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Reliability and validity of a self-reported measure of medication adherence in patients with type 2 diabetes mellitus in Korea Agreement Between Telerehabilitation and Face-to-Face Clinical Outcome Assessments for Low Back Pain in Primary Care [Oral morphine administration for children's traumatic pain]. Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis. [Multimodal distraction to relieve pain in children undergoing acute medical procedures]. The Wong-Baker Pain FACES Scale Measures Pain, Not Fear Measuring quality of life in cosmetic surgery patients with a condition-specific instrument: the Derriford Scale. Validation of a symptom measure suitable for use among palliative care patients in the community: CAMPAS-R. Development and validation of a lower-extremity activity scale. Use for patients treated with revision total knee arthroplasty. Development of two instruments examining stress and adjustment in children with cancer. 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The present study cross-vali date d self-report pain scales : Verbal Rating Scale ( VRS  ) ,  Facial Expression Scale ( FACES  ) ,  Color Analogue Scale ( CAS ) and Poker Chip Tool ( PCT ) in Thai children aged 5 - 12 years . The concordance with observational measure , Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) was also tested . Among 100 students , test-retest reliability of all self-report measures was moderate to good ( K = 0.501 - 0.712 ) and only FACES yielded acceptable face validity(IC > 0.5 ) . Validation in 87 patients , all scales showed construct and concurrent validity . FACES was the most preferred scale . Agreement of self-report measures and CHEOPS was better in the age group 5 - 8 years ( K = 0.417 - 0.826 ) than 9 - 12 years ( K = 0.231 - 0.529 ) . In conclusion , FACES is a valid , reliable and practical tool . Self-report measures are more in concordance with CHEOPS in the younger age group OBJECTIVE To augment available validation data for the Faces Pain Scale - Revised ( FPS-R ) and to assess interscale agreement and preference in comparison with the Coloured Analogue Scale ( CAS ) in pediatric acute pain . METHOD The present prospect i ve , multicentre study included 131 in patients five to 15 years of age ( mean age 8.8 years ; 56 % male ) seen in postoperative recovery . They provided CAS and FPS-R pain scores before and after administration of analgesic medication . Nurses and physicians used the same tools as observational scales . Children and health care providers indicated which scale they preferred . RESULTS  FPS-R scores for the intensity of postoperative pain correlated highly with the corresponding CAS scores in all age groups ( 0.66 < or= r < or= 0.88 ) . There were no significant mean differences in any age group between the scales . Scores on the two scales differed by 210 or less in 81 % to 91 % of children , depending on age . Both scales demonstrated expected changes in postoperative pain following administration of an analgesic . Scores at the upper end point were given by approximately 20 % of children five to six years of age on both scales , compared with 2 % to 9 % in the older age groups . Health care providers ' observational ratings were significantly lower than self-ratings . The FPS-R was preferred over the CAS by most children in all age groups and both sexes . Global satisfaction of the health care providers was similar for both tools . DISCUSSION These results support the use of the FPS-R for most children five years of age or older in the postoperative period . Further research is needed to identify young children , particularly those younger than seven years of age , who have difficulty with self-report tools , and to establish methods for training them in the reliable use of these measures There are inadequate age-specific data to support the use of current self-report pain scales in 3- and 4-year-old children . Most preschool-aged children also lack the necessary cognitive development to use st and ard scales . We aim ed to evaluate the validity and feasibility of 2 novel simplified scales ( Simplified Faces Pain Scale , S-FPS ; Simplified Concrete Ordinal Scale , S-COS ) for preschool-aged children . These simplified scales used a 2-step self-report method : children were first asked whether they have pain ( yes/no ) ; only if yes , then pain intensity was self-reported using a 3-point scale with visual aids signifying mild/moderate/severe . We recruited 180 3- to 6-year-old children undergoing routine blood collection . Each child was r and omly assigned 2 of 3 scales-S-FPS , S-COS , Faces Pain Scale-Revised (FPS-R)-to self-report pain before venipuncture , immediately after , and 5 minutes later , using both scales at each time-point . Pain was also assessed using observation ( Face Legs Activity Cry Consolability ) at each time point . The ability to discriminate pain from no pain was improved with S-FPS and S-COS , compared with the FPS-R , among 4-year-olds , but not 3-year-olds . Correlation with Face Legs Activity Cry Consolability was moderate to strong and cooperation rates were similar for all self-report scales . The simplified scales can improve and simplify pain assessment for 4-year-olds . Quantitative pain rating remains challenging for 3-year-olds . PERSPECTIVE This study evaluated 2 novel simplified pain assessment tools for preschool-aged children undergoing blood sampling . These scales demonstrated good validity and feasibility compared with the FPS-R , suggesting these simplified pain scales may have a role in clinical practice for children as young as 4 years & NA ; Altogether 553 children ( 195 first grade rs , mean age 6.8 years , and 358 third grade rs , mean age 8.7 years ) participated in the development of a self‐report measure to assess the intensity of children 's pain .  The first step was the derivation , from children 's drawings of facial expressions of pain , of 5 sets of 7 schematic faces depicting changes in severity of expressed pain from no pain to the most pain possible . With the set of faces that achieved the highest agreement in pain ordering , additional studies were conducted to determine whether the set had the properties of a scale . In one study , children rank‐ordered the faces on 2 occasions , separated by 1 week . All 7 faces were correctly ranked by 64 % ( retest 1 week later , 61 % ) of grade 1 children and by 86 % ( retest 89 % ) of grade 3 children . In a second study , the faces were presented in all possible paired combinations . All 7 faces were correctly placed by 62 % ( retest 86 % ) of the younger and by 75 % ( retest 71 % ) of the older subjects . A third study asked children to place faces along scale : a procedure allowing a check on the e quality of intervals . The fourth study checked on whether pain was acting as an underlying construct for ordering the faces in memory . We asked whether children perceived the set as a scale by asking if memory for an ordered set of faces was more accurate than for a r and om set . The final study checked , with 6‐year‐old children , the test‐retest reliability of ratings for recalled experiences of pain . Overall , the faces pain scale incorporates conventions used by children , has achieved strong agreement in the rank ordering of pain , has indications that the intervals are close to equal , and is treated by children as a scale . The test‐retest data suggest that it may prove to be a reliable index over time of self‐reported pain BACKGROUND AND OBJECTIVES : The Faces Pain Scale – Revised ( FPS-R ) and Color Analog Scale ( CAS ) are self-report pain scales commonly used in children but insufficiently vali date d in the emergency department setting . Our objectives were to determine the psychometric properties ( convergent validity , discriminative validity , responsivity , and reliability ) of the FPS-R and CAS , and to determine whether degree of validity varied based on age , sex , and ethnicity . METHODS : We conducted a prospect i ve , observational study of English- and Spanish-speaking children ages 4 to 17 years . Children with painful conditions indicated their pain severity on the FPS-R and CAS before and 30 minutes after analgesia . We assessed convergent validity ( Pearson correlations , Bl and -Altman method ) , discriminative validity ( comparing pain scores in children with pain against those without pain ) , responsivity ( comparing pain scores pre- and postanalgesia ) , and reliability ( Pearson correlations , repeatability coefficient ) . RESULTS : Of 620 patients analyzed , mean age was 9.2 ± 3.8 years , 291(46.8 % ) children were girls , 341(55 % ) were Hispanic , and 313(50.5 % ) were in the younger age group ( < 8 years ) . Pearson correlation was 0.85 , with higher correlation in older children and girls . Lower convergent validity was noted in children < 7 years of age . All subgroups based on age , sex , and ethnicity demonstrated discriminative validity and responsivity for both scales . Reliability was acceptable for both the FPS-R and CAS . CONCLUSIONS : The FPS-R and CAS overall demonstrate strong psychometric properties in children ages 4 to 17 years , and between subgroups based on age , sex , and ethnicity . Convergent validity was question able in children < 7 years old & NA ; A new instrument was design ed to provide a practical clinical measure for assessing children 's pain intensity and pain affect .  The pocket size measure includes a Coloured Analogue Scale ( CAS ) to assess intensity and a facial affective scale to assess the aversive component of pain . Both scales have numerical ratings on the back , so that the person administering it can quickly note the numbers that represent a child 's pain . This study was conducted to determine : the validity of the new instrument by evaluating the psychophysical properties of the intensity scale and by evaluating the discriminant validity of the intensity and affective scales . Since visual analogue scales ( VAS ) are valid and reliable measures for assessing children 's pain , children 's ability to use the new analog scale was compared with their performance on a VAS . Children 's ability to rate pain affect using an affective scale , in which the 9 faces on a Facial Affective Scale ( FAS ) are presented in an ordered sequence from least to most distressed , was compared to their performance on the original FAS , in which the same faces were presented in a r and om order . Using a parallel groups design , 104 children ( 5–16 years ; 60 female , 44 male ; 51 healthy and 53 with recurrent headaches ) were r and omized into two groups : CAS or VAS . Children used the assigned scale to complete a calibration task , in which they rated the sizes of 7 circles varying in area ( 491 , 804 , 1385 , 2923 , 3848 , 5675 and 7854 mm2 ) . The psychophysical function relating perceived circle size to actual physical size was determined for the CAS and VAS . Children 's  CAS and VAS  responses on the calibration task yielded similar mathematical relationships ; & PHgr;cas = 0.035I0.87 , & PHgr;vas = 0.027I0.89 , where & PHgr ; = perceived magnitude and I = stimulus intensity . The R2 values were 0.921 and 0.922 for the CAS and VAS groups , respectively . Analyses of covariance revealed no significant differences in the characteristics of these relationships , i.e. , R2 , slope , or y intercept , by scale type . Children used the same scale to complete the Children 's Pain Inventory ( CPI ) , in which they rated the intensity and affect of 16 painful events ( varying in nature and extent of tissue damage ) . Children 's  CAS and VAS  responses on the CPI were similar . Analyses of covariance indicated that there were no differences in either intensity or affective ratings by scale type . However , the mean number of painful events experienced by children increased significantly with age ( P = 0.0001 ) . Intensity ratings decreased significantly with age ( P = 0.002 ) , but affective ratings did not vary with age . The new instrument has equivalent psychometric properties to a 165 mm VAS . However , the CAS was rated as easier to administer and score than the VAS , so it may be more practical for routine clinical use . Since the CAS has fulfilled the first two criteria for a pain measure ( psychophysical properties and discriminant validity ) , it is ethical to proceed with the formal definitive test for construct validity , in which children from various clinical population s use the CAS scale to assess their own pain The purpose of this study was to examine the psychometric properties ( test-retest and interrater reliability , criterion concurrent validity ) of 3 verbal pain- assessment tools ( Faces Pain Scale , Numerical Rating Scale , Present Pain Intensity Scale )  and a behavioural pain- assessment scale for use with an elderly population . The study used a repeated- measures design to examine the reliability and validity of the tools across 4 groups of participants with varying levels of cognitive impairment using a non-r and om stratified sample of 130 elderly long-term-care residents . The findings support the test-retest and interrater reliability of the  behavioural pain- assessment tool  across all levels of cognitive impairment , whereas the same measures of reliability for the verbal-report tools decreased with increasing cognitive impairment ; however , the majority of elderly with mild to moderate cognitive impairment were able to complete at least 1 of these tools . The findings are discussed in relation to their clinical and research implication Faces scales have become the most popular approach to eliciting children 's self-reports of pain , although different formats are available . The present study examined : ( a ) the potential for bias in children 's self-reported ratings of clinical pain when using scales with smiling rather than neutral ' no pain ' faces ; ( b ) levels of agreement between child and parent reports of pain using different faces scales ; and ( c ) preferences for scales by children and parents . Participants were 75 children between the ages of 5 and 12 years undergoing venepuncture , and their parents . Following venepuncture , children and parents independently rated the child 's pain using five different r and omly presented faces scales and indicated which of the scales they preferred and why . Children 's ratings across scales were very highly correlated ; however , they rated significantly more pain when using scales with a smiling rather than a neutral ' no pain ' face . Girls reported significantly greater levels of pain than boys , regardless of scale type . There were no age differences in children 's pain reports . Parents ' ratings across scales were also highly correlated ; however , parents also had higher pain ratings using scales with smiling ' no pain ' faces . The level of agreement between child and parent reports of pain was low and did not vary as a function of the scale type used ; parents overestimated their children 's pain using all five scales . Children and parents preferred scales that they perceived to be happy and cartoon-like . The results of this study indicate that subtle variations in the format of faces scales do influence children 's and parents ' ratings of pain in clinical setting AIM This study describes the development and validation of the  Nursing Profession Self-Efficacy Scale . BACKGROUND Self-efficacy can be useful in predicting performance , job satisfaction or well-being . In the nursing field , there is a shortage of studies on self-efficacy with regard to nurses ' global confidence in coping ability across a range of everyday , challenging work situations . METHODS To define the theoretical framework of nursing professional self-efficacy , two focus groups and a literature review were performed . An empirical study was then conducted to test validity and reliability . Face and content validity , construct validity , concurrent validity , internal consistency and test-retest reliability were examined . The content validity index was evaluated by 12 experts who suggested deleting 11 redundant items . The final developed tool was tested for construct analysis using a cross-validation approach , r and omly splitting the overall sample of 917 nurses in two sub-groups . FINDINGS The construct validity indicated two dimensions . The face and content validity were adequate . Test-retest reliability displayed a good stability , and internal consistency ( Cronbach 's α ) was acceptable . Moreover , concurrent validity using the Generalized Self-Efficacy Scale was in line with the theoretical framework . CONCLUSION The scale showed evidence of validity and reliability . The major limitation is the strong influence of the Italian context in the tool development . IMPLICATION S FOR NURSING AND HEALTH POLICY The Nursing Profession Self-Efficacy Scale could be a fruitful tool that facilitates the application of theories ( i.e. social-cognitive theory ) in the nursing field and even development of interventions . Furthermore , a measurement of self-efficacy could be used to predict nursing clinical performance & NA ; The purpose of the study was to compare the psychometric properties of four established pain scales in a population of hospitalized older adults ( mean age , 76 years ) with varying levels of cognitive impairment . Patients made ratings of current pain three times/day for 7 days . They also made retrospective daily , weekly , and bi‐weekly ratings of usual , worst , and least pain levels over a 14‐day period . Ratings were made on four different scales , varying in numeric and verbal dem and s : a five‐point verbal rating scale , a seven‐point faces pain scale , a horizontal 21‐point ( 0–100 ) box scale , and two vertical 21‐point ( 0–20 ) box scales ( measuring pain intensity and pain unpleasantness ) . The accuracy , reliability , construct validity , postdictive validity , and bias susceptibility of each scale were evaluated . The horizontal 21‐point box scale emerged as the best scale with respect to both psychometrics and validity , regardless of mental status . Pain intensity did not vary as a function of mental status . Retrospective estimates of pain varied by mental status : a combination of usual/worst pain was best for cognitively impaired patients , while a combination of usual/least pain was best for unimpaired patients . These findings support the use of the 21‐point box scale for pain assessment in older patients , including those with mild‐to‐moderate cognitive impairment . They also support the ability of older , cognitively impaired patients to rate pain reliably and validly OBJECTIVE To determine the construct , content , and convergent validity of 2 self-report pain scales for use in the untrained child in the emergency department ( ED ) . METHODS A prospect i ve study was conducted of all children who presented to an urban ED between 5 and 16 years of age inclusive after written informed consent was obtained . Children were excluded if they were intoxicated , had altered sensorium , were clinical ly unstable , did not speak English , or had developmental delays . Children marked their current pain severity on a st and ardized Color Analog Scale ( CAS ) and a 7-point Faces Pain Scale ( FPS ) . They were then asked whether their pain was mild , moderate , or severe . Children were then administered an analgesic at the discretion of the attending physician and asked to repeat these measurements . For assessing content validity , the scales were also administered to age- and gender-matched children in the ED for nonpainful conditions . Convergent validity was assessed by determining the Spearman correlation coefficient between the 2 pain scales . RESULTS A total of 60 children were enrolled , 30 with pain and 30 without , with a mean age of 9.3 + /- 3.3 years . Boys accounted for 38 of the enrollees ( 63.3 % ) . The median score before analgesic administration was 6.0 cm ( interquartile range [ IQR ] : 4.0 - 8.0 ) on the CAS and 3.0 faces ( IQR : 2.0 - 5.0 ) on the FPS ; after analgesic administration , the median scores decreased to 3.1 cm ( IQR : 1.1 - 4.3 ) and 2.0 faces ( IQR : 1.0 - 3.0 ) , respectively . As the reported pain intensity increased , so did the scores on the 2 pain scales . The 30 children with no pain had a median score on the CAS of 0.0 ( IQR : 0.0 - 1.0 ) and on the FPS of 0.0 ( IQR : 0.0 - 1.0 ) , whereas the 13 children with severe pain had a median CAS of 7.0 ( IQR : 6.0 - 8.0 ) and a median FPS of 5.0 ( IQR : 4.0 - 6.0 ) . The Spearman correlation coefficient between the CAS and the FPS was positive and strong ( r = 0.894 ) . CONCLUSION The CAS and the FPS exhibit construct , content , and convergent validity in the measurement of acute pain in children in the ED OBJECTIVE The main objective was to compare the utility of the Faces Pain Scale  ( Bieri et al. , 1990 ) with three alternative self-report measures of pain intensity in children , as well as with pain ratings based on observations of the child 's behavior . DESIGN Fifty children used 4 self-report scales to rate the severity of needle pain from routine immunization . Using videotapes , the child 's pain-related behavior was coded in detailed fashion , and a subset of the sample were also rated globally by 60 registered pediatric nurses . MAIN OUTCOME MEASURES  Faces Pain Scale ; Poker Chip Tool ; Visual Analogue Toy ; Verbal Rating Scale ;  behavioral checklist ( scoring observable facial , motor , verbal and vocal reactions ) . RESULTS AND CONCLUSIONS The  Faces Pain Scale  was simple to use , readily understood by the children , and showed a realistic distribution of scores with respect to the type of pain being measured . With the exception of verbal reactions ( which were not meaningfully related to self-report ) , observer ratings based on detailed coding of the child 's behavior correlated only poorly to moderately well with self-report scores ( r = .39 to r = .58 ) . Similarly , although confident in their judgments , the nurses ' ratings showed only moderate agreement with those of the children . In estimating the child 's pain , all observers appeared to appropriately weigh changes in the child 's facial behavior , which showed evidence of being the most sensitive behavioral index to the intensity of short sharp ( needle ) pain in 4 to 6 years olds Summary The validity of 4 common pain intensity measures is supported , although the 0–10 Numerical Rating Scale and Visual Analogue Scale evidence d the most responsivity . Abstract 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 setting s. 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 result ing 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 sample STUDY OBJECTIVE In children , the agreement between the many scales used to document the intensity of pain is not well known . Thus , to determine the agreement , we evaluate the visual analog scale , the st and ardized color analog scale , the Wong-Baker FACES Pain Rating Scale , and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department ( ED ) . METHODS Participants were children who were aged 8 to 18 years , presented to a pediatric ED with abdominal pain suggestive of appendicitis , and were recruited to participate in a r and omized controlled trial evaluating the efficacy of morphine . Patients were initially asked to grade their pain on a plasticized color analog scale , a paper visual analog scale , a paper Wong-Baker FACES Pain Rating Scale , and then with a verbal numeric scale . Thirty minutes after morphine or placebo administration , the assessment was repeated . All scores were then converted to a value of 0 to 100 . Agreements between scores were evaluated with the Bl and -Altman method , and the 95 % lower and upper limits were reported . We defined a priori the maximum limit of agreement at + /-20 mm . RESULTS A total of 87 children were included in the study , 58 of them with confirmed appendicitis . The 95 % limits of agreement for each pair of scales were visual analog scale/color analog scale -18.6 , 14.4 ; visual analog scale/Wong-Baker FACES Pain Rating Scale -20.1 , 33.7 ; visual analog scale/verbal numeric scale -30.2 , 20.7 ; color analog scale/Wong-Baker FACES Pain Rating Scale -18.5 , 36.3 ; color analog scale/verbal numeric scale -26.9 , 22.1 ; and Wong-Baker FACES Pain Rating Scale/verbal numeric scale -38.7 , 15.7 . CONCLUSION Our study suggests that only the visual analog scale and the color analog scale have acceptable agreement in children with moderate to severe acute abdominal pain . In particular , the verbal numeric scale is not in agreement with the other evaluated scales Objective The objectives of this study were to : ( 1 ) evaluate the validity of the Neonatal Facial Coding System ( NFCS ) for assessment of postoperative pain and ( 2 ) explore whether the number of NFCS facial actions could be reduced for assessing postoperative pain . Design Prospect i ve , observational study . Patients Thirty-seven children ( 0–18 months old ) undergoing major abdominal or thoracic surgery .  