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Validation of the Individualized Numeric Rating Scale (INRS): a pain assessment tool for nonverbal children with
Jean C Solodiuk1, Jennifer Scott-Sutherland, Margie Meyers
1Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, MA, USA Department of Perioperative Nursing, Children's Hospital Boston, MA, USA Harvard Medical School, Boston, MA, USA Critical Care and Cardiovascular Nursing Program, Children's Hospital Boston, MA, USA Faculty of Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
Insights
The Individualized Numeric Rating Scale (INRS) is a feasible and reliable tool for assessing pain in nonverbal children with severe intellectual disability. This parent-based approach demonstrated good validity and reliability in an acute care setting.
Area of Science:
- Pediatrics
- Pain Management
- Intellectual Disability
Background:
- Nonverbal children with severe intellectual disability display unique pain indicators.
- Accurate pain assessment is crucial for this population.
Purpose of the Study:
- To investigate the feasibility of the Individualized Numeric Rating Scale (INRS).
- To describe the initial psychometric properties of the INRS for pain assessment.
- To evaluate the INRS's validity and reliability in nonverbal children with intellectual disability.
Main Methods:
- Parents of 50 nonverbal children with severe intellectual disability described and ranked their child's pain indicators.
- A parent, bedside nurse, and research assistant (RA) triad independently scored post-operative pain using the INRS.
- 170 triad assessments were conducted pre- and post-intervention.
Main Results:
- High inter-rater agreement was found between parents and research nurses (ICC 0.82-0.87).
- Good reliability was observed between parents and bedside nurses (ICC 0.65-0.74) and bedside and research nurses (ICC 0.74-0.80).
- Moderate to strong correlations (0.63-0.73) with NCCPC-PV scores indicated convergent validity.
Conclusions:
- The INRS is a feasible and reliable tool for assessing pain in nonverbal children with severe intellectual disability.
- Preliminary data support the INRS's validity in acute care settings.
- The INRS offers a personalized approach to pain assessment for this vulnerable group.
Abstract:
Clinical observations suggest that nonverbal children with severe intellectual disability exhibit pain in a wide variety yet uniquely individual ways. Here, we investigate the feasibility and describe the initial psychometrics properties of the Individualized Numeric Rating Scale (INRS), a personalized pain assessment tool for nonverbal children with intellectual disability based on the parent's knowledge of the child. Parents of 50 nonverbal children with severe intellectual disability scheduled for surgery were able to complete the task of describing then rank ordering their child's usual and pain indicators. The parent, bedside nurse and research assistant (RA) triad then simultaneously yet independently scored the patient's post-operative pain using the INRS for a maximum of two sets of pre/post paired observations. A total of 170 triad assessments were completed before (n=85) and after (n=85) an intervention to manage the child's pain. INRS inter-rater agreement between the parents and research nurse was high (ICC 0.82-0.87) across all ratings. Parent and bedside nurse agreement (ICC 0.65-0.74) and bedside nurse and research nurse agreement (ICC 0.74-0.80) also suggest good reliability. A moderate to strong correlation (0.63-0.73) between INRS ratings and NCCPC-PV total scores provides evidence of convergent validity. These results provide preliminary data that the INRS is a valid and reliable tool for assessing pain in nonverbal children with severe intellectual disability in an acute care setting.
