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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">The current aging of the population and the increased life expectancy and longevity are leading to an increase in chronic diseases in the elderly&#46; Chief among these diseases is dementia&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;2</span></a> due to its high incidence rate and to being one of the main causes of disability&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a> In advanced ages&#44; diseases that progress with chronic pain occur often &#40;e&#46;g&#46;&#44; degenerative and inflammatory joint diseases&#44; fractures secondary to senile osteoporosis&#44; malignancies and neuropathic pain in type 2 diabetes mellitus&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The combination of pain and dementia is one of the most common causes of suffering and disability&#44; because it greatly affects both the quality of life of those who have the condition and their caregivers and relatives&#46; This process also significantly increases healthcare costs&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a> because the presence of pain in individuals with dementia can worsen their cognitive impairment&#44; increase their functional impairment and lengthen their hospital stay&#44; among other issues&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;6</span></a> Despite the importance of a correct approach to pain&#44; this symptom is underdiagnosed and undertreated&#44; especially in individuals with communication problems&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To assess the presence and intensity of pain&#44; self-reporting is considered the gold standard&#46; Although self-reporting can be useful in the initial phases of dementia and even during moderate phases&#44; when patients have significant difficulties in communicating and are incapable of remembering&#44; understanding and responding to their experience of pain&#44; these reports are not applicable&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a> To assess pain in these conditions&#44; various approaches and tools have been proposed&#46; One of these approaches is to assess autonomic reactions such as sweating&#44; increased blood pressure&#44; increased heart rate and breathing rate and the release of stress hormones and endorphins&#46; These parameters can indicate the presence of acute pain&#44; although they are not specific for assessing pain&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a> These reactions are also attenuated in individuals with dementia and are therefore not useful for identifying persistent pain&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> Another problem is that measuring some of these reactions can be invasive&#44; slow and expensive&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Other directed tools have therefore been proposed to identify behavioral changes &#40;vocal and body&#41; in the presence of pain&#46; Several systematic reviews have been conducted comparing the psychometric properties of these tools and their scope of use&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;7</span></a> Most of the tools have been developed and validated for English settings&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#8211;16</span></a> although some have been translated and validated to other languages&#44;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">17&#8211;21</span></a> which is important because the interpretation of the behavior of pain can differ dramatically from one culture to the next&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">22</span></a> A cultural adaptation and validation of the various instruments designed to assess pain in individuals with dementia and communication problems is therefore especially important&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In 2014&#44; a systematic review was published on pain assessment scales for patients with dementia&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a> Although this review was published in Spanish&#44; it analyzed scales published in their original language and did not examine the Spanish validation of these scales&#46; To date&#44; we have found no specific systematic review on what instruments have been validated in the Spanish context&#46; Therefore&#44; this study&#39;s objective was to determine&#44; through a systematic literature review&#44; what instruments are available for assessing pain in individuals with dementia and communication problems in the Spanish healthcare setting&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design&#44; protocol and recording</span><p id="par0030" class="elsevierStylePara elsevierViewall">From September to December 2017&#44; we conducted a systematic literature review following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses &#40;PRISMA&#41; Declaration&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">23&#44;24</span></a> To manage the references&#44; we used the Mendeley Reference Manager&#44; version 1&#46;17&#46;12&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Eligibility criteria</span><p id="par0035" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Inclusion criteria&#58; We included studies published up to December 31&#44; 2017&#44; on tools developed in Spain to assess pain in individuals with dementia and communication problems&#46; We also included methodological studies of scales translated and validated to Spanish&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Exclusion criteria&#58; We excluded studies that covered nonspecific instruments for assessing pain&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Information sources</span><p id="par0050" class="elsevierStylePara elsevierViewall">We consulted the following databases&#58; PubMed&#44; Web of Science&#44; CINAHL&#44; Scopus&#44; Dialnet and Cuitatge&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Search strategy</span><p id="par0055" class="elsevierStylePara elsevierViewall">Our search strategy included all terms potentially related to the study topic and that produced results in the Spanish context&#46; We opted for a broad strategy that ensured good sensitivity and sufficient specificity&#44; thereby avoiding losing relevant publications on the topic&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the search strategy used for PubMed&#46; This strategy was adapted for each database mentioned above&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Strategies