Outcome Measures The outcome measures were the NFCS , COMFORT “ behavior ” scale , and a Visual Analog Scale ( VAS ) , as well as heart rate , blood pressure , and catecholamine and morphine plasma concentrations . At 3-hour intervals during the first 24 hours after surgery , nurses recorded the children 's heart rates and blood pressures and assigned COMFORT “ behavior ” and VAS scores . Simultaneously we videotaped the children 's faces for NFCS coding .  Plasma concentrations of catecholamine , morphine , and its metabolite M6 G were determined just after surgery , and at 6 , 12 , and 24 hours postoperatively . Results All 10 NFCS items were combined into a single index of pain . This index was significantly associated with COMFORT “ behavior ” and VAS scores , and with heart rate and blood pressure , but not with catecholamine , morphine , or M6 G plasma concentrations . Multidimensional scaling revealed that brow bulge , eye squeeze , nasolabial furrow , horizontal mouth stretch , and taut tongue could be combined into a reduced measure of pain . The remaining items were not interrelated . This reduced NFCS measure was also significantly associated with COMFORT “ behavior ” and VAS scores , and with heart rate and blood pressure , but not with the catecholamine , morphine , or M6 G plasma concentrations . Conclusion This study demonstrates that the NFCS is a reliable , feasible , and valid tool for assessing postoperative pain . The reduction of the NFCS to 5 items increases the specificity for pain assessment without reducing the sensitivity and validity for detecting changes in pain & NA ; The numerous pain rating scales using faces depicting varying degrees of distress to elicit reports of pain from children fall into two categories ; those with a neutral face as the ‘ no pain ’ anchor , and those with a smiling face as the ‘ no pain ’ anchor . This study examined the potentially biasing impact of these anchor types on children 's self‐reports  of pain  in response to a series of vignettes . Participants were 100 children stratified by age ( 5–6 years , 7–8 years , 9–12 years ) and r and omly assigned to one of three groups : ( 1 ) neutral scale/sensory instructions ; ( 2 ) smiling scale/sensory instructions ; ( 3 ) smiling scale/affective instructions . Children completed a  faces scale , a VAS , and emotions ratings  in response to four scenarios depicting : ( 1 ) no pain/negative emotions ; ( 2 ) pain/negative emotions ; ( 3 ) no pain/positive emotions ; ( 4 ) pain/positive emotions . Results showed that children who used the smiling scale had significantly higher pain scores for no pain and pain/negative emotions vignettes and significantly lower faces scale scores for pain/positive vignettes than children who used the neutral faces scale . Instructions varying in focus on sensory or affective qualities of pain had no effect on children 's pain ratings . Group differences in children 's ratings with the VAS and emotions measure suggested that rating pain with a smiling faces scale may alter a child 's concept of pain . Age differences indicated the younger children rated the negative emotion vignettes as more painful than the older children . These findings suggest that children 's pain ratings vary depending on the types of faces scale used , and that faces scales with smiling anchors may confound affective states with pain ratings OBJECTIVES The objective was to assess in a pediatric emergency department ( ED ) the reliability of the color analog scale ( CAS ) for acute pain assessment , overall and between traumatic and nontraumatic pain etiology . METHODS This was a prospect i ve study of children aged 5 to 16 years in the ED of a children 's hospital who had a complaint of pain . The CAS was administered to the patient at admission and at 30 minutes . To evaluate repeatability , a second measurement was obtained 1 minute following each assessment . This assumed there would be no substantial change in pain intensity within 1 minute . The authors used the intraclass correlation coefficient ( ICC ) to evaluate the repeatability of 1-minute interval measurements . RESULTS A total of 170 patients were enrolled . The origin of pain was traumatic in 81 cases ( 48 % ) . Regardless of pain etiology , the  CAS scores were highly repeatable ( r = 0.97 , 95 % confidence interval [ CI ] = 0.95 to 0.98 ) . CONCLUSIONS The color analog scale is both a valid and a reliable self-reporting tool in the assessment of acute pain in children BACKGROUND Acute and chronic pain is common in hospitalized demented elderly people , yet there are limited data about the performance of pain assessment tools in this population . The aim of this study was to evaluate the feasibility and reliability of four  pain self- assessment scales  in this population and compare their performance to an observational pain rating scale . METHODS Our prospect i ve clinical study was conducted in an acute-care and intermediate-care geriatric hospital on 160 consecutive inpatient referrals to the dementia consultation who met Diagnostic and Statistical Manual of Mental Disorders-IV criteria for dementia . Exclusion criteria were delirium , terminal care , and severe sensory impairment .  Four unidimensional self- assessment tools -- the verbal , horizontal visual , vertical visual , and faces pain scales -- were administered in r and omized order to mild , moderate , and severely demented patients . An observational pain rating scale was independently completed by the nursing team . RESULTS Only 12 % of the 160 patients ( mean age 85 years , 71 % women ) understood no scale . Respectively , 97 % , 90 % , and 40 % of patients with mild , moderate , and severe dementia understood at least one scale ( p < .05 ) . There was a nonsignificant trend toward poorer comprehension of the faces scale . Test-retest reliability was high for all four self- assessment scales , and the correlation between these scales was very strong ( Spearman 's r(s ) = 0.81 - 0.95 ; p < .001 ) . Observational rating correlated moderately with self- assessment and tended to underestimate pain intensity ( r(s ) = 0.31 - 0.40 ; p < .05 ) . CONCLUSIONS Self- assessment pain scales  can be used reliably in the vast majority of older hospitalized patients with mild to moderate dementia and in nearly half of those with severe dementia . Observational pain rating scales correlate only moderately with self- assessment and should be reserved for those few patients who have demonstrated that they can not complete a self- assessment This study explored whether global unidimensional self-report pain scales based on facial expression help children separately estimate the sensory and affective magnitude of post-operative pain . Ninety paediatric elective surgery patients ( in two age groups : 5 - 9 and 10 - 15 years ) used each of four scales to estimate pain intensity and pain affect during the first 2 days after surgery . The four scales were :  Faces Pain Scale ( FPS ) , Facial Affective Scale ( FAS ) , and the Coloured Analogue Scale ( CAS )  ( one for intensity and one for unpleasantness ) . As hypothesised , ratings on the FPS correlated more highly with analogue scale ratings for intensity than for unpleasantness , whereas ratings on the FAS correlated more highly with those on the analogue scale for unpleasantness than for intensity . Factor analysis indicated that although all measures loaded on a single dimension of distress , there was an additional weaker factor corresponding to a unique contribution of the FAS . No systematic age effects were observed . It was concluded that the FPS and the FAS may partly measure different aspects of the postoperative pain experience in children , although shared instrument variance may obscure true estimates of covariation in ratings of intensity and affective magnitude . The clinical relevance of the present results remains to be determined UNLABELLED Cl aims regarding the ability of preschool-age children to provide accurate self-reports using st and ard pain scales are not well supported by age-specific evidence . Responses of children younger than 5 years are often idiosyncratic and subject to biases . Simplifying the task of self-report of pain would make it more developmentally appropriate for 3- to 5-year-olds . A binary question is asked : " Does it hurt ? " or an equivalent . If yes , a simplified scale is presented , comprising 3 categories representing low , medium , and high pain severity . Children aged 3 to 5 years ( N = 184 ) were recruited from preschools and day care centers . Following parental consent and child assent , children were r and omly assigned to use either the  Faces Pain Scale-Revised or a 3-face scale preceded by a yes-no question to rate pain in 9 picture stories from the Charleston Pediatric Pain Pictures portraying no pain , moderate pain , and severe pain . The  simplified pain rating task  made no difference for 5-year-olds , whose mean scores were nearly identical using the 2 approaches . However , discrimination of the 3 levels of Charleston Pediatric Pain Pictures items was significantly better in 3- and 4-year-olds with the simplified task than with the  Faces Pain Scale-Revised .  Simplifying the task improved preschool-age children 's ability to estimate pain intensity . PERSPECTIVE St and ard self-report pain scales with 6 faces are confusing for many 3- and 4-year-olds . In basic preparatory research for future development of a preschool self-report pain scale , we simplified the task . This simplification made no difference for 5-year-olds but improved the performance of 3- and 4-year-olds UNLABELLED The design used in this study was a prospect i ve cohort . Pain intensity levels recorded by the digital version of the visual analog scale ( VAS-D ) are easy to both score and share with other health care professionals . The purpose of the study was to examine the test-retest reliability , concurrent validity , and responsiveness of the VAS-D.  Thirty-three people with upper extremity injuries reported pain intensity levels before and after performing four maximal grip contractions ( pre- and postgripping ) . Our version of the VAS-D had high test-retest reliability ( r=0.96 ) and good concurrent validity ( r=0.84 - 0.97 ) with both the paper version of the VAS ( VAS-P ) and the verbal numerical rating scale ( NRS-V ) . Responsiveness of the VAS-D was indicated by a significant increase in pain levels from pre- to postgripping . Similar responsiveness to that of the VAS-P and NRS-V was indicated by similar effect size coefficients and analysis of variance of pain change scores . In conclusion , the VAS-D is a reliable , valid , and responsive measure of pain intensity for people with upper extremity injuries . However , differences in accuracy ( resolution ) among the VAS-D , VAS-P , or NRS-V may render the three pain scales not fully compatible . LEVEL OF EVIDENCE Not applicable PURPOSE Pain is a frequent symptom of oral disease . It is difficult to measure , however , due to its subjectivity , especially among children . The purpose of this study was to verify the utility and applicability of a  visual analogue scale of faces ( VASOF ) , adapted for 8- to 9-year-olds , to measure the severity of toothaches . METHODS A cross-sectional study was undertaken , which included 601 boys and girls r and omly selected from state and private schools in the city of Belo Horizonte , Minas Gerais , Brazil . They were interviewed and clinical ly examined , and a VASOF was applied . RESULTS The VASOF 's application revealed a high percentage of intense/very intense pain in the sample ( 39 % ) . The presence of this pain intensity was accompanied by a high incidence of children who cried , were awakened by the pain , and were unable to carry out habitual tasks . Furthermore , this severe pain was strongly associated with less-privileged economic groups and the presence of oral pathology ( P < or = .05 ) . The scale was well understood by children , independent of gender or economic group . CONCLUSIONS A VASOF was found to be capable of measuring toothache severity experienced by school-age children Objective To identify the structure of facial reaction to procedural pain and to determine the subset of facial actions that best describe the response . Design Observational . Setting Five rural and five urban physicians ' offices . Patients One hundred twenty-three children aged 4 to 5 years undergoing routine diphtheria , pertussis , tetanus , and polio immunization .  Outcome Measures The Child Facial Coding System , comprising 13 discrete facial actions , was used to code each second of five 10-second phases from videotape : baseline , preneedle , needle , postneedle , and posth and ling . Parents and a technician provided visual analog scale ratings of children 's pain . Children provided a self-report using a  Faces Pain Scale  , and parents and nurses rated the children 's pain and anxiety using visual analog scales . Results A “ pain face ” similar to that reported in adults emerged with the onset of pain . Principal component analyses revealed the frequency and intensity of facial action during the needle phase could be represented by components reflecting pain sensation , a “ brave face , ” and the children 's expectations for pain . Children 's Faces Pain Scale and adult visual analog scale ratings were best predicted by components reflecting pain sensation and expectations of high pain . Conclusions These results provide a preliminary indication that the Child Facial Coding System can be reduced to components that reflect several aspects of children 's acute pain experience and predict self-reports and observer reports of children 's pain OBJECTIVES To assess the performance of self- assessment scales in severely demented hospitalized patients and to compare it with observational data . DESIGN Prospect i ve clinical study . SETTING Geriatrics hospital and a geriatric psychiatry service . PARTICIPANTS All patients who met Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria for dementia , with a Mini-Mental State Examination score less than 11 and a Clinical Dementia Rating score of 3 . MEASUREMENTS Three self- assessment tools -- the verbal , horizontal visual , and faces pain scales -- were administered in r and omized order . A nursing team independently completed an  observational pain rating scale .  Main outcomes were comprehension ( ability to explain scale use and correctly indicate positions for no pain and extreme pain , on two separate occasions ) , inter- and intrarater reliability , and comparison of pain intensities measured by the different scales . RESULTS Sixty-one percent of 129 severely demented patients ( mean age 83.7 , 69 % women ) demonstrated comprehension of at least one scale . Comprehension rates were significantly better for the verbal and the faces pain scales . For patients who demonstrated good comprehension , the inter- and intrarater reliability of the three self- assessment scales was high ( intraclass correlation coefficient=0.88 - 0.98 ) . Correlation between the three self- assessment scales was moderate to strong ( Spearman correlation coefficient (r)=0.45 - 0.94 ; P<.001 ) . Observational rating correlated at least moderately with self- assessment ( r=0.25 - 0.63 ) , although for patients reporting pain , the observational rating scale underestimated severity compared with all three self- assessment scales . CONCLUSION Clinicians should not apply observational scales routinely in severely demented patients , because many are capable of reliably reporting their own pain STUDY OBJECTIVE To develop and vali date an instrument to assess nausea intensity  in children aged 4 - 18 years . DESIGN Prospect i ve , descriptive study . SETTING Tertiary-quaternary , university-affiliated pediatric hospital . PATIENTS Four pediatric inpatient groups ( 177 patients ): group 1 ( 107 ) , those receiving cancer chemotherapy ; group 2 ( 24 ) , those receiving cancer chemotherapy before hematopoietic stem cell transplantation ; group 3 ( 23 ) , those with cancer who were not receiving cancer chemotherapy ; and group 4 ( 23 ) , those without cancer . INTERVENTION We developed a scale with a st and ard script for administration , the Pediatric Nausea Assessment Tool ( PeNAT ) . Revisions were made after face validity testing with clinicians and parents , and pilot testing with 15 in patients undergoing chemotherapy .  MEASUREMENTS AND MAIN RESULTS The PeNAT scores were obtained 4 - 24 hours after chemotherapy in groups 1 and 2 . Dietary intake scores and number of emetic episodes were recorded for the 4 hours before PeNAT administration for all patients in group 2 and 36 patients in group 1 . Parents of a subset of patients made an independent assessment of their child 's nausea and pain intensities immediately before PeNAT administration . Reliability was evaluated in groups 1 and 2 by correlating the first and second ( obtained 1 hr after the first ) PeNAT scores . Construct validity was evaluated by comparing PeNAT scores in groups 1 - 4 . Criterion-related validity was evaluated by correlating PeNAT scores with emetic episodes and dietary intake . Convergent and discriminant validity were evaluated by correlating PeNAT scores with parental assessment s of nausea and pain . Significant differences in PeNAT scores were noted among the study groups ( p=0.035 ) . Moderate correlation was noted between the first and second PeNAT scores ( Spearman rho = 0.649 ) . The PeNAT scores correlated modestly with emetic episodes ( Spearman rho = 0.322 ) but not with dietary intake ( Spearman rho = -0.217 ) . Children 's PeNAT scores correlated moderately with their parents ' assessment of nausea ( Spearman rho = 0.442 ) , whereas little correlation was seen between children 's PeNAT scores and parents ' assessment of pain ( Spearman rho = 0.167 ) . CONCLUSION The PeNAT is a new instrument that can be used by children to assess nausea intensity STUDY OBJECTIVES To develop a sleepiness scale devoid of semantic or geometric elements . DESIGN Subjects were asked to rank in order 7 cartoon faces representing degrees of sleepiness . We used Thurstone 's scaling procedure to transform these rankings into an interval scale , which allowed us to eliminate 2 of the faces . The remaining 5 faces were ranked again using other subjects . In a validation study , subjects rated their perceived level of sleepiness using our scale and other sleepiness scales . Employed shiftworkers and school-going children used our scale to assess its practical applicability . SETTING S Research and diagnostic sleep laboratories , pre- primary to tertiary institutions , shift-working industry . PARTICIPANTS Ethnically diverse healthy and sleep-disordered adults ( n = 490 ) , and school-going children ( n = 345 ) . MEASUREMENTS AND RESULTS Our faces scale correlated with the Karolinska Sleepiness Scale ( P < .05 ) , the Stanford Sleepiness Scale ( P < .04 ) , and a visual analog scale measuring sleepiness ( P < .0001 ) . Shiftworkers showed a time-on-task effect on the evening shift ( P < .0001 ) and a peak in sleepiness at 4:00 and 5:00 ( P < .0001 ) on the night shift . Eight to 10 year old children appeared sleepier than older children throughout a school day ( P < or = .02 ) and became sleepier as the day progressed ( P < .0001 ) . We confirmed that our scale measures sleepiness , uncontaminated by pain , anger , or happiness . CONCLUSIONS We have devised a sleepiness scale  suitable for people too young or insufficiently educated to employ more-conventional scales . We envisage the scale being used for diagnostic , therapeutic , and research purpose OBJECTIVE Visual analog pain scales are reliable measures in older children and adults ; however , pain studies that include young children often rely on parental or practitioner assessment s for measuring pain severity . The authors correlated patient , parental , and practitioner pain assessment s for young children with acute pain . METHODS This was a prospect i ve , descriptive study of a convenience sample of 63 emergency department patients aged 4 - 7 years , with acute pain result ing from acute illness or painful invasive procedures . A trained research assistant administered a structured pain survey containing demographic and historical features to all parents/guardians . Children assessed their pain severity using a vali date d ordinal scale that uses five different faces with varying degrees of frowning ( severe pain ) or smiling ( no pain ) . Each face was converted to a numeric value from 0 ( no pain ) to 4 ( severe pain ) . Parents and practitioners independently assessed their child 's pain using a vali date d 100-mm visual analog scale ( VAS ) marked " most pain " at the high end . Pairwise correlations between child , parent , and practitioner pain assessment s were performed using Spearman 's or Pearson 's test as appropriate . The association between categorical data was assessed using chi(2 ) tests . RESULTS Sixty-three children ranging in age from 4 to 7 were included . Mean age ( + /-SD ) was 5.7 ( + /-1.1 ) ; 42 % were female . Fifty-seven successfully completed the face scale . The distribution of the children 's scores was 0 - 17 % , 1 - 9 % , 2 - 30 % , 3 - 14 % , and 4 - 30 % . Mean parental and practitioner scores ( + /-SD ) on the VAS were 61 ( + /-26 ) mm and 37 ( + /-26 ) mm , respectively ( maximal = 100 mm ) . Correlation between child and parent scores was 0.47 ( p < 0.001 ) . Correlation between child and practitioner scores was 0.08 ( p = 0.54 ) . Correlation between parent and practitioner scores was 0.04 ( p = 0.001 ) . CONCLUSIONS There is poor agreement between pain ratings by children , parents , and practitioners . It is unclear which assessment best approximates the true degree of pain the child is experiencing STUDY DESIGN Prospect i ve observation study . OBJECTIVES To compare the test-retest reliability and longitudinal validity ( sensitivity to change ) of 2 single-item numeric pain rating scales ( NPRSs ) with a 4-item pain intensity measure ( P4 ) . BACKGROUND Pain is a frequent outcome measure for patients seen in physical therapy ; however , the error associated with efficient pain measures , such as the single-item NPRS , is greater than for self-report measures of functional status . Initial evaluation of the P4 suggests that it is more reliable and sensitive to change than the NPRS . METHODS AND MEASURES Two single-item NPRSs and the P4 were administered on 3 occasions -- initial visit ( n = 220 ) , within 72 hours of baseline ( n = 213 ) , and 12 days following baseline assessment ( n = 183)--to patients with musculoskeletal problems receiving physical therapy .  Reliability was assessed using a type 2,1 intraclass correlation coefficient . Longitudinal validity was assessed by correlating the measures ' change scores with a retrospective rating of change that included patients ' and clinicians ' perspectives . RESULTS The test-retest reliability and longitudinal validity of the P4 were significantly greater ( P1<.05 ) than both single-item NPRSs . Minimal detectable change of the P4 at the 90 % confidence level was estimated to be a change of 22 % of the scale range ( 9 points ) compared to 27.3 % ( 3 points ) and 31.8 % ( 3.5 points ) for the 2-day NPRS and 24-hour NPRS , respectively . CONCLUSIONS The findings of this study suggest the P4 is more adept at assessing change in pain intensity than popular versions of single-item NPRSs OBJECTIVES The Wong-Baker FACES Pain Rating Scale ( WBS ) , used in children to rate pain severity , has been vali date d outside the emergency department ( ED ) , mostly for chronic pain . The authors vali date d 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 prospect i ve , 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 ( rho ) 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 ( rho = 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 implication s for research on pain management using the WBS as an assessment tool The psychometric characteristics of the  Faces Pain Scale ( FPS )  were evaluated in three groups of preschool and school-aged children ( 3 . 5 - 4.5 ; 4.5 - 5.5 and 5.5 - 6.5 years , respectively ) . The FPS was adequately comprehended by even young children . It was easily administered and was valid and discriminating . It did not , however , possess the linear scalability cl aim ed by its authors OBJECTIVE Develop and test a short-form comprehensive outcome measure for back pain . DESIGN Prospect i ve longitudinal study of 3 consecutive cohorts of back pain patients . SETTING Anglo-European College of Chiropractic outpatient clinic and several field chiropractic practice s. METHOD Domains judged important in the back pain model and responsive to clinical change were identified from the literature . Items were scored on an 11-point numerical rating scale . The instrument was psychometrically tested by use of those tests relevant to an evaluative measure . RESULTS Seven dimensions of the back pain model were included in the question naire . Having established face validity , the instrument was shown to demonstrate high internal consistency ( Cronbach 's alpha = 0.9 ) and good test-retest reliability ( ICC = 0.95 ) . All items were retained on the basis that they contributed to the overall score ( item-corrected total score correlations ) and to the instrument 's responsiveness to clinical change ( item change-corrected total change score correlations ) . The instrument demonstrated acceptable construct and longitudinal construct validity with established external measures . The effect size of the instrument was high ( 1.29 ) and comparable with established measures . CONCLUSION A reliable , valid , and responsive instrument has been developed for use in back pain patients . It is practical for use in investigations of both the efficacy and effectiveness of back pain treatments INTRODUCTION The purpose of this study was to compare distress behaviors and perceptions of distress in 4- to 6-year-old children who received two immunization injections simultaneously with those in children who received their immunizations sequentially .  