Self‐report of pain in young people and adults with spastic cerebral palsy: interrater reliability of the revised Face, Legs, Activity, Cry, and Consolability (r‐FLACC) …
MA Fox, R Ayyangar, R Parten… - … Medicine & Child …, 2019 - Wiley Online Library
MA Fox, R Ayyangar, R Parten, HJ Haapala, SG Schilling, CZ Kalpakjian
Developmental Medicine & Child Neurology, 2019•Wiley Online LibraryAim People with cerebral palsy (CP) are often unable to express pain owing to cognitive or
speech impairments. Reports that rely on observation can be inaccurate, because
behaviours such as grimacing, common in people with spastic CP, resemble pain
expressions. We examined preliminary validity and reliability of the revised Face, Legs,
Activity, Cry, and Consolability (r‐FLACC) scale in people with spastic CP. Method Forty‐
eight young people and adults (35 females, 13 males; mean [SD] age 29y 2mo [13y]) were …
speech impairments. Reports that rely on observation can be inaccurate, because
behaviours such as grimacing, common in people with spastic CP, resemble pain
expressions. We examined preliminary validity and reliability of the revised Face, Legs,
Activity, Cry, and Consolability (r‐FLACC) scale in people with spastic CP. Method Forty‐
eight young people and adults (35 females, 13 males; mean [SD] age 29y 2mo [13y]) were …
Aim
People with cerebral palsy (CP) are often unable to express pain owing to cognitive or speech impairments. Reports that rely on observation can be inaccurate, because behaviours such as grimacing, common in people with spastic CP, resemble pain expressions. We examined preliminary validity and reliability of the revised Face, Legs, Activity, Cry, and Consolability (r‐FLACC) scale in people with spastic CP.
Method
Forty‐eight young people and adults (35 females, 13 males; mean [SD] age 29y 2mo [13y]) were video‐recorded during a standard examination, rating their pain (0–10) afterwards. Two raters completed the r‐FLACC using the video recordings. Interrater reliability was assessed with an unconditional cross‐classified random‐effects model and item response theory approach; Pearson correlations measured agreement between raters and participants.
Results
Mean (SD) participant (n=48) pain scores were 2.48 (2.5) and mean (SD) r‐FLACC scores were 1.46 (1.68). There was moderate agreement between raters (intraclass coefficient 0.41 and 0.57 respectively) but low agreement between participants and raters (r=0.26). There were no significant effects for raters (lay observers, nurses, physicians, and inexperienced raters).
Interpretation
Results provide mixed support for the interrater reliability of the r‐FLACC in people with spastic CP.
What this paper adds
- The revised Face, Legs, Activity, Cry, and Consolability (r‐FLACC) scale can be reliably used by experts and lay raters for people with spastic cerebral palsy (CP).
- Support is mixed for interrater reliability of the r‐FLACC scale used with people with spastic CP.
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