Paediatric Pain Profile

Instrument Name: Paediatric Pain Profile

Abbreviation: PPP

Points for Consideration:

None

Description of Tool:

The Paediatric Pain Profile (PPP) is a 20-item ObsRO developed to assess pain behaviour in children (ages 1-18) with severe to profound neurological impairment (i.e., physical and learning impairments). Parents are asked to describe their child's history of pain, baseline behaviour 'On a good day', and current pain problems including 'Most troublesome pain (Pain A)', 'Second most troublesome pain (Pain B)' and 'Third most troublesome pain (Pain C)', summary graph, ongoing pain assessments and assessment actions and outcomes on a 4-level scale "Not at all", "A little", "Quite a lot", "A great deal". Higher scores represent more severe pain.

Other Related Tools (if applicable):

None identified

Minimum Qualification Required by COA Administrator: PhD or MA

Comment:

None

Year: 2001

Objective of Development:

To assess pain behaviour in children with severe to profound neurological impairment

Population of Development: Age range (therapeutic indication):

Age range: 1-18 years (nervous system diseases)

Pediatric Population(s) in which COA has been used:

Cerebral palsy; Neurodegenerative diseases; Congenital or chromosonal disorder; Developmental delay; Brain damage following infection or trauma; Spastic quadriplegia; Cerebral malformations; Adrenoleucodystrophy; Hallervorden spatz; Sanfilippa; Rett; Late infatile Batten's disease; Undiagnosed degenerative conditions; Autism; Severe learning disabilities

COA type: ObsRO

Number of Items 20

Mode of Administration: Caregiver-rated

Data Collection Mode: Paper and pen administration

Time for Completion: 2 to 3 minutes

Response Scales: 4-point Likert scale ranging from 0="Not at all", 1="A little", 2="Quite a lot", 3="A great deal"

Summary of Scoring:

Available scores: Total score ranging from 0 to 60

Weighting: No

Score Interpretation: higher score=More severe pain

Evidence of Literature Review: None identified

Evidence of Instrument Review: None identified

Evidence of Clinical or Expert Input: Yes

Evidence of concept elicitation in target patient population: Yes

Evidence of a Saturation Grid: None identified

Evidence for Selection of Data Collection Method: Yes

Recall/Observation Period: Present time

Evidence for Selection of Reponse Options: None identified

Evidence of cognitive interviewing of draft instrument in target patient population: None identified

Evidence of Preliminary Scoring of Items and Domains: None identified

Evidence related to respondent and administrator burden: Yes

Evidence of a Conceptual Framework: None identified

Evidence of an item-tracking matrix: None identified

Evidence related to item selection: Yes

Evidence of re-testing the final version: Yes

Internal consistency (Cronbach's alpha): Yes

Evidence of internal consistency: Hunt A (2001) - Method: Cronbach's alpha -Results: Total PPP scores for children 'at their best': 0.75 Total PPP scores for children with 'most troublesome pain' (Pain A): 0.82 Total PPP scores for children with 'other, usually less troublesome pain' (Pain B): 0.86 Item-total correlation: 0.3-0.7 for 75% of items for Pain A assessments and 85% of Pain B assessments Total PPP score (excluding two items 'reluctant to eat/difficulty in feeding' and 'had disturbed sleep') for n=41 children before administration of analgesic: 0.89 Item-total correlation: <0.3 for all items - Population/Disease: Children (mean age 9 years 11 months, SD 4 years 7 months; 1-18 years) unable to communicate through speech or augmentative communication; n=140 Hunt A (2007) - Method: Cronbach's alpha was used to assess internal consistency of 16/20 items of the Paediatric Pain Profile (PPP) scale. - Results: 0.88 - Population/Disease: Children (mean age 9.6, SD 5.8) who experience pain; n=29 children

Test-retest Reliability (ICC):

None identified

Inter-rater/ inter-interviewer reliability (kappa):

Hunt A (2004)
Interrater reliability
- Correlation coefficient used: Intraclass Correlation. Reliability of the total PPP score was 0.74. Correlation between raters on total score was 0.75. Reliability for individual items varied from 0.14-0.76 (mean 0.51)
- Population/Disease: Children aged 1 to 18unable to communicate through speech or augmentative communication; n=111

Hunt A (2004)
- Correlation coefficient used: Intraclass Correlation and Pearson's r. Reliability for the total PPP score was 0.73. Correlations between parent and healthcare professional raters was 0.70 (p<0.001). - Population/Disease: Children aged 1 to 18 unable to communicate through speech or augmentative communication; n=54 Hunt A (2004) - Correlation coefficient used: Intraclass Correlation. Reliability for the total PPP score was 0.87 and 0.19- 0.84 (mean 0.64) for individual items - Population/Disease: Children aged 1 to 18 unable to communicate through speech or augmentative communication who ad undergone short-acting analgesia; n=54 Hunt A (2007) Interrater reliability - Correlation Coefficient used: Intraclass Correlations (ICC). Reliability for the total PPP score was 0.62 and 0.21 to 0.71 (average 0.45) for the individual items - Population/Disease: Children (mean age 9.6, SD 5.8) who experience pain; n=29 Hunt A (2007) Intrarater reliability - Correlation Coefficient used: Intraclass Correlations (ICC). Reliability for the total PPP score was 0.02 and 0.21 to 1.0 (average 0.72) for the individual items - Population/Disease: Children (mean age 9.6, SD 5.8) who experience pain; n=29

Evidence of test-retest or inter-rater reliability: Yes

Concurrent validity (convergent, divergent):