METHOD This experimental study used a convenience sample of 46 children scheduled for pre-kindergarten examinations . The children were r and omly assigned to either a sequential injection or a simultaneous injection group . Direct observation and videotapes were made of the children 's behaviors before and after injection . Distress behaviors were analyzed with the Observation Scale of Behavioral Distress-Revised , and perceptions of distress were obtained from both children ( with the Wong-Baker Pain Rating Scale [ FACES ] ) and parents ( with the Visual Analog Scale ) . RESULTS Results of the Observation Scale of Behavioral Distress-Revised showed no significant differences in children 's distress behaviors between the two groups either before or after injection . The children 's self-reports of distress also showed no group differences . Parents ' perceptions of the children 's distress before and after injection were lower for the sequential group but were judged to be unrelated to the intervention . Given the opportunity to state a preference , however , parents preferred the simultaneous method . DISCUSSION The simultaneous procedure was not found to be associated with reduced distress behaviors ; however , parents preferred the simultaneous method PURPOSE Development and validation of a physical activity scale for measuring physical activity in 24 h of sports , work , and leisure time on an average weekday . METHODS For development of the physical activity scale , 2500 r and omly selected Danish men and women between the age of 20 and 60 were contacted by mail and asked to select frequent and relevant physical activities from a number of activities of known MET intensity . The activities were included in the physical activity scale , organized in nine different MET levels ranging from sleep/rest ( 0.9 METs ) to high-intensity physical activities ( > 6 METs ) . Face validity of the physical activity scale was explored through interviews with 10 volunteer men and women .  Concurrent validity was assessed against 4 d of accelerometry ( CSA 7164 ) and physical activity diary in 40 volunteer men and women between 20 and 60 yr of age . RESULTS The correlation between the activity scale and the diary was high ( r = 0.74 , P = 0.000 ) , whereas correlation between the activity scale and accelerometer measurements was poor ( r = 0.20 , NS ) . The physical activity scale MET-time was systematic ally higher than average MET-time estimated from the diary , and the difference increased with increasing total MET-time . CONCLUSION The physical activity scale appears to be a simple and valid alternative to measuring physical activity by diary in adult sedentary to moderately active Danes . The scale encompasses work , leisure time , and sports activity in one measure ; it is easy to administer , and it provides detailed information on different activity levels as well as a single measure of the total amount of physical activity on an average weekday & NA ; Although the verbal numeric scale ( VNS ) is used frequently at patients ’ bedsides , it has never been formally vali date d in children with acute pain . In order to vali date this scale , a prospect i ve cohort study was performed in children between 8 and 17 years presenting to a pediatric emergency department ( ED ) with acute pain . Pain was grade d using the VNS , the visual analogue scale ( VAS ) , and the verbal rating scale ( VRS ) .  A second assessment was done before discharge . We determined a priori that in order to be valid , the VNS would need to : correlate with the VAS ( concurrent validity ) ; decrease after intervention to reduce pain ( construct validity ) ; and be associated with the VRS categories ( content validity ) . The VNS interchangeability with the VAS , its minimal clinical ly significant difference , and test – retest reliability were also determined . A total of 202 patients ( mean age : 12.2 ± 2.6 years ) were enrolled . The VNS correlated with the VAS : ric = 0.93 , p < 0.001 . There were differences in the VNS before versus after interventions ( p < 0.001 ) , and between VRS categories ( mild versus moderate , p < 0.001 ; moderate versus severe , p < 0.001 ) . The 95 % limits of agreement ( interchangeability ) between VNS/VAS were outside the a priori set limit of ±2.0 : −1.8 , 2.5 . The VNS minimal clinical ly significant difference was 1 . The VNS had good test – retest reliability with 95 % limits of agreement of −0.9 and 1.2 . In conclusion , the VNS  provides a valid and reliable scale to evaluate acute pain in children aged 8–17 years but is not interchangeable with the VAS This study evaluated the effectiveness of a distraction intervention on subjects ' perceptions of pain .  During phlebotomy , 96 adults received either usual care or used a kaleidoscope as a distraction . After phlebotomy they rated their level of experienced pain with each of three instruments : Wong-Baker FACES Pain Scale , pain visual analogue scale , and Present Pain Intensity Scale . Statistical analyses revealed significantly lower perceptions of experienced pain among subjects using the kaleidoscope and concurrent validity for using the FACES Pain Scale with adults . Because the distraction intervention is effective , inexpensive , and easy to implement , its routine use during phlebotomy is recommended Various clinical protocol s are used to manage early postoperative tonsillectomy and /or adenoidectomy ( T&A ) pain in children . Although believed to be effective , these protocol s are not evidence d-based . Therefore , a double-blind , r and omized , placebo controlled ( 2 x 2 ) factorial design was used ( 1 ) to evaluate the effectiveness of 2 pain protocol s used interchangeably to manage early postoperative T&A pain and ( 2 ) to investigate whether nurses ' systematic pain assessment s improve pain management . In the first protocol children receive a loading dose ( 30 to 50 mg/kg ) of paracetamol ( acetaminophen ) Formularium der Nederl and se Apothekers ( Formulary of the Dutch Royal Society for the Advancement of Pharmacy ) intraoperatively , followed by regular doses ( 70 to 100 mg/kg/24 hours ) of paracetamol . In the second protocol children receive the first protocol , plus intramuscular fentanyl citrate ( 1 microgram/kg ) intraoperatively . Subjects were 83 healthy children between the ages of 3 and 12 years , admitted for T&A as an outpatient procedure . The child 's pain was measured using observation scales ( Children 's Hospital of Eastern Ontario Pain Scale and Face Legs Activity Cry Consolability Scale ) , a visual analogue scale , and self-report measures ( Faces Pain Scale and Oucher ) . Neither pain protocol sufficiently relieved early postoperative T&A pain , and systemic pain assessment s did not improve the effectiveness of analgesics . Further research evaluating the effectiveness of pain management protocol s is needed Objective . To compare the Faces Pain Scale and Color Analogue Scale among children aged 6–12 years undergoing selected procedures ( Venipuncture , Intravenous cannulation , Intramuscular injection , Lumbar puncture , Bone marrow aspiration )  and to compare the procedural pain in a child as perceived by the child , parents and health care professionals using the above mentioned scales Methods . This was a prospect i ve , descriptive correlational study of children aged 6–12 years , who had undergone selected procedures . Children were assessed for their pain severity using  Faces Pain Scale and Color Analogue Scale .  Parents and health care professionals also independently assessed the child 's pain using the same scales Results . 181 children who fulfilled the eligibility criteria were enrolled in the study . There was a significant positive correlation ( r = > 0.8 ) between both the pain scales . There was fair to moderate positive correlation ( r = 0.29 to 0.58 ) of pain perception of child with parents and health care professionals Conclusions . Faces Pain Scale and Color Analogue Scales seem to be appropriate instruments for measuring pain intensity among Indian children aged 6–12 years undergoing selected Background : The FACE-Q is a new patient-reported outcome instrument to evaluate a range of outcomes for patients undergoing any type of facial cosmetic operation , minimally invasive cosmetic procedure , or facial injectable . This article describes the development and validation of FACE-Q scales relevant to face-lift patients . Methods : The FACE-Q was developed by following international guidelines for patient-reported outcome instrument development . For outcomes following a face lift , the authors developed five  appearance appraisal scales ( i.e. , Satisfaction with Cheeks , Satisfaction with Lower Face and Jawline , Appraisal of Nasolabial Folds , Appraisal of Area Under the Chin  , and Appraisal of the Neck ) and an adverse effects checklist . A field test of these scales was performed in a sample of 225 face-lift patients , and were evaluated using both modern and traditional psychometric methods . Results : The five FACE-Q appearance appraisal scales were found to be clinical ly meaningful , reliable , valid , and responsive to clinical change . These findings were supported by Rasch measurement theory analysis ( e.g. , overall chi-square values of p ≥ 0.18 ; Person Separation Index ≥ 0.88 ) . Responsiveness analyses showed that patient scores for facial appearance improved significantly after treatment ( p < 0.001 ) ; changes in scores were associated with moderate effect sizes ( range effect size , 0.40 to 0.79 ; range st and ardized response mean , 0.37 to 0.69 ) . Traditional psychometric statistics provided further support ( e.g. , Cronbach ’s alpha values ≥0.94 ) Conclusions : The FACE-Q appearance appraisal scales are scientifically sound and clinical ly meaningful and can be used with the adverse effects checklist to measure patient-reported outcomes following a face lift . CLINICAL QUESTION /LEVEL OF EVIDENCE : Diagnostic , III Background One economical way to inform patients about their illness and medical procedures is to provide written health information material . So far , a generic and psychometrically sound scale to evaluate cognitive , emotional , and behavioral aspects of the subjectively experienced usefulness of patient information material from the patient ’s perspective is lacking . The aim of our study was to develop and psychometrically test such a scale . Methods The Usefulness Scale for Patient Information Material ( USE ) was developed using a multistep approach . Ultimately , three items for each subscale ( cognitive , emotional , and behavioral ) were selected under consideration of face validity , discrimination , difficulty , and item content . The final version of the USE was subjected to reliability analysis . Structural validity was tested using confirmatory factor analysis , and convergent and divergent validity were tested using correlation analysis . The criterion validity of the USE was tested in an experimental design . To this aim , patients were r and omly allocated to one of two groups . One group received a full version of an information brochure on depression or chronic low back pain depending on the respective primary diagnosis . Patients in the second group received a reduced version with a lower design quality , smaller font size and less information .  Patients were recruited in six hospitals in Germany . After reading the brochure , they were asked to fill in a question naire . Results Analyzable data were obtained from 120 question naires . The confirmatory factor analysis supported the structural validity of the scale . Reliability analysis of the total scale and its subscales showed Cronbach ’s α values between .84 and .94 . Convergent and divergent validity were supported . Criterion validity was confirmed in the experimental condition . Significant differences between the groups receiving full and reduced information were found for the total score ( p<.001 ) and its three subscales ( cognitive p<.001 , emotional p=.001 , and behavioral p<.001 ) , supporting criterion validity . Conclusions We developed a generic scale to measure the subjective usefulness of written patient information material from a patient perspective . Our construct is defined in line with current theoretical models for the evaluation of written patient information material . The USE was shown to be a short , reliable and valid psychometric scale Background Semi-structured interview scales for psychosis are the gold st and ard approach to assessing psychotic and other symptoms . However , such assessment s have limitations such as recall bias , averaging , insensitivity to change and variable interrater reliability . Ambulant , real-time self-report assessment devices may hold advantages over interview measures , but it needs to be shown that the data thus collected are valid , and the collection method is acceptable , feasible and safe . We report on a monitoring system for the assessment of psychosis using smartphone technology . The primary aims were to : i ) assess validity through correlations of item responses with those on widely accepted interview assessment s of psychosis , and ii ) examine compliance to the procedure in individuals with psychosis of varying severity . Methods A total of 44 participants ( acute or remitted DSM-4 schizophrenia and related disorders , and prodromal ) completed 14 branching self-report items concerning key psychotic symptoms on a touch-screen mobile phone when prompted by an alarm at six pseudo-r and om times , each day , for one week . Face to face PANSS and CDS interviews were conducted before and after the assessment period blind to the ambulant data . Results Compliance as defined by completion of at least 33 % of all possible data -points over seven days was 82 % . In the 36 compliant participants , 5 items ( delusions , hallucinations , suspiciousness , anxiety , hopelessness ) showed moderate to strong ( rho 0.6 - 0.8 ) associations with corresponding items from interview rating scales . Four items showed no significant correlation with rating scales : each was an item based on observable behaviour . Ambulant ratings showed excellent test-retest reliability and sensitivity to change . Conclusions Ambulatory monitoring of symptoms several times daily using smartphone software applications represents a feasible and valid way of assessing psychotic phenomena for research and clinical management purpose s. Further evaluation required over longer assessment periods , in clinical trials and service setting Background No appropriate measures have been specifically developed for pelvic girdle pain ( PGP ) . There is a need for suitable outcome measures that are reliable and valid for people with PGP for use in research and clinical practice . Objective The objective of this study was to develop a condition-specific measure , the Pelvic Girdle Question naire ( PGQ ) , for use during pregnancy and postpartum . Design This was a methodology study . Methods Items were developed from a literature review and information from a focus group of people who consulted physical therapists for PGP .  Face validity and content validity were assessed by classifying the items according to the World Health Organization 's International Classification of Functioning , Disability and Health . After a pilot study , the PGQ was administered to participants with clinical ly verified PGP by means of a postal question naire in 2 surveys . The first survey included 94 participants ( 52 pregnant ) , and the second survey included 87 participants ( 43 pregnant ) . Rasch analysis was used for item reduction , and the PGQ was assessed for unidimensionality , item fit , redundancy , and differential item functioning . Test-retest reliability was assessed with a r and om sample of 42 participants . Results The analysis result ed in a question naire consisting of 20 activity items and 5 symptom items on a 4-point response scale . The items in both subscales showed a good fit to the Rasch model , with acceptable internal consistency , satisfactory fit residuals , and no disordered threshold . Test-retest reliability showed high intraclass correlation coefficient estimates : .93 ( 95 % confidence interval=0.86–0.96 ) for the PGQ activity subscale and .91 ( 95 % confidence interval=0.84–0.95 ) for the PGQ symptom subscale . Limitations The PGQ should be compared with low back pain question naires as part of a concurrent evaluation of measurement properties , including validity and responsiveness to change . Conclusions The PGQ is the first condition-specific measure developed for people with PGP . The PGQ had acceptably high reliability and validity in people with PGP both during pregnancy and postpartum , it is simple to administer , and it is feasible for use in clinical practice BACKGROUND The Army Surgeon General released the Pain Management Task Force final report in May 2010 . Among military providers , concerns were raised that the st and ard numeric rating scale ( NRS ) for pain was inconsistently administered and of question able clinical value . In response , the Defense and Veterans Pain Rating Scale ( DVPRS ) was developed . METHODS The instrument design integrates pain rating scale features to improve interpretability of incremental pain intensity levels , and to improve communication and documentation across all transitions of care . A convenience sample of 350 inpatient and outpatient active duty or retired military service members participated in the study at Walter Reed Army Medical Center . Participants completed the five-item DVPRS-one pain intensity NRS with and without word descriptors presented in r and om order and four supplemental items measuring general activity , sleep , mood , and  level of stress and the Brief Pain Inventory seven interference items . Using systematic sampling , a r and om sample was selected for a word descriptor validation procedure matching word phases to corresponding pain intensity on the NRS . RESULTS Parallel forms reliability and concurrent validity testing demonstrated a robust correlation . When the DVPRS was presented with the word descriptors first , the correlation between the two ratings was slightly higher , r = 0.929 ( N = 171 ; P < 0.001 ) , than ordering first without the descriptors , r = 0.882 ( N = 177 ; P < 0.001 ) . Intraclass correlation coefficient was 0.943 showing excellent alignment of word descriptors by respondents ( N = 42 ) , matching them correctly with pain level . CONCLUSIONS The DVPRS tool demonstrated acceptable psychometric properties in a military population CONTEXT Goal -directed delivery of sedative and analgesic medications is recommended as st and ard care in intensive care units ( ICUs ) because of the impact these medications have on ventilator weaning and ICU length of stay , but few of the available sedation scales have been appropriately tested for reliability and validity . OBJECTIVE To test the reliability and validity of the Richmond Agitation-Sedation Scale ( RASS ) . DESIGN Prospect i ve cohort study . SETTING Adult medical and coronary ICUs of a university-based medical center . PARTICIPANTS Thirty-eight medical ICU patients enrolled for reliability testing ( 46 % receiving mechanical ventilation ) from July 21 , 1999 , to September 7 , 1999 , and an independent cohort of 275 patients receiving mechanical ventilation were enrolled for validity testing from February 1 , 2000 , to May 3 , 2001 . MAIN OUTCOME MEASURES Interrater reliability of the RASS , Glasgow Coma Scale ( GCS ) , and Ramsay Scale ( RS ) ; validity of the RASS correlated with reference st and ard ratings , assessment s of content of consciousness , GCS scores , doses of sedatives and analgesics , and bispectral electroencephalography . RESULTS In 290-paired observations by nurses , results of both the RASS and RS demonstrated excellent interrater reliability ( weighted kappa , 0.91 and 0.94 , respectively ) , which were both superior to the GCS ( weighted kappa , 0.64 ; P<.001 for both comparisons ) . Criterion validity was tested in 411-paired observations in the first 96 patients of the validation cohort , in whom the RASS showed significant differences between levels of consciousness ( P<.001 for all ) and correctly identified fluctuations within patients over time ( P<.001 ) . In addition , 5 methods were used to test the construct validity of the RASS , including correlation with an attention screening examination ( r = 0.78 , P<.001 ) , GCS scores ( r = 0.91 , P<.001 ) , quantity of different psychoactive medication dosages 8 hours prior to assessment ( eg , lorazepam : r = - 0.31 , P<.001 ) , successful extubation ( P = .07 ) , and bispectral electroencephalography ( r = 0.63 , P<.001 ) . Face validity was demonstrated via a survey of 26 critical care nurses , which the results showed that 92 % agreed or strongly agreed with the RASS scoring scheme , and 81 % agreed or strongly agreed that the instrument provided a consensus for goal -directed delivery of medications . CONCLUSIONS The RASS demonstrated excellent interrater reliability and criterion , construct , and face validity . This is the first sedation scale to be vali date d for its ability to detect changes in sedation status over consecutive days of ICU care , against constructs of level of consciousness and delirium , and correlated with the administered dose of sedative and analgesic medications Background : Patient-reported outcome measures are increasingly used evaluating clinical care . Many measures used to assess operative hindfoot interventions vary in content , and some have not been psychometrically vali date d in this population . The purpose of this study was to compare measurement properties of  6 lower-extremity patient-reported outcome measures  , and to evaluate their reliability and validity in light of patients ’ preferences . Methods : Cross-sectional survey of 42 preoperative and 100 postoperative patients completed 6 lower-extremity outcome measures  on 2 occasions : Foot Function Index ( FFI ) , Ankle Osteoarthritis Scale ( AOS ) , patient-reported items of the  American  Orthopaedic Foot & Ankle Society Question naire ( AOFAS ) , Lower Extremity Functional Scale ( LEFS ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and the Short Musculoskeletal Function Assessment ( SMFA ) , as well as measures of preference , and symptoms . Results : Internal consistency was good to excellent for all scales and subscales ( α = .84-.97 ; ICC [ 2,1 ] = .81-.96 ) . Correlations between scales ranged from .50 ( WOMACStiffness and FFIActivity Limitations ) to .92 ( LEFS and SMFAOverall , WOMACPain and AOSOverall , FFIOverall and AOFASOverall ) . Higher correlations occurred within instruments ( r = .97 AOSPain and AOSOverall ) and between similar subscales from different instruments ( r = .91 WOMACPain and AOSPain ) . Construct validity showed moderate to high correlations to global ratings of Pain , Stiffness , and difficulty performing Daily Activities . The highest correlations ( r > .75 ) occurred between Pain and AOSOverall ( r = .84 ) , stiffness and WOMACStiffness ( r = .81 ) , and Daily Activities and AOSDisability ( r = .87 ) . Patients rated instruments by preference . FFI , WOMAC , LEFS , and SMFA rated favorably for length . FFI , WOMAC , LEFS , and AOFAS rated high for underst and ability . FFI was rated by postoperative patients as most likely to capture change due to surgery . SMFA rated the best overall . Conclusions : Direct comparison of instruments revealed similarity between scales in construct validity and reliability . Patient preferences supported the use of these scales . Foot-specific instruments offered no clear advantage over lower-extremity instruments . Level of Evidence : Level II , prospect i ve comparative study OBJECTIVE Demographic , behavioral , and diagnostic information should routinely be collected from clients with severe mental illness , and data gathering should employ the most efficient techniques available . Surveys are increasingly conducted via Web-based computer-assisted interviewing ( CAI ) , but this technique is not well vali date d for patients with severe mental illness . A r and omized clinical trial of 245 clients was carried out to compare face-to face and computer-assisted interviewing ( 233 clients completed two surveys ) . METHODS Self-report data were collected on demographic characteristics , substance abuse , risk behaviors for blood-borne diseases , trauma history , and posttraumatic stress disorder . Each client was assessed twice and r and omly assigned to one of the four possible combinations of interviewer and computer ( computer and computer , N=53 ; computer and interviewer , N=56 ; interviewer and computer , N=59 ; and interviewer and interviewer , N=65 ) . The two formats were compared on feasibility , client preference , cost , reliability , convergent validity , and criterion validity . RESULTS This study demonstrated the feasibility of  CAI across a variety of inpatient and outpatient setting s. All participants who began the CAI process completed the interview and responded to over 95 % of the survey items . Participants liked using the computers as well as they liked face-to-face interviews , and they completed the  CAI  as quickly . CAI produced data as reliable and valid as face-to-face interviews produced and was less expensive , and results were available more quickly . The two formats were similar in criterion validity . CONCLUSIONS CAI appears to be a viable technology for gathering clinical data from the population with severe mental illness and for transforming such information into a useful , quickly accessible form to aid in clinical decision making The purpose of this study was to evaluate an automated voice-interactive program for screening  depression in English and Spanish . The Center for Epidemiological Studies -Depression Scale ( CES-D ) was administered in two interview formats : a speech recognition program presented by cellular telephone , and a face-to-face method . In a single-session counterbalanced design , 32 English speakers and 23 Spanish speakers completed r and omly ordered administrations of the two  CES-D methods , the  Beck Depression Inventory ( BDI ) , and the  Short Acculturation Scale ( SAS ) . There was strong evidence that the two CES-D methods were psychometrically equivalent , reliable , and valid in both language s. The two methods were highly rated by both language groups . The Spanish speakers did not display a preference for either method , but the English speakers preferred the face-to-face method . The results also suggested that verbal response latency time was positively correlated with depression scores . Last , the Spanish-speakers ' acculturation levels were not correlated with depression scores . Differences in age , education , and income between the language groups were confounded by unequal sample sizes . The findings generally supported the viability of the automated CES-D as a culturally and linguistically appropriate tool for screening depression in English and Spanish . Furthermore , the analyses of respondent voice characteristics show promise as a method for screening depression in both language OBJECTIVES The objective was to determine the minimum and ideal clinical ly significant differences ( MCSD , ICSD ) in  pain intensity in children for the Faces Pain Scale-Revised ( FPS-R ) and the Color Analog Scale ( CAS ) and to identify any differences in these estimates based on patient characteristics . METHODS This was a prospect i ve study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments . Participants self-reported their pain intensity using the FPS-R and CAS and qualitatively described their changes in pain . Changes in pain score reported using the FPS-R and CAS that were associated with " a little less " and " much less " pain ( MCSD and ICSD , respectively ) were identified using a receiver operating characteristic-based method and expressed as raw change score and percent reductions . Estimates of MCSD and ICSD were determined for each category of initial pain intensity ( mild , moderate , and severe ) and patient characteristics ( age , sex , and ethnicity ) . Post hoc exploratory analyses evaluated categories of race , primary language , and etiology of pain . RESULTS A total of 314 children with acute pain were enrolled ; mean ( ±SD ) age was 9.8 ( ±3.8 ) years . The FPS-R raw change score and percent reduction MCSD estimates were 2/10 and 25 % , with ICSD estimates of 3/10 and 60 % . For the CAS , raw change score and percent reduction MCSD estimates were 1/10 and 15 % , with ICSD estimates of 2.75/10 and 52 % . For both scales , raw change score and percent reduction estimates of the MCSD remained unchanged in children with either moderate or severe pain . For both scales , estimates of ICSD were not stable across categories of initial pain intensity . There was no difference in MCSD or ICSD based on age , sex , ethnicity , race , primary language , or etiology of pain . CONCLUSIONS The MCSD estimates can be expressed as raw change score and percent reductions for the FPS-R and CAS . These estimates appear stable for children with moderate to severe pain , irrespective of age , sex , and ethnicity . Estimates of ICSD were not stable across different categories of initial pain intensity , therefore limiting their potential generalizability PURPOSE The purpose of this study was to develop a self-administered evaluative tool to measure health-related quality of life in young , active patients with hip disorders . METHODS This outcome measure was developed for active patients ( aged 18 to 60 years , Tegner activity level ≥ 4 ) presenting with a variety of symptomatic hip conditions . This multicenter study recruited patients from international hip arthroscopy and arthroplasty surgeon practice s. The outcome was created using a process of item generation ( 51 patients ) , item reduction ( 150 patients ) , and pretesting ( 31 patients ) . The question naire was tested for test-retest reliability ( 123 patients ) ; face , content , and construct validity ( 51 patients ) ; and responsiveness over a 6-month period in post-arthroscopy patients ( 27 patients ) . RESULTS Initially , 146 items were identified . This number was reduced to 60 through item reduction , and the items were categorized into 4 domains : ( 1 ) symptoms and functional limitations ; ( 2 ) sports and recreational physical activities ; ( 3 ) job-related concerns ; and ( 4 ) social , emotional , and lifestyle concerns . The items were then formatted using a visual analog scale . Test-retest reliability showed Pearson correlations greater than 0.80 for 33 of the 60 questions . The intraclass correlation statistic was 0.78 , and the Cronbach α was .99 . Face validity and content validity were ensured during development , and construct validity was shown with a correlation of 0.81 to the Non-Arthritic Hip Score . Responsiveness was shown with a paired t test ( P ≤ .01 ) , effect size of 2.0 , st and ardized response mean of 1.7 , responsiveness ratio of 6.7 , and minimal clinical ly important difference of 6 points . CONCLUSIONS We have developed a new quality -of-life patient-reported outcome measure , the 33-item International Hip Outcome Tool ( iHOT-33 ) . This question naire uses a visual analog scale response format design ed for computer self-administration by young , active patients with hip pathology . Its development has followed the most rigorous methodology involving a very large number of patients . The iHOT-33 has been shown to be reliable ; shows face , content , and construct validity ; and is highly responsive to clinical change . In our opinion the iHOT-33 can be used as a primary outcome measure for prospect i ve patient evaluation and r and omized clinical trials Objective This study examined the psychometric properties of the Korean version of the eight-item  Morisky Medication Adherence Scale ( MMAS-8 ) to measure adherence to diabetes medication in patients with type 2 diabetes mellitus . Methods The English version of the MMAS-8 was translated into Korean and administered to patient with type 2 diabetes mellitus via face-to-face interviews  , conducted by an independent interviewer . Patient characteristics and glycosylated haemoglobin ( HbA1c ) levels were assessed at the same clinic visit . A proportion of patients was r and omly selected for 2-week test-retest reliability via telephone interviews . Convergent validity of the MMAS-8 against a four-item MMAS , correlations with HbA1c levels and construct validity of the MMAS-8 were evaluated . Results In total , 317 patients were included ; 70 completed the 2-week test – retest interview . Internal consistency reliability was moderate and test – retest reliability of the MMAS-8 was excellent , although a ceiling effect was detected . Good convergent validity was shown by the high correlation of the new scale scores with the original MMAS-4 . A significant association was found between MMAS-8 scores and HbA1c levels . Using glycaemic control as a gold st and ard , sensitivity was 74.1 % and specificity was 38.3 % . Explanatory factor analysis identified three dimensions of the scale . Conclusions In light of acceptable reliability and validity , the MMAS-8 is a simple and quick method for the assessment of medication adherence among patient with type 2 diabetes mellitus , in a busy clinic setting Study Design . A descriptive study of repeated measures using a crossover design . Objective . To determine the level of agreement between assessment s obtained via telerehabilitation and those obtained by traditional face-to-face method in a population of individuals with chronic low back pain ( LBP ) in a primary care setting . Summary of Background Data . Musculoskeletal assessment using telerehabilitation has shown adequate inter- and intrarater agreement and concordance with face-to-face clinical assessment in different diseases . There have been no published studies on the reliability of a telerehabilitation system to assess LBP . Methods . Fifteen individuals ( 6 males ; mean age , 37 yr ) with chronic LBP attended a session for a clinical interview , followed by face-to-face and real-time online telerehabilitation evaluations . There was a 30-minute interval between the 2 assessment s , the order of which was r and omly selected for each patient . The telerehabilitation system used an Internet application conducted via Internet connection ( 17 kB/s ) between 2 personal computers . Real-time video connection facilitated communication between the therapist and the subject . Outcome measures included lumbar spine mobility , Sorensen test , anterior straight leg raise test , Oswestry Disability Index , visual analogue scale for pain , 12-Item Short Form Health Survey question naire , and Tampa Kinesiophobia Scale . Results . The & agr ; reliability between face-to-face and telerehabilitation evaluations was more than 0.80 for 7 of the 9 outcome measures . Lowest reliability was for lateral flexion range of motion ( & agr;= 0.75 ) . Very good inter- and intrarater intraclass correlation coefficients ( & rgr ; ) were obtained ( 0.92–0.96 ) . Conclusion . The findings of our pilot study suggest that this telerehabilitation system may be useful to assess individuals with chronic LBP , providing initial support for its implementation in primary care . Level of Evidence : OBJECTIVES To study the compliance of prescription , the efficacity and the adverse events of oral morphine used in the pediatric emergency department ( ED ) in traumatic pains . METHOD This prospect i ve study was conducted in the ED from october 2002 to september 2003 . Children aged six months to 16 years with a visual analogic scale ( VAS ) score higher than 70 or with a traumatic member deformation received oral morphine ( 0,5 mg/kg ) .  Pain was assessed every 30 minutes using two scales : behavioral observation by the faces scale  and  objective pain scale ( OPS ) for children less than five years , behavioral observation by the  faces scale and self-report by  VAS  for children older than five years . The compliance of prescription , the pain scores and the adverse events were studied . RESULTS Ninety-one children received oral morphine and seventy-four children were studied . Seventy per cent of prescriptions were in accordance with the recommendations . For patients younger than five years a rapid decrease of pain was observed in thirty minutes . The pain 's reduction was respectively 79 and 84 % with faces scale and OPS when they left ED . For children older than five years , pain 's reduction was more important and more rapid when pain assessment was made by nurses than when it was self-reported in the first hour ( pain reduction 58,2 and 36,1 % ) . When leaving , pain reduction was the same with the two different assessment s. No major adverse event was noted . CONCLUSION Use of oral morphine in ED is simple , with a few numbers of adverse events . None was severe . Efficiency is correct after 30 to 60 minutes The Brief Pain Inventory short form ( BPI-sf ) is a vali date d , widely used , self-administered question naire developed to assess the severity of pain and the impact of pain on daily functions . A modified version was used daily in r and omised control trials of patients with arthritis undergoing treatment with cyclooxygenase-2 specific inhibitors and non-steroidal anti-inflammatory drugs .  Results indicate that the modified BPI-sf , much like the original scale , was internally reliable , consistent over time , and had good construct , as well as convergent and predictive validity in assessment of patients suffering from conditions of chronic pain . Each scale and individual pain intensity item refers to changes in osteoarthritis pain associated with medication use . The modified BPI-sf , like the parent scale , is a valid and reliable tool for situations in which pain is assessed daily and minimises the burden placed on patients to record information necessary for scientific investigations OBJECTIVE Non-pharmacological approaches to pain management have been used by therapists for decades to reduce the anxiety and pain experienced by children during burn care procedures . With a greater underst and ing of pain and the principles behind what causes a child to be distracted , combined with access to state of the art technology , we have developed an easy to use , h and held multimodal distraction device ( MMD ) . MMD is an interactive device that prepares the child for a procedure and uses developmentally appropriate distraction stories and games during the procedures to alleviate anxiety and pain . This paper summarizes the results of three r and omized control trials . The trials aim ed to underst and the effectiveness of MMD as a distraction and preparation tool in reducing anxiety and pain in children undergoing burns and non-burns medical procedures compared to pure pharmacological approaches St and ard Distraction ( SD ) and off the shelf video games ( VG ) . METHODS Three separate prospect i ve r and omized control trials involving 182 children having 354 dressing changes were conducted in the burns and orthopedic departments at Royal Children 's Hospital , Brisbane , Australia , to address the above aims . Pain and anxiety scores were completed for the child , caregiver and nursing staff according to the Modified Faces , Legs , Activity , Cry and Consolability Scale , Faces Pain Scale-Revised , Visual Analogue Scale and Wong-Baker Faces Pain Rating Scale . Procedural length was recorded . RESULTS MMD as a preparation and distraction tool were shown to have a significant impact on child , parent and nursing staff reported anxiety and pain during procedures compared to st and ard care and video games ( P < 0.01 ) . The MMD had a positive effect on clinical time and was shown to sustain its impact on pain and time with further dressing changes . CONCLUSIONS MMD is more effective in reducing the pain and anxiety experienced by children in acute medical procedures as compared with SD and VG . MMD is continuing to be trialed and is continuing to show positive clinical outcomes Objective The Wong-Baker FACES Pain Rating Scale ( WBS ) is preferred by parents and patients for reporting pain severity . However , it is speculated that the “ no hurt ” and “ hurts worst ” anchors confound pain measurement with nonnociceptive states . The objective of our study was to determine if fear confounds reporting of pain severity on the WBS . We hypothesized that the WBS would correlate with a psychometrically different pain severity scale ( the visual analog scale [ VAS ] ) and not correlate with a fear measure , the Child Medical Fear Scale ( CMFS ) . Methods This was a prospect i ve observational study of children 7 to 12 years presenting to a university-based suburban pediatric ED with acute pain . Patients rated pain severity on the WBS ordinal scale and a 100-mm unhatched VAS with marked end points of “ no pain ” and “ worse pain ever . ” Patients also completed a 26-item CMFS . Correlations between the WBS and VAS with the CMFS total score were assessed with Spearman correlation and exploratory factor analysis . Results All 3 scales were completed in 197 children .  Correlation between the severity scales ( WBS-VAS ) was moderate : 0.63 ( 95 % confidence interval [ CI ] , 0.54–0.71 ) . However , correlations between the WBS-CMFS and VAS-CMFS were poor : −0.02 ( 95 % CI , −0.16 to −0.12 ) and 0.01 ( 95 % CI , −0.13 to 0.15 ) , respectively . Correlations did not differ by sex , grade , pain location , or cause of pain ( traumatic vs atraumatic ) . Exploratory factor analysis demonstrated excellent loadings within 2 factors : pain and fear . Conclusions The WBS demonstrates moderate correlation with another measure of pain ( VAS ) and is not mistaken for fear among school-aged patients presenting to the ED with pain OBJECTIVE To assess the reliability , validity and sensitivity to change of the Derriford Scale , a quality of life instrument design ed to assess the distress and dysfunction experienced by people who are self-conscious about their physical appearance . SUBJECTS AND DESIGN Postal question naire survey of 656 cosmetic surgery patients recruited from new referral letters and plastic surgery waiting list reports . A total of 443 subjects completed and returned the question naire .  Of these respondents , 203 were sent a second question  naire to assess reproducibility , of whom 155 subjects responded . MAIN OUTCOME MEASURES Reliability was assessed in terms of internal consistency and reproducibility . Face , content and construct validity were also investigated . RESULTS The analyses led to mixed results . There was some evidence of internal consistency , but a number of items had low endorsement levels and there may be scope for reducing the overall size of the instrument . When assessed for reproducibility , the level of agreement between scores of individuals completing the question naire on two occasions was high , but an important systematic shift in responses was also detected . Correlations between the other health status measures and the Derriford Scale provided some evidence of construct validity . CONCLUSION In its present form the Derriford Scale has good descriptive value , but there are some measurement problems identified in this report that need to be addressed before the scale is taken up into general use The purpose of the study was to investigate psychometric properties of CAMPAS-R , an instrument for prospect ively monitoring patients ' symptoms and needs during palliative care at home .  CAMPAS-R was piloted for face and content validity and then administered alongside criterion measures to a home care sample . Cronbach 's alpha was used to test internal consistency and criterion-related validity was tested by non-parametric correlation with Brief Pain Inventory ( BPI ) , Hospital Anxiety and Depression Scale ( HADS ) and EORTC QLQ-C30 . Predictive validity was assessed by relating CAMPAS-R scores to survival .  One hundred and nine patients were recruited to the study . Good reliability and high correlations between CAMPAS-R and criterion measures were found . Predictive validity was demonstrated by significant differences in symptom scores between groups differing in length of survival .  CAMPAS-R is acceptable to patients , families and primary care professionals and is a valid , reliable instrument , which has the benefit of being easy to score BACKGROUND Valid outcome measurement tools are required to reliably demonstrate the effectiveness and clinical outcomes of lower-extremity arthroplasty . Having ascertained a lack of a practical and valid measure of the change in actual daily physical activity that occurs prior to and following lower-limb arthroplasty , we developed and vali date d a lower-extremity activity scale . METHODS The eighteen-level self-administered scale was developed with the aid of content experts to ensure face validity . Validity and reliability were assessed with the use of ( 1 ) pedometer measurements of seventy subjects over seven days ;  ( 2 )  next-of-kin proxy measurements of the activity levels of ninety patients before they underwent lower-limb arthroplasty ;  and ( 3 ) application , and correlation with the Western Ontario and McMaster Universities Osteoarthritis Index scores , in a prospect i ve seventeen-center clinical study of 297 consecutive patients undergoing revision total knee arthroplasty . In this latter study , demographic and comorbidity data were also collected . Univariate and bivariate correlations were performed , and a multivariate structured equation modeling approach was used to further test responsiveness , reliability , and validity of the lower-extremity activity scale . RESULTS Pedometer readings correlated with the activity levels derived with the lower-extremity activity scale ( r = 0.79 ) . Of note was the finding that age , weight , and body mass index did not correlate well with the average number of steps per day ( r = -0.32 , -0.32 , and -0.25 , respectively ) . A significant correlation was found between the lower-extremity activity scores recorded by the patients and those reported by their next of kin ( Pearson correlation , r = 0.715 ; p = 0.0001 ) and between the initial lower-extremity activity scores and two-week-retest scores ( intraclass correlation = 0.9147 ; p < 0.0001 ) , demonstrating the validity and reliability of the scale . The  lower-extremity activity scale was responsive , accurately reflecting changes in the patient 's condition between baseline and the time of follow-up ( p < 0.001 ) , and it was reliable , with baseline values correlating with follow-up scores ( p < 0.001 ) . The convergent validity of the lower-extremity activity scale was established by correlations with the function scores ( r = -0.301 , p < 0.001 ) and pain scores ( r = -0.241 , p < 0.001 ) derived with the Western Ontario and McMaster Universities Osteoarthritis Index and with a higher number of comorbidities ( r = -0.244 , p < 0.001 ) . Multivariate path modeling further demonstrated diminished activity in patients who had more difficulty in functioning and a greater number of comorbidities . CONCLUSIONS We developed a lower-extremity activity scale and vali date d that it was an effective instrument for the assessment of patients ' actual activity levels . It is easy to apply and interpret , and it is valid and ready for use in the clinical setting . This scale will allow more accurate analysis and prediction of outcomes . Consequently , it will become a useful , practical adjunct to objective clinical decision-making and intervention for patients undergoing arthroplasty The childhood cancer literature provides limited underst and ing of the school-age child 's perception of cancer stressors and factors that contribute to adjustment in the midst of these stressors . This study evaluated the reliability and validity of two question naires : the  Childhood Cancer Stressors Inventory ( CCSI ) and the  Children 's Adjustment to Cancer Index ( CACI ) . The following steps were involved in the instrument development process : item development , face and content validation , internal consistency reliability , and construct validity . Questions for both instruments were developed from the literature and experience of the principal investigator . A panel of five expert pediatric oncology nurses was asked to evaluate the content validity of both instruments . All the experts rated every item a 4 - 5 using the content validity index , indicating that each item measured the concept addressed by the scale . Seventy-five children with cancer were asked to complete the two question naires and parents completed a demographic data sheet that included eight questions about the child 's  school attendance , performance , number of friends , and activities .  Children were 7 to 13 years of age ; 64 % were diagnosed with a leukemia/ lymphoma , and 36 % had a solid tumor .  