Use of the Oucher Numeric and the Word Graphic Scale in children aged 9–14 years with post‐operative pain

? The construct validity and clinical applicability of two self‐report scales, the Oucher Numeric and the Word Graphic Scales, were examined in this study. Construct validity was tested on the assumption that pain declines following the administration of analgesia. ? Eighty‐one children aged between nine and 14 years with post‐operative pain used the two scales before and for each of the 4 hours following the administration of analgesia, to report their intensity of pain. The method used for testing construct validity was a replication of the study conducted by 3 ; Children’s pain perception before and after analgesia: a study of instrument construct validity and related issues. Journal of Pediatric Nursing 3 (1), 11–23) to test the construct validity of the Oucher Scale. Construct validity was supported for both the scales. ? Twenty‐eight nurses who administered the scales and the parents of 45 children who had observed their children use the scales, commented on the usefulness of the scales in assessment of pain during hospitalization. ? A majority of children and nurses preferred the Oucher Numeric, whereas the Word Graphic Scale was preferred by a majority of the parents. ? Preference of scale was based on its ease of use and whether the child preferred to use numbers or words to describe the intensity of pain. ? A majority of the children and nurses and all parents believed that a self‐report scale was useful for assessment and communication of children’s pain following surgery.     

The convergent validity of the Manchester Pain Scale.

OBJECTIVE: To test the convergent validity of the Manchester pain scale when compared to the current 'gold standard' in children's pain assessment, the Oucher pain scale. METHOD: One hundred and fifty two children presenting to the emergency department had pain scale assessments using both the Manchester and Oucher pain scales. The order of presentation of the scales was randomised. The degree of convergence between the scales was assessed using Spearman's rank correlation as well as Bland and Altman plots. RESULTS: One hundred and thirteen children used numerical scales; the correlation coefficient for these was 0.802. Thirty nine children used pictorial scales; the correlation coefficient was 0.820. CONCLUSION: There is strong convergent validity between the scales as demonstrated by a high degree of correlation between the numerical and pictorial scores generated by the Manchester and Oucher pain scales. The Manchester pain scale can be used to assess pain in children presenting to emergency departments.     

Assessing procedural pain in children with cancer in Beirut, Lebanon.

This study describes the relationship between different indicators of pain, including self-reports, behavioral observations, and physiological measures, in children with cancer undergoing invasive procedures. Forty-five children between the ages of 4 and 10 years were evaluated while undergoing Port-a-Cath access. The study was conducted in the outpatient clinics of the Children's Cancer Center in Beirut, Lebanon. Children used 2 self-report measures of pain (the Wong-Baker FACES Pain Rating Scale and an adaptation of the FACES, the DOLLS). Parents and nurses assessed the child's pain on the FACES and the child's distress on the Observational Scale of Behavioral Distress-Revised. Nurses recoded behavioral observations as well as physiological responses to pain. There was a high degree of consistency between the self-reports and moderate to high correlations between self-reports, behavioral parameters, and physiological parameters, suggesting that accurate pain assessments can be made by both nurses and parents. The results also demonstrate adequate validity and reliability of the DOLLS scale in a Lebanese population, in addition to being the preferred assessment tool for all the children in the study.     

The alternate forms reliability of the Oucher pain scale.

The purpose of this study was to determine the adequacy of the alternate forms reliability of three versions of the Oucher pain scale. Because the original large-sized posters were unwieldy for use by nurses with children in clinical settings, it became necessary to reduce it in size. To determine whether the resulting tools were psychometrically equivalent to the original versions of the Oucher, this study was undertaken. In a group of 3- to 12-year-old children who underwent surgical or dental procedures ( n = 137), scores were obtained after the procedure on small and large versions of the Oucher. The order of presentation of the two different Ouchers was randomized. Findings revealed that correlation coefficients between the scores provided for the small and large versions of the Oucher were strong, positive, and significant for the Caucasian, African-American, and Hispanic versions in 3- to 12-year-old children. These results provided evidence of the adequacy of the alternate forms reliability of these scales.     