Hunt A (2004)
- Correlation coefficient used: paired t-tests were used to investigate differences between the child's PPP scores 'at best' and when in pain; analysis of variance (ANOVA) for linear relationship was calculated to assess the relationship between the PPP score and VRS score; Cronbach's alpha to determine the extent to which all items in the scale measure the same construct.
- Measure: PPP; Verbal Rating Scale (VRS)
- Results:
Mean PPP score for children's most troublesome pain (Pain A) was greater (mean 31.3, SD 9.9) than children with less troublesome pain (Pain B) (mean 26.9, SD 10.9); scores were significanly higher than those for children at their best (mean 11.1, SD 6.3)
PPP scores for pain A and B increased in line with parents' evaluations of the pain on the VRS (p<0.001). - Population/Disease: Children aged 1 to 18 unable to communicate through speech or augmentative communication; n=30 Hunt A (2007) - Correlation coefficient used: Pearson's r - Measures: Paediatric Pain Profile (PPP); Numerical Rating Scale (NRS) - Results: Rater's PPP percent scores and their NRS: 0.76-0.90 (p<0.001) PPP scores across raters: 0.58-0.78 (p<0.001) Average PPP percent score and NRS by each rater and average by parent and caregivers: 0.33-0.61 (p=0.002 to p<0.001) PPP and NRS: 0.91 PPP and VRS: linear relationship (p<0.0001) - Population/Disease: Children (mean age 9.6, SD 5.8) who experience pain; n=29 Hunt A (2007) - Measure/Groups: PPP score; saliva cortisol concentration - Correlation coefficient used: Pearson's r - Results: PPP score and saliva cortisol concentration: r=0.378-0.451 (not significant) - Population/Disease: Children (mean age 9.6, SD 5.8) who experience pain; n=29

Known-group validity:

Hunt A (2007)
- Measure/Groups of patients: high-pain (n=19) and low-pain (n=10)
- A priori hypotheses: Children in the high-pain group would have higher PPP scores than the low-pain group
- Were hypotheses confirmed: Yes
- Results: PPP percent scores were significantly higher in the high pain group than the low-pain group (independent-sample t-test P=0.23-0.009)
- Population/Disease: Children (mean age 9.6, SD 5.8) who experience pain; n=29

Evidence of Translatability Assessment: None identified

Evidence related to missing data: None identified

Evidence for Selection of Recall Period: None identified

Evidence of Administration Instructions and Training Provided: Yes

Evidence of concurrent validity: Yes

Evidence of known-groups validity: Yes

Evidence of ability to detect change over time: Yes

Ability to detect change (Responsiveness):

Hunt A (2004)
- Method: Responsiveness to change in pain in a short-acting analgesic group (n=41) (before administration of analesics and at hourly intervals for four hours following administration of the analgesic) and responsiveness to change in pain in children following orthopaedic or gastrointestinal surgery (n=30) (before surgery, two-hourly on the first postoperative day, four-hourly on the second day and eight-hourly on postoperative days three and five) was assessed using paired-sample t-tests. Time under the time-analgesic effect curve (AUC effect was calculated for the PPP scores of each child.
- Results:
Mean PPP score pre-dose was significantly greater than all later assessments (paired-sample t-test, p<0.001). Mean AUC-effect: 44.2 (SD 27.1); treatment resulted in reduction in PPP score by 50% or more in n=23 (68%) children and n=5 children (15%) had less than 30% reduction in pain. Postoperative group - Were hypotheses confirmed: No, average pain scores did not differ across postoperative days. Population/Disease: Children aged 1-18 years unable to communicate through speech or augmentative communication; n=30

Responder Thresholds:

None identified

Evidence of responder thresholds: None identified

Hunt, A. (2001). Towards an understanding of pain in the child with severe neurological impairment development of a behaviour rating scale for assessing pain (Doctoral dissertation, University of Manchester) Full Text Article: No

Hunt, A., Goldman, A., Seers, K., Crichton, N., Mastroyannopoulou, K., Moffat, V., Oulton, K., & Brady, M. (2004). Clinical validation of the paediatric pain profile. Developmental medicine and child neurology, 46(1), 9–18. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/14974642/

Hunt, A., Wisbeach, A., Seers, K., Goldman, A., Crichton, N., Perry, L., & Mastroyannopoulou, K. (2007). Development of the paediatric pain profile: role of video analysis and saliva cortisol in validating a tool to assess pain in children with severe neurological disability. Journal of pain and symptom management, 33(3), 276–289. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/17349497/

Development history described: https://ppprofile.org.uk/

Hunt, A., Mastroyannopoulou, K., Goldman, A., & Seers, K. (2003). Not knowing--the problem of pain in children with severe neurological impairment. International journal of nursing studies, 40(2), 171–183.Full Text Article: https://pubmed.ncbi.nlm.nih.gov/12559141/

Hunt, A., Robertson, S. H., Rycroft-Malone, J., Seers, K., Crichton, N., Thompson, A., & Newlove, A. Lessons learned from a study implementing the Paediatric Pain Profile in the community. Full Text Article: https://www.researchgate.net/publication/306119804_Lessons_learned_from_a_study_implementing_the_Paediatric_Pain_Profile_in_the_community

None identified

None identified

Yes

Original language: English for the UK

None identified

Author:
Anne Hunt
Nursing Institute, Radcliffe Infirmary, Woodstock Road,
Oxford OX2 6HE.
E-mail: Anne.Hunt@rcn.org.uk

The PPP is copyrighted by the University College of London (UCL)

The PPP tool is available for download as a PDF document on the developers website: https://ppprofile.org.uk/
If you wish to use the PPP pages commercially please visit The University College London Business (UCLB) website XIP: https://xip.uclb.com/product/ppp

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