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Gude P, Geldermann N, Gustedt F, Grobe C, Weber TP, Georgevici AI. New postoperative pain instrument for toddlers-Secondary analysis of prospectively collected assessments after tonsil surgery. Paediatr Anaesth 2024; 34:347-353. [PMID: 38140808 DOI: 10.1111/pan.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/06/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The Children's and Infant's Postoperative Pain Scale (CHIPPS) and the German version of the Parent's Postoperative Pain Measure (PPPM-D) are used to assess postoperative pain intensity in preschool children. However, they have shown low concordance in previous prospective studies on quality improvement. AIMS Our secondary analysis aimed to estimate the association strength between the pain score items and indication for rescue medication defined as CHIPPS ≥4 and/or PPPD-D ≥ 6. Thus, we intended to create a further developed pain instrument with fewer variables for easier routine use. METHODS We analyzed 1067 pain intensity assessments of hospitalized children for the development of our novel tool in two steps using modern statistical and machine-learning methods: (1) Boruta variable selection to analyze the association strength between CHIPPS score, PPPM-D items, age, weight, and elapsed time after surgery, including their interactions and pattern stability, and the binary outcome (analgesics required yes/no). (2) Symbolic regression to generate a short formula with the least number of variables and highest accuracy for rescue medication indication. RESULTS Additional analgesics were required in 19.96% of pain intensity assessments, whereby the PPPM-D showed higher variance than CHIPPS. Boruta identified PPPM-D score, CHIPPS score, 9 of the 15 PPPM-D variables, and time of assessment as associated with the indication for RM. Symbolic regression revealed that additional analgesics are required if CHIPPS is ≥4 OR PPPM-D item "less energy than usual" AND one of the items "more easily cry" or "more groan/moan" are answered with "yes." These PPPM-D items were not redundant and showed nonlinear course over time. The cross-validated accuracy for this assessment tool was 94.94%. CONCLUSIONS The new instrument is easy to use and may improve postoperative pain intensity assessment in children. However, it requires prospective validation in a new cohort.
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Affiliation(s)
- P Gude
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - N Geldermann
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - F Gustedt
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - C Grobe
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - T P Weber
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - A I Georgevici
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth-Hospital Bochum, Bochum, Germany
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Pinto Filho WA, Silveira LDHJ, Vale ML, Fernandes CR, Gomes JA. Gabapentin in Improvement of Procedural Sedation and Analgesia in Oncologic Pediatric Patients: A Clinical Trial. Anesth Pain Med 2020; 9:e91197. [PMID: 31903327 PMCID: PMC6935294 DOI: 10.5812/aapm.91197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 09/23/2019] [Accepted: 10/01/2019] [Indexed: 01/11/2023] Open
Abstract
Background Preoperative anxiety and distress can produce significant psychological impacts on children undergoing oncologic care or investigation. Adjuvant therapy is used for pain management in children; however, pre-analgesia options are restricted because they can cause undesirable outcomes. Objectives Our study aimed to investigate the use of gabapentin in procedural sedation as adjuvant therapy in children undergoing oncologic treatment. Methods We performed a double-blinded, randomized, clinical trial at Albert Sabin Infant’s Hospital in Fortaleza, Brazil. Children aged 1 - 6 years who had myelogram or lumbar puncture (associated or not with intrathecal chemotherapy) received placebo or gabapentin syrups (15 mg/kg and 30 mg/kg) one to two hours before the procedure. Preoperative anxiety was evaluated by the Yale preoperative anxiety scale modified (m-YPAS scale). The pediatric anesthesia emergence delirium (PAED) and children and infants postoperative pain scale (CHIPP) scales were used for emergence delirium and pain intensity measurement, respectively. Results We evaluated 135 patients. We observed that the gabapentin groups presented lower m-YPAS scores than the placebo group at separation and induction times. Postoperatively, the gabapentin groups had lower PAED and CHIPP scores than the placebo group; however, only had PAED scores clinical relevance. No significant differences were found between the gabapentin groups. Furthermore, children with less than three prior similar procedures were more likely to benefit from gabapentin. Postoperative vomiting was prevented by 30 mg/kg gabapentin. Conclusions Although gabapentin has little preoperative effects, it ameliorates anxiety before induction, improves anesthetic induction, and reduces the occurrence of emergence delirium and postoperative vomiting up to eight hours after the procedure. Thus, we indicate gabapentin as adjuvant therapy for procedural sedation.
