The development of a back pain scale for Tswana speaking individuals

A THESIS submitted in fulfillment for the degree of DOCTOR OF PHILOSOPHY. June 2015Pain is a subjective sensation and is difficult to measure. Quantifying pain provides a measure of assessing effectiveness of treatment and behaviour of the patient’s pain. In Africa unlike in the developed world, a paucity of research into the measurement of pain exists. Historically, Anglo-American scales have been used to measure pain in Africa. Aim: The aim of this thesis was to develop a back pain scale for use in Tswana speaking South Africans. Methods: Four hundred and forty participants from different education, gender and age groups participated in five studies. Study One developed new scales: Colour Analogue Scale(CAS green- red), modified Wong-Baker Faces Pain Scale (WBFPS three faces) , Ascending Injection Scale, Injection Size Scale, Ascending Coin Scale, Coin Heap Scale and previously used scales Visual Analogue Scale (VAS), CAS (white-red), WBFPS (six faces). Study Two tested these scales in 100 asymptomatic participants. “No pain” “”worst pain” was marked on original and reversed scales. Since no significant difference existed between the original and reversed versions, reversed versions were not taken further. In Study Three 40 back pain sufferers developed a Tswana Verbal Descriptive Scale. This was then tested together with the scales from the previous studies, in Study Four, in 250 Tswana individuals with back pain. Pain perception was marked on all scales. Study Five tested the Ascending Injection Scale and the Ascending Coin Scale (best scales from Study Four) and a right angle Triangle Scale in 50 back pain sufferers. “No pain”, “worst pain” and “present pain” perception was marked on all scales. Results: The Ascending Injection Scale was found to be the best understood pain scale in Tswana speaking, back pain sufferers. Conclusion: The Ascending Injection Scale can be used to test back pain severity in Tswana speaking South Africans. I recommend that this scale be translated into the other black languages spoken in South Africa for testing and possible use

The reliability and validity of the Tswana translations of three pain rating scales amongst patients with back pain

ABSTRACT Pain is a subjective sensation and is difficult to measure. It is important to quantify pain as benefits are obtained from its quantification. The validity and reliability of pain outcome measures have been extensively researched in Europe, America and Asia. In Africa on the other hand, very few studies have been done. This study was a cross-sectional study to validate and test the reliability of pain scales.The aim of this study was to establish the validity and reliability of the Tswana translations of three pain scales, namely, the Visual Analogue scale (two versions), the Verbal Rating Scale and the Wong-Baker Faces Pain Measure. The validity of the study was determined by the face validity,criterion validity and construct validity.The statistical analysis of the results showed several significant p values (p< 0.05).However, none of the correlations illustrated a strong relationship as there were no r values in excess of 0.5 indicating a moderate correlation or greater than 0.7 indicating a good correlation. The statistical significance only indicated that the observed values were not due to chance.From the statistical analysis of the results, it became apparent that the subjects tested did not have an understanding of any of the three scales .This was seen in all the age groups and education levels selected for the purpose of this study. It is our recommendation therefore, that suitable, new scales be developed for our local population. The scales which have been used up until now are not being understood and hence are not being interpreted or used correctly in the South African context amongst Tswana speaking individuals. Future research needs to be done in developing entirely different scales for the South African scenario. More relevant and better understood scales should be developed for our local population to include persons of different languages and different education levels. This will assist in a better understanding of the health care process and will by so doing, improve their health care and management

A verbal descriptor incremental pain scale developed by South African Tswana-speaking patients with low back pain

Background: Measuring pain in patients whose home language is not English can be difficult as there may not be a scale available in their home language. Scales devised in other countries may also not be accurate after translation. Objectives: The aim of this study was to develop and test a new verbal pain descriptor scale in a Tswana-speaking population in South Africa with low back pain. Method: Two separate Tswana-speaking groups (20 males and 20 females) of patients with low back pain were asked to describe each of four categories of pain: mild, moderate, severe and worst. They then voted and descriptions obtaining more than 70% of the vote were taken to the next round of voting with both groups together. A final scale of one description for each category of pain (Tswana Verbal Pain Descriptor Scale – TVPDS) for both males and females was tested on a sample of 250 patients with low back pain and against three other non-verbal pain scales. Results: All items on the final scale were approved by at least 70% of both male and female participants. The scores for the TVPDS correlated well with present pain perception (r = 0.729, p < 0.0001) measured on the numerical visual analogue scale. The TVPDS correlated well with the Wong–Baker FACES Pain Rating Scale (r = 0.695, p < 0.0001) and the Pakistani Coin Pain Scale (r = 0.717, p < 0.0001). Conclusion: The TVPDS has the potential to be a useful clinical scale but more testing in other languages is still required. Clinical implications: This pain scale has the potential to be a useful scale to use for Tswana-speaking persons with low back pain and could also be useful for persons of other languages, if translated

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care