Validity of parent ratings as proxy measures of pain in children with cognitive impairment

Title

Validity of parent ratings as proxy measures of pain in children with cognitive impairment

Creator

Voepel-Lewis T; Malviya S; Tait AR

Publisher

Pain Management Nursing

Date

2005

Subject

PedPal Lit; N.I.H.; Adolescent Attitude to Health Bias (Epidemiology) Child Child Behavior Child; Extramural Severity of Illness Index Time Factors; Postoperative/complications/diagnosis/physiopathology/psychology Parents/psychology Proxy/psychology Questionnaires Research Support; Preschool Cognition Disorders/complications Comparative Study Crying Facial Expression Humans Kinesics Michigan Nursing Assessment/methods/standards Nursing Evaluation Research Pain Measurement/methods/nursing/standards Pain

Description

Parent-assigned pain scores have been used as proxy measures of pain for children, such as those with cognitive impairment (CI), who cannot self-report. However, the accuracy of parent-assigned pain ratings for children with CI has not been studied. This study evaluated the construct and criterion validity of parental pain scores of children with CI. Fifty-two children aged 4 to 19 years with CI and their parents/guardians were included in this observational study. Children were observed and assessed for pain by parents using the Faces, Legs, Activity, Cry, and Consolability (FLACC) observational tool and the 0 to 10 Numbers Scale, and simultaneously by nurses using the FLACC. Children who were cognitively able scored pain using simplified scales. Parent scores decreased after analgesic administration (6.4 +/- 2.5 vs. 3.1 +/- 2.3; p = .004), supporting their construct validity. Parents' FLACC and Numbers ratings correlated well with nurse ratings (intraclass correlation coefficient = 0.78 [confidence interval = 0.63-0.87] and intraclass correlation coefficient = 0.73 [confidence interval = 0.59-0.83], respectively). The parents' coded Numbers ratings correlated moderately with their child's ratings (rho = 0.57; p = .05) and agreed in 20% to 100% of cases (kappa = 0.388). There was better overall agreement between parents' FLACC scores and child ratings (33%-67% agreement; kappa = 0.43). The parent underestimated the child's pain with FLACC ratings in only one case (8%), but overestimated pain in three cases (25%). This study suggests that parents of children with CI provide reasonable estimates of their child's pain, particularly when using a structured pain tool. Parents may, however, tend to overestimate their child's pain during the early postoperative period.
2005

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Citation

Voepel-Lewis T; Malviya S; Tait AR, “Validity of parent ratings as proxy measures of pain in children with cognitive impairment,” Pediatric Palliative Care Library, accessed February 9, 2023, https://pedpalascnetlibrary.omeka.net/items/show/13672.

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