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Affiliation(s)
- Washington Aspilicueta Pinto Filho
- Department of Pharmacology, Federal University of Ceará, Fortaleza, Brazil
- Corresponding Author: : Department of Pharmacology, Federal University of Ceará, Fortaleza, Brazil. Tel: +55-85999580971,
| | | | - Mariana Lima Vale
- Department of Pharmacology, Federal University of Ceará, Fortaleza, Brazil
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Relland LM, Gehred A, Maitre NL. Behavioral and Physiological Signs for Pain Assessment in Preterm and Term Neonates During a Nociception-Specific Response: A Systematic Review. Pediatr Neurol 2019; 90:13-23. [PMID: 30449602 DOI: 10.1016/j.pediatrneurol.2018.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND/GOAL Assessment and treatment of neonatal pain is difficult because current scales are rarely validated against brain-based evidence. We sought to systematically evaluate published evidence to extract validation of the most promising markers of neonatal pain. METHODS We searched four databases using germane MeSH terms. We focused on assessments of pain and/or nociception that had at least two measures among behavioral, physiological, or cortical components in preterm and/or term neonates. We evaluated studies for quality of evidence and strength of recommendations using standardized tools. RESULTS Fifteen articles met our inclusion criteria. Among the behavioral components uncovered in this review, the withdrawal reflex and changes in facial expression are the most strongly associated with nociception-specific brain activity. These associations may be influenced by gestational age and change over time. Physiological signs, such heart rate and oxygen saturation, have little to no association with this type of response. CONCLUSIONS Current assessments of neonatal pain include behavioral components that are associated with nociceptive processing, but also other less valid components, while omitting newer measures based on neuroscientific research.
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Affiliation(s)
- Lance M Relland
- Center for Clinical and Translational Research at Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Alison Gehred
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Nathalie L Maitre
- Center for Perinatal Research at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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Comparison of two neonatal pain assessment tools (Children and Infant’s Postoperative Pain Scale and the Neonatal Facial Coding System—Revised) and their relations to clinicians’ intuitive pain estimates. Eur J Pain 2018; 23:708-718. [DOI: 10.1002/ejp.1338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 11/07/2022]
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Kaplan SL, Coulter C, Sargent B. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy. Pediatr Phys Ther 2018; 30:240-290. [PMID: 30277962 PMCID: PMC8568067 DOI: 10.1097/pep.0000000000000544] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side due to unilateral shortening of the sternocleidomastoid muscle; it may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT should be referred to physical therapists to treat these postural asymmetries as soon as they are identified. PURPOSE This update of the 2013 CMT clinical practice guideline (CPG) informs clinicians and families as to whom to monitor, treat, and/or refer and when and what to treat. It links 17 action statements with explicit levels of critically appraised evidence and expert opinion with recommendations on implementation of the CMT CPG into practice. RESULTS/CONCLUSIONS The CPG addresses the following: education for prevention; referral; screening; examination and evaluation; prognosis; first-choice and supplemental interventions; consultation; discontinuation from direct intervention; reassessment and discharge; implementation and compliance audits; and research recommendations. Flow sheets for referral paths and classification of CMT severity have been updated.
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Affiliation(s)
- Sandra L Kaplan
- Department of Rehabilitation and Movement Sciences (Dr Kaplan), Rutgers, The State University of New Jersey, Newark, New Jersey; Orthotics and Prosthetics Department (Dr Coulter), Children's Healthcare of Atlanta, Atlanta, Georgia; Division of Biokinesiology and Physical Therapy at the Herman Ostrow School of Dentistry (Dr Sargent), University of Southern California, Los Angeles, California
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Dias FDSB, Gasparino RC, Carmona EV, Marba STM. Validation of the Échelle Douleur Inconfort Nouveau-Né for Brazilian culture. Rev Esc Enferm USP 2018; 51:e03285. [PMID: 29412227 DOI: 10.1590/s1980-220x2017008603285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the reliability and validity of the Brazilian version of the Échelle Douleur Inconfort Nouveau-Né, which measures prolonged pain in neonates. METHOD A methodological study carried out with 96 neonates. The Brazilian versions of the Échelle Douleur Inconfort Nouveau-Né and the Children's and Infants' Postoperative Pain Scale were used for data collection. For reliability, equivalence measured by intraobserver agreement and homogeneity were considered. To evaluate the validity, the convergent construct approach was considered correlating the Brazilian versions of the Échelle Douleur Inconfort Nouveau-Né and the Children's and Infants' Postoperative Pain Scale. RESULTS In assessing reliability, the coefficient of agreement between observers varied between 0.64 and 0.85 for the items that make up the instrument, and 0.96 for the total score. Cronbach's alpha was 0.82. Regarding the convergent validity evaluation, Spearman correlation coefficient between the values found for both scales was 0.79 (p< 0.0001). CONCLUSION The Brazilian version of the Échelle Douleur Inconfort Nouveau-Né is a reliable and valid instrument for assessing prolonged pain in neonates.
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de Melo GM, Lélis ALPDA, de Moura AF, Cardoso MVLML, da Silva VM. [Pain assessment scales in newborns: integrative review]. REVISTA PAULISTA DE PEDIATRIA 2016; 32:395-402. [PMID: 25511005 PMCID: PMC4311795 DOI: 10.1016/j.rpped.2014.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 04/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze studies on methods used to assess pain in newborns. DATA SOURCES Integrative review study of articles published from 2001 to 2012, carried out in the following databases: Scopus, PubMed, CINAHL, LILACS and Cochrane. The sample consisted of 13 articles with level of evidence 5. DATA SYNTHESIS 29 pain assessment scales in newborns, including 13 one-dimensional and 16 multidimensional, that assess acute and prolonged pain in preterm and full-term infants were available in scientific publications. CONCLUSION Based on the characteristics of scales, one cannot choose a single one as the most appropriate scale, as this choice will depend on gestational age, type of painful stimulus and the environment in which the infant is inserted. It is suggested the use of multidimensional or one-dimensional scales; however, they must be reliable and validated.
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Carniel MP, Santetti D, Andrade JS, Favero BP, Moschen T, Campos PA, Goldani HAS, Dornelles CTL. Validation of a subjective global assessment questionnaire. J Pediatr (Rio J) 2015; 91:596-602. [PMID: 26192715 DOI: 10.1016/j.jped.2015.03.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/04/2015] [Accepted: 03/11/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To validate the Subjective Global Nutritional Assessment (SGNA) questionnaire for Brazilian children and adolescents. METHODS A cross-sectional study with 242 patients, aged 30 days to 13 years, treated in pediatric units of a tertiary hospital with acute illness and minimum hospitalization of 24h. After permission from the authors of the original study, the following criteria were observed to obtain the validation of SGNA instruments: translation and backtranslation, concurrent validity, predictive validity, and inter-observer reliability. The variables studied were age, sex, weight and length at birth, prematurity, and anthropometry (weight, height, body mass index, upper arm circumference, triceps skinfold, and subscapular skinfold). The primary outcome was considered as the need for admission/readmission within 30 days after hospital discharge. Statistical tests used included ANOVA, Kruskal-Wallis, Mann-Whitney, chi-square, and Kappa coefficient. RESULTS According to SGNA score, 80% of patients were considered as well nourished, 14.5% moderately malnourished, and 5.4% severely malnourished. Concurrent validity showed a weak correlation between the SGNA and anthropometric measurements (p<0.001). Regarding predictive power, the main outcome associated with SGNA was length of admission/readmission. Secondary outcomes associated included the following: length of stay at the unit after SGNA, weight and length at birth, and prematurity (p<0.05). The interobserver reliability showed good agreement among examiners (Kappa=0.74). CONCLUSION This study validated the SGNA in this group of hospitalized pediatric patients, ensuring its use in the clinical setting and for research purposes in the Brazilian population.
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Affiliation(s)
| | - Daniele Santetti
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | | | - Tábata Moschen
- Centro Universitário La Salle (UNILASALLE), Canoas, RS, Brazil
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Carniel MP, Santetti D, Andrade JS, Favero BP, Moschen T, Campos PA, Goldani HA, Dornelles CT. Validation of a subjective global assessment questionnaire. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Motta GDCPD, Schardosim JM, Cunha MLCD. Neonatal Infant Pain Scale: Cross-Cultural Adaptation and Validation in Brazil. J Pain Symptom Manage 2015; 50:394-401. [PMID: 26025270 DOI: 10.1016/j.jpainsymman.2015.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 11/25/2022]
Abstract
CONTEXT The Neonatal Infant Pain Scale (NIPS), initially developed in Canada, has been previously used but not adequately adapted and validated for use in Brazil. OBJECTIVES The goal of the present study was to perform a cross-cultural adaptation and clinical validation of the NIPS for use in the Brazilian population. METHODS The instrument was adapted based on the method outlined by Beaton et al., including the production and combination of translated versions, back-translation, committee review, and pilot testing. The psychometric properties of the adapted instrument, including its validity, reliability, and internal consistency, were tested in a clinical validation study. The sample comprised 60 at-term newborns who were evaluated by six nurses as they experienced vaccination. Psychometric properties were evaluated using Student's t-tests, prevalence-adjusted and bias-adjusted kappa scores, the Bland-Altman method, and Cronbach's alpha coefficients. RESULTS The Brazilian version of the NIPS (Escala de Dor no Recém-Nascido [NIPS-Brazil]) demonstrated excellent interobserver and intraobserver reliability. Total NIPS-Brazil scores yielded prevalence-adjusted and bias-adjusted kappa scores of 0.93, whereas the Bland-Altman method revealed interobserver and intraobserver reliability values of 95% and 90%, respectively. The NIPS-Brazil had adequate internal consistency, as evidenced by a Cronbach's alpha of 0.762. CONCLUSION The NIPS was successfully adapted for use in Brazil and is now available for use in the assessment of acute pain in at-term newborns in Brazil.
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Dias FDSB, Marba STM. The evaluation of prolonged pain in the newborn: adaptation of the EDIN scale for the brazilian culture. TEXTO & CONTEXTO ENFERMAGEM 2014. [DOI: 10.1590/0104-07072014002100013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study aims to undertake the translation and cultural adaptation of the Échelle Douleur Inconfort Nouveau-Né scale into Brazilian Portuguese, following the steps recommended internationally: a) dual translation into Brazilian Portuguese; b) a synthesis of the translations; c) back translation into the original language; d) evaluation by a panel of judges; and e) pre-testing. All internationally recommended steps were performed satisfactorily. The panel of judges made alterations in most parts of the instrument, in order to keep the semantic, idiomatic, conceptual and cultural equivalences between the original and the translated versions. Pre-testing revealed the translated version is easy to understand and to fill out, and rapid to use. The translation and cultural adaption of the EDIN into Brazilian Portuguese were successfully completed.
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Pain assessment scales in newborns: integrative review* *Study conducted at Universidade Federal do Ceará, Fortaleza, CE, Brazil. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/s2359-3482(15)30076-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Melo GMD, Lélis ALPDA, Moura AFD, Cardoso MVLML, Silva VMD. Pain assessment scales in newborns: integrative review. REVISTA PAULISTA DE PEDIATRIA 2014. [DOI: 10.1590/s0103-05822014000400017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To analyze studies on methods used to assess pain in newborns.DATA SOURCES: Integrative review study of articles published from 2001 to 2012, carried out in the following databases: Scopus, PubMed, CINAHL, LILACS and Cochrane. The sample consisted of 13 articles with level of evidence 5.DATA SYNTHESIS: 29 pain assessment scales in newborns, including 13 one-dimensional and 16 multidimensional, that assess acute and prolonged pain in preterm and full-term infants were available in scientific publications.CONCLUSION: Based on the characteristics of scales, one cannot choose a single one as the most appropriate scale, as this choice will depend on gestational age, type of painful stimulus and the environment in which the infant is inserted. It is suggested the use of multidimensional or one-dimensional scales; however, they must be reliable and validated.
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Pasin S, Avila F, de Cavatá T, Hunt A, Heldt E. Cross-cultural translation and adaptation to Brazilian Portuguese of the paediatric pain profile in children with severe cerebral palsy. J Pain Symptom Manage 2013; 45:120-8. [PMID: 22917714 DOI: 10.1016/j.jpainsymman.2012.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 01/06/2012] [Accepted: 01/19/2012] [Indexed: 11/19/2022]
Abstract
CONTEXT Pain is a prevalent symptom in children with severe cerebral palsy (CSCP), mainly as a result of the progression of muscle contractures, bone deformities, gastroesophageal reflux, and recurrent infections. Considering the lack of verbal communication in this population, both pain diagnosis and assessment of the analgesic treatment are often neglected. Although the Paediatric Pain Profile (PPP), an instrument with 20 items, is used to assess behavior indicative of pain in CSCP, it is not validated in Brazil. OBJECTIVES To translate, adapt, and evaluate the psychometric properties of the PPP to Brazilian Portuguese. METHODS The study was carried out at a philanthropic institution for CSCP and a university hospital. The sample of CSCP unable to communicate through speech or any device, their respective parents or primary caregivers, and health professionals were included. First, the instrument was translated and then back translated, and its clarity was evaluated by parents, primary caregivers, and professionals. The psychometric properties of the final version were evaluated for internal consistency (Cronbach's α) and stability (test-retest). RESULTS Forty-five children with a mean (SD) chronological age of 16 (8.69) years, 26 of whom were male, were included in the study. A total of 150 applications of PPP were carried out: 30 to assess clarity and 120 to assess the psychometric properties. Each item of the translated version showed a median between 3.00 and 4.00, considered to be clear and very clear, respectively. The internal consistency of the items was α=0.864, with no significant difference between test and retest (P=0.271). CONCLUSION The adapted version of the PPP in Brazilian Portuguese demonstrated good internal consistency (similar to the original instrument) and stability over time, decisive for the next step of clinical validation for CSCP.
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Affiliation(s)
- Simone Pasin
- Post Graduate Program in Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther 2013; 25:348-94. [PMID: 24076627 DOI: 10.1097/pep.0b013e3182a778d2] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital muscular torticollis (CMT) is an idiopathic postural deformity evident shortly after birth, typically characterized by lateral flexion of the head to one side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. CMT may be accompanied by other neurological or musculoskeletal conditions. KEY POINTS Infants with CMT are frequently referred to physical therapists (PTs) to treat their asymmetries. This evidence-based clinical practice guideline (CPG) provides guidance on which infants should be monitored, treated, and/or referred, and when and what PTs should treat. Based upon critical appraisal of literature and expert opinion, 16 action statements for screening, examination, intervention, and follow-up are linked with explicit levels of evidence. The CPG addresses referral, screening, examination and evaluation, prognosis, first-choice and supplemental interventions, consultation, discharge, follow-up, suggestions for implementation and compliance audits, flow sheets for referral paths and classification of CMT severity, and research recommendations.
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Predebon CM, da Cruz DDALM, Matos FGDOA, Ferreira AM, Pasin S, Rabelo ER. Evaluation of Pain and Accuracy Diagnostic in Hospitalized Children. Int J Nurs Knowl 2012; 23:106-13. [DOI: 10.1111/j.2047-3095.2012.01206.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wilson S, Bremner AP, Mathews J, Pearson D. The use of oral sucrose for procedural pain relief in infants up to six months of age: a randomized controlled trial. Pain Manag Nurs 2012; 14:e95-e105. [PMID: 24315282 DOI: 10.1016/j.pmn.2011.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 08/14/2011] [Accepted: 08/16/2011] [Indexed: 11/24/2022]
Abstract
The aim of this study was to evaluate the effectiveness of oral sucrose in decreasing pain during minor procedures in infants of 1-6 months corrected age. A blinded randomized controlled trial with infants aged 4-26 weeks who underwent venipuncture, heel lance or intravenous cannulation were stratified by corrected age into > 4-12 weeks and > 12-26 weeks. They received 2 mL of either 25% sucrose or sterile water orally 2 minutes before the painful procedure. Nonnutritional sucking and parental comfort, provided in adherence to hospital guidelines, were recorded. Pain behavior was recorded using a validated 10 point scale at baseline, during and following the procedure. Data collectors were blinded to the intervention. A total of 21 and 20 infants received sucrose and water, respectively, in the > 4-12-week age group, and 21 and 22, respectively, in the > 12-26-week age group. No statistical differences were found in pain scores between treatment and control groups at any data collection points in either age group. Infants aged > 4-12 weeks who did nonnutritional sucking showed statistically significantly lower median pain scores at 1, 2, and 3 minutes after the procedure than those who did not suck. Infants aged > 4-26 weeks exhibited pain behavior scores that indicated moderate to large pain during painful procedures; however, there was insufficient evidence to show that 2 mL 25% sucrose had a statistically significant effect in decreasing pain. Infants should be offered nonnutritional sucking in compliance with the Baby Friendly Health Initiative during painful procedures.
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Affiliation(s)
- Sally Wilson
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia; School of Nursing and Midwifery, Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, Western Australia.
| | - Alexandra P Bremner
- School of Population Health, The University of Western Australia, Perth, Western Australia
| | - Judy Mathews
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia
| | - Diane Pearson
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia
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