Validity of four pain intensity rating scales

The Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and the Faces Pain Scale-Revised (FPS-R) are among the most commonly used measures of pain intensity in clinical and research settings. Although evidence supports their validity as measures of pain intensity, few studies have compared them with respect to the critical validity criteria of responsivity, and no experiment has directly compared all 4 measures in the same study. The current study compared the relative validity of VAS, NRS, VRS, and FPS-R for detecting differences in painful stimulus intensity and differences between men and women in response to experimentally induced pain. One hundred twenty-seven subjects underwent four 20-second cold pressor trials with temperature order counterbalanced across 1°C, 3°C, 5°C, and 7°C and rated pain intensity using all 4 scales. Results showed statistically significant differences in pain intensity between temperatures for each scale, with lower temperatures resulting in higher pain intensity. The order of responsivity was as follows: NRS, VAS, VRS, and FPS-R. However, there were relatively small differences in the responsivity between scales. A statistically significant sex main effect was also found for the NRS, VRS, and FPS-R. The findings are consistent with previous studies supporting the validity of each scale. The most support emerged for the NRS as being both (1) most responsive and (2) able to detect sex differences in pain intensity. The results also provide support for the validity of the scales for use in Portuguese samples.     

疼痛强度评估量表应用于老年腰痛患者的同时效度与偏好性

目的探讨疼痛强度评估量表在老年腰痛患者疼痛评估中的同时效度与选择量表时的偏好。方法由测评人员对30例有腰痛临床症状的老年患者进行疼痛强度评估量表测试,包括数字评定量表(NRS)、视觉模拟评分表(VAS)、词语描述量表(VDS)、修改版面部表情疼痛量表(FPS-R)和组合型疼痛评估表(MIX)。以NRS为校标工具,通过Spearman相关系数检验NRS与FPS-R、MIX、VAS和VDS之间的相关程度来确定FPS-R、MIX、VAS和VDS的同时效度。统计患者对5种评估量表的首选率。结果 FPS-R、MIX、VAS和VDS与NRS高度正相关(r=0.753～0.957,P<0.001)。首选疼痛强度评估量表依次为FPS-R、NRS、VDS、MIX、VAS。结论 FPS-R、MIX、VAS和VDS具有良好的同时效度,疼痛强度评估量表的同时效度适用于老年腰痛人群的评估。FPS-R是首选率最高的量表。     

The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement.

The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version. In the first phase, the FPS was revised from its original seven faces to six, while maintaining its desirable psychometric properties, in order to make it compatible in scoring with other self-rating and observational scales which use a common metric (0-5 or 0-10). Using a computer-animated version of the FPS developed by Champion and colleagues (Sydney Animated Facial Expressions Scale), psychophysical methods were applied to identify four faces representing equal intervals between the scale values representing least pain and most pain. In the second phase, children used the new six-face Faces Pain Scale-Revised (FPS-R) to rate the intensity of pain from ear piercing. Its validity is supported by a strong positive correlation (r=0.93, N=76) with a visual analogue scale (VAS) measure in children aged 5-12 years. In the third phase, a clinical sample of pediatric inpatients aged 4-12 years used the FPS-R and a VAS or the colored analogue scale (CAS) to rate pain during hospitalization for surgical and non-surgical painful conditions. The validity of the FPS-R was further supported by strong positive correlations with the VAS (r=0.92, N=45) and the CAS (r=0.84, N=45) in this clinical sample. Most children in all age groups including the youngest were able to use the FPS-R in a manner that was consistent with the other measures. There were no significant differences between the means on the FPS-R and either of the analogue scales. The FPS-R is shown to be appropriate for use in assessment of the intensity of children's acute pain from age 4 or 5 onward. It has the advantage of being suitable for use with the most widely used metric for scoring (0-10), and conforms closely to a linear interval scale.     

Reliability and validity of the Hindi version of the Neck Pain and Disability Scale in cervical radiculopathy patients

PURPOSE: To assess the reliability and validity of the Neck Pain and Disability Scale (NPAD) translated into Hindi. METHOD: Following a pilot study to ascertain uncertainties with existing terminology in the NPAD scale, a cervical radiculopathy patient cohort (n = 63) was assessed with the translated NPAD. Reliability was assessed by regression analysis for test-retest and by item-factor and factor-total score correlations. Face validity was compared in a cross-sectional design study with an asymptomatic group (n = 38). Convergent and divergent validity were investigated by correlating the NPAD scores with the Numerical Pain Rating Scale (NPRS) for neck and arm pain, and 10 cm long VAS Activity and VAS Depression scales. RESULTS: ICC values for test-retest NPAD total and factor scores were >0.92 and R2 values >0.912. Pearson product moment correlation of item vs. factor scores varied from 0.17 - 0.91 and for factor vs. total scores 0.72 - 0.91. Differences in NPAD scores between the patient and the asymptomatic group were significant (t = 30.90, p < 0.05). Convergent validity was explained when Factor 2 (minus item 20) was correlated (r = 0.67) with NPRS maximum value scores. Divergent validity was illustrated by low correlation with VAS Activity (r = 0.15) and negative correlation with VAS Depression (r = -0.80) scores. CONCLUSION: Based on the results of this study, the Hindi version of the NPAD is a reliable and valid instrument for the assessment of pain and disability in cervical radiculopathy patients.     

