How can someone tell you they\u2019re experiencing pain or discomfort that isn\u2019t overtly visible, if they can\u2019t communicate through speech? Professor Jeff Hughes from Curtin\u2019s School of Pharmacy and Biomedical Sciences has created an app that gives a voice to people who are living with conditions that impact upon their ability to verbally communicate with others.<\/p>\n
One of these conditions is dementia, a neurodegenerative condition that affects the brain\u2019s cognitive ability. It\u2019s currently the second leading cause of death in Australia, and with the number of people living with dementia set to reach more than 536,000 by 2025, the demand for tools that help treat and manage the condition is sure to increase.<\/p>\n
Professor Hughes\u2019 brainchild was the world\u2019s first smartphone app for pain assessment and monitoring, developed under the banner of Curtin start-up company ePAT (electronic Pain Assessment and Technologies Ltd) from 2014. The start-up was acquired by PainChek Ltd in 2016, and the app is now being further developed and marketed by the company as \u2018PainChek\u2019.<\/p>\n
The app provides an accurate and reliable means for healthcare professionals and family members providing care at home to assess pain, and ultimately help to improve quality of life for those they care for.<\/p>\n
\u201cA significant issue among people with advanced dementia is that they no longer have the communication skills to express the level of pain they are suffering,\u201d Hughes explains.<\/p>\n
\u201cThe seriousness of their pain can often go unrecognised. But PainChek, a smart-device app, which utilises automation and artificial intelligence, allows for the detection and quantification of pain, based in part on a patient\u2019s facial expressions.<\/p>\n
PainChek uses facial recognition and a 42-point pain scale to help healthcare professionals and family members decipher the level of pain being experienced by their patient or family member, allowing them to respond accordingly. A level between zero to six represents no pain, seven to 11 mild pain, 12 to 15 moderate pain and anything above 15 means severe pain.<\/p>\n
The tailored pain scale was developed by Hughes and his team through a tireless review of existing literature and tools, including the well-known Abbey Pain Scale, an observational pain assessment tool used nationally in the assessment of pain in people with dementia.<\/p>\n
PainChek automates pain assessment, allowing for the continual evaluation of pain, and providing the user with access to a personalised pain chart of their patient or family member, which has been mapped over an extended timeframe. The chart is designed to be used in conjunction with other information recorded on the app, which correlates with or affects pain levels, such as medication types and dosages, activity levels and behaviour. All recorded data is backed up when the device is connected to the internet.<\/p>\n
Since its inception in 2013, Hughes and his team have been working hard to assess and monitor the performance of the app. They\u2019ve conducted validation studies with a range of Perth-based aged care providers, including Mercy Care, Juniper, Bethanie and Brightwater, comparing each generation of the app with the Abbey Pain Scale. Data from these trials was used to support the registration of the app as a Class 1 medical device in Australia (Therapeutics Goods Administration registration) and Europe (CE Mark) by PainChek Ltd.<\/p>\n
Trials in aged care facilities were successful, validating the functionality and purpose of PainChek. One of the residents living with dementia was previously cared for at home by her husband. He says the app has been an invaluable tool for assessing his wife\u2019s constant lower back pain.<\/p>\n
\u201cWhen we tested the app on my wife, we got a score of four out of 10. It was so quick and accurate. She\u2019s in pain constantly with her lower back, and has trouble sitting down. The pain scale changes daily, and it makes me feel really comfortable that I can administer the necessary pain killers at any given time.\u201d<\/p>\n
In addition, the research has led to the development of a partnership with Dementia Support Australia, which comprises the two entities Dementia Behaviour Management Advisory Service and Severe Behaviour Response Teams.<\/p>\n
\u201cDementia Support Australia sends consultants out to assist in the care of people living with dementia who have significant behavioural problems,\u201d Professor Hughes says.<\/p>\n
\u201cWhat they had found from their own observations was that somewhere between 35 to 60 per cent of the people had undetected or undertreated pain, and they wanted the means to improve the assessment and documenting of that pain, and better demonstrate the effectiveness of their service.<\/p>\n
\u201cPainChek Ltd are effectively doing an implementation trial with them, starting here in Western Australia and then in South Australia. As part of the trial, we provide training and, after each roll out, we also offer clinical and technical support. In 2018, we\u2019ll roll out the app to all 150 of their consultants Australia-wide.\u201d<\/p>\n
The development of the app hasn\u2019t stopped there, with PainChek Ltd working on adaptations that can cater for other groups unable to communicate verbally: infants and pre-verbal children.<\/p>\n
\u201cTwenty per cent of children have chronic pain, with common causes being headaches and gastrointestinal or musculoskeletal conditions. And that pain can produce a whole range of issues, such as behavioural problems, poor interaction with others and avoiding school. Most people think that little kids don\u2019t feel pain the way adults do, but we\u2019re learning this isn\u2019t the case,\u201d Hughes reveals.<\/p>\n
The intended impact of the children\u2019s app is three-fold. One, to provide parents with surety about whether they\u2019re taking the appropriate action. Two, to assist healthcare professionals in deciding what level of pain a child might be in and which medication to administer if applicable, and three, to encourage the investigation of the root cause of the pain to then seek the appropriate treatment.<\/p>\n
Much like the adult app, the children\u2019s app contains a number of items to help assess pain, however, the facial recognition element is far more in-depth due to the fact that children typically use more pain-associated facial expressions than adults. As a result, Hughes\u2019 team has been capturing videos of children who are in pain, primarily during the immunisation process, with each video contributing to a database of coded images. With a preliminary algorithm already built, PainChek Ltd plans to have the first prototype available for trialling in 2018.<\/p>\n
More information about the app can be found on the PainChek website<\/a>.<\/p>\n <\/p>\n