intensity Scale Circles (DISCs)
Most severe
Depression
No Depression
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