Reliability,Validity and Effectiveness of Strain Counterstrain Techniques

Abstract

This study examined the reliability and validity of a tender-point palpation scale (TPPS) and the effect of Strain Counterstrain (SCS) on painful tender-points (TP). The experimental design employed a convenience sample of 49 volunteers with bilateral hip TPs, randomly assigned to three groups each receiving SCS, Exercise (EX), or SCS and EX. Pain before and after intervention was assessed with the TPPS and visual analog scale (VAS). Pre-intervention reliability of the TPPS was poor for the hip abductors (kappa = .327) and adductors (kappa = .228). TPPS concurrent validity as compared to VAS was weak (Spearman r=.233 to .709). Even weaker reliability and validity estimates can be assumed for a sample not limited to those with TPs, such as a general clinical population. Interventions were performed twice over two weeks. By study end, all groups demonstrated significant pain decreases in both muscle groups demonstrated with the VAS and TTPS (Wilcoxon: SCS and SCS+EX p<.001; EX p<.01). The SCS groups tended toward greater pain reductions than the EX group for hip abductors and adductors (Kruskal Wallis: VAS p<.05 and p=.06; TPPS p=.09 and p<.001 respectively). However, low TPPS reliability and validity preclude any conclusions based on this assessment method.     

Validation of the Wong-Baker FACES Pain Rating Scale in Pediatric Emergency Department Patients

Objectives: The Wong‐Baker FACES Pain Rating Scale (WBS), used in children to rate pain severity, has been validated outside the emergency department (ED), mostly for chronic pain. The authors validated the WBS in children presenting to the ED with pain by identifying a corresponding mean value of the visual analog scale (VAS) for each face of the WBS and determined the relationship between the WBS and VAS. The hypothesis was that the pain severity ratings on the WBS would be highly correlated (Spearman’s rho > 0.80) with those on a VAS. Methods: This was a prospective, observational study of children ages 8–17 years with pain presenting to a suburban, academic pediatric ED. Children rated their pain severity on a six‐item ordinal faces scale (WBS) from none to worst and a 100‐mm VAS from least to most. Analysis of variance (ANOVA) was used to compare mean VAS scores across the six ordinal categories. Spearman’s correlation (ρ) was used to measure agreement between the continuous and ordinal scales. Results: A total of 120 patients were assessed: the median age was 13 years (interquartile range [IQR] = 10–15 years), 50% were female, 78% were white, and six patients (5%) used a language other than English at home. The most commonly specified locations of pain were extremity (37%), abdomen (19%), and back/neck (11%). The mean VAS increased uniformly across WBS categories in increments of about 17 mm. ANOVA demonstrated significant differences in mean VAS across face groups. Post hoc testing demonstrated that each mean VAS was significantly different from every other mean VAS. Agreement between the WBS and VAS was excellent (ρ = 0.90; 95% confidence interval [CI] = 0.86 to 0.93). There was no association between age, sex, or pain location with either pain score. Conclusions: The VAS was found to have an excellent correlation in older children with acute pain in the ED and had a uniformly increasing relationship with WBS. This finding has implications for research on pain management using the WBS as an assessment tool. ACADEMIC EMERGENCY MEDICINE 2010; 17:50–54 © 2009 by the Society for Academic Emergency Medicine     

Assessment of the validity and reliability of the University of Wisconsin Children's Hospital Pain scale for Preverbal and Nonverbal Children

