On the Unidimensionality and Agreement of Four Self-Report Pain Intensity Scales: A Study with Arabic-Speaking Children and Adolescents

ABSTRACT

Purpose

The agreement of pain intensity reports is still a matter of controversy in pediatric pain studies. The aims of this study were to determine the unidimensionality of the electronic versions of four of the most widely used scales (i.e. eNRS-11, eVAS, eFPS-R and eCAS), and the level of agreement between their pain intensity scores, when used with Arabic-speaking children and adolescents.

Methods

A convenience sample of 292 participants, including 137 children (8–12 years old) and 155 adolescents (13–18 years old) were asked to imagine themselves in a painful situation and rate the expected pain intensity using the four scales. A confirmatory factor analysis (CFA) was conducted to determine their unidimensionality. Subsequently, the level of agreement was calculated using the Bland—Altman method in the samples of children and adolescents independently. The maximum limit of agreement was set at ±2 with a confidence interval of 80% (CI).

Results

The data showed the unidimensionality of the four scales and that, with a confidence interval of 80%, only the pain intensity reports of the eVAS and the eCAS in the sample of adolescents were concordant. The data showed no agreement among the pain intensity scores in the sample of children.

Conclusions

The findings suggest that the Arabic versions of the four scales measure a single factor; pain intensity. However, only the scores of the eVAS and the eCAS in adolescents could be used interchangeably.

KEYWORDS:

• Pain intensity; faces pain scale-revised; numerical rating scale; visual analogue scale; colored analogue scale; agreement
• unidimensionality; children; adolescents

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was partially supported by the Spanish Ministry of Economy, Industry and Competitiveness [RTI2018-09870-B-I00; RED2022-134869-T], the European Regional Development Fund (ERDF), the Government of Catalonia [AGAUR; 2021SGR-730], and Universitat Rovira i Virgili (PFR program). ES’s work is supported by the Spanish Ministry of Science and Innovation [MCIN/AEI/10.13039/501100011033 (PID2020- 113869RA-I00)], JM’s work is supported by ICREA-Acadèmia. The Chair in Pediatric Pain is supported by Fundación Grünenthal.

Notes on contributors

Jessica Finianos

Jessica Finianos, postdoc in a nursing program at the University of Balamand (Lebanon), studies chronic pain in children and adolescents in Lebanon. Among her recent publications: Finianos, J., Sánchez-Rodríguez, E., & Miró, J. (2021). The Arabic version of the faces pain scale-revised: Cultural adaptation, validity, and reliability properties when used with children and adolescents. Children, 8(12), 1184–1192.

Elisabet Sánchez-Rodríguez

Elisabet Sánchez-Rodríguez is an associate professor in the Department of Psychology at Universitat Rovira iI Virgili (Spain). Her research interests are focused on the prevention of chronic pain and disability in the pediatric population. To do so, her efforts are focused on the evaluation of pain experience and the development of programs to prevent acute pain from becoming chronic.

Jordi Miró

Jordi Miró is Professor of Health Psychology and director of the Chair in Pediatric Pain at Universitat Rovira i Virgili (Spain). He has published extensively in the area of chronic pain in children. His research interests are related to developing better programs to help children with chronic pain and their families, including the use of mobile applications.