OBJECTIVE: The objective of this scoping review was to identify assessment instruments used for the self-report of pain by hospitalized patients who have had a stroke and who have communication problems. INTRODUCTION: Pain assessment in various patient groups has received considerable attention, and a variety of pain assessment instruments exists. Nevertheless, there is a lack of consensus regarding which pain assessment instruments are used for self-report of pain in stroke patients with communication problems. INCLUSION CRITERIA: This review included articles that focused on hospitalized adults who have had a stroke, have communication problems attributable to a stroke, and describe the use of an assessment instrument for the self-report of pain. The scoping review considered systematic reviews, quantitative and qualitative studies, and mixed method studies. METHODS: Ten databases were searched from inception to August 2020, using Embase as the key information source (it yielded 424 papers). Hand-searching of the references of the included articles yielded an additional 12 papers. Papers written in any language were considered. A data extraction table was created to record relevant information in line with the goals and results of each article, the sample studied, and the pain assessment instrument used. RESULTS: Ten papers were included in the review, most of which were descriptive studies. Most papers were from the United Kingdom and the United States. The most common communication problem in stroke patients was aphasia. The participants received care in various hospital settings (eg, rehabilitation units, comprehensive stroke units, palliative care). Eleven assessment instruments were identified. In most cases, the assessment instruments focused on assessing pain presence and pain intensity. The most frequently used unidimensional pain intensity instrument was the numerical rating scale. Four instruments were multidimensional, of which two assessed health-related quality of life, including pain. The most thorough pain assessment instrument was the ShoulderQ, which contains 10 verbal questions and three visual vertical graphic rating scales that focus on the assessment of stroke-related shoulder pain. CONCLUSIONS: A range of both unidimensional and multidimensional self-report pain instruments was identified; however, of all the possible communication problems, most studies focused solely on patients with mild to moderate aphasia. Therefore, further research is recommended, including studies that also enroll patients with various stroke-related communication problems other than aphasia. In addition, the instruments should be translated for research in non-Western countries. Finally, apart from descriptive studies, experimental research with a robust randomized controlled trial design is needed to examine the effect of pain-inducing procedures on the perceived pain in patients with stroke-related communication problems.

Department of Public Health and Primary Care Leiden University Medical Centre Leiden The Netherlands

Faculty of Health Studies University of Pardubice Pardubice Czech Republic

Geriatric Rehabilitation Center Topaz Revitel Leiden The Netherlands

Science and Research Centre Faculty of Health Sciences Palacky University Olomouc Czech Republic

The Czech National Centre for Evidence Based Healthcare and Knowledge Translation Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

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Johns Hopkins Medicine. [Types of stroke] [internet]. The Johns Hopkins University; 2021 [cited 2021 Nov 16]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/types-of-stroke .

Katan M, Luft A. Global burden of stroke. Semin Neurol 2018;38 (2):208–211.

Mc Sharry J, Baxter A, Wallace LM, Kenton A, Turner A, French DP. Delay in seeking medical help following transient ischemic attack (TIA) or “mini-stroke”: a post study. PLoS One 2014;9 (8):e104434.

Treister AK, Hatch MN, Cramer SC, Chang EY. Demystifying poststroke pain: from etiology to treatment. PM R 2017;9 (1):63–75.

International Association for the Study of Pain. Pain [internet]. Washington, DC: International Association for the Study of Pain; 2018 [cited 2020 Dec 19]. Available from: https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=9218 .

Klit H, Finnerup NB, Jensen TS. Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol 2009;8:857–868.

Park J. A study on the sleep quality, pain, and instrumental activities of daily living of outpatients with chronic stroke. J Phys Ther Sci 2019;31 (2):149–152.

Delpont B, Blanc C, Osseby GV, Hervieu-Bègue M, Giroud M, Béjot Y. Pain after stroke: a review. Rev Neurol (Paris) 2018;174 (10):671–674.

de Vries NJC, Sloot PH, Achterberg WP. Pain and pain assessment in stroke patients with aphasia: a systematic review. Aphasiology 2017;31 (6):703–719.

