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Validation of the Premature Infant Pain Profile-Revised (PIPP-R)
Sharyn Gibbins1, Bonnie J Stevens2, Janet Yamada3
1Trillium Health Partners, Mississauga, Ontario, Canada; The University of Toronto, Toronto, Ontario, Canada.
Insights
The Premature Infant Pain Profile-Revised accurately assesses pain in neonates across different gestational ages, showing strong reliability and feasibility for clinical use.
Area of Science:
- Neonatal care
- Pain assessment in infants
- Clinical measurement validation
Background:
- Accurate pain assessment in premature infants is crucial for optimal care.
- Existing pain scales require validation across diverse neonatal populations and clinical settings.
Purpose of the Study:
- To evaluate the construct validity, inter-rater reliability, and feasibility of the Premature Infant Pain Profile-Revised.
- To assess the measure's performance in infants of varying gestational ages, diagnoses, and procedures.
Main Methods:
- Prospective cross-over study in Canadian