McGrath Patricia A, Seifert Cheryl E, Speechley Kathy N, Booth John C, Stitt Larry, Gibson Margaret C
Pediatric Pain Program, University of Western Ontario, Canada Epidemiology Program, Child Health Research Institute and Department of Pediatrics, University of Western Ontario, Canada Department of Communicative Disorders, University of Western Ontario, Canada Biostatistical Resource, Child Health Research Institute, Canada Department of Psychology, Parkwood Hospital, London, Ontario, Canada.
Pain. 1996 Mar;64(3):435-443. doi: 10.1016/0304-3959(95)00171-9.
A new instrument was designed 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 random order. Using a parallel groups design, 104 children (5-16 years; 60 female, 44 male; 51 healthy and 53 with recurrent headaches) were randomized 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: psi cas = 0.035I0.87, psi vas = 0.027I0.89, where psi = 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 populations use the CAS scale to assess their own pain.
设计了一种新仪器，用于提供一种实用的临床测量方法，以评估儿童的疼痛强度和疼痛感受。这种袖珍型测量工具包括一个彩色模拟量表（CAS）用于评估强度，以及一个面部表情量表用于评估疼痛的厌恶成分。两个量表背面都有数字评分，以便实施测量的人员能够快速记录代表儿童疼痛的数字。本研究旨在通过评估强度量表的心理物理学特性以及强度和情感量表的区分效度来确定新仪器的效度。由于视觉模拟量表（VAS）是评估儿童疼痛的有效且可靠的测量方法，因此将儿童使用新模拟量表的能力与其在VAS上的表现进行了比较。儿童使用情感量表对疼痛感受进行评分，面部表情量表（FAS）上的9张面部表情从最不痛苦到最痛苦按顺序呈现，将其与儿童在原始FAS上的表现进行比较，原始FAS中相同的面部表情是随机呈现的。采用平行组设计，104名儿童（5至16岁；60名女性，44名男性；51名健康儿童和53名患有复发性头痛的儿童）被随机分为两组：CAS组或VAS组。儿童使用指定的量表完成一项校准任务，即对7个面积不同（491、804、1385、2923、3848、5675和7854平方毫米）的圆圈大小进行评分。确定了CAS和VAS的感知圆圈大小与实际物理大小之间的心理物理学函数。儿童在CAS和VAS校准任务上的反应产生了相似的数学关系：psi cas = 0.035I0.87，psi vas = 0.027I0.89，其中psi = 感知大小，I = 刺激强度。CAS组和VAS组的R2值分别为0.921和0.922。协方差分析表明，按量表类型，这些关系的特征（即R2、斜率或y截距）没有显著差异。儿童使用相同的量表完成儿童疼痛量表（CPI），在该量表中他们对16个疼痛事件（组织损伤的性质和程度各不相同）的强度和感受进行评分。儿童在CPI上的CAS和VAS反应相似。协方差分析表明，按量表类型，强度或情感评分没有差异。然而，儿童经历的疼痛事件平均数量随年龄显著增加（P = 0.0001）。强度评分随年龄显著降低（P = 0.002），但情感评分不随年龄变化。新仪器具有与165毫米VAS相当的心理测量特性。然而，与VAS相比，CAS被评为更易于实施和评分，因此它可能在常规临床使用中更实用。由于CAS满足了疼痛测量的前两个标准（心理物理学特性和区分效度），进行构念效度的正式确定性测试是符合伦理的，即来自不同临床群体的儿童使用CAS量表来评估他们自己的疼痛。