to minimize selection bias</span><p id="par0060" class="elsevierStylePara elsevierViewall">To minimize selection bias&#44; we clearly defined the inclusion and exclusion criteria&#46; In addition&#44; the entire process of searching and selecting articles was conducted in pairs&#46; Each pair of authors was responsible for replicating the search in a database&#46; We employed a single reference manager in which the first author removed the duplicates&#46; The selected articles were divided by title and abstract into 3 groups&#44; such that each pair of evaluators&#44; the first author and each of the other 3 authors performed this selection&#46; Lastly&#44; the selection by full text was once again divided among pairs&#44; discussing with the entire team the questions regarding the selection of a specific article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Data analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">For the data analysis&#44; we designed a table to perform a thematic synthesis of the included articles&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">To assess the methodological quality and psychometric properties of each identified instrument&#44; we followed the Evaluating the Measurement of Patient-Reported Outcomes &#40;EMPRO&#41; method&#46; This method enables the assessment of instruments that measure patient-perceived results&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">25&#44;26</span></a> The tool was requested of the authors&#44; and permission was obtained to use it in this study&#46; The standard measurement of the EMPRO score could not be applied due to the different characteristics between the assessed tools and EMPRO&#46; However&#44; we did use the tool as a reference for the items it includes and the areas it incorporates&#44; because it provides a standard for examination based on the ideal recommendations of the Scientific Advisory Committee of the Medical Outcomes Trust&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">27</span></a></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">Ultimately&#44; the sample included for the thematic synthesis analysis consisted of 10 articles&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the article selection process and the results&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Of the 10 selected studies&#44; 5 were publications on the development or validation of scales to Spanish&#46; We also identified 5 studies conducted in the Spanish healthcare context&#44; which used some pain assessment instrument for individuals with dementia and communication problems&#46; We performed a descriptive synthesis of each article&#46; A meta-analysis could not be performed due to the heterogeneity of the selected studies&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Studies on the development or validation to Spanish of pain assessment instruments for individuals with dementia and communication problems</p><p id="par0090" class="elsevierStylePara elsevierViewall">We identified 4 studies that covered the process of adapting and validating a scale to Spanish&#58; the Spanish versions of the Abbey&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a> PAINAD&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> Doloplus<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a> and Algoplus<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a> scales&#46; We also included a doctoral thesis that covered the development and validation process of the Spanish Assessment of Pain in Elderly with Dementia &#40;EDAD&#41; scale&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a> This scale was originally designed in Spanish and used in the Spanish healthcare context&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> synthesizes the main characteristics of each of the aforementioned scales in their Spanish version&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In terms of their usefulness&#44; all discriminated the presence&#47;absence of pain&#59; however&#44; the Abbey&#44; Algoplus and PAINAD-Sp scales also measured intensity&#46; However&#44; the use of Algoplus and PAINAD-Sp required prior training&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The Algoplus and Doloplus scales have been used in the Spanish context&#44; not only in individuals with dementia but also in other conditions in which communication disorders occur&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Of the questionnaires that specified the estimated time of application&#44; all were rapid-use tools because they required between 1 and 5<span class="elsevierStyleHsp" style=""></span>min to apply&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The pain assessment with the EDAD scale&#44; the Spanish version of the PAINAD scale &#40;PAINAD-Sp&#41; and Algoplus were conducted in the validation studies interchangeably by physicians and nurses&#46; In the first 2 scales&#44; other health professionals were also employed &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the methodological quality of each instrument&#44; according to the EMPRO structure&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Studies conducted in the Spanish healthcare context that used pain assessment instruments in individuals with dementia and communication problems</p><p id="par0125" class="elsevierStylePara elsevierViewall">We included 5 studies conducted in the Spanish healthcare context that mentioned having used some pain assessment instrument in individuals with advanced dementia and communication problems&#46; The most relevant aspects of these studies are shown below and can be seen in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; Alaba and Arriola&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a> Garr&#233;-Olmo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a> and de la Rica Escu&#237;n and Gonz&#225;lez Vaca<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a> &#40;in studies conducted in San Sebastian&#44; Girona and Albacete&#44; respectively&#41; employed the translation of the original version of the PAINAD scale&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a> The validation of this scale to Spanish<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> was published in 2014 &#40;online since June 2013&#41;&#46; In 2015&#44; Rodr&#237;guez-Mansilla et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">33</span></a> published a study conducted in Extremadura that used&#44; among other instruments&#44; the Doloplus2 scale&#46; The