Amos Hundert1, Kathryn A. Birnie1, Chitra Lalloo1, Cynthia Nguyen1, Jennifer N. Stinson1
Background and aims: While many self-report measures of pediatric pain exist, the measures used in clinical trials establishing the efficacy and effectiveness of pain treatments must have well-established psychometric properties. The aim of this study was to update a previous systematic review (Stinson et al., 2006 PAIN) evaluating the psychometric properties of self-report pain intensity measures in children and adolescents. At that time, six of 34 (18%) measures had well-established evidence of reliability and validity, and were recommended for use in pediatric clinical trials.
Methods: Medline, EMBASE, CCRCT, PsycINFO, CINAHL, and Web of Science databases were searched in May 2016 for publications since the previous review. Eligible studies assessed psychometric properties of single-item self-report pain intensity measures in 3-18 year olds. Measures were included if they met criteria of “well-established assessment” (Cohen et al., 2008, J Pediatr Psychol). Studies were independently rated by two coders for reliability, validity, responsiveness, interpretability, and generalizability using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist (Mokkink et al., 2006 BMC Med Res Methodol).
Results: Of 16,353 record titles screened, 35 new studies met inclusion and reported on 5 unique measures. They provided psychometric evidence for paper and electronic presentations of the Faces Pain Scale-Revised, Visual Analogue Scale, Wong Baker FACES Pain Scale (paper only), the 11-point Numeric Rating Scale (NRS), and the Color Analogue Scale (CAS). No new studies examined the Oucher Scale, the Pieces of Hurt Tool, or the original Faces Pain Scale. Four new measures were excluded for not meeting Cohen’s criteria of well-established assessment. COSMIN ratings for reliability, validity, and responsiveness ranged from poor to excellent.
Conclusions: Evidence from the last 10 years supports two additional measures as psychometrically sound for self-report of pain intensity in children (NRS and CAS), and electronic versions of previously well-established measures.