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· DOS Abstracts
The revised FLACC behavioural pain scale:
Translation, reliability and validation for pain
assessment in children with cerebral palsy
Line Kjeldgaard Pedersen, Ole Rahbek, Lone Nikolajsen, Bjarne Møller-Madsen
Department of Childrens Orthopedics,
, Aarhus University
Hospital; Department of Anaestesiology, Aarhus University Hospital
Background:
Assessment of pain in children with cerebral palsy (CP) is a chal-
lenge since they might not be capable of using a self-rating assessment tool;
hence an observational or behavioral pain score is needed. The r-FLACC behav-
ioral pain scale has only been assessed for reliability and validity in the original
language version.
Purpose / Aim of Study:
To translate the r-FLACC pain scale and evaluate the
parameters of reliability and validity in order to use the r-FLACC for pain assess-
ment in children with (CP).
Materials and Methods:
Forward and back-translations were performed ac-
cording to guidelines. Twenty children with CP undergoing orthopedic surgery
were included. The parents assessed the pain intensity with the Observational
Visual Analog Scale and a 2 min standardized video recording was made for r-
FLACC scoring. Two nurses r-FLACC scored the recordings independently. Ten
of the recordings were reviewed again 1 year later.
Findings / Results:
Reliability was supported by three measurement proper-
ties. Internal consistency was excellent with a Cronbachs alpha of 0.9278 and
0.9758. A test–retest showed excellent intra-rater reliability with a Spearman
Correlation of 0.0040 and an intra- class correlation (ICC) of 0.97530. Inter-
rater reliability was acceptable with a Spearman Correlation of 0.000 and an
ICC of 0.74576. Validity was supported by three measurement properties.
Construct validity was supported by a significant increase in r- FLACC scores
following surgery (p=0.0427). Criterion validity was acceptable with Pearson’s
Correlation Coefficients of 0.75 and 0.59 when comparing the r-FLACC scores
and the VAS-OBS scores.
Conclusions:
The translated version of the r-FLACC behavioral pain scale has
high reliability and validity and may be considered as gold standard for pain as-
sessment in children with CP.
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