Internal coefficient reliability for the total CCSI was .82 , and .91 for the CACI . The CCSI correlated negatively with the adjustment scale ( r = -.63 , P = 000 ) . The number of days missed from school correlated positively with the CCSI and negatively with the CACI . Children who missed more school perceived more cancer stressors and had a lower adjustment rating . Children with lower adjustment ratings on the CACI also had fewer friends ( t = 3.4(72 ) , P = .001 ) . Scores on both instruments demonstrated expected relationships with measures hypothesized to covary with the dimensions assessed by the new instruments . Adjustment issues for children with cancer have been difficult to assess because of the lack of appropriate instruments . These study findings indicate that the two new instruments can help to measure the child 's perceptions of the cancer experience Background We examined the psychometric properties of the Korean version of the 8-item Morisky Medication Adherence Scale ( MMAS-8 ) among adults with hypertension . Methods A total of 373 adults with hypertension were given  face-to-face interviews in 2 cardiology clinics at 2 large teaching hospitals in Seoul , South Korea . Blood pressure was measured twice , and medical records were review ed . About one-third of the participants ( n = 109 ) were r and omly selected for a 2-week test-retest evaluation of reliability via telephone interview . Results Internal consistency reliability was moderate ( Cronbach α = 0.56 ) , and test-retest reliability was excellent ( intraclass correlation = 0.91 ; P < 0.001 ) , although a ceiling effect was detected . The correlation of MMAS-8 scores with scores for the original 4-item scale indicated that convergent validity was good ( r = 0.92 ; P < 0.01 ) . A low MMAS-8 score was significantly associated with poor blood pressure control ( χ2 = 29.86 ; P < 0.001 ; adjusted odds ratio = 5.08 ; 95 % CI , 2.56–10.08 ) . Using a cut-off point of 6 , sensitivity and specificity were 64.3 % and 72.9 % , respectively . Exploratory factor analysis identified 3 dimensions of the scale , with poor fit for the 1-dimensional construct using confirmatory factory analysis . Conclusions The MMAS-8 had satisfactory reliability and validity and thus might be suitable for assessment and counseling regarding medication adherence among adults with hypertension in a busy clinical setting in Korea OBJECTIVES Outcome assessment s as clinical trial endpoints should be well-defined , reliable , and reflect meaningful treatment benefits . For acute bacterial skin and skin structure infections ( ABSSSI ) trials , recent recommendations suggest a primary endpoint of reduction in skin lesion area . Objectives were : evaluate ABSSSI lesion area measurement reliability , evaluate impact of various lesion area definitions on treatment effect size , and explore relationships between lesion area and pain . METHODS Data from two r and omized , double-blinded Phase 3 trials comparing tedizolid to linezolid in ABSSSI and one open-label , non-comparative Phase 2 study of tedizolid in cellulitis/erysipelas and skin abscess were analyzed . Repeated lesion area measurements were prospect ively obtained in all studies . In the open-label study , lesion area was measured by two investigators , using four different definitions . Repeated pain assessment s using two patient-reported outcome instruments ( Visual Analog Scale [ VAS ] and Faces Rating Scale [ FRS ] ) were elicited in the r and omized trials . RESULTS At baseline , lesion size did not correlate with pain intensity : r=0.02 for VAS and r<0.01 for FRS pain scores . However , decreasing lesion size and decreasing pain were strongly associated over time , regardless of initial lesion size or pain intensity ( r=0.20 for VAS and r=0.21 for FRS scores at Day 10 - 13 ) . Each lesion area definition demonstrated high inter-observer reliability ( intra-class correlation coefficient>0.95 ) . CONCLUSIONS Decreasing lesion area ( indirect clinician-reported measure of benefit ) and pain ( direct patient-reported measure of benefit ) were strongly associated over time , and lesion area measurements were reliable , regardless of their definition . These findings support both measures as outcome assessment s in ABSSSI clinical trials . REGISTRATION Clinical trials.govNCT01519778 , NCT01170221 , and NCT01421511 OBJECTIVE To develop a reliable and user-friendly digital Childhood HAQ ( CHAQ ) to facilitate systematic monitoring of disease activity at the outpatient clinic in juvenile idiopathic arthritis ( JIA ) patients . METHODS The digital CHAQ was tested with patients who visited the outpatient paediatric rheumatology clinic of the Erasmus MC Sophia Children 's Hospital . These patients completed in a r and omized order the paper form and digital CHAQ while being observed . Validity was tested by comparing outcomes with the paper form CHAQ .  User-friendliness was evaluated through a short question naire . RESULTS A digital CHAQ was developed and revised several times according to our observations . Outcome is automatically calculated and can be printed . Fifty-one patients completed both the digital and paper form CHAQ . Correlation coefficient between both outcomes of the CHAQ Disability Index was 0.974 . No statistically significantly differences in median outcome were found in visual analogue scale ( VAS ) pain ( 25.6 vs 25.9 mm ) and VAS well-being ( 20.1 vs 19.5 mm ) . Although the mean time ( 5.06 min ) to complete the digital CHAQ was significantly longer than the mean time ( 3.75 min ) to complete the paper form , the majority of patients ( 75 % ) preferred the digital version . User-friendliness received maximum positive score . CONCLUSION We developed a reliable and user-friendly digital CHAQ , which can be easily and systematic ally completed during routine clinic visits . Such digitalization of question naires can be applied in any field to make systematic monitoring of disease activity in daily practice possible This analysis of retrospective and prospect i ve data quantified children ( age range 0 - 18 years , total n = 132 ) during their stay in a cardiothoracic intensive care unit and examined pain management and sedation practice s. Data on both factors that could potentially affect pain and its management , and analgesics/sedatives ordered for and administered to subjects were collected from chart review . In the prospect i ve group , pain intensity was measured twice daily using the Wong-Baker FACES Pain Rating Scale . Repeat cardiac surgical procedure subjects reported significantly more pain than nonrepeat subjects on the first postoperative night . Subjects with sternal incisions  reported significantly more pain than subjects with submammary incisions . Not all subjects were premedicated with analgesia for invasive procedures . Significantly greater amounts of analgesia were received by the 0 - 3 year-old subjects . Large amounts of  sedation  were used , especially in children under 3 years of age . The results prompted development of a nursing st and ard to assess and manage pain and sedation in this population Objectives : To compare patient , guardian and professional assessment of acute pain in children presenting to an Emergency Department , and to examine whether there was a correlation between the scores obtained using the Faces and linear scales for each group . Methods : A prospect i ve , observational cohort study of 73 children aged 4–14 years attending a paediatric hospital Emergency Department between March and April 2002 with pain caused by an acute injury . The child 's pain on admission , as estimated by the child , their guardian and a healthcare professional ( nurse/doctor/emergency nurse practitioner ) was recorded using a Faces scale and a linear scale . Results : Professionals consistently score pain lower [ median linear scale score 3.1 ; interquartile range ( IQR ) 1.6–5.3 ] than do patients ( 6.6 ; 4.9–7.4 ) or guardians ( 6.0 ; 3.9–7.1 ) using both linear and Faces scales . There is a significant correlation between pain scores obtained using the two scales for professionals [ Spearman R value 0.88 ; 95 % confidence interval ( CI ) 0.82–0.93 ] , guardians ( 0.83 ; 0.74–0.89 ) and patients ( 0.42 ; 0.21–0.59 ) . Conclusion : Professionals score pain lower than do children or guardians . Similar pain scores are obtained using both a Faces and a linear scale . This study offers no support for the introduction of a uniform pain assessment tool in a paediatric Emergency Department setting Few studies have attempted to describe the experience of symptoms in young children with cancer . This is due , in part , to the lack of vali date d symptom assessment scales for this patient population . The objective of this study was to evaluate the reliability and validity of a revised Memorial Symptom Assessment Scale ( MSAS ) in patients aged 7 - 12 as an instrument for the assessment of symptoms in young children with cancer . The MSAS ( 7 - 12 ) was administered to 149 children ( in patients and out patients ) who were undergoing treatment at either the Royal Marsden NHS Trust , London , United Kingdom or The Children 's Hospital at Westmead , Sydney , Australia . Validity was evaluated by comparison with the medical record , parental report , and concurrent assessment on visual analogue scales for selected symptoms . The data provide evidence of the reliability and validity of MSAS ( 7 - 12 ) and demonstrate that children with cancer as young as 7 years can report clinical ly relevant and consistent information about their symptom experience . Young children with cancer experience multiple symptoms . Approximately one-third had experienced lethargy and /or pain and /or insomnia during the 48 hours prior to the completion of MSAS ( 7 - 12 ) . The completion rate for MSAS ( 7 - 12 ) was high and the majority of children completed the instrument in a short period of time and with little difficulty . The instrument appears to be age appropriate and may be helpful to older children unable to independently complete MSAS ( 10 - 18 ) . Systematic symptom assessment may be useful in future epidemiological studies of symptoms and in cancer chemotherapy drug trials PURPOSE There is limited consensus about the most appropriate measures to evaluate the adequacy of pain treatment in cancer patients . There are no known studies describing commonly used measures to simultaneously evaluate the adequacy of cancer  pain  treatment .  The purpose of this study was to compare measures , which are frequently reported in the literature , to assess the adequacy of pain treatment in cancer patients with chronic pain . This study was part of a r and omized controlled trial . PATIENTS AND METHODS In total , 313 cancer patients with a pain duration of at least 1 month were evaluated . After a baseline measure in the hospital , patients were followed up at 2 , 4 , and 8 weeks after discharge at home . Adequacy of cancer pain treatment  was evaluated by means of four different types of outcome measures . The four types included three  pain intensity markers based on patients ' pain intensity , a pain relief scale , a patient satisfaction scale , and three pain management indexes that related patients ' pain medication with pain intensity . RESULTS The proportion of inadequately treated pain patients varied extremely . Depending on the outcome measure used , the percentage of inadequately treated patients ranged from 16 % to 91 % . The choice of measure , rather than pain treatment itself , determined the proportion of inadequacy . CONCLUSION There is an urgent need for consensus about how to evaluate the effectiveness of pain treatment . Studies that evaluate adequacy of pain treatment should be interpreted with caution . Further research is necessary to eluci date the validity and reliability of outcome measures simultaneously OBJECTIVES To further vali date and assess the reliability and validity of the Trust in Physician Scale . METHODS Consecutive adult patients ( n = 414 ) from 20 community-based , primary care practice s were enrolled in a prospect i ve , 6-month study . At enrollment , subjects completed the 11-item Trust in Physician Scale plus measures of demographics , preferences for care , and satisfaction with care received from the physician .  Continuity , satisfaction with care , and self-reported adherence to treatment were measured at 6 months . Reliability , construct validity , and predictive validity were assessed using correlation coefficients and analysis of variance techniques . RESULTS The  Trust in Physician Scale showed high internal consistency ( Cronbach 's alpha = .89 ) and good 1-month test-retest reliability ( intraclass correlation coefficient = .77 ) . As expected , trust increased with the length of the relationship and was higher among patients who actively chose their physician , who preferred more physician involvement , and who expected their physician to care for a larger proportion of their problems ( P < 0.001 for all associations ) . Baseline trust predicted continuity with the physician , self-reported adherence to medication , and satisfaction at 6 months after adjustment for gender , age , education , length of the relationship , active choice of the physician , and preferences for care . After additional adjustment for baseline satisfaction with physician care , trust remained a significant predictor of continuity , adherence , and satisfaction . CONCLUSIONS The  Trust  in Physician Scale has desirable psychometric characteristics and demonstrates construct and predictive validity . It appears to be related to , but still distinct from , patient satisfaction with the physician and , thus , provides a valuable additional measure for assessment of the quality of the patient-physician relationship This study examined experimentally the effectiveness of preparatory information provided by parents  in creating accurate expectations and reducing  children 's procedural pain .  Ear piercing was used as an analogue to minor painful medical procedures . Sixty children , aged 5 - 12 years , requesting ear piercing and accompanied by their parents , were r and omly assigned to a parental information or contact-control condition . Parents in the information group were asked to read their child a description of the procedures and sensations of ear piercing . Parents in the contact-control condition played picture games for the same amount of time .  Expected pain was measured on a visual analogue scale ( VAS ) and the Faces Pain Scale-Revised ( FPS-R ) before and after the parental information or contact-control procedure . Experienced pain was measured on the same two scales immediately after the ear piercing . Prepared children had more accurate expectations and reported significantly less pain ( M=27.3 ) than non-prepared children ( M=49.8 ) . The validity of the measures was supported by strong correlations ( r=0.87 to 0.96 ) between the VAS and FPS-R. The findings suggest that parental provision of preparatory information creates accurate expectations and reduces pain for children Objectives The aims of this study were to define the Faces Pain Scale – Revised ( FPS-R ) and Color Analog Scale ( CAS ) scores associated with no pain , mild pain , moderate pain , and severe pain in children with acute pain , and to identify differences based on age , sex , and ethnicity . Methods We conducted a prospect i ve observational study in 2 pediatric emergency departments of children aged 4 to 17 years with painful and nonpainful conditions . We assessed their pain intensity using the FPS-R , CAS , and qualitative measures .  Pain score cut points that best differentiated adjacent categories of pain were identified using a receiver operating characteristic – based method . Cut points were compared within subgroups based on age , sex , and ethnicity . Results We enrolled 620 patients , of whom 314 had painful conditions . The mean age was 9.2 years ; 315 ( 50.8 % ) were in the younger age group ( aged 4–7 years ) ; 291 ( 46.8 % ) were female ; and 341 ( 55 % ) were Hispanic . The scores best representing categories of pain for the FPS-R were as follows : no pain , 0 and 2 ; mild pain , 4 ; moderate pain , 6 ; and severe pain , 8 and 10 . For the CAS , these were 0 to 1 , 1.25 to 2.75 , 3 to 5.75 , and 6 to 10 , respectively . Children with no pain frequently reported nonzero pain scores . There was considerable overlap of scores associated with mild and moderate pain . There were no clinical ly meaningful differences of scores representing each category of pain based on age , ethnicity , and race . Conclusions We defined pain scores for the FPS-R and CAS associated with categories of pain intensity in children with acute pain that are generalizable across subgroups based on patient characteristics . There were minor but potentially important differences in pain scores used to delineate categories of pain intensity compared to prior convention Within the context of a double blind r and omized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs , we vali date d WOMAC , a new multidimensional , self-administered health status instrument for patients with osteoarthritis of the hip or knee . The pain , stiffness and physical function subscales fulfil conventional criteria for face , content and construct validity , reliability , responsiveness and relative efficiency . WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials To determine whether reliable and valid rankings of pain and discomfort result ing from hospital procedures encountered by advanced dementia patients could be developed from interviews with cognitively intact adults , rankings of pain and discomfort result ing from 16 common procedures were obtained from two sample s of hospitalized , nondemented adults using ten- ( N = 100 ) and five- ( N = 35 ) point numeric rating scales ( NRS ) . Reliability was assessed by having 30 additional subjects complete ten-point NRS representing the ten most frequent procedures in a re-arranged order . By repeated measure analysis of variance , the scales discriminated between procedures ( F = 35.1 , P < 0.001 ) . Subjects could discriminate between pain and discomfort ( F = 21.6 , P < 0.001 ) . The five-point NRS exhibited better subject discrimination between experiences . Reliability was also acceptable . A five-point NRS produced reliable and valid pain and discomfort rankings for 16 common hospital procedures and experiences . These rankings should prove useful in reducing suffering and can serve as surrogates for quantifying pain and discomfort in dementia patients This paper reports aspects of the validity and reliability of an asthma general knowledge question naire for adults ( AGKQA ) , developed as one of the outcome measures for a r and omized controlled effectiveness trial of an asthma education program for adults with asthma . It also illustrates how study data can provide a valuable , generally neglected opportunity to assess the validity and reliability of a measure where re sources are not available for the extensive investigation of these properties prior to administration of the measure in a study . The AGKQA was demonstrated to have good content and face validity . Construct validity assessed using the principal components method for factor analysis suggested the scale was unidimensional . Criterion-related validity , assessed using the contrasted groups method , demonstrated a significant difference ( p < 0.0001 ) in total score and for 68 % of item responses for the adults with and without direct experience of asthma . The Kuder-Richardson 20 reliability coefficient for internal consistency calculated using responses at baseline , immediately , and 12 months post-intervention were , respectively , 0.56 , 0.80 , and 0.75 , indicating excellent reliability . The AGKQA is an acceptably valid and reliable measure for the assessment of program content mastery that it was design ed to test Summary The repeatability coefficient of the 100‐mm visual analogue scale in children , a measure of test‐retest reliability , is 12 mm when pain did not change . Abstract In children , many psychometric properties of the  visual analogue scale ( VAS )  are known , including the minimum clinical ly significant difference ( 10 mm on a 100‐mm VAS ) . However , its imprecision or reliability is not well known . Thus , in order to determine the reliability of this scale , a prospect i ve cohort study was performed in patients aged 8–17 years presenting to a pediatric emergency department with acute pain . Pain was grade d 4 times using a paper VAS ( 0–100 mm ) : T0 , T3 , T6 , and T⩾36 minutes . After T6 , patients were asked if their pain had changed since T0 minute . The primary analysis was the repeatability coefficient of the VAS , determined according to the Bl and ‐Altman method for measuring agreement using repeated measures in patients reporting that their pain was the same for T0 , T3 , and T6 . In order to appropriately estimate the within‐subject SD , 96 patients were required if we obtained 3 measurements for each patient . A total of 151 patients with a mean age of 12.2 ± 2.5 years were enrolled . Among them , 100 mentioned that their pain was the same for T0 , T3 , and T6 minutes . The repeatability coefficient of the VAS for these children was 12 mm when the pain did not change . This implies that , for a child , all pain intensity measurements within 12 mm should be considered the same pain intensity on a paper VAS . This measure should also be evaluated on other types of VAS & NA ; A 3 × 6 factorial design with a double blind and placebo control was employed to investigate the effect of TENS treatment on pain produced by venipuncture . The three treatment groups consisted of TENS , placebo‐TENS and control . Subjects were blocked into six 2‐year age groups ( ages : 5–17 years ) . During the period of the study , 896 children attending the outpatient laboratory of a general hospital were screened and 514 children completed the study . The data which were collected before venipuncture included expected pain and state anxiety . Following venipuncture , pain intensity was measured with a vertical visual analogue scale ( VAS ) and pain affect was assessed with McGrath 's faces scale . Significant main effects for treatment and age groups were obtained . Pain intensity and affect were lowest for the TENS group and highest for the control group . The pain scores were greatest for lower age groups and lowest for higher age groups . The results of this study support the use of TENS for children 's pain and the need for interventions for children 's procedural pain OBJECTIVES The objective of the study was to develop and vali date an adequate tool to evaluate the risk of bias of r and omized controlled trials , observational studies , and systematic review s assessing drug adverse events . STUDY DESIGN AND SETTING We developed a structured risk of bias checklist applicable to r and omized trials , cohort , case-control and nested case-control studies , and systematic review s focusing on drug safety . Face and content validity was judged by three experienced review ers . Interrater and intrarater reliability were determined using 20 r and omly selected studies , assessed by three other independent review ers including one performing a 3-week retest . RESULTS The developed checklist examines eight domains : study design and objectives , selection bias , attrition , adverse events information bias , other information bias , statistical methods to control confounding , other statistical methods , and conflicts of interest . The total number of questions varied from 10 to 32 depending on the study design . Interrater and intrarater agreements were fair with Kendall 's W of 0.70 and 0.74 , respectively . Median time to complete the checklist was 8.5 minutes . CONCLUSION The developed checklist showed face and content validity and acceptable reliability to assess the risk of bias for studies analyzing drug adverse events . Hence , it might be considered as a novel useful tool for systematic review s and meta-analyses focusing on drug safety Abstract Despite its importance in clinical practice , little research has examined memory for pain in children . This prospect i ve study tried to justify the use of  children 's pain recall  in clinical practice . The purpose of this study was to ( a ) investigate the accuracy of children 's recall of their worst and average pain intensity when controlling for the effects of repeated pain measurement and ( b ) examine the influence of children 's anxiety , age , general memory ability and pain coping strategies on this accuracy . The accuracy of children 's  recalled pain intensities was studied in 55 in patients aged 5–16 years by comparing the level of recorded pain intensity with the level of recalled pain intensity  1 day and 1 week after recording using Bieri 's Faces Pain Scale .  The accuracy of children 's recalled pain intensities was high and showed little decrement over 1 week . Older children had more accurate recall of their worst pain intensity . Anxiety , general memory ability and pain coping strategies were not related to accuracy of recalled pain intensities Reliable and valid measures of pain are essential for conducting research on chronic pain . The purpose of this longitudinal study was to compare the reliability and validity of several measures of pain intensity .  