study referred to the original scale<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a> but not to the publication of the validation in Spanish in 2009&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a> Additionally&#44; a study<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">35</span></a> was identified on the adaptation and psychometric validation of the Spanish version of the quality-of life-scale in advanced dementia&#44; which used the PAIN-VAS&#46; This visual analog scale was completed by the nearby informants&#44; indicating &#40;on a scale of 0&#8211;100&#41; the degree of pain they thought the patient had at that time&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion and conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">There are currently 4 available Spanish-validated scales for assessing pain in individuals with dementia and communication problems&#58; Abbey&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a> PAINAD-Sp&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> Doloplus<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a> and Algoplus&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a> Despite the topic&#39;s considerable relevance&#44; we found only a small number of studies in the Spanish context that employed some pain assessment instrument for individuals with dementia and communication problems&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">With respect to the scales employed in the studies conducted in Spain&#44;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#44;31&#8211;33&#44;35</span></a> it is noteworthy that no reference was made in any case to the instruments already validated in Spanish but rather to the original scale &#40;in another language&#41; or even to secondary sources&#46; These studies also provide insufficient data on the process of adapting to the new context and language&#46; These findings could further hinder our understanding of Spanish-validated instruments and perpetuate a significant problem&#58; the underdiagnosis and undertreatment of pain in individuals with a high incidence of pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">7&#44;8</span></a> We also need to consider that the characteristics of the Spanish-validated scales might not coincide with the characteristics of the original scales&#46; The recommendations and conclusions obtained after the analysis of the original scales might therefore differ<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;7&#44;9</span></a> from those of the present review&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">With regard to the scales validated to the Spanish context&#44;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">20&#44;21&#44;28&#44;29</span></a> we found that the validation processes were not always completely explicit and had various limitations that hinder their replicability&#46; In this respect&#44; all authors provided data on the scales&#8217; reliability but not on their validity&#46; The Abbey and PAINAD-Sp scales provided the most complete data on this process&#44; although the sample used in the PAINAD-Sp scale was much smaller&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Taking into account the criteria of application time&#44; training&#44; usefulness&#44; applicability and psychometric properties&#44; the Spanish-validated Abbey scale appears to be the best option&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a> However&#44; the observer profile &#40;the individual who uses the scale&#41; has been limited to medical professionals with extensive clinical experience&#46; Therefore&#44; if other professionals want to use the scale&#44; it would be advisable to analyze the scale&#39;s psychometric properties for this new observer profile&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Various international authors have recommended the use of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate &#40;PACSLAC&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a> due its good psychometric properties&#46; However&#44; this scale has yet to be validated to Spanish&#46; In fact&#44; in the Spanish palliative care setting&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">36</span></a> the use of Doloplus&#44; PACSLAC &#40;for the nursing home context&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a> and PAINAD-Sp &#40;for the hospital setting&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a> are recommended&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Based on our results&#44; it is important to recommend the use of already validated instruments&#44; instead of creating new ones that might lack rigorous validation&#46; However&#44; the validation processes should also be rigorous and provide sufficient data so that authors may choose the scale that best adapts to their context&#44; thereby generating results that can show the efficacy of the interventions&#44; and that are comparable in our context and with other countries&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">We would also recommend including &#40;in the continuing education of healthcare practitioners and caregivers&#41; the assessment of pain in individuals with dementia and communication problems&#44; training in the use of these instruments and in selecting the most appropriate instrument depending on the setting in which they work&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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            0 => "Pain"
            1 => "Dementia"
            2 => "Spain"
            3 => "Review"
            4 => "Communication problems"
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            0 => "Dolor"
            1 => "Demencia"
            2 => "Espa&#241;a"
            3 => "Revisi&#243;n"