Brady MC, Kelly H, Godwin J, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2016;6:CD000425.

Mitchell C, Bowen A, Tyson S, Butterfint Z, Conroy P. Interventions for dysarthria due to stroke and other adult-acquired, non-progressive brain injury. Cochrane Database Syst Rev 2017;1:CD002088.

New AB, Robin DA, Parkinson AL, Duffy JR, McNeil MR, Piguet O, et al. Altered resting-state network connectivity in stroke patients with and without apraxia of speech. Neuroimage Clin 2015;8:429–439.

Clark WC, Yang JC, Tsui SL, Ng KF, Bennett Clark S. Unidimensional pain rating scales: a multidimensional affect and pain survey (MAPS) analysis of what they really measure. Pain 2002;98 (3):241–247.

Edwards SA, loannou A, Carin-Levy G, Cowey E, Brady M, Morton S, et al. Properties of pain assessment tools for use in people living with stroke: systematic review. Front Neurol 2020;11:792.

Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Aromataris E, Munn Z. Chapter 11: Scoping Reviews. JBI, JBI Manual for Evidence Synthesis [internet]. Adelaide:2020.

Mandysova P, Klugar M, de Vries NJC, Matějkova I. Assessment instruments used for the self-report of pain by hospitalized stroke patients with communication problems: a scoping review protocol. JBI Evid Synth 2020;18 (8):1731–1737.

Munn Z, Aromataris E, Tufanaru C, Stern C, Porritt K, Farrow J. The development of software to support multiple systematic review types: the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Int J Evid Based Healthc 2019;17 (1):36–43.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71.

Allison R. Developing a longitudinal profile of the consequences of the profoundly-affected arm after stroke: a feasibility study [dissertation]. Exeter, UK: University of Exeter; 2013.

Gokkaya NKO, Aras MD, Cakci A. Health-related quality of life of Turkish stroke survivors. Int J Rehabil Res 2005;28 (3):229–235.

van Bragt PJ, van Ginneken BT, Westendorp T, Heijenbrok-Kal MH, Wijffels MP, Ribbers GM. Predicting outcome in a postacute stroke rehabilitation programme. Int J Rehabil Res 2014;37:110–117.

Schuster J, Hoyer C, Ebert A, Alonso A. Use of analgesics in acute stroke patients with inability to self-report pain: a retrospective cohort study. BMC Neurol 2020;20:18.

Turner-Stokes L, Jackson D. Assessment of shoulder pain in hemiplegia: sensitivity of the ShoulderQ. Disabil Rehabil 2006;28 (6):389–395.

Smith JH, Bottemiller KL, Flemming KD, Cutrer FM, Strand EA. Inability to self-report pain after a stroke: a populationbased study. Pain 2013;154:1281–1286.

Soares CD, Panuganti PK, Shrivastava A, Aroor S, Keinath KM, Bromagen MC, et al. Experimental pain assessment in patients with poststroke aphasia. Neurology 2018;91:e793–e799.

Mazzocato C, Nemitza JM, Anwara D, Michel P. The last days of dying stroke patients referred to a palliative care consult team in an acute hospital. Eur J Neurol 2010;17:73–77.

Turner-Stokes L, Rusconi S. Screening for ability to complete a questionnaire: a preliminary evaluation of the AbilityQ and ShoulderQ for assessing shoulder pain in stroke patients. Clin Rehabil 2003;17:150–157.

Hui D, Bruera E. The Edmonton Symptom Assessment System 25 years later: past, present, and future developments. J Pain Symptom Manage 2017;53 (3):630–643.

Mandysova P, Herr K. The translation and linguistic validation of the Revised Iowa Pain Thermometer into Czech for a clinical study involving Czech stroke patients. Kontakt 2019;21 (1):55–64.