Validation of the Italian version of the Non-Communicating Children's Pain Checklist-Postoperative Version
Zanchi et al. Italian Journal of Pediatrics
Validation of the Italian version of the Non- Communicating Children's Pain Checklist- Postoperative Version
C. Zanchi 3
M. Massaro 0
G. Ferrara 0 1 4
M. Montico 3
F. D'Osualdo 2
R. Rutigliano 3
A. Taddio 0 3
L. Vecchi Brumatti 3
G. Cozzi 3
E. Barbi 3
0 University of Trieste , Trieste , Italy
1 Pediatric Clinic, Insitute for Maternal and Child Health IRCCS Burlo Garofolo , via dell'Istria 65/1, Trieste , Italy
2 Institute of Physiatrics and Rehabilitation Gervasutta , Udine , Italy
3 Institute for Maternal and Child Health IRCCS “Burlo Garofolo” Trieste , Trieste , Italy
4 Pediatric Clinic, Insitute for Maternal and Child Health IRCCS Burlo Garofolo , via dell'Istria 65/1, Trieste , Italy
Background: This study evaluated the validity and reliability of the Italian version of the Non-Communicating Children's Pain Checklist-Postoperative version (I-NCCPC-PV). Methods: The original NCCPC-PV version was translated into Italian following the guidelines for “the translation, adaptation, and validation of instruments or scales for cross-cultural healthcare research”. We tested the Italian NCCPC-PV version (I-NCCPC-PV) in 40 children (3-18 years of age) with severe to profound Intellectual Disability and no verbal communication. Each child's behavior was observed by a parent or caregiver and by an external observer in a quiet situation and a painful one. They independently assessed the child's level of pain using the translated Italian version of the NCCPCPV (I-NCCPC-PV). Results: The results from 80 assessments showed that children's behavioral signs differed significantly between painful and calm situations (p < 0.001). The inter-rater reliability was poor in a quiet condition (ICC 0.62) and fair in a painful situation (ICC 0.77). The inter-rater agreement was good in both calm and painful conditions (72.50% and 77.50% respectively). Conclusion: The Italian version of the NCCPC-PV (I-NCCPC-PV) can be used for pain assessment in children with Intellectual Disability who lack verbal communication.
Child; Pain; Intellectual disability; Pain assessment
Background
Pediatric pain management is an important and challenging
area of research, especially in children with Intellectual
Disability (ID). Patients with ID experience pain more
frequently than healthy children: they are at a high risk of
chronic conditions and associated diseases which could
evoke pain: muscular contractures, chronic constipation,
gastro-esophageal reflux, hip-luxation, bone fractures and
tooth decay. Moreover, they frequently need invasive
diagnostic and therapeutic procedures which can lead to
stressful and painful situations, such as botulinum toxin injection,
gastrointestinal endoscopy, stomatological treatment, blood
sampling and surgical procedures [
1, 2
]. Pain has a strong
negative impact on the quality of life of these children and
their families, and it interferes with their ability to perform
established skills. Chronic pain has also been associated with
sleep disturbances, increased fatigue, depression and
decreased physical functioning [
3–6
]. A study that described
the pattern of these children’s typical pain on a daily basis
revealed that 35 to 52% of children with moderate to
profound ID felt pain each week, and the average time they
spent in pain was 9–10 h per week. Children with the
poorest abilities resulted in experiencing the greatest pain [
3, 7
].
Nevertheless, their pain often remains unrecognized and
untreated, due to their limited capacities to self-report pain [1].
In the last 10 years, several observational pain
assessment tools were developed, mainly based on the
observation of physiological and behavioral indicators of pain;
unfortunately, these are not routinely used in clinical
settings. We recently conducted a telephone interview
contacting 56 pediatric wards in three regions of
NorthEastern Italy and only 1 center out of 56 reported to use a
specific tool for pain assessment in children with CI [
8
].
The lack of a valid and reliable Italian pain assessment
tool makes it difficult for health professionals to evaluate
a child’s pain and to provide effective pain treatment,
and this results in poor pain management. Recent
reports proved that children with ID undergoing surgery
receive less opioid infusion in the perioperative period
than children without ID [
9–11
].
The Non-Communicating Children’s Pain
ChecklistPostoperative version (NCCPC-PV) is a pain assessment
tool specifically designed for children between 3 and
18 years of age with ID, which has been developed from
semi-structured interviews with parents of children with
severe neurological impairment. It is proved to be a valid
and reliable instrument to evaluate pain even when it is
used by adults who are not familiar with the patients,
and it is easy to perform also in a clinical setting [
2, 7,
12, 13
]. An Italian version of the NCCPC-PV has not
been validated yet.
The aim of our stud (...truncated)