The revised FLACC behavioural pain score Reliability and

The revised FLACC behavioural pain score: Reliability and validation for pain assessment in children with cerebral palsy Line Kjeldgaard Pedersen, MD Ole Rahbek, MD, Ph. D Lone Nikolajsen, MD, Ph. D, DMSc Bjarne Møller-Madsen, MD, DMSc EP 84 No conflicts of interest declared

Background • Pain in children with severe cerebral palsy (CP) is underrecognized and undertreated • A self-rating assessment tool is not possible in children with severe cognitive impairments • A valid observational or behavioral pain score is needed • r-FLACC: revised Face, Legs, Activity, Cry and Consolability behavioural pain score • r-FLACC: Incorporates individual typical and atypical pain behaviour

Background • The quality of the r-FLACC can be assessed by the COSMIN Checklist: • The quality domain reliability is based on internal consistency (Crohnbachs Alpha, Factoranalysis) and intra- and inter rater reliability (Intra-Class Correlation) • The quality domain validity is based on content validity (core pain behaviours), construct validity (expected change in pain) and criterion validity (Pearson’s Correlation Coefficient) • The aim of this study is to assess reliability and validity of the r-FLACC pain score for use in Scandinavian children with CP.

Methods • 27 children with CP undergoing orthopedic surgery • 2 min standardized video recording was made for r-FLACC scoring. • Parent-assessed Observational Visual Analog Scale (VAS-OBS) • Two nurses r-FLACC scored the recordings independently. Ten of the recordings were reviewed again 1 year later.

Results • Excellent internal consistency with Crohnbachs alpha: 0. 93 / 0. 98, Factoranalysis indicates unidimensionality • Excellent intra-rater reliability (ICC=0. 98) and good inter-rater reliability (ICC=0. 75) • Content validity was tested by the originators of the r-FLACC • Construct validity supported by an increase in r-FLACC scores following surgery (p=0. 0427) • Criterion validity was acceptable when comparing VAS-OBS and r-FLACC scores (Pearson’s Correlation Coefficient: 0. 76 / 0. 59)

Conclusion • The r-FLACC have excellent reliability and validity • The translated version of the r-FLACC behavioural pain score is valid for use in postoperative pain assessment in children with CP