Highlights
- •VASobs scores were sensitive and responsive to procedural pain.
- •Clinicians were not confident about the clinical utility of the scores.
- •VASobs scores for procedural pain assessment show poor reliability.
- •VASobs scores did not distinguish adequately between pain and distress.
- •This scale cannot be recommended for research or clinical use.
Abstract
Purpose
The Visual Analogue Scale applied by an observer (VASobs) is widely used to quantify
pain but the evidence to support validity is poor. The aim of this study was to evaluate
the psychometric and practical properties of the VASobs used to assess procedural
pain in infants and young children.
Design and methods
In an observational study, 26 clinicians applied the VASobs independently to video
segments of 100 children aged six to 42 months undergoing a procedure to generate
pain and distress scores. Each video segment was scored by four randomly selected
reviewers.
Results
Reliability for pain scores was poor to fair (ICC 0.35 to 0.55) but higher for distress
scores (ICC 0.6 to 0.89). At a cut-off score of 3, sensitivity and specificity were
84.7% and 95.0%, respectively for pain and 91.5% and 77.5% respectively for distress.
Linear mixed modelling confirmed responsiveness. An increase in pain scores (regression
slope 4.95) and distress scores (regression slope 5.52) across phases (baseline to
procedure) was seen for painful procedures. The correlation between VASobs pain and
FLACC scores was good (r = 0.74) and correlations between VASobs distress and FLACC
scores were excellent (r = 0.89).
Conclusion
VASobs was easily applied and preferred by clinicians. Despite evidence of sensitivity
and responsiveness to pain, the reliability results were poor, and this scale cannot
be recommended for use.
Practice implications
The results of this study prevent recommending the VASobs for assessing procedural
pain in infants and young children for clinical or research purposes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric Nursing: Nursing Care of Children and FamiliesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Measurement of feelings using visual analogue scales.Proceedings of the Royal Society of Medicine. 1969; 62: 989-993
- The measurement properties of pediatric observational pain scales: A systematic review of reviews.International Journal of Nursing Studies. 2017; 73: 93-101
- Fitting linear mixed-effects models using {lme4}.Journal of Statistical Software. 2015; 67: 1-48
- The psychometric properties of the MBPS scale used to assess procedural pain.Journal of Pain. 2018; 19: 660-670
- Procedural Pain Scale Evaluation (PROPoSE) study: protocol for an evaluation of the psychometric properties of behavioural pain scales for the assessment of procedural pain in infants and children aged 6–42 months.BMJ Open. 2017; 7
- Systematic review of the FLACC scale for assessing pain in infants and children: is it reliable, valid, and feasible for use?.Pain. 2015; 156: 2132-2151
- The psychometric properties of the FLACC scale used to assess procedural pain.Journal of Pain. 2018; 19: 862-872
- Discounting pain in the absence of medical evidence is explained by negative evaluation of the patient.Pain. 2013; 154: 669-676
- Health care professionals’ reactions to patient pain: Impact of knowledge about medical evidence and psychosocial influences.Journal of Pain. 2014; 15: 262-270
- Observational visual analog scale in pediatric pain assessment: Useful tool or good riddance?.Clinical Journal of Pain. 2002; 18: 310-316
- Establishing intra- and inter-rater agreement of the face, legs, activity, cry, consolability scale for evaluating pain in toddlers during immunization.Pain Research and Management. 2013; 18: e124-e128
- Measurement of pain.Lancet. 1974; 304: 1127-1131
- Reliability, validity and clinical utility of three types of pain behavioural observation scales for young children with burns aged 0–5 years.Pain. 2010; 150: 561-567
- The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: An international Delphi study.Quality of Life Research. 2010; 19: 539-549
- The FLACC behavioral scale for procedural pain assessment in children aged 5–16 years.Paediatric Anaesthesia. 2008; 18: 767-774
- Methodological problems in the measurement of pain: A comparison between the verbal rating scale and the visual analogue scale.Pain. 1975; 1: 379-384
- The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.Pain. 1983; 17: 45-56
- R: A language and environment for statistical computing.R Foundation for Statistical Computing, Vienna, Austria2016
- Graphic representation of pain.Pain. 1976; 2: 175-184
- Stata Statistical Software: Release 14.Stata Corp LP, College Station Texas2015
- Evaluation of the reliability, validity and practicality of 3 measures of acute pain in infants undergoing immunization injections.Vaccine. 2011; 29: 1390-1394
- Reliability and validity of observer ratings of pain using the visual analog scale (VAS) in infants undergoing immunization injections.Pain. 2009; 147: 141-146
- Defining no pain, mild, moderate, and severe pain based on the faces pain scale-revised and color analog scale in children with acute pain.Pediatric Emergency Care. 2016; 34 (PMID: 27228146; PMCID: PMC5123984): 537-544
- Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients.American Journal of Critical Care. 2010; 19 (quiz 62): 55-61
- FLACC behavioural pain assessment scale: A comparison with a child’s self-report.Pediatric Nursing. 2003; 29: 195-198
Article info
Publication history
Published online: February 06, 2021
Accepted:
January 18,
2021
Received in revised form:
January 18,
2021
Received:
May 13,
2020
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