One hundred twenty-three patients with chronic pain were administered telephone interview versions of 0 - 10 scales of current , worst , least and average pain , immediately prior to beginning a multidisciplinary treatment program . The measures were administered again to these subjects 2 weeks ( n=108 ) , 1 month ( n=106 ) and 2 months ( n=105 ) after the end of treatment . The validity ( defined as ability to detect changes in pain intensity over the course of treatment up to the 2-month follow-up assessment ) and reliability ( defined as stability over time in the 2 months after treatment ) of these four measures and of composite combinations of these measures were examined . Contrary to prediction , the composite measures did not show a statistically significant superiority to the individual ratings in terms of their ability to detect change in pain intensity from pre-treatment to various points after treatment . The composite scores did , however , show greater stability than did the individual ratings after treatment . The practical conclusions of this study are ; ( 1 ) , individual 0 - 10 pain intensity ratings have sufficient psychometric strengths to be used in chronic pain research , especially research that involves group comparison design s with relatively large sample sizes , but , ( 2 ) , composites of 0 - 10 ratings may be more useful when maximal reliability is necessary , ( e.g. in studies with relatively small sample sizes , or in clinical setting s where monitoring of changes in pain intensity in individuals is needed ) This study examined concurrent self-reports of pain intensity  and behavioral responses in 25 children aged 3 - 7 yr .  Behavioral (  Children 's Hospital of Eastern Ontario Pain Scale , CHEOPS ) and self-report ( the Oucher and Analogue Chromatic Continuous Scale ) measures of pain were obtained following major surgery . The two self-report measures were strongly and significantly correlated , and the pattern of scores over the 36-hr observation period was as expected . There was little relationship between the scores for the self-report and the behavioral measures . Many children who reported severe pain manifested few of the behavioral indicators of distress used in the CHEOPS . This behavioral response pattern may occur commonly in children experiencing pain after surgery and may limit the applicability of current behavioral scales as sole measures of pain intensity in younger children Abstract Background : In the 11 years since its development at McMaster University Medical School , the multiple mini-interview ( MMI ) has become a popular selection tool . We aim ed to systematic ally explore , analyze and synthesize the evidence regarding MMIs for selection to undergraduate health programs . Methods : The review protocol was peer- review ed and prospect ively registered with the Best Evidence Medical Education ( BEME ) collaboration . Thirteen data bases were search ed through 34 terms and their Boolean combinations . Seven key journals were h and - search ed since 2004 . The reference sections of all included studies were screened . Studies meeting the inclusion criteria were coded independently by two review ers using a modified BEME coding sheet . Extracted data were synthesized through narrative synthesis . Results : A total of 4338 citations were identified and screened , result ing in 41 papers that met inclusion criteria . Thirty-two studies report data for selection to medicine , six for dentistry , three for veterinary medicine , one for pharmacy , one for nursing , one for rehabilitation , and one for health science . Five studies investigated selection to more than one profession . MMIs used for selection to undergraduate health programs appear to have reasonable feasibility , acceptability , validity , and reliability . Reliability is optimized by including 7–12 stations , each with one examiner . The evidence is stronger for face validity , with more research needed to explore content validity and predictive validity . In published studies , MMIs do not appear biased against applicants on the basis of age , gender , or socio-economic status . However , applicants of certain ethnic and social background s did less well in a very small number of published studies . Performance on MMIs does not correlate strongly with other measures of noncognitive attributes , such as personality inventories and measures of emotional intelligence . Discussion : MMI does not automatically mean a more reliable selection process but it can do , if carefully design ed . Effective MMIs require careful identification of the noncognitive attributes sought by the program and institution . Attention needs to be given to the number of stations , the blueprint and examiner training . Conclusion : More work is required on MMIs as they may disadvantage groups of certain ethnic or social background s. There is a compelling argument for multi-institutional studies to investigate areas such as the relationship of MMI content to curriculum domains , graduate outcomes , and social missions ; relationships of applicants ’ performance on different MMIs ; bias in selecting applicants of minority groups ; and the long-term outcomes appropriate for studies of predictive validity Background and Objectives Systematic review s evaluate the utility of procedural interventions of the spine , including epidural steroid injections ( ESIs ) . However , existing quality assessment tools either fail to account for proper technical quality and patient selection or are not vali date d. We developed and vali date d a simple scale for ESIs to provide a quality assessment and rating of technique for injections of the spine ( AQUARIUS ) . Methods Seven experts generated items iteratively based on prior ESI technique studies and professional judgment . Following testing for face and content validity , a 17-item instrument was used by 8 raters from 2 different background s to assess 12 r and omized controlled trials , selected from 3 different categories . Using frequency of assessment , a 12-item instrument was also generated . Both instruments underwent reliability ( intraclass correlation coefficient ) , validity ( ability to distinguish “ low , ” “ r and om , ” and “ high ” study categories ) , and diagnostic accuracy ( receiver operating characteristics ) testing . Results Both 17- and 12-item instruments were scored consistently by raters regardless of background , with overall intraclass correlation coefficients of 0.72 ( 95 % confidence interval [ CI ] , 0.53–0.89 ) and 0.71 ( 95 % CI , 0.51–0.89 ) , respectively . Both instruments discriminated between clinical trials from all 3 categories . Diagnostic accuracy was similar for the 2 instruments , with areas under receiver operating characteristic curves of 0.89 ( 95 % CI , 0.82–0.96 ) and 0.90 ( 95 % CI , 0.82–0.97 ) , respectively . Conclusions The instrument in both 17- and 12-item formats demonstrates good reliability and diagnostic accuracy in rating ESI studies . As a complement to other tools that assess bias , the instrument may improve the ability to evaluate evidence for systematic review s and improve clinical trial design Management of pain in the immediate postoperative period is a major concern of postanesthesia nurses . Music is a nursing intervention with the potential to decrease patient perception of pain in the PACU . The purpose of this study was to examine the effect of the use of music on the level of patient pain  in the immediate postoperative period . A quasi-experimental study design was used with three study groups . All patients scheduled for elective abdominal hysterectomies using a general anesthesia technique were eligible for participation in the study . The setting is a PACU in a community hospital in a suburban area . Subjects were asked to rate their pain level every 15 minutes while in the PACU using two valid and reliable measures , a verbal pain rating scale and a graphic numeric pain intensity scale . Repeated measures of analysis of variance showed no differences in level of pain between groups or over time The PedsQL rheumatology module is currently the only available measure of disease‐specific quality of life for children and adolescents with juvenile fibromyalgia ( FM ) , but limited information has been published about the psychometric properties of the instrument , specifically in juvenile FM . The objective of this study was to assess the reliability , validity , and sensitivity to change of the 5 scales ( pain and hurt , daily activities , treatment , worry , and communication ) of the patient and parent proxy versions of the PedsQL rheumatology module in the context of a r and omized controlled trial in juvenile FM This report describes efforts to develop and test scales for measuring attitudes toward the medical care of chronically and terminally ill patients and their families . The following satisfaction scales were developed : General Satisfaction , Availability of Care , Continuity of Care , Physician Availability , Physician Competence , Personal Qualities of Physician , Communication with Physician , Involvement of Patient and Family in Treatment Decisions , Freedom from Pain , and Pain Control . Preference scales were developed to measure preference for home care and preference for physician decisions . These scales were tested in two independent study sample s : Home Care Study subjects— patients and their caretakers enrolled in a trial to evaluate a new method of home care for chronically and terminally ill homebound patients ; and Terminal Care Study subjects — surviving relatives of a r and om sample of cancer patients who died . The internal consistency , discriminant validity , and convergent validity of each scale were assessed by means of item-total correlations , Cronbach 's alpha , and comparison with other question naire items . The results supported the use of several scales in their original form . Recommendations are made for appropriate modifications in the remaining scales Objective : To examine the reliability , validity and responsiveness of the generic Current Perceived Health 42 ( CPH42 ) Profile in Chinese patients with neck pain in Hong Kong . Design : A prospect i ve observational study . Setting : Physiotherapy outpatient departments . Subjects : Two sample s with 472 consecutive adult patients with neck pain from seven physiotherapy outpatient departments in Hong Kong . Methods : Subjects were requested to complete the CPH42 Profile , and their pain intensity was measured using the 11-point numerical rating scale ( NRS ) . They were observed and measured at the beginning of physiotherapy , at seven days , at week 3 and at week 6 after treatment began . Results : The CPH42 Profile had very good test – retest reliability and internal consistency ( intraclass correlation coefficient 0.91 , Cronbach 's alpha 0.90 ) . Validity was confirmed by a moderate correlation with the NRS at the beginning of treatment and week 6 ( rank correlation 0.41–0.53 ) . Moreover , a significant difference in scores was found between those who had sought medical consultation and /or had taken medication because of neck pain than those who did not . The responsiveness measured from the beginning of treatment to week 3 and week 6 ( st and ard response means of 0.33 and 0.36 ) was comparable to the respective changes in pain intensity . Conclusion : The CPH42 Profile has been shown to demonstrate good reliability and validity , and it is sensitive to changes in severity over time . It is suitable for use as an outcome measure for evaluation of patients with neck pain The objective of this study was to test the efficacy and suitability of virtual reality ( VR ) as a pain distraction for pediatric intravenous ( i.v . ) placement . Twenty children ( 12 boys , 8 girls ) requiring i.v . placement for a magnetic resonance imaging/computed tomography ( MRI/CT ) scan were r and omly assigned to two conditions : ( 1 ) VR distraction using Street Luge ( 5DT ) , presented via a head-mounted display , or ( 2 ) st and ard of care ( topical anesthetic ) with no distraction .  Children , their parents , and nurses completed self-report question naires that assessed numerous health-related outcomes . Responses from the Faces Pain Scale-Revised indicated a fourfold increase in affective pain within the control condition ; by contrast , no significant differences were detected within the VR condition . Significant associations between multiple measures of anticipatory anxiety , affective pain , i.v . pain intensity , and measures of past procedural pain provided support for the complex interplay of a multimodal assessment of pain perception . There was also a sufficient amount of evidence supporting the efficacy of Street Luge as a pediatric pain distraction tool during i.v . placement : an adequate level of presence , no simulator sickness , and significantly more child- , parent- , and nurse-reported satisfaction with pain management . VR pain distraction was positively endorsed by all reporters and is a promising tool for decreasing pain , and anxiety in children undergoing acute medical interventions . However , further research with larger sample sizes and other routine medical procedures is warranted Measurement of pediatric cancer patients ' health‐related quality of life ( HRQL ) in phase III r and omized , controlled clinical trials is being recognized increasingly as an essential component in evaluating the comprehensive health outcomes of modern anti‐neoplastic treatment protocol s. Use of a brief core measure of HRQL plus disease‐specific symptom modules is a way to assess specific HRQL outcomes with a minimum of subject burden . Demonstrating a measure 's feasibility , reliability and validity also represents children 's ability to provide reliable and valid responses to HRQL questions . The Pediatric Cancer Quality of Life Inventory ( PCQL ) Modular Approach consists of a 15‐item core measure of HRQL and 2 specific symptom modules : pain and nausea . To vali date a patient‐report form and a parent‐report form , the PCQL was administered to 291 pediatric cancer patients and to their parents . Feasibility and range of measurement , as well as patient – parent concordance , were assessed . Internal consistency reliability was assessed via Cronbach 's alpha . Validity was determined by the known‐groups approach and by correlating PCQL scores with days missed from school . Patients had minimal missing data , and the range of measurement for the items was good . Patient – parent concordance was large but not perfect . For both patient and parent forms , internal consistency reliability of the PCQL core scale ( 0.83 and 0.86 , respectively ) was strong . The internal consistency reliabilities of the 2 symptom modules for both patient and parent forms were in the acceptable range for group comparisons . Regarding clinical validity , the core scale and the 2 symptom modules distinguished between patients on and off treatment for both patient and parent reports . Further , both patient and parent reports correlated with days of missed school in the past 6 and 12 months . The PCQL Modular Approach has demonstrated acceptable internal consistency reliability and clinical validity for both patient‐report and parent‐report forms . By implication , children are capable of providing reliable and valid responses to these HRQL questions . Int . J. Cancer Suppl . 12:71–76 , 1999 . © 1999 Wiley‐Liss , OBJECTIVE To test the convergent validity of the Manchester pain scale when compared to the current ' gold st and ard ' in children 's pain assessment , the Oucher pain scale . METHOD One hundred and fifty two children presenting to the emergency department had  pain scale assessment  s using both the Manchester and Oucher pain scales .  The order of presentation of the scales was r and omised . The degree of convergence between the scales was assessed using Spearman 's rank correlation as well as Bl and 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 OBJECTIVE To develop and vali date a scale suitable for use in clinical practice as a tool for assessing prolonged pain in premature infants . METHODS Pain indicators identified by observation of preterm infants and selected by a panel of experts were used to develop the EDIN scale ( Échelle Douleur Inconfort Nouveau-Né , neonatal pain and discomfort scale ) . A cohort of preterm infants was studied prospect ively to determine construct validity , inter-rater reliability , and internal consistency of the scale . RESULTS The EDIN scale uses five behavioural indicators of prolonged pain : facial activity , body movements , quality of sleep , quality of contact with nurses , and consolability . The validation study included 76 preterm infants with a mean gestational age of 31.5 weeks .  Inter-rater reliability was acceptable , with a κ coefficient range of 0.59–0.74 . Internal consistency was high : Cronbach 's α coefficients calculated after deleting each item ranged from 0.86 to 0.94 . To establish construct validity , EDIN scores in two extreme situations ( pain and no pain ) were compared , and a significant difference was observed . CONCLUSIONS The validation data suggest that the EDIN is appropriate for assessing prolonged pain in preterm infants . Further studies are warranted to obtain further evidence of construct validity by comparing scores in less extreme situations & NA ; Few studies have directly compared the clinical features of neuropathic and non‐neuropathic pains . For this purpose , the French Neuropathic Pain Group developed a clinician‐administered question naire named DN4 consisting of both sensory descriptors and signs related to bedside sensory examination . This question naire was used in a prospect i ve study of 160 patients presenting with pain associated with a definite neurological or somatic lesion . The most common aetiologies of nervous lesions ( n=89 ) were traumatic nerve injury , post herpetic neuralgia and post stroke pain . Non‐neurological lesions ( n=71 ) were represented by osteoarthritis , inflammatory arthropathies and mechanical low back pain . Each patient was seen independently by two experts in order to confirm the diagnosis of neuropathic or non‐neuropathic pain . The prevalence of pain descriptors and sensory dysfunctions were systematic ally compared in the two groups of patients . The analysis of the psychometric properties of the DN4 question naire included : face validity , inter‐rater reliability , factor analysis and logistic regression to identify the discriminant properties of items or combinations of items for the diagnosis of neuropathic pain . We found that a relatively small number of items are sufficient to discriminate neuropathic pain . The 10‐item question naire developed in the present study constitutes a new diagnostic instrument , which might be helpful both in clinical research and daily practice & NA ; Assessment of infant pain is a pressing concern , especially within the context of neonatal intensive care where infants may be exposed to prolonged and repeated pain during lengthy hospitalization . In the present study the feasibility of carrying out the complete Neonatal Facial Coding System ( NFCS ) in real time at bedside , specifically reliability , construct and concurrent validity , was evaluated in a tertiary level Neonatal Intensive Care Unit ( NICU ) . Heel lance was used as a model of procedural pain , and observed with n=40 infants at 32 weeks gestational age . Infant sleep/wake state , NFCS facial activity and specific h and movements were coded during baseline , unwrap , swab , heel lance , squeezing and recovery events . Heart rate was recorded continuously and digitally sample d using a custom design ed computer system . Repeated measures analysis of variance ( ANOVA ) showed statistically significant differences across events for facial activity ( P<0.0001 ) and heart rate ( P<0.0001 ) . Planned comparisons showed facial activity unchanged during baseline , swab and unwrap , then increased significantly during heel lance ( P<0.0001 ) , increased further during squeezing ( P<0.003 ) , then decreased during recovery ( P<0.0001 ) . Systematic shifts in sleep/wake state were apparent . Rise in facial activity was consistent with increased heart rate , except that facial activity more closely paralleled initiation of the invasive event . Thus facial display was more specific to tissue damage compared with heart rate . Inter‐observer reliability was high . Construct validity of the NFCS at bedside was demonstrated as invasive procedures were distinguished from tactile . While bedside coding of behavior does not permit raters to be blind to events , mechanical recording of heart rate allowed for an independent source of concurrent validation for bedside application of the NFCS scale OBJECTIVES To compare self-reporting of pain by cognitively impaired ( CI ) older adults living in the community with reports of their caregivers ; to identify the factors associated with differences in agreement ; and to identify those pain assessment tools that are most useful to nonprofessional caregivers . DESIGN Prospect i ve observational cohort of patients with dementia and their caregivers . SETTING In-home assessment s of community-dwelling CI older adults and family members , adult foster care providers , or aides in residential care facilities . All CI subjects were enrolled in a Program for All-inclusive Care of the Elderly program ( ElderPlace ) in Portl and , Oregon . PARTICIPANTS A total of 156 CI adults and their caregivers . METHODS St and ardized  pain assessment instruments were administered to the CI subjects and their caregivers in the subject 's home by trained research assistants between June and October 1998 . CI subjects were assessed with the  Nonverbal Visual Analog scale ( " line " ) , the  Faces Pain Scale ( " faces " ) , and the  Philadelphia Pain Intensity Scale ( PIS ) . Research assistants observed pain behaviors in the CI subjects using the Hospice Approach Discomfort Scale . The CI subject 's caregivers completed the " line , " " faces , " PIS , and Cornell Scale for Depression in Dementia . A baseline Mini-Mental State Exam , Functional Assessment Stage Test , and Geriatric Depression Scale were performed on all CI subjects by ElderPlace medical , nursing , or social work staff . RESULTS The mean age of the CI subjects was 83 , and 83 % were women . The mean Mini-Mental State Exam score was 15.7 . One-third of the CI subjects were unable to complete any of the three pain assessment tools . Of the 104 subjects completing at least one tool , 13 ( 12.5 % ) reported no pain and 91 ( 87.5 % ) reported some pain . Sixteen ( 10 % ) of the subjects were depressed as measured with the GDS or Cornell instrument . In 70 of the 104 subjects ( 67 % ) able to complete any tool , the caregiver and CI subject agreed as to the level of pain experienced by the CI subject . The number of tools completed by the CI subjects decreased with increased cognitive impairment . The Pain Intensity Scale was the tool most likely to be completed by both CI subjects and caregivers . The means of test scores were not significantly different for the paired groups of CI subject and caregiver , and the nonparametric correlation of each tool was significant : " faces " ( Spearman 's rho ( p ) = .417 ) ; " line " ( p = .420 ) ; and PIS ( p = .452 ) . The Hospice Approach Discomfort Scale did not correlate well with other tools . The Pain Intensity Scale seems to be more useful than other pain assessment tools in assessing pain in cognitively impaired patients and can be used by nonprofessional caregivers in a community-based care setting OBJECTIVE The goals of this study were to examine agreement and estimate differences in sensitivity between pain assessment scales . DESIGN  Multiple simultaneous pain assessment s by patients in acute pain after oral surgery were used to compare a four-category verbal rating scale ( VRS-4 ) and an 11-point numeric rating scale ( NRS-11 ) with a 100-mm visual analog scale ( VAS ) . The sensitivity of the scales ( i.e. , their ability [ power ] to detect differences between treatments ) was compared in a simulation model by sampling from true pairs of observations using varying treatment differences of predetermined size . RESULTS There was considerable variability in VAS scores within each VRS-4 or NRS-11 category both between patients and for repeated measures from the same patient . Simulation experiments showed that the VAS was systematic ally more powerful than the VRS-4 in all simulations performed . The sensitivity of the VAS and NRS-11 was approximately equal . CONCLUSIONS In this acute pain model , the VRS-4 was less sensitive than the VAS . The simulation results demonstrated similar sensitivity of the NRS-11 and VAS when comparing acute postoperative pain intensity . The choice between the VAS and NRS-11 can thus be based on subjective preferences As day case surgery increases , one needs to improve the management of pain in children at home . This study wished to determine whether the use of a self-report pain scale would result in children receiving more analgesia . Eighty-eight children aged four to 12 years undergoing tonsillectomy , whose parents agreed they could participate , were r and omly assigned into two groups . Group A received the routine postoperative advice and a three-day prescription of paracetamol , ibuprofen and codeine . In addition , group B used the Wong — Baker Faces Pain Scale .  