PURPOSE: This study tested the reliability and validity of a pain scale that was developed at University of Wisconsin Children's Hospital for the preverbal child (less than 3 years old) and the nonverbal child (children who cognitively were not able to communicate a pain rating on traditional pain scales). METHOD: Content validity was established by expert review. Construct validity was demonstrated by having the nurse rate the child's pain before and after analgesic and during a procedure. Inter-rater reliability was achieved by two nurses simultaneously and independently rating the child's pain. Criterion validity was determined by comparing ratings with those obtained on the Wong-Baker Faces scale. Internal consistency was calculated using Cronbach's alpha. FINDINGS: Seventy-four patients provided data for 124 observation times. At 58 of the observation times, two nurses independently used the newly developed University of Wisconsin Children's Hospital (UWCH) scale, resulting in 182 pain ratings. Internal consistency of the scale (Cronbach's alpha) was 0.93. Mean pain scores were significantly higher prior to pain medication administration and during procedures than following analgesic administration. Inter-rater reliability was 0.92. Correlation of the new scale with the Wong-Baker Faces Scale was r = .62. CONCLUSIONS: Initial testing of the construct validity, internal reliability, and internal consistency of the UWCH Pain Scale for Preverbal and Nonverbal Children were acceptable. Parents provided ratings for most of the faces scale, which could account for the low correlation in the construct validity testing.     

Development and validation of the Asian version of the oucher: a pain intensity scale for children.

The present study was designed to develop and test the validity of the Asian version of the Oucher pain intensity scale, with color photographs of Taiwanese children as the pain intensity cues. A series of 3 studies were conducted. The aim of the first study was to create male and female versions of the Asian Oucher poster. Each poster consisted of 6 color photographs of children's faces, ranging from "no hurt at all" (scored as 0) to the "biggest hurt you could ever have" (scored as 5). In the second study, 220 children aged 3 to 6 years were recruited to examine the content validity. Children who were able to complete a Piagetian seriation task were asked to choose the sequence of 6 photographs. Photo sequences were adjusted according to the study findings. The third study was conducted to examine the convergent, discriminate, and clinical validity for children who are at different levels of pain intensity. In total, 111 children aged 3 to 10 years old who were experiencing surgical pain were recruited. The construct validity of the Asian Oucher was supported. PERSPECTIVE: This study developed an Asian version of Oucher, with photographs of facial expressions of real Taiwanese children who were experiencing pain. The Asian Oucher can assess pain for children as young as 3 years old.     

FLACC Behavioral Pain Assessment Scale: a comparison with the child's self-report

The purpose of this study was to further test the validity of the Faces, Legs, Activity, Cry and Consolability (FLACC) Behavioral Pain Assessment Scale for use with children. Thirty children aged 3-7 years (5.01 +/- 1.44) who had undergone a variety of surgical procedures were observed and assessed for pain intensity at 20 + 2 hours after surgery. FLACC scores were assigned by one of the nurse investigators, and a self-report of pain using the FACES scale was obtained from the child. There were significant and positive correlations between the FLACC and FACES scores for the entire sample and for the scores of children 5-7 years of age, but not for children < age 5. These findings provide additional support for the construct validity of the FLACC Pain Assessment Tool.     

Validation of the numerical rating scale for pain intensity and unpleasantness in pediatric acute postoperative pain: sensitivity to change over time

This study evaluates the construct validity (including sensitivity to change) of the numerical rating scale (NRS) for pain intensity (I) and unpleasantness (U) and participant pain scale preferences in children/adolescents with acute postoperative pain. Eighty-three children aged 8 to 18 years (mean = 13.8, SD = 2.4) completed 3 pain scales including NRS, Verbal Rating Scale (VRS), and faces scales (Faces Pain Scale-Revised [FPS-R] and Facial Affective Scale [FAS], respectively) for pain intensity (I) and unpleasantness (U) 48 to 72 hours after major surgery, and the NRS, VRS and Functional Disability Index (FDI) 2 weeks after surgery. As predicted, the NRSI correlated highly with the VRSI and FPS-R and the NRSU correlated highly with the VRSU and FAS 48 to 72 hours after surgery. The FDI correlated moderately with the NRS at both time points. Scores on the NRSI and NRSU at 48 to 72 hours were significantly higher than at 2 weeks after surgery. Children found the faces scales the easiest to use while the VRS was liked the least and was the hardest to use. The NRS has adequate evidence of construct validity including sensitivity for both pain intensity and unpleasantness. This study further supports the validity of the NRS as a tool to measure both intensity and unpleasantness of acute pain in children. PERSPECTIVE: This article evaluates the construct validity including sensitivity of the Numerical Rating Scale for pain intensity and pain unpleasantness over time in children after major surgery. The NRS could be used by clinicians to assess these 2 different dimensions of children's pain experience in acute pain settings.     

