Clinical validation of the Paediatric Pain Profile

Abstract

The Paediatric Pain Profile (PPP) is a 20-item behaviour rating scale designed to assess pain in children with severe neurological disability. We assessed the validity and reliability of the scale in 140 children (76 females, mean age 9 years 11 months, SD 4 years 7 months; range 1 to 18 years), unable to communicate through speech or augmentative communication. Parents used the PPP to rate retrospectively their child's behaviour when 'at their best' and when in pain. To assess interrater reliability, two raters concurrently observed and individually rated each child's behaviour. To assess construct validity and responsiveness of the scale, behaviour of 41 children was rated before and for four hours after administration of an 'as required' analgesic. Behaviour of 30 children was rated before surgery and for five days after. Children had significantly higher scores when reported to have pain than 'at their best' and scores increased in line with global evaluations of pain. Internal consistency ranged from 0.75 to 0.89 (Cronbach's alpha) and interrater reliability from 0.74 to 0.89 (intraclass correlation). Sensitivity (1.00) and specificity (0.91) were optimized at a cut-off of 14/60. PPP score was significantly greater before administration of the analgesic than after (paired-sample t-tests, p<0.001). Though there was no significant difference in mean pre-and postoperative scores, highest PPP score occurred in the first 24 hours after surgery in 14 (47%) children. Results suggest that the PPP is reliable and valid and has potential for use both clinically and in intervention research.

The revised FLACC score: Reliability and validation for pain assessment in children with cerebral palsy

“…The Bland-Altman plots for both reliability measures illustrates that the differences of measurements are concentrated around the mean difference, though with a rather large interval of agreement for especially inter-rater reliability. This is in accordance to other studies testing the psychometric properties of pain assessment scales, where the range of ICCs for inter-rater reliability for the INRS was 0.65-0.87 [10], for the NCCPC-PV 0.78-0.82 [11] and for the PPP 0.74-0.89 [13]. This suggests that even though intra-rater reliability is established, the most exact pain assessment during hospitalization of a child with CP is performed using only one rater continuously for each child.…”

“…Other pain assessment tools for children with CP validated for postoperative pain assessment include the Individualized Numeric Rating Scale (INRS) [10] with established construct validity and inter-rater reliability and the Noncommunicating Childrens's Pain Checklist-Postoperative Version (NCCPC-PV) [11,12] with established construct validity, inter-rater reliability and internal consistency. Good psychometric properties were found for the Paediatric Pain Profile (PPP) [13] for assessment of everyday pain with established content and construct validity, inter-rater reliability and internal consistency and for the Echelle Douleur Enfant San Salvador (DESS) [14] for procedural pain assessment with established construct validity [15].…”

Kinderpalliativmedizin

“…Besondere Schwierigkeiten ergeben sich bei Patienten, deren intellektuelle oder sprachliche Entwicklung eine Kommunikation über ihr Schmerzerleben nicht zulässt. Die Beobachtung des Kindes durch Eltern und Pflegende unter Verwendung entsprechend validierter Instrumente wie PPP ("paediatric pain profile", [15] [17]). Wichtig ist, dass sich ein opioidnaives Kind bei starken Schmerzen nicht die Schmerzleiter hochleiden muss, bei entsprechend ausgeprägten Schmerzen werden bereits initial stark wirksame Opioide in Kombination mit Nichtopioidanalgetika eingesetzt.…”

The Effects of Psychopathology on the Pain Expression of Children and Youth With Intellectual and Developmental Disabilities

“…Because of the limited ability of people with IDD to self-report pain verbally, a number of observational pain assessment tools have been developed for them since the 1990s Collignon & Giusiano, 2001;Hunt et al, 2004). It was believed that providing observers with validated, standardized tools would improve the quality and reliability of the information available when attempting to use overt behavior to detect pain.…”