Seventy-two children completed the study . There was no difference in the total number of analgesics administered to children in the two groups ( p = 0.26 , Mann— Whitney U-test ) . It appears that a self-report pain scale does not improve the postoperative management of pain in children at home OBJECTIVE To develop a condition-specific quality of life question naire for the menopause with documented psychometric properties , based on women 's experience . METHODS SUBJECTS Women 2 - 7 years post-menopause with a uterus and not currently on hormone replacement therapy . Question naire development : A list of 106 menopause symptoms was reduced using the importance score method . Replies to the item-reduction question naire from 88 women result ed in a 30-item question naire with four domains , vasomotor , physical , psychosocial and sexual , and a global quality of life question . Psychometric properties : A separate sample of 20 women was used to determine face validity , and a panel of experts was used to confirm content validity . Reliability , responsiveness and construct validity were determined within the context of a r and omized controlled trial . Construct validation involved comparison with the Neugarten and Kraines'Somatic , Psychosomatic and Psychologic subscales , the reported intensity of hot flushes , the General Well-Being Schedule , Channon and Ballinger 's Vaginal Symptoms Score and Libido Index , and the Life Satisfaction Index . RESULTS The face validity score was 4.7 out of a possible 5 . Content validity was confirmed . Test-retest reliability measures , using intraclass correlation coefficients were 0.81 , 0.79 , 0.70 and 0.55 for the physical , psychosocial , sexual domains and the quality of life question . The intraclass correlation coefficient for the vasomotor domain was 0.37 but there is evidence of systematic change . Discriminative construct validity showed correlation coefficients of 0.69 for the physical domain , 0.66 and 0.40 for the vasomotor domain , 0.65 and -0.71 for the psychosocial domain , 0.48 and 0.38 for the sexual domain , and 0.57 for the quality of life question . Evaluative construct validity showed correlation coefficients of 0.60 for the physical domain , 0.28 for the vasomotor domain , 0.55 and -0.54 for the psychosocial domain , 0.54 and 0.32 for the sexual domain , and 0.12 for the quality of life question . Responsiveness scores ranged from 0.78 to 1.34 . CONCLUSIONS The MENQOL ( Menopause-Specific Quality of Life ) question naire is a self-administered instrument which functions well in differentiating between women according to their quality of life and in measuring changes in their quality of life A Foot Function Index ( FFI ) was developed to measure the impact of foot pathology on function in terms of pain , disability and activity restriction . The FFI is a self-administered index consisting of 23 items divided into 3 sub-scales . Both total and sub-scale scores are produced . The FFI was examined for test-retest reliability , internal consistency , and construct and criterion validity . A total of 87 patients with rheumatoid arthritis were used in the study .  Test-retest reliability of the FFI total and sub-scale scores ranged from 0.87 to 0.69 . Internal consistency ranged from 0.96 to 0.73 . With the exception of two items , factor analysis supported the construct validity of the total index and the sub-scales . Strong correlation between the FFI total and sub-scale scores and clinical measures of foot pathology supported the criterion validity of the index . The FFI should prove useful for both clinical and research purpose Objective : To develop and test the reliability and validity of the State Behavioral Scale for use in describing sedation/agitation levels in young intubated patients supported on mechanical ventilation . Design : In this prospect i ve , psychometric evaluation , pairs of trained pediatric critical care nurse evaluators simultaneously and independently assessed a convenience sample of pediatric intensive care unit patients along eight state/behavioral dimensions and a numeric rating scale ( NRS ) of 0 ( extremely se date d ) to 10 ( extremely agitated ) . The eight dimensions were derived from the sedation/agitation literature and expert opinion and included respiratory drive , response to ventilation , coughing , best response to stimulation , attentiveness to careprovider , tolerance to care , consolability , and movement after consoled , each with 3–5 levels . Setting : An 18-bed pediatric medical – surgical intensive care unit and 26-bed pediatric cardiovascular intensive care unit in a university-affiliated academic children ’s hospital . Patients : A total of 91 intubated mechanically ventilated patients 6 wks to 6 yrs of age provided a median of two observations ( interquartile range , 1–3 ) for a total of 198 sets of observations . Excluded were postoperative patients or those receiving neuromuscular blockade . Interventions : Patients were observed for 1 min , and then incremental levels of stimulation were applied until patient response . After 2 mins of consoling , the state behavioral assessment and NRS were completed . Measurements : Weighted kappa and intraclass coefficients were generated to assess interrater reliability of the eight dimension and NRS ratings . Distinct state behavior profiles were empirically identified from the dimension ratings using hierarchical cluster analysis using a squared Euclidean distance measure and between-groups linkage . Construct validity of these profiles was assessed by comparing group mean NRS scores using one-way analysis of variance . Main Results : Weighted kappa scores for all 198 dimension ratings ranged from .44 to .76 , indicating moderate to good interrater reliability . The intraclass coefficient of .79 was high for NRS ratings . Cluster analysis revealed five distinct state profiles , with mean NRS ratings of 1.1 , 2.5 , 4.0 , 5.3 , and 7.6 , all of which differed significantly from each other ( F = 75.8 , p < .001 ) , supporting the profiles ’ construct validity . Conclusions : Based on empirically derived state behavior profiles , we have constructed the State Behavioral Scale to allow systematic description of the sedation – agitation continuum in young pediatric patients supported on mechanical ventilation . Further studies including prospect i ve validation and describing the effect of State Behavioral Scale implementation on clinical outcomes , including the quality of sedation and length of mechanical ventilation , are warranted OBJECTIVE Reliable and valid measures of pain are needed to advance research initiatives on appropriate and effective use of analgesia in the emergency department ( ED ) . The reliability of  visual analog scale ( VAS ) scores  has not been demonstrated in the acute setting where pain fluctuation might be greater than for chronic pain . The objective of the study was to assess the reliability of the  VAS  for measurement of acute pain . METHODS This was a prospect i ve convenience sample of adults with acute pain presenting to two EDs . Intraclass correlation coefficients ( ICCs ) with 95 % confidence intervals ( 95 % CIs ) and a Bl and -Altman analysis were used to assess reliability of  paired VAS measurements  obtained 1 minute apart every 30 minutes over two hours . RESULTS The summary ICC for all paired VAS scores was 0.97 [ 95 % CI = 0.96 to 0.98 ] . The Bl and -Altman analysis showed that 50 % of the paired measurements were within 2 mm of one another , 90 % were within 9 mm , and 95 % were within 16 mm . The paired measurements were more reproducible at the extremes of pain intensity than at moderate levels of pain . CONCLUSIONS Reliability of the  VAS  for acute pain measurement as assessed by the ICC appears to be high . Ninety percent of the pain ratings were reproducible within 9 mm . These data suggest that the VAS is sufficiently reliable to be used to assess acute pain Background . Health-related quality of life can be measured by patients ' health preferences ( utilities or values ) . No method for measuring health state preferences has been st and ardized for children with arthritis or other musculoskeletal disorders ( MSKDs ) . Such a method is needed for economic evaluations of current and new pediatric treatments . Objectives . 1 ) To assess the feasibility of utility measurements in children with MSKDs , 2 ) to test the validity of the Health Utility Index ( HUI ) for these children , 3 ) to assess whether rating scale values can be mathematically converted into meaningful st and ard gamble ( SG ) utilities , and 4 ) to study whether parents can act as proxies for their children with respect to health state preferences . Methods . Eighty parents of children with MSKDs were consecutively sample d. Their children , if 8 years of age or older ( n = 55 ) , were studied concurrently . Utilities of current health states were obtained by using the SG and the HUI in r and om order . In addition , health state preferences were assessed using categorical and analog rating scales . Traditional nonutility measures of health status ( the Childhood Health Assessment Question naire [ CHAQ ] and the Activities Scale for Kids [ ASK ] ) were also completed . Intraclass correlation coefficients ( ICCs ) were calculated to assess concordance between the different utility measures and also between the ratings of the parents and their children . Results . Children 8 years of age or older were able to express the strength of their health state preferences using the HUI and rating scales . Children older than 10 years of age were able to use the SG method . The health state utilities of the parents were higher than those of their children . The utilities varied widely depending on the elicitation method . The expected high agreement between the SG and the HUI was not found ( ICC = 0.028 for parents , ICC = 0.016 for patients ) . Unlike the SG , the global utilities derived from the HUI agreed better with preferences derived from rating scales ( ICC = 0.23 - 0.25 ) and correlated with traditional health status measures ( with CHAQ , r = -0.56 ; with ASK , r = 0.46 ) both for parents and children . It was not possible to mathematically convert rating scale preferences into SG utilities . The SG utilities were unrelated to results from the rating scales , the CHAQ , and the ASK . Especially for parents , the SG utilities were very high , even when ratings of the other measures indicated poor health . Conclusions . Although it is possible to measure health utilities for children with MSKDs , the results are highly method dependent . The properties of the HUI in this population are more like those of the traditional health status measures rather than those of the SG . Preferences derived from rating scales , although easily performed , can not readily be converted into SG utilities . Parents ' ratings for their children are impaired by risk aversion BACKGROUND The current study investigated the efficacy , safety , tolerability , and compliance of a transdermal buprenorphine delivery system for the management of chronic cancer pain in the pediatric population . PROCEDURE Sixteen pediatric patients with moderate to severe cancer-related pain not satisfactorily controlled with previous non-opioid therapies were enrolled .  Transdermal buprenorphine was administered following a 72 hour schedule and rescue medication ( tramadol ) was allowed for breakthrough pain . Pain intensity was assessed using the Wong-Baker faces pain rating scale ( WBS ) and other parameters related to the global quality of life were evaluated . Children 's evaluations of efficacy , compliance , and tolerability were recorded using numerical scales . Adverse events were monitored during the study and the medications needed to control opioid-related nausea and constipation were recorded . RESULTS Eleven patients ( 68.75 % ) responded to transdermal buprenorphine after 2 weeks of treatment . Pain intensity measured with WBS decreased from 6.25 at baseline to 1.38 at Day + 60 ( P < 0.001 ) . All outcome measures of global quality of life ( quality of sleep , alimentation , play and activity , speech , and crying ) significantly improved over the 60-day study period . Children 's evaluations of compliance and tolerability of the drug were always positive over the entire period of treatment . No severe adverse events were recorded . Opioid-related nausea was well controlled with medication on request , and the need for laxative therapy was greater at the end of the second month of treatment . CONCLUSIONS Transdermal buprenorphine was found to represent an efficient , safe and well tolerated approach to the management of children 's chronic cancer pain OBJECTIVES To examine the construct validity , inter-rater reliability , and feasibility of the Premature Infant Pain Profile-Revised in infants of varying gestational ages , diagnoses , and procedures . METHODS A prospect i ve cross-over study with infants in three gestational age groups ( 26 - 31 , 32 - 36 , and ≥37 weeks ) at three university-affiliated Neonatal Intensive Care Units in Canada . One hundred and ninety five bedside nurses and expert raters rated 202 hospitalized infants ' pain during scheduled procedures using the measure . An expert rater and a nurse independently assessed infants ' pain scores , using the  Premature Infant Pain Profile-Revised  , during 246 scheduled pairs of painful and non-painful procedures in the 202 infants . Nurses also completed a feasibility survey on using the measure in a clinical setting . To establish construct validity , pain scores were computed during painful and non-painful procedures . Inter-rater reliability between pain experts and nurses was calculated . A 5-point Likert scale was used to measure feasibility in terms of clarity , ease of use , and time to complete . RESULTS Irrespective of gestational age , Premature Infant Pain Profile-Revised scores were significantly higher during painful procedures ( mean 6.7 [ SD 3.0 ] ) compared to non-painful procedures ( mean 4.8 [ SD 2.9 ] ) . There was a high degree of correlation between nurses ' and experts ' ratings for painful ( all R(2)=0.92 , p<0.001 ) and non-painful ( all R(2)=0.87 , p<0.001 ) procedures . Mean scores on all feasibility indicators were equal to or higher than 3.8 . DISCUSSION The Premature Infant Pain Profile Revised has beginning construct validation , inter-rater reliability , and is considered feasible by clinicians . Concurrent validation studies should be considered Study Design . Validation of 2 self-report question naires . Objective . To evaluate the internal consistency , reliability , and construct validity of the Persian versions of the fear avoidance beliefs question naire ( FABQ ) and the Tampa Scale of Kinesiophobia ( TSK ) in patients with acute and chronic neck pain . Summary of Background Data . The FABQ and TSK are 2 important measures to evaluate fear of pain and fear avoidance beliefs in patients with spinal pain . To date , the psychometric properties of these question naires have not been demonstrated in Persian-speaking patients with neck pain in Iran . Methods . One hundred sixty-six patients with acute and chronic neck pain participated in the study . The construct validity of the question naires was evaluated by measuring convergent and known-groups validity . The visual analogue scale measure of pain , neck disability index , hospital anxiety and depression scale , and the physical ( PCS-12 ) and mental ( MCS-12 ) summary scores of the Short Form health survey ( SF-12 ) were used to test construct validity of the Persian FABQ and TSK . In addition , 50 r and omly selected patients with chronic neck pain were asked to complete the question naires 48 hours later for the second time . Results . Cronbach & agr ; coefficient for the FABQ and TSK in patients with acute and chronic pain was in the range from 0.77 to 0.92 and 0.77 to 0.78 , respectively . The Persian FABQ and TSK showed satisfactory test-retest reliability with intraclass correlation coefficient of more than 0.80 . There were moderate to strong correlations between the Persian FABQ and TSK scores and the neck disability index ( r = 0.44–0.55 ) , Depression subscales of the hospital anxiety and depression scale ( r = 0.42–0.48 ) , and PCS-12 ( r = −0.34 to −0.62 ) . Conclusion . The Persian FABQ and TSK have acceptable reliability and validity for measuring pain related fear and avoidance beliefs among Persian-speaking patients with acute and chronic neck pain . However , considering the study limitations , the findings should be interpreted with caution . Level of Evidence : & NA ; The efficacy of ketorolac , a non‐steroidal anti‐inflammatory drug , in the management of moderate to severe pain in adults , has led us to conduct a trial of this analgesic in children following tonsillectomy . Children were r and omized to receive intramuscular ( i.m . ) ketorolac ( 1 mg/kg , EXP group , n = 45 ) or saline ( CTL group , n = 42 ) at the completion of surgery . Intravenous ( i.v . ) fentanyl ( 0.5 & mgr;g/kg/dose ) was administered in repeated doses postoperatively . Pain intensity was measured using both the Oucher and the Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) to allow for comparison between self‐report and behavioral measures of pain intensity . Severity of postoperative bleeding was measured using a 4‐point rating scale . The EXP group had a significant reduction in total fentanyl dose ( mean : 35.9 & mgr;g ) compared to the CTL group ( mean : 48.3 & mgr;g , t = −2.21 , P < 0.03 ) . There was a statistically significant decrease in pre‐fentanyl CHEOPS scores in the Post‐Anesthesia Care Unit ( PACU ) in the ketorolac group ( F ( 2,30 ) = 5.34 , P < 0.01 ) , but not in the saline group ( F ( 2.24 ) = 2.46 , P > 0.05 ) . In the first hour postoperatively , the CHEOPS demonstrated significant decreases in pain intensity scores in response to opioids , in both groups . In the PACU , children were unable to provide a self‐report of pain intensity potentially due to a variety of factors ( e.g. , emergence delirium , agitation , excitement , sedation , and /or pain ) . However , during the remainder of the postoperative stay , the photographic scale of the Oucher was a more valid measure of pain intensity than the CHEOPS . There were no differences between the 2 groups in the severity of postoperative bleeding . Children in the EXP group were discharged significantly earlier ( i.e. , 30 min , t = −2.22 , P < 0.03 ) . Our data demonstrate that i.m . administration of ketorolac , at the end of surgery , significantly reduces opioid requirements and shortens length of stay without any evidence of increased bleeding . In addition , our data suggest that the patient 's altered level of consciousness and attention span may diminish the utility of self‐report measures of  pain intensity  in the immediate postoperative period AIMS AND OBJECTIVES To evaluate the usefulness of  registered nurses ' ( RNs ) and nursing assistants ' ( NAs ) pain report among 304 institutional older people with dementia and eluci date the factors influencing the agreement of pain reports within dyadic assessors . BACKGROUND Using informant reports has been suggested as an effective strategy to solve the dilemma of pain assessment in people with dementia . However , the validity of pain information provided by institutional caregivers is still under-investigated . DESIGN A prospect i ve study was undertaken in six dementia special care units in Northern Taiwan . METHODS Both the four-item pain inventory and Doloplus-2 scale were used to investigate different raters ' pain reports . RESULTS Across pain variables , fair to moderate agreement was noted in RNs ' assessment ( Kappa = 0.29 - 0.42 ) , but poor agreement in NAs assessment ( Kappa = 0.11 - 0.24 ) . Comparing mean scores on intensity , frequency of pain and Doloplus-2 , statistically systematic bias existed in most pairs , but the greater bias occurred in NAs ' assessment . In logistic regression analysis , when pain was assessed by the  pain inventory  , residents ' cognitive impairment level and caregiver 's age were associated with the agreement of pain presence perceived in either resident-nurse or resident-NA pairs . Nevertheless , when pain was rated by the Doloplus-2 scale , only residents ' physical function influenced the agreement of pain report for both research assistants (RAs)-nurse and RAs-NA pairs . CONCLUSIONS Nurses ' pain report across pain variables may be more reliable than NAs . Furthermore , factors influencing the agreement of pain assessed by self-report measurement or behavioural observations may be different , needing further investigation . RELEVANCE TO CLINICAL PRACTICE Pain inquiry and behavioural observation should be performed routinely as the fifth vital sign for developing effective care plans . Institutional caregivers should be used as alternative or complementary informants for assessing pain in older people with dementia Introduction : The  Decisional Conflict Scale  ( DCS , 16 items , 5 dimensions ) design ed to measure the level of decisional conflict experienced by patients making health care decisions has not yet been vali date d in French . Methods : A national sample of French cancer patients ( n = 644 ) facing the decision to undergo BRCA genetic testing  was tested for this purpose , including a control group and an experimental group who had received an information booklet .  Reliability and criterion validity were investigated . To check the validity of the factors selected , an exploratory factor analysis was then conducted , followed by confirmatory factor analyses . Results : Reliability was satisfactory ( α = 0.913 ) . Women who definitely wanted to undergo genetic testing showed significantly lower DCS scores than uncertain women ( p<0.001 ) . Exploratory factor analysis suggested an optimal 4-dimensional model . In the control group , confirmatory factor analyses showed that the French model was more accurate than the original one . When the decision-making conflicts decreased ( in the experimental group ) , both models yielded only fairly accurate indices . Conclusion : The French version of the DCS was found to give a reliable overall score . However , special care should be taken when using the individual subscores . In addition , it is necessary to take into account the context in which the decision-making occurs Low Back Pain Rating scale is an index scale which includes measurements of pain intensity , disability , and physical impairment . The scale was design ed to monitor the outcome of clinical trials of low back pain treatment . It has been vali date d in 58 patients following first-time discectomy .  The scale rating can be rapidly carried out and requires no special aids . With slight modification it can be used in office and telephone interviews , as well as postal question naires . These modifications only slightly reduce the quantity of information gathered . In the study , a high rater agreement ( 97.7 % ) was found without level difference between two observers using the scale . The validation process included : construct validity , criterion-related validity and item bias , relative to Global Assessment s pronounced by the patient and an experienced clinician . Low Back Pain Rating scale hs been shown to be valid and reliable in the assessment of low back pain Health care policy background Findings from scientific studies form the basis for evidence -based health policy decisions . Scientific background Quality assessment s to evaluate the credibility of study results are an essential part of health technology assessment reports and systematic review s. Quality assessment tools ( QAT ) for assessing the study quality examine to what extent study results are systematic ally distorted by confounding or bias ( internal validity ) . The tools can be divided into checklists , scales and component ratings . Research questions What QAT are available to assess the quality of interventional studies or studies in the field of health economics , how do they differ from each other and what conclusions can be drawn from these results for quality assessment s ? Methods A systematic search of relevant data bases from 1988 onwards is done , supplemented by screening of the references , of the HTA reports of the German Agency for Health Technology Assessment ( DAHTA ) and an internet search . The selection of relevant literature , the data extraction and the quality assessment are carried out by two independent review ers . The substantive elements of the QAT are extracted using a modified criteria list consisting of items and domains specific to r and omized trials , observational studies , diagnostic studies , systematic review s and health economic studies . Based on the number of covered items and domains , more and less comprehensive QAT are distinguished . In order to exchange experiences regarding problems in the practical application of tools , a workshop is hosted . Results A total of eight systematic method ological review s is identified as well as 147 QAT : 15 for systematic review s , 80 for r and omized trials , 30 for observational studies , 17 for diagnostic studies and 22 for health economic studies . The tools vary considerably with regard to the content , the performance and quality of operationalisation . Some tools do not only include the items of internal validity but also the items of quality of reporting and external validity . No tool covers all elements or domains . Design -specific generic tools are presented , which cover most of the content criteria . Discussion The evaluation of QAT by using content criteria is difficult , because there is no scientific consensus on the necessary elements of internal validity , and not all of the generally accepted elements are based on empirical evidence . Comparing QAT with regard to contents neglects the operationalisation of the respective parameters , for which the quality and precision are important for transparency , replicability , the correct assessment and interrater reliability . QAT , which mix items on the quality of reporting and internal validity , should be avoided . Conclusions There are different , design -specific tools available which can be preferred for quality assessment , because of its wider coverage of substantive elements of internal validity . To minimise the subjectivity of the assessment , tools with a detailed and precise operationalisation of the individual elements should be applied . For health economic studies , tools should be developed and complemented with instructions , which define the appropriateness of the criteria . Further research is needed to identify study characteristics that influence the internal validity of studies Objective : To examine if observational pain assessment can be used for purpose s of triage in children aged > 3 years . Methods : A prospect i ve , single blind , controlled trial was undertaken in children who presented to the emergency department ( ED ) with pain .  