Background: Observational tools have been developed to assess pain in cognitively impaired individuals. It is not known, however, whether these tools are universal enough so that even pain depicted in print art can be assessed reliably. Therefore, the aim of this study was to assess the reliability in scoring facial expressions of pain in dental print art from the 17th, 18th, and 19th century, using a Short Form of the 15-item Pain Assessment in Impaired Cognition (PAIC15-SF) tool. Methods: Seventeen prints of patients undergoing dental procedures were scored twice by two inexperienced observers and an expert and once by a Gold Standard observer. Results: All observers achieved high intra-observer reliability for all four items of the category “facial expressions” and for three items of the category “body movements” (ICC: 0.748–0.991). The remaining two items of the category “body movements”, viz., “rubbing” and “restlessness”, were excluded from further research because it was not possible to calculate a reliable ICC. Overall, the intra-observer reliability of the expert was higher than that of the inexperienced observers. The inter-observer reliability scores varied from poor to excellent (ICC: 0.000–0.970). In comparison to the Gold Standard, the inter-observer reliability of the expert was higher than that of the inexperienced observers. Conclusion: The PAIC15-SF tool is universal enough even to allow reliable assessment of facial expressions of pain depicted in dental print art.

中文翻译：

---

牙科手术中的疼痛面孔：印刷艺术中面部表情评分的可靠性

背景：已经开发了观察工具来评估认知障碍个体的疼痛。然而，尚不清楚这些工具是否具有足够的通用性，以至于可以可靠地评估印刷艺术中描绘的疼痛。因此，本研究的目的是使用 15 项认知障碍疼痛评估 (PAIC15-SF ） 工具。方法：接受牙科手术的患者的 17 幅指纹由两名缺乏经验的观察者和一名专家评分两次，一次由黄金标准观察者评分。结果：所有观察者在“面部表情”类别的所有四个项目和“身体运动”类别的三个项目上都实现了高观察者内可靠性（ICC：0.748-0.991）。“身体运动”类别的其余两项，即“摩擦”和“烦躁”，由于无法计算出可靠的 ICC，因此被排除在进一步研究之外。总体而言，专家的观察者内部可靠性高于没有经验的观察者。观察者间的可靠性分数从差到优（ICC：0.000-0.970）不等。与黄金标准相比，专家的观察者间可靠性高于没有经验的观察者。结论：PAIC15-SF 工具具有足够的通用性，甚至可以对牙科印刷艺术中描绘的疼痛面部表情进行可靠评估。专家的观察者内部可靠性高于没有经验的观察者。观察者间的可靠性分数从差到优（ICC：0.000-0.970）不等。与黄金标准相比，专家的观察者间可靠性高于没有经验的观察者。结论：PAIC15-SF 工具具有足够的通用性，甚至可以对牙科印刷艺术中描绘的疼痛面部表情进行可靠评估。专家的观察者内部可靠性高于没有经验的观察者。观察者间的可靠性分数从差到优（ICC：0.000-0.970）不等。与黄金标准相比，专家的观察者间可靠性高于没有经验的观察者。结论：PAIC15-SF 工具具有足够的通用性，甚至可以对牙科印刷艺术中描绘的疼痛面部表情进行可靠评估。