Integrating the Numerical Pain Rating Scale (NPRS) with an Eye Tracker: Feasibility and Initial Validation

This chapter details the integration of a Numerical Rating Scale (NPRSETI) with a portable eye tracker, enabling the assessment of pain in conditions in which verbal communication and use of hands are limited (e.g., advanced Amyotrophic lateral sclerosis, ALS). After detailing the construction of the NPRSETI, we describe its validation in an outpatient pain clinic. More specifically, thirty chronic pain patients performed the NPRSETI and filled a conventional NPRS (order was pseudo-randomized). Eye movements, including gaze direction and additional eye movement measures (e.g., saccade rate), were recorded, while participants rated their pain using the NPRSETI. The study’s findings indicated no significant differences in pain severity ratings of the NPRSETI and conventional NPRS. Notably, ratings using the two scales were highly correlated (r = 0.99). NPRSETI’s ratings were also strongly associated with participants’ currently experienced pain rating using the Brief Pain Inventory (BPI). The findings provide initial proof of concept for integrating conventional pain rating scales with an eye tracker and validate the NPRSETI compared with the well-validated and commonly used NPRS. Enhanced usability and decreasing costs of eye trackers will ease the additional research mandated to validate these preliminary findings and hopefully advance their integration into clinical practice

Does pain take holidays? Non-attendance rates at a hospital-based pain clinic are elevated during the Jewish high-holidays

Abstract Background Patient non-attendance is an expensive and persistent problem worldwide with rates between 5–39% reported in the literature. The objective of the study was to assess whether there is a higher incidence of non-attendance in a hospital-based pain clinic during the period of the Jewish High Holidays (Rosh-Hashanah to Sukkot) and whether this is further compounded by other factors, such as demographic characteristics and previous visits to the clinic. Methods Records were taken from the Lowenstein Rehabilitation Hospital appointment scheduling system. Data was gathered from two time-periods: High-Holidays and Control for each year, over a total of 6 years 2008–2013. Non-attendance was analyzed by period, by age, by gender and by previous visits to the clinic. Results In the entire population studied (666 distinct records), the non-attendance rate was higher during the High-Holidays as compared to the Control period (32 vs. 24.1%; p = 0.030). Non-attendance rates were significantly higher during the Holidays among repeating patients (28.6 vs. 14.8%; p = 0.002) and among women (34.6 vs. 20.7%; p = 0.004). Discussion Our data suggest that non-attendance is elevated during the High-Holidays in specific groups of patients, namely, repeating patients and women. Despite no direct inquiry into the reasons for non-attendance, we speculate that the elevated well-being and familial support during the holidays contribute to the patients’ ability to cope with persistent pain and possibly directly reduce the amount of pain, leading to patients missing their pain clinic appointments. Conclusion Our results, provided they can be corroborated by larger-scale studies, can assist in scheduling policy adjustments such as avoidance of appointments during the High-holidays for specific patient populations and more rigorous reminder efforts during these times of the year that may lead to reduction in overall non-attendance rates in the pain clinic. Further, our data provide an impetus for further studies of non-attendance patterns among pain clinic patients, in order to acquire a better understanding of the reasons for non-attendance and develop strategies to reduce it and thus contribute to the continuous improvement of the Israeli health systems as well as others worldwide

Additional file 1 of Enoxaparin for VTE thromboprophylaxis during inpatient rehabilitation care: assessment of the standard fixed dosing regimen

Additional file 1: Table S1. Analysis of patient-related covariates and anti-Xa activity