Validation of an Electronic Visual Analog Scale App for Pain Evaluation in Children and Adolescents With Symptomatic Hypermobility: Cross-sectional Study

Abstract

Background Rapid advances in mobile apps for clinical data collection for pain evaluation have resulted in more efficient data handling and analysis than traditional paper-based approaches. As paper-based visual analogue scale (p-VAS) scores are commonly used to assess pain levels, new emerging apps need to be validated prior to clinical application with symptomatic children and adolescents. Objective This study aimed to assess the validity and reliability of an electronic visual analogue scale (e-VAS) method via a mobile health (mHealth) App in children and adolescents diagnosed with hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (HSD/HEDS) in comparison with the traditional p-VAS. Methods Children diagnosed with HSD/HEDS aged 5-18 years were recruited from a sports medicine center in Sydney (New South Wales, Australia). Consenting participants assigned in random order to the e-VAS and p-VAS platforms were asked to indicate their current lower limb pain level and completed pain assessment e-VAS or p-VAS at one time point. Instrument agreement between the 2 methods was determined from the intraclass correlation coefficient (ICC) and through Bland–Altman analysis. Results In total, 43 children with HSD/HEDS aged 11 (SD 3.8) years were recruited and completed this study. The difference between the 2 VAS platforms of median values was 0.20. Bland–Altman analysis revealed a difference of 0.19 (SD 0.95) with limits of agreement ranging –1.67 to 2.04. An ICC of 0.87 (95% CI 0.78-0.93) indicated good reliability. Conclusions These findings suggest that the e-VAS mHealth App is a validated tool and a feasible method of collecting pain recording scores when compared with the traditional paper format in children and adolescents with HSD/HEDS. The e-VAS App can be reliably used for pediatric pain evaluation, and it could potentially be introduced into daily clinical practice to improve real-time symptom monitoring. Further research is warranted to investigate the usage of the app for remote support in real clinical settings.

Using Digital Health Technologies to Monitor Pain, Medication Adherence and Physical Activity in Young People with Juvenile Idiopathic Arthritis: A Feasibility Study

“…The left endpoint indicates no pain, and the right endpoint indicates the worst possible pain. This reporting scale has been found to be highly reliable and consistent with the original paper-based visual analogue scale (VAS) [32,34] (Figure 2). • Data feedback: Visual feedback was then provided to the participants, displaying their daily pain level using the numerical score (0-10) and a monthly pain graph.…”

“…User actions: Pain levels were recorded in the app using the validated electronic visual analogue scale (eVas) [32][33][34]. eVas utilises a simple horizontal line with defined pain limits.…”

“…A personal message to each participant was also created.During the study period: Personalised notifications were sent daily to the smartwatch and phone to remind participants to record their pain.  User actions: Pain levels were recorded in the app using the validated electronic visual analogue scale (eVas)[32][33][34]. eVas utilises a simple horizontal line with defined pain limits.…”

PaiNEd app. Assessing central sensitization in survivors of breast cancer: A reliability study

“…Furthermore, the Pain Monitor app 49 also had moderate-to-strong correlations between app content and traditional measures for pain intensity and interference, pain catastrophizing, PCS (rumination), PCS (magnification), and PCS (helplessness) in adults with heterogeneous chronic pain. Furthermore, Muhammad Maarj et al 50 pioneered the development of an electronic VAS through an mHealth app, which was deployed for children and adolescents diagnosed with hypermobility spectrum disorder/hypermobile Ehlers‒Danlos syndrome. In a comparative analysis against the traditional paper-based VAS, their mHealth app approach demonstrated good reliability.…”

The Impact of Podiatric Intervention on the Quality of Life and Pain in Children and Adolescents with Hypermobility

“…The primary outcome of pain was measured using the VAS in which self-reported pain was indicated on a 100 mm line ranging from 0 = "no pain" to 10 = "worst possible pain" [32]. The electronic version of VAS (eVAS) which has been recently validated for pain evaluation in children and adolescents with symptomatic GJH was used [33].…”