Reliability, validity, and responsiveness of the daily sleep interference scale among diabetic peripheral neuropathy and postherpetic neuralgia patients

To evaluate the psychometric characteristics of the Daily Sleep Interference Scale (DSIS) in patients with painful diabetic peripheral neuropathy (DPN) or postherpetic neuralgia (PHN), a post hoc secondary analysis of data from eight randomized clinical trials (four DPN and four PHN) was performed. Data were pooled within patient populations when assessment weeks were the same. The DSIS was completed by 1,124 DPN and 1,034 PHN patients. Patient-reported outcomes, including a Daily Pain Diary, the Short-Form McGill Pain Questionnaire, SF-36 Health Survey, Profile of Mood States, MOS-Sleep Scale (MOS-SS), EQ-5D, and Patient Global Impression of Change, were used to validate the DSIS. Test-retest reliability was high for both samples (intraclass correlation coefficient>0.90). The DSIS showed good construct validity, with moderate to high correlations between the DSIS and weekly mean pain scores (r=0.48-0.80), MOS-SS sleep disturbance subscale (r=0.45-0.64), MPQ-SF Pain Experience (r=0.37-0.61), and VAS (r=0.42-0.72). The DSIS showed good discriminant validity in both groups; high and low MOS-SS sleep disturbance groups had significantly different DSIS scores (P<0.001). DPN patients who improved minimally on the Patient Global Impression of Change and in pain scores improved 1.5-2 DSIS points on average; for PHN, patient scores improved an average of 1-2 points. The DSIS demonstrated robust test-retest reliability, good construct and discriminant validity and responsiveness in painful DPN and PHN patients. A 1-2 point change on the DSIS might be interpreted as an important difference.     

护理信息能力量表的编制及信度效度检验

目的 :旨在研制出一套适合我国国情并体现护理专业学科特征,同时具有较高信度、效度的护理信息能力量表。方法 :综合利用定性与定量相结合的方法,构建护理信息能力评价指标体系,形成护理信息能力量表的雏形;利用多种统计方法对量表进行信度、效度检验。结果 :构建了包含5个维度32个条目的护理信息能力量表,总量表的Cronbach’sα系数为0.947;探索性因子分析结果显示编制的量表具有较好的结构效度;内容效度CVI指数为0.957,验证性因子分析结果证明模型拟合较好(χ2/df=0.293、AGFI=0.82、RMSEA=0.06、RMR=0.04、CFI=0.91)。结论 :研制的护理信息能力量表具有较好的信度及效度,为临床护理人员护理信息能力的测评提供了客观、科学的评价工具。     

Evaluating pain induced by venipuncture in pediatric patients with developmental delay

OBJECTIVES: Little attention has been paid to the assessment of pain in children with developmental delay. The aim of this study was to explore several methods for assessing pain during venipuncture in this population of children, using classic and modified scales to evaluate the children's response to simplified tools. METHODS: Sixteen children with mild or moderate developmental delay were evaluated using three standard self-rating scales (Visual Analog Scale [VAS], Eland Scale, and Faces Scale) and three modified methods (Cube Test, Modified Eland Scale, and Modified Faces Scale), recording subjective self-ratings and behavioral expressions of pain during a venipuncture procedure, apart from the initial fear. The children's pain and reaction time were assessed by an outside observer, while their pain and fear were also evaluated by the parents. RESULTS: The VAS was used without difficulty by all the children and revealed a good consistency with the Cube Test. The parents' and neutral observer's indirect pain assessment was also consistent with the child's evaluations. The Eland Scale proved difficult to use, especially for Down's syndrome children, while its modified version was easier. Results emerging from the original and modified Faces Scales were inconsistent. Frightened children attributed higher pain scores, demonstrating that negative emotions exacerbate the experience of pain in developmentally delayed children. The patients showed a limited capacity for verbal and behavioral expression in reaction to the painful stimulus (especially the Down's cases). DISCUSSION: These findings support the conviction that even developmentally delayed children can use self-rating methods effectively. This sector demands further, more extensive study, including the development of simplified tools, to ensure an adequate pain assessment and optimal antalgic approach to this particular pediatric population.