            4 => "Problemas de comunicaci&#243;n"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pain assessment in individuals with advanced dementia and communication problems continue to be underdiagnosed and undertreated due to the difficulty in performing this assessment&#46; This review explores and synthesizes how pain in individuals with advanced dementia and communication problems are being assessed in the context of Spanish healthcare&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A systematic review of the literature was conducted following the PRISMA criteria&#46; We reviewed the databases of PubMed&#44; Web of Science&#44; Cinahl&#44; Scopus&#44; Dialnet and Cuitatge up to December 2017&#46; Four independent reviewers identified studies that included instruments to assess pain in individuals with dementia and communication problems in the Spanish healthcare context&#46; We performed a narrative synthesis of the included articles&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">After applying the inclusion criteria&#44; 10 studies were included&#46; Of these&#44; 4 were methodological studies validating Spanish versions of scales &#40;Abbey&#44; Algoplus&#44; Doloplus and PAINAD-Sp&#41;&#44; and 1 was on the development of the original EDAD scale&#46; We also identified 3 studies conducted in Spain that used a translation of the PAINAD&#44; 1 study that used a Spanish translation of Doloplus2 and 1 publication that included the use in Spain of a scale not validated for this patient profile &#40;Pain-VAS&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There are currently several instruments validated in Spanish to assess pain in individuals with advanced dementia and communication problems &#40;Abbey&#44; Algoplus&#44; Doloplus y PAINAD-Sp&#41;&#46; However&#44; these instruments have still not been widely used in research&#44; and their psychometric properties could be improved&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La valoraci&#243;n del dolor en personas con demencia avanzada y problemas de comunicaci&#243;n contin&#250;a siendo infradiagnosticada e infratratada debido a la dificultad que conlleva realizar esta valoraci&#243;n&#46; Esta revisi&#243;n pretende explorar y sintetizar c&#243;mo se est&#225; valorando el dolor en personas con demencia avanzada y problemas de comunicaci&#243;n en el contexto sanitario espa&#241;ol&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n sistem&#225;tica de la literatura siguiendo los criterios PRISMA&#46; Se revisaron las bases de datos Pubmed&#44; Web of Science&#44; Cinahl&#44; Scopus&#44; Dialnet y Cuitatge hasta diciembre de 2017&#46; Cuatro revisores independientes identificaron los estudios que inclu&#237;an instrumentos para evaluar el dolor en personas con demencia y problemas de comunicaci&#243;n&#44; en el contexto sanitario espa&#241;ol&#46; Se realiz&#243; una s&#237;ntesis narrativa de los art&#237;culos incluidos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Despu&#233;s de aplicar los criterios de inclusi&#243;n se seleccionaron 10 estudios&#46; De estos 4 fueron estudios metodol&#243;gicos de validaciones de escalas al espa&#241;ol &#40;Abbey&#44; Algoplus&#44; Doloplus y PAINAD-Sp&#41; y uno del desarrollo de la escala original EDAD&#46; Adem&#225;s&#44; se identificaron 3 estudios realizados en Espa&#241;a&#44; que utilizaban una traducci&#243;n de la PAINAD&#44; un estudio que utiliz&#243; una traducci&#243;n al espa&#241;ol de la Doloplus2 y una publicaci&#243;n que incluy&#243; el uso en Espa&#241;a de una escala no validada para este perfil de pacientes &#40;Pain-VAS&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Actualmente&#44; existen varios instrumentos validados en espa&#241;ol para valorar el dolor en personas con demencia avanzada y problemas de comunicaci&#243;n &#40;Abbey&#44; Algoplus&#44; Doloplus y PAINAD-Sp&#41;&#46; Aunque a&#250;n estos instrumentos no han sido muy utilizados en investigaci&#243;n y las propiedades psicom&#233;tricas de los mismos pueden mejorar&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; de Juan Pardo M&#193;&#44; Saracibar-Razquin M&#44; Crespo I&#44; Fuster Linares P&#46; Valoraci&#243;n del dolor en personas con demencia y problemas de comunicaci&#243;n en Espa&#241;a&#46; Revisi&#243;n sistem&#225;tica&#46; Rev Cl&#237;n Esp&#46; 2018&#59;218&#58;435&#8211;444&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Search&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Terms used in PubMed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pain&#91;Title&#47;abstract&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8220;Cognitive dysfunction&#8221;&#91;Title&#47;abstract&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8220;Cognitive impairment&#8221;&#91;Title&#47;abstract&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8220;Cognitive deficits&#8221;&#91;Title&#47;abstract&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dementia&#91;Title&#47;abstract&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#35;2 OR &#35;3 OR &#35;4 OR &#35;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spanish&#91;Text Word&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spain&#91;Text Word&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#35;7 OR &#35;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#35;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#35;1 AND &#35;6 AND &#35;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">PubMed search strategy&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Scales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference of the original scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference of the Spanish validation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Description&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population&#47;setting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Evaluator profile&#47;training on the use of the scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration of the observation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abbey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abbey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">13</span></a>&#44; 2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chamorro and Puche&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pain intensity in elderly patients with advanced dementia&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Patients admitted to the geriatric unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Physicians with extensive clinical experience&#47;without training&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>min approximately&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Algoplus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rat et al&#46;&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pickering et al&#46;&#44; 2017<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Presence&#47;absence of pain in elderly patients with communication disorders&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not indicated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Physician&#47;nurse specialists in geriatric medicine and pain assessment in individuals with communication