Pain was assessed in the waiting room and again at triage before any treatment was administered using the Alder Hey Triage Pain Score ( AHTPS ) , an observational tool design ed for triage , and a self-report tool , either the Wong-Baker Faces Pain Rating Scale ( WBS ) for 3–7-year-old children or a visual analogue scale ( VAS ) for 8–15-year-old children . Scores were compared by instrument ( observational and self-report ) and ED location ( waiting room and triage room ) . Results : 75 children ( 29 aged 3–7 years and 46 aged 8–15 years ) were enrolled in the study . The AHTPS scores were significantly lower than the scores measured by the WBS/VAS ( p<0.001 ) . The level of pain measured by both methods ( self-report , observational ) was lower in the triage room . Compared with the AHTPS , the WBS and VAS scored significantly lower in the triage room than in the waiting room ( p<0.042 and p<0.006 , respectively ) . Conclusions : Observational pain assessment underestimates children ’s perception of pain and should not be recommended in children aged > 3 years . Triage has a calming effect on children Problem Current research suggests behavioral and environmental interventions to prevent neonatal pain prior to an invasive procedure are rarely administered and seldom documented . The aim of this study was to systematic ally review findings from published r and omized controlled trials that tested the effects of behavioral and environmental procedural pain management interventions on behavioral pain response in preterm infants . Eligibility Criteria R and omized controlled trials examining the effects of behavioral and environmental pain management interventions on behavioral pain response in preterm infants were identified . Articles accepted for inclusion met the following criteria : English language , original , peer refereed , r and omized controlled clinical trials published within the past 5 years , study sample : preterm infants , setting : neonatal intensive care units , study intervention behavioral and environmental , outcome pain measurement score from valid and reliable pain scale . Sample Fourteen r and omized controlled trials from a literature search of PubMed and Medline data bases were included in this review . Results Across all age groups , facilitated tucking , oral sucrose , and kangaroo care decreased behavioral and physiologic pain response alone and in combination with other behavioral and environmental interventions . Conclusion Among preterm infants , facilitated tucking , oral sucrose , and kangaroo care significantly mitigates biobehavioral pain response associated with acutely painful procedures . Implication s Evidence suggests that behavioral and environmental interventions can decrease biobehavioral pain response associated with acutely painful procedures in preterm infants . This review highlights the need for rigorous studies to help healthcare providers to build a tailored pain treatment plan for preterm infants PURPOSE We developed a self-administered paper based instrument to assess patient preferences quantified as utilities for common outcomes associated with the management of prostate cancer . MATERIAL S AND METHODS A total of 50 patients was invited to test a self-administered paper based instrument design ed to assess preferences for health outcomes associated with the management of localized prostate cancer . The 50 patients were selected from a group of 625 r and omly identified men with prostate cancer who responded to a survey instrument design ed to assess health related quality of life . The 50 patients selected for this pilot project were chosen because of the wide range of responses to the  quality of life survey . Patient utilities were assessed for the 5 health states of overall quality of life , problems related to prostate cancer , and problems related to urinary , bowel and sexual dysfunction . RESULTS Patients were able to complete the assigned tasks . The self-administered instrument had high test-retest reliability . In addition results obtained from this instrument showed a correlation with results obtained from assessment s using other instruments , including an analog scale , a computer based system known as U-Titer , a quality of life survey and the Health Utility Index:3 . CONCLUSIONS A self-administered paper based instrument can be used to assess patient utilities for health states associated with prostate cancer management . Results from the instrument tested appear to be reliable and valid , and are comparable to those obtained from other assessment techniques . A self-administered paper based instrument has distinct advantages when conducting large survey studies because it can be incorporated at relatively low cost The assessment of a measure of chronic pain , should be reliable , valid and sensitive to change . Our study evaluated the reliability of 3 pain scales , visual analogue scale ( VAS ) , numerical rating scale ( NRS ) and verbal rating scale ( VRS )  in literate and illiterate patients with rheumatoid arthritis ( RA ) . Patients with RA attending an outpatient rheumatology clinic were interviewed and asked to score their pain levels on the 3 pain scales . The scales were presented in r and om order , twice , before and just after a regular medical consultation . Ninety-one patients were studied ( 25 illiterate and 66 literate ) . The Pearson product moment correlation between first and second assessment was 0.937 for VAS , 0.963 for NRS and 0.901 for VRS in the literate patient group and 0.712 for VAS , 0.947 for NRS and 0.820 for VRS in the illiterate patient group . These results indicate that the NRS has the higher reliability in both groups of patients Objective : To establish beginning evidence of clinical validity and reliability of the Neonatal Pain , Agitation and Sedation Scale ( N-PASS ) in neonates with prolonged pain postoperatively and during mechanical ventilation . Study Design : Prospect i ve psychometric evaluation . Two nurses administered the N-PASS simultaneously and independently before and after pharmacologic interventions for pain or sedation . One nurse also administered the premature infant pain profile ( PIPP ) concurrently with the N-PASS . The setting consisted of 50-bed level III neonatal intensive care unit . Convenience sample of 72 observations of 46 ventilated and /or postoperative infants , 0 to 100 days of age , gestational age 23 to 40 weeks was used . Outcome measures comprised convergent and construct validity , interrater reliability and internal consistency . Result : Interrater reliability measured by intraclass coefficients of 0.85 to 0.95 was high ( P<0.001 to 0.0001 ) . Convergent validity was demonstrated by correlation with the PIPP scores ( Spearman 's rank correlation coefficient of 0.83 at high pain scores , 0.61 at low pain scores ) . Internal consistency , measured by Cronbach 's α , was evident with pain scores ( 0.82 ) , and with sedation scores ( 0.87 ) . Construct validity was established via the Wilcoxon signed-rank test , comparing the distribution of N-PASS scores before and after pharmacologic intervention  showing pain scores of 4.86 ( 3.38 ) and 1.81 ( 1.53 ) ( mean ( s.d . ) , P<0.0001 ) and sedation scores of 0.85 ( 1.66 ) and −2.78 ( 2.81 ) ( P<0.0001 ) for pre- and postintervention assessment s , respectively . Conclusions : This research provides beginning evidence that the N-PASS is a valid and reliable tool for assessing pain/agitation and sedation in ventilated and /or postoperative infants 0 to 100 days of age , and 23 weeks gestation and above In a previous study it was proved impossible to evaluate the validity of a system modified according to McGrath et al. for measuring  postoperative pain in children . Three reasons were postulated for this result . The analgesics used did not modulate the pain in such a manner that the statistical analysis was effective ; or the postoperative pain had an acute onset or fluctuated and the regular observations did not allow detection of the pain peaks ; or the system used did not measure pain . Therefore , a new and different approach was adopted to evaluate the reliability and validity of a scoring system for the measurement of  postoperative pain in small children . MATERIAL . Sixty children classed as ASA I and II and aged between 1 and 5 years were r and omly allocated to 2 groups : one group received Tramadol ( 0.5 mg/kg ) after the induction of anesthesia and the other group received placebo . Premedication and anesthesia were st and ardized . All indications were accepted except for urgent operations and painful diseases . For 1 h after the operation the children were continuously observed by an experienced pediatric anesthetist who did not know what drugs had been given . Every 15 min and when the observer was convinced that the children were in pain and needed analgesics the following items were scaled : wakefulness , wake-up reaction , crying , facial expression , position of the trunk , position of the legs , muscle tone , making contact , verbal communication on being asked about pain , special defense against stimuli and consolability . The items were included in a factor analysis ( principal components ) . The number of the factors was detected using the Scree test . The only items accepted as reliable were those that had a substantial load of at least 0.4 at each measurement . The reliability coefficient was computed with the split-half technique ( odd-even ) . The validity was estimated with a multifactorial analysis of variance with repeated measurements . When the observer was convinced that any child was in pain , Metamizol ( 15 mg/kg ) was administered . Significance was assumed at P less than 0.05 . The study was accepted by the ethical committee of the Ruhr University , Bochum . RESULTS . A replication verified the results of the previous study : the factor analysis result ed in a one-factorial solution . Of the 8 items ( wakefulness , wake-up reactions , crying , position of the trunk , position of the legs , verbal communications on being asked about pain , special defense against stimuli ) only 4 had a sufficiently substantial load on all measurements ( crying , facial expression , position of the trunk and position of the legs ) . ( ABSTRACT TRUNCATED AT 400 WORDS The purpose of this study was to investigate the psychometric properties of a Dutch translation of the Multidimensional Pain Inventory , MPI-DLV . Data was available on 733 chronic pain patients . There were three issues of special interest . The first one related to the comparability between the MPI-DLV and the American and German MPI versions with regard to the psychometric aspects . The second dealt with the construct validity of the  MPI-DLV scale ' general activity ' . It was predicted that patients with high scores on this scale would be in better physical condition , as measured on a working-to-tolerance bicycle ergometer test . In relation to the third issue , attention was given to the factor-invariance between fibromyalgia patients and back pain patients . From the results obtained it was concluded that ( 1 ) the factorial structure of the three MPI parts is replicated and the reliability estimates and validity indicators are similar to those from the American and German versions ; ( 2 ) patients with high scores on the ' general activity ' scale are in better physical condition and ( 3 ) MPI-DLVs of fibromyalgia and back pain patients do have similar factorial structures . Evidence was also obtained that the  MPI-DLV  is sensitive to treatment changes . Applications of the MPI-DLV are discussed Acute mountain sickness ( AMS ) is a common condition that affects people that ascend too rapidly to high altitude . It is typically assessed with the Lake Louise AMS Self-report Score ( LLSelf ) that uses a categorical numeric rating scale to answer five questions addressing AMS-related symptoms , such as headache . A 100-mm visual analog scale ( VAS ) is commonly used to assess subjective phenomena such as pain , but this scale has never been used for the self- assessment of AMS . The purpose of this study was to compare a  VAS score  to the total LLSelf and to evaluate the test-retest and interrater reliability of the VAS when used as an assessment of AMS .  Participants ( N = 356 ) completed both the LLSelf and the VAS on the summit of Mt. Whitney ( 4419 m ) . There was a significant relationship ( r = 0.65 , p < 0.01 ) between the LLSelf ( 2.8 + /- 2.0 , mean + /- SD ) and the VAS ( 14.4 + /- 14.1 mm ) . Fifty-seven participants were r and omly selected for reliability testing of the VAS . Both test-retest reliability ( ICC = 0.996 , 95 % CI = 0.992 to 0.998 ) and interrater reliability ( ICC = 1.000 , 95 % CI = 0.999 to 1.000 ) were high . The mean difference in the VAS score between tests was < 1 mm , as was the difference between raters . These results demonstrate excellent reliability for the VAS as an assessment of AMS Postoperative analgesia in infants and young children is a topic of growing interest in pediatric anesthesia . Two systems measuring postoperative pain in this group of patients have been offered recently : CHEOPS ( Childrens Hospital of Eastern Ontario Pain Scale ) by McGrath et al. and OPS ( Objective Pain Scale ) by Hannallah et al. and Broadman et al. [ 3 , 7 , 8 ] . Both systems are economical and not reactive , but their validity is not satisfying . The validity of CHEOPS is based on the statements of experienced nurses , using the method of convergent validation by an expert 's assertion . Hannallah and Broadman et al. judged the validity of their objective pain scale for infants and young children by statements of juveniles between 13 and 18 years of age . McGrath et al. accepted the item of spontaneous verbal communication as useful in the CHEOPS , although no such verbal comment occurred in their study on interrater and inter-item correlations . The aim of the present study was to evaluate the statistical qualification of items for measurements of the intensity of postoperative pain in young children and to investigate some aspects of their validity . MATERIAL AND METHODS . The study was performed in 54 children of ASA groups I and II aged 29.2 + /- 10.7 months . They were included in the study if they were pain-free before the operation and had no signs and symptoms of neurologic disease . The following operations were accepted : herniorrhapy , orchidopexy , circumcision , and umbilical herniorrhaphy . Premedication and general anesthesia were st and ardized . The patients were premedicated with midazolam 0.5 mg/kg rectally and subsequent intramuscular injections of ketamine 2.0 mg/kg with atropine 0.01 mg/kg . Anesthesia was induced and maintained by inhalation of oxygen/nitrous oxide and halothane ( FiO2 0.3 ) . All children were intubated and ventilation was controlled during the operation . After the operation and under steady-state anesthesia with 0.5 vol.% halothane and spontaneous respiration , the children received either nalbuphine 0.1 mg/kg , piritramide 0.1 mg/kg , or placebo in a r and omized and double-blind manner . Respiratory and circulatory parameters were recorded for 15 min before anesthesia was discontinued . Five minutes after halothane had been discontinued the first measurement of the childrens ' behavior was started with four subsequent measurements at fixed time intervals of 15 min . The measuring system was based on the six items of CHEOPS complemented by five items related to the waking state because it was assumed that the waking state generally modulates the child 's ability to demonstrate pain . The design of the study was accepted by the ethic committee with the provision that neither a sedative nor an analgesic drug should be withheld from any child if indicated . Therefore , all children who seemed to feel discomfort according to the subjective impression of the anesthetist received midazolam intraveneously to a maximal dose of 2 mg . All the behavioral data were included in a factor analysis ( principal components ) OBJECTIVES To evaluate the validity , reliability , responsiveness , and mode preference of electronic data capture ( EDC ) using the Western Ontario and McMaster ( WOMAC ) numerical rating scale ( NRS ) 3.1 Osteoarthritis ( OA ) Index on Motorola V3 mobile phones . STUDY DESIGN AND SETTING Patients with OA undergoing hip or knee joint replacement were assessed preoperatively and 3 - 4 months postoperatively , completing the WOMAC Index in paper ( p-WOMAC ) and electronic ( m-WOMAC ) format in r and om order . RESULTS Data were successfully and securely transmitted from patients in Australia to a server in the United States . Pearson correlations between the summated total index scores ( TISs ) for the p-WOMAC and m-WOMAC pre- and postsurgery were 0.98 and 0.99 ( P<0.0001 ) . There were no clinical ly important or statistically significant between- method differences in the adjusted total summated scores , pre- and postsurgery ( adjusted mean differences=4.44 , P=0.474 and 1.73 , P=0.781 , respectively ) . Internal consistency estimates of m-WOMAC reliability were 0.87 - 0.98 . The m-WOMAC detected clinical ly important , statistically significant ( P<0.0001 ) improvements in pain , stiffness , function , and TIS . No statistically significant differences in mode preference were detected . CONCLUSIONS There was close agreement and no significant differences between m-WOMAC and p-WOMAC scores . This study confirms the validity , reliability , and responsiveness of the Exco InTouch-engineered , Java-based m-WOMAC Index application . EDC with the m-WOMAC Index provides unique opportunities for using quantitative measurement in clinical research and practice Study Design . A prospect i ve repeated- measures design was applied . Objectives . To examine the measurement properties of the Back Pain Functional Scale ( BPFS ) and the Rol and –Morris Question naire ( RMQ )  and to formulate hypotheses and sample size estimates for a subsequent comparison study . Summary of Background Data . Although there are numerous functional status measures for patients with low back pain , most have been conceived of and vali date d with a group rather than an individual patient as the unit of interest . Also , little has been done to formally compare — this includes the generation of a priori hypotheses , followed by statistical hypotheses testing — the many competing measures . Methods . Subjects were 77 patients with low back pain who were referred by physicians to 10 outpatient physical therapy clinics located in Canada and the United States . The question naires were administered at patients ’ initial visits , within 48 hours of the initial visit , and at 1- , 2- , and 3-week follow-up visits . Reliability , cross-sectional validity , and longitudinal validity ( sensitivity to change ) coefficients were calculated . Results . Test – retest reliability estimates of 0.81 and 0.88 were obtained for the RMQ and BPFS , respectively . The measures demonstrated similar levels of cross-sectional validity . Correlations of 0.56 and 0.65 were noted between a prognostic rating of change and the RMQ and BPFS , respectively . The RMQ demonstrated a ceiling effect .  Approximately 180 patients are needed for a subsequent head-to-head comparison study of the measures . Conclusions . The BPFS appears to have sound measurement properties , and a formal head-to-head comparison study with the RMQ is warranted In clinical setting s , the spastic catch is judged subjectively . This study assessed the psychometric properties of objective parameters that define and quantify the severity of the spastic catch in children with cerebral palsy ( CP ) . A convenience sample of children with spastic CP ( N=46 ; age range : 4 - 16 years ) underwent objective spasticity assessment s. High velocity , passive stretches were applied to the gastrocnemius ( GAS ) and medial hamstrings ( MEH ) .  Muscle activity was measured with surface electromyography ( sEMG ) , joint angle characteristics using inertial sensors and reactive torque using a force sensor . To test reliability , a group of 12 children were retested after an average of 13 ± 9 days . The angle of spastic catch ( AOC ) was estimated by three biomechanical definitions : joint angle at ( 1 ) maximum angular deceleration ; ( 2 ) maximum change in torque ; and ( 3 ) minimum power . Each definition was checked for reliability and validity . Construct and clinical validity were evaluated by correlating each AOC definition to the averaged root mean square envelope of EMG ( RMS-EMG ) and the Modified Tardieu Scale ( MTS ) . Severity categories were created based on selected parameters to establish face validity . All definitions showed moderate to high reliability . Significant correlations were found between AOC3 and the MTS of both muscles and the RMS-EMG of the MEH , though coefficients were only weak . AOC3 further distinguished between mild , moderate and severe catches . Objective parameters can define and quantify the severity of the spastic catch in children with CP . However , a comprehensive underst and ing requires the integration of both biomechanical and RMS-EMG data BACKGROUND AND PURPOSE This study examined the reliability , validity , and responsiveness to change of measurements obtained with a 66-item version of the Gross Motor Function Measure ( GMFM-66 ) developed using Rasch analysis . SUBJECTS AND METHODS The validity of measurements obtained with the GMFM-66 was assessed by examining the hierarchy of items and the GMFM-66 scores for different groups of children from a stratified r and om community-based sample of 537 children with cerebral palsy ( CP ) . A subset of 228 children who had been reassessed at 12 months was used to test the hypothesis that children who are young ( < 5 years of age ) and have " mild " CP will demonstrate greater change in  GMFM-66 scores than children who are older ( ( 5 years of age ) and whose CP is more severe . Data from an additional 19 children with CP who were assessed twice , one week apart , were used to examine test-retest reliability . RESULTS The overall changes in GMFM-66 scores over 12 months and a time ( severity ( age interaction supported our hypotheses . Test-retest reliability was high ( intraclass correlation coefficient=.99 ) . CONCLUSION AND DISCUSSION This study demonstrated that the GMFM-66 has good psychometric properties . By providing a hierarchical structure and interval scaling , the GMFM-66 can provide a better underst and ing of motor development for children with CP than the 88 item GMFM and can improve the scoring and interpretation of data obtained with the GMFM
All 4 faces pain scales were found to be adequately supported by psychometric data .
When given a choice between faces scales , children preferred the WBFPRS .
Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS .
: For clinical use , we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use .
CONTEXT : Numerous faces scales have been developed for the measurement of  pain intensity in children .
It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity , reliability , feasibility , and preference .
OBJECTIVES : To summarize and systematic ally review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility .