Observed and Perceived Pain: Findings of a Cross-Sectional Study in Hospitalized Subjects.

BACKGROUND: Pain constitutes a serious problem of a health, economic, ethical, and social equity nature affecting negatively quality of life. Its assessment is often subjected to overestimation or underestimation. AIM: The aim of this study is threefold: (1) to estimate the prevalence of pain in hospitalized patients; (2) to assess the grade of correlation between the level of pain observed by the nurses and the pain perceived by the patients; and (3) to examine the level of scientific knowledge among the healthcare professionals. DESIGN: Cross-sectional study. METHODS: The intensity level of observed and perceived pain has been evaluated in 401 patients with validated scales. Analyzed data have been extracted from the electronic medical record and integrated into the data-collection sheet. A questionnaire has been submitted to nurses to investigate their level of knowledge on pain assessment and management. RESULTS: The study included 350 patients out of 401; for 51 patients the "pain" data was missing. Prevalence of perceived pain was 40.15%. Nurses overestimated pain in 7.43% of cases and underestimated it in 24.9%. The majority of the nursing staff claimed to be aware of the pain topic, however, they showed some uncertainties in clinical practice. CONCLUSIONS: The differential variation between the observed pain and the perceived one resulted in 43.71% of cases, highlighting the dependence on the two variables: "area of hospitalization" and "intensity level". The observation and monitoring of pain did not appear to be a consolidated practice, thus representing an important area for investments in the nursing profession.

Arthrodesis Versus Arthroplasty in Thumb Carpometacarpal Osteoarthritis: Impact on Maximal Voluntary Force, Endurance, and Accuracy of Pinch.

PURPOSE: To investigate differences in pinch strength recovery among patients with first carpometacarpal joint osteoarthritis treated with either arthrodesis or suspension arthroplasty. METHODS: Thirty-seven subjects who underwent arthrodesis or suspension arthroplasty for carpometacarpal osteoarthritis were included. Force exerted during maximal voluntary contraction (MVC) in a pinch task was measured. Maximal voluntary contraction was recorded using a haptic device equipped with a load cell from which an analog signal was acquired and digitized for visual feedback. Dynamic force was assessed by a task consisting of 10 repetitions, with a target of 70% of MVC. Endurance was assessed by the length of sustained pinch task at 30% of MVC. Task performance was quantified by mean distance and offset error from the target force as error indices, and standard deviation of force was used as index of force steadiness. RESULTS: The arthrodesis group obtained considerably higher MVC values than the arthroplasty group. No notable differences were found for pinch endurance. The standard deviation for dynamic force was lower for arthroplasty, indicating greater force steadiness. CONCLUSIONS: Arthrodesis is associated with greater pinch strength. Arthroplasty is associated with better pinch precision. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.