The Reliability and Validity of the Face, Legs, Activity, Cry, Consolability Observational Tool as a Measure of Pain in Children with Cognitive Impairment

Voepel‐Lewis, Terri; Merkel, Sandy; Tait, Alan R.; Trzcinka, Agnieszka; Malviya, Shobha

doi:10.1097/00000539-200211000-00020

Cited by 239 publications

(136 citation statements)

References 9 publications

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“…8 Furthermore, the FLACC was also used with preverbal children with typical development, 15 and with children with atypical development. 13,14 One review study of behavioral measures of pain assessment submitted certain scales to a rigorous review procedure and found their levels of clinical evidence. 40 The FLACC was recommended for postoperative pain assessment, the CHEOPS for preoperative and postoperative pain assessment, and the PPPM for postoperative pain assessment on hospital discharge: three scales widely used for pain assessment, according to the levels of clinical evidence given.…”

Section: Discussionmentioning

confidence: 99%

“…11 Nevertheless, in the course of this literature review it was found that ordinal scales are also used by trained observers or by the medical and nursing teams to assess child pain. In these cases the following instruments were used: the Objective Pain Scale (OPS), 8 the Faces, Leg, Activity, Cry and Consolability scale (FLACC), 8,[13][14][15] the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), 8 the Pediatric Pain Profile (PPP), 16 the Alder Hey Triage Pain Score (AHTPS), 17 the Child Facial Coding System (CFCS) 18 and the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R). 19 …”

Section: Measurement Scales Of the Instruments Analyzedmentioning

confidence: 99%

“…13,14 In addition to the FLACC, a further 12 instruments for pain assessment of children in a clinical-hospital context were identified. Three are of note for the specific contributions of three instruments.…”

Section: Contexts Of Pain Assessmentmentioning

confidence: 99%

“…19 Specifically with relation to the studies related to surgical procedures, eight defined their objectives as assessing pain during the postoperative period; not including a baseline pain assessment. 7,9,11,[13][14][15]20,21 These studies performed either two or three postoperative pain assessments, and there was a great deal of variation in terms of the time when assessments were carried out. The multiple-assessment approach is highly to be recommended in postoperative pain assessment, since it offers better monitoring of the clinical progress of the patient's pain during this period, in contrast with acute pain, which is focused.…”

Section: Phases Of Pain Assessmentmentioning

confidence: 99%

“…Furthermore, the FLACC is the only scale that, in addition to being widely used in studies with samples of typical populations, also had its psychometric properties investigated with samples of populations with atypical development 13,14 and with preverbal children. 15 The psychometric properties of four of the scales (FLACC, CHEOPS, OPS and TPPPS) were investigated when administrated by trained examiners who assessed the pain of children aged 1 to 5 years at four distinct pain assessment times (before and after surgery, before analgesia and during admission to the ward).…”

Section: The Psychometric Properties Assessedmentioning

confidence: 99%

See 4 more Smart Citations

Avaliação do comportamento de crianças em situações de dor: revisão da literatura

Correia¹,

Linhares²

2008

J. Pediatr. (Rio J.)

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Objective: To analyze the scientific production published between 2001 and 2006 describing studies assessing children in painful situations, with a focus on preschool children.Sources: Searches were run for empirical articles indexed in electronic databases using the keywords pain assessment and behavior and their equivalents in Portuguese. Summary of the findings:A total of 33 articles were identified, 18 of which were studies of the psychometric properties of instruments for the measurement of pain, while 11 dealt with the application of such instruments and four were studies of intervention procedures for the relief of pain. Conclusions:The results indicate that more recent literature on the assessment of preschool children's behavior in painful situations is focused on testing the psychometric properties of measurement instruments. Acute pain, especially during surgical procedures, was most often assessed using one-dimensional instruments. Pain in children was most often assessed using facial activity as indicator and intensity as dimension. With relation to assessment of pain in special populations, advances were observed related to assessment of pain in preverbal children or preschool children with special needs.J Pediatr (Rio J). 2008;84(6):477-486: Pain measurement, behavior, preschool.

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Section: Discussionmentioning

confidence: 99%

Section: Measurement Scales Of the Instruments Analyzedmentioning

confidence: 99%

Section: Contexts Of Pain Assessmentmentioning

confidence: 99%

Section: Phases Of Pain Assessmentmentioning

confidence: 99%

Section: The Psychometric Properties Assessedmentioning

confidence: 99%

See 3 more Smart Citations

Avaliação do comportamento de crianças em situações de dor: revisão da literatura

Correia¹,

Linhares²

2008

J. Pediatr. (Rio J.)

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Current Status of Pain Management in Children

Howard¹

2003

JAMA

247

111

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Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score

Bringuier

Macioce

Boulhais

et al. 2021

European Journal of Pain

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Background: Behavioural pain scales are recommended to assess postoperative pain for children who are too young to use self-report tools. Their main limitation is underestimation of pain in the days following an intervention. Although relevant, facial expression is not used in daily clinical practice. This prospective study aimed to assess the validity and reliability of the Facial Action Summary Score (FASS), a fiveitem scale, to assess postoperative pain until hospital discharge in children <7 years. Methods: Assessments of pain and anxiety of 123 children using FASS and validated scales were used to study the psychometric validity of the FASS in clinical practice. Results: The content validity was previously investigated in a development study. The internal validity of the FASS was high with excellent reliability (intraclass coefficient = 0.94) and a high Cronbach α (0.89). Convergent validity with pain scales (FLACC [Face, Legs, Activity, Cry, Consoling] and FPS-R [Faces Pain Scale -Revised]) was high (r > 0.8). Sensitivity to change was verified by a significant decrease in the score after rescue analgesia. For a threshold of 2/5, the FASS shows excellent specificity (97%) and sensitivity (82%). The low number of false negatives is the main strength of this tool. Conclusions: This work highlights the interest in using facial expression in daily clinical practice to manage postoperative pain. The FASS is easy to use with excellent psychometric properties and is particularly sensitive to measure pain in the days following surgery. Significance: The aim of this study was to prove that facial expression of pain can be used in clinical practice to measure postoperative pain in children. The reduced number of false negatives is the main strength of this tool.

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The Reliability and Validity of the Face, Legs, Activity, Cry, Consolability Observational Tool as a Measure of Pain in Children with Cognitive Impairment

Abstract: The FLACC pain assessment tool may facilitate reliable and valid observational pain assessment in children with cognitive impairment who cannot self-report their pain. Objective pain assessment is important to facilitate effective postoperative pain management in these vulnerable children.

Cited by 239 publications

References 9 publications

Avaliação do comportamento de crianças em situações de dor: revisão da literatura

Avaliação do comportamento de crianças em situações de dor: revisão da literatura

Current Status of Pain Management in Children

Facial expressions of pain in daily clinical practice to assess postoperative pain in children: Reliability and validity of the facial action summary score

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