problems&#47;with training&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Doloplus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wary et al&#46;&#44; 2001<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pickering et al&#46;&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a> &#40;online&#44; 10 Sep 2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pain intensity in elderly individuals with communication disorders&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Long-stay units&#59; rehabilitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Physician specialists in geriatric medicine and pain assessment in patients with communication disorders&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unspecified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EDAD<br>Pain Assessment Scale in elderly patients with dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baeza Lanuza&#44; 2006<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Original in Spanish&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Presence&#47;absence of pain in elderly patients with communication disorders and severe cognitive impairment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Residences and healthcare centers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Health professionals<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> who provide standard care to the evaluated individuals&#47;without training&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not specified &#40;includes the observation before and during the care and during the last 48<span class="elsevierStyleHsp" style=""></span>h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PAINAD-Sp<br>Pain Assessment in Advanced Dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Warden and Hurley&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Garc&#237;a-Soler et al&#46;&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a><br>&#40;online&#44; 7 Jun 2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pain intensity in elderly patients with communication disorders and severe cognitive impairment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gerontological center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Health professionals<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> and researchers&#47;with considerable training&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Assistants&#44; nurses&#44; physiotherapists&#44; physicians&#44; psychologists&#44; occupational therapists&#46;</p>"
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            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Assistants&#44; nurses&#44; psychologists&#44; social workers&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Spanish validation studies and studies on the development of observational scales to assess pain in individuals with dementia and communication problems&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">All values shown are statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; CCC&#58; Lin&#39;s concordance correlation coefficient&#59; ICC&#58; intraclass correlation coefficient&#59; Kappa <span class="elsevierStyleItalic">i</span>&#46;&#58; kappa index&#59; Pearson <span class="elsevierStyleItalic">r</span>&#58; Pearson&#39;s correlation&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Spanish Ref&#46; Scales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Validation process<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&#47;development&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Sample&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Reliability</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Validity</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Sensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Translation-cultural adaptation<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Internal consistency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stability&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Of content&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Of criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Of construct&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abbey&#44; Chamorro and Puche&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Validation of Spanish version&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#945;</span> Cronbach 0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intraobserver ICC 0&#46;77<br>Intraobserver Kappa <span class="elsevierStyleItalic">i</span>&#46; 0&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Expert committee&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Predictive 100&#37; &#40;ROC 0&#46;94&#41; Concurrent Pearson&#39;s <span class="elsevierStyleItalic">r</span> 0&#46;82 &#40;between researcher holistic impression and Abbey&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Convergent&#58; Sensitivity 96&#37; &#40;Youden index 0&#46;96&#41; Divergent&#58; Specificity 100&#37; Value Z No factorial analysis<br>Predictive validity ROC curve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Z<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;35 for measures before and after analgesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partially described&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Algoplus Pickering et al&#46;&#44; 2017<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Validation of Spanish version&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Kudder-Richardson 0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Test&#8211;retest<br>CCC 0&#46;85<br>Intraobserver<br>Kappa <span class="elsevierStyleItalic">i</span>&#46; 0&#46;69&#8211;0&#46;84<br>&#40;5 items&#41;<br>CCC 0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sufficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Doloplus Pickering et al&#46;&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Validation of Spanish version&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intraobserver<br>Pearson&#39;s <span class="elsevierStyleItalic">r</span> 0&#46;92<br>ICC 0&#46;84<br>Kappa <span class="elsevierStyleItalic">i</span>&#46; 0&#46;47&#8211;0&#46;85 &#40;10 items&#41;<br>Test&#8211;retest<br>Pearson&#39;s <span class="elsevierStyleItalic">r</span> 0&#46;96<br>ICC 0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sufficient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EDAD Baeza Lanuza&#44; 2006<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Development of original scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Different for each analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#945;</span> Cronbach 0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intraobserver<br>ICC 0&#46;51&#8211;0&#46;97 &#40;8 items&#41;<br>ICC 0&#46;94 &#40;total scale&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Delphi<br>Expert committee&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Concurrent<br>Analysis of variance&#47;Duncan between EDAD and assessment of no pain by experts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exploratory factor analysis and confirmatory factor analysis<br>3 Factors &#40;8-item scale&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Discriminates between presence&#47;absence of pain in acute and chronic pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not applicable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PAINAD-Sp Garc&#237;a Soler et al&#46;&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Validation of Spanish version&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cronbach <span class="elsevierStyleItalic">&#945;</span> for the 3 rest conditions 0&#46;727&#8211;0&#46;811<br>Pleasant activity<br>0&#46;59&#8211;0&#46;82<br>Pain<br>0&#46;46&#8211;0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intraobserver<br>ICC for the 3 conditions<br>Rest 0&#46;58&#8211;0&#46;88<br>Pleasant activity 0&#46;73&#8211;0&#46;84<br>Pain 0&#46;70&#8211;0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Convergent&#58;<br>Spearman Rho &#40;PAINAD-Sp&#47;EVA&#41;<br>Rest 0&#46;52&#8211;0&#46;67<br>Pleasant activity 0&#46;37&#8211;0&#46;72<br>Pain 0&#46;54&#8211;0&#46;92<br>Divergent&#58;<br>differences between mean score in the 3 conditions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No data provided&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partially described&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Cultural translation-adaptation&#58; sufficient &#40;including the translation&#44; back-translation&#44; pre-test&#41;&#59; partially described &#40;includes only some of the previous items&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Psychometric properties of the Spanish validation and development of observational scales to assess pain in individuals with dementia and communication problems according to EMPRO structure&#46;</p>"
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        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Scale used&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Scale reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population&#47;setting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Evaluator profile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alaba and Arriola&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a> 2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Translation of the PAINAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Warden and Hurley&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Individuals with cognitive impairment&#47;in nursing homes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Geriatric care assistants &#40;caregivers for the elderly&#41; Standard care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Garr&#233;-Olmo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a> 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Translation of the PAINAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Warden and Hurley&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Individuals with advanced dementia&#47;in nursing homes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nurses<br>Standard care&#47;with training on the use of the scale&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">De la Rica Escu&#237;n and Gonz&#225;lez Vaca&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Translation of the PAINAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Warden and Hurley&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Individuals with advanced dementia&#47;in nursing homes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nursing assistants<br>Standard care&#47;with training on the use of the scale&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rodr&#237;guez Mansilla et al&#46;&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Translation of the Doloplus2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wary and Doloplus&#44; 1999<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Garr&#233;-Olmo et al&#46;&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pain-VAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Teenier and Sender&#44; 2007<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a> &#40;secondary source&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Individuals with advanced dementia&#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nearby informants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Studies that use a pain assessment instrument for individuals with dementia and communication problems in the Spanish context&#46;</p>"
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    "bibliografia" => array:2 [
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Review
DOI: 10.1016/j.rceng.2018.05.007
Pain assessment in individuals with dementia and communication problems in Spain. A systematic review
Valoración del dolor en personas con demencia y problemas de comunicación en España. Revisión sistemática
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M.Á. de Juan Pardoa,
Corresponding author
mdejuan@uic.es

Corresponding author.
, M. Saracibar-Razquinb,c, I. Crespod, P. Fuster Linaresa
a Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Spain
b Facultad de Enfermería, Universidad de Navarra, Pamplona, Spain
c Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
d Cátedra WeCare, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Barcelona, Spain

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Highlighted articles
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Revista Clínica Española
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The value of multi-modal ultrasound in the assessment of...
Rev Clin Esp. 2024;224:437-44
Adverse cardiovascular, obstetric and perinatal events...
Rev Clin Esp. 2024;224:337-45
How to detect non-institutionalized older patients at risk...
Rev Clin Esp. 2024;224:217-24
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www.publicationethics.org.
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