THE RELIABILITY OF REPORTING LOCATION AND EXTENT OF PAIN IN ADOLESCENTS

A. Folli^1,2, D. Falla¹, C. Cescon², F. Vanoni^3,4, E. Soldini⁵, M. Barbero²

¹University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, Birmingham, United Kingdom, ²University of Applied Sciences and Arts of Southern Switzerland, Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, Manno, Switzerland, ³EOC, Institute of Pediatrics of Southern Switzerland, Bellinzona, Switzerland, ⁴Università della Svizzera italiana, Faculty of Biomedical Sciences, Lugano, Switzerland, ⁵University of Applied Sciences and Arts of Southern Switzerland, Competence Centre for Healthcare Practices and Policies, Department of Business Economics, Health and Social Care, Manno, Switzerland

Background: A Pain Drawing (PD) is a self-administered pain assessment that requires the person to shade in on a body chart the areas in which he or she experiences pain, regardless of the intensity. PDs can be analysed by digitally extracting the shaded area and assessing the spatial spread of pain (pain extent) and localising it with respect to an anatomical grid (pain location). Clinicians can use these data to document the patient’s pain characteristics, to assess the evolution of a patient's symptoms or to evaluate their response to provocative tests. PDs have already been validated in several adult populations and a recent scoping review determined that the extent of pain in adults suffering from musculoskeletal pain correlates with other self-reported measures. Although body charts are included in several questionnaires for pain assessment of children and adolescents, no one has investigated the reliability of adolescents in reporting the extent and location of their pain via a PD.

Purpose: To establish the test-retest reliability of adolescents in reporting the extent and location of their pain using a PD.

Methods: Adolescents with musculoskeletal pain aged 11-16 years were included. All participants were asked to shade the areas where they experienced pain over the last week (T1). After the administration of a questionnaire and the acquisition of further personal data, the PD was administered again (T2). The PDs were then scanned and analysed using a digital platform, which allowed the extraction of pain extent values on which the test-retest reliability was calculated. Intraclass Correlation Coefficient (ICC_2,1) and Bland Altman analysis were used to assess pain extent reliability, whereas the Jaccard similarity coefficient was used to calculate pain location reliability.

Results: The analysis of the data extracted from the PDs of the 26 included adolescents showed excellent reliability (ICC_2,1: 0.960; 95% CI: 0.914 - 0.982). The Bland-Altman analysis showed a mean difference close to zero: 0.045 (limits of agreements -1.049 to 1.140).
The reliability of pain location was also supported by Jaccard index mean score of 0.82 (±0.20).

Conclusions: The analysis of data extracted from the 26 participants shows that adolescents with musculoskeletal pain are reliable in reporting the extent and location of their pain using PDs.

Implications: The confirmation of the reliability of adolescents in reporting the extent and location of their pain confirms the appropriateness of an important psychometric property of the instrument, which is mandatory for the use of PDs in this population.

Funding acknowledgements: This research received no external funding.

Keywords:
Adolescents
Pain drawing
Reliability

Topics:
Pain & pain management
Musculoskeletal
Paediatrics

Did this work require ethics approval? Yes

Institution: Comitato etico cantonale, Repubblica e Cantone Ticino

Committee: Comitato etico del Canton Ticino

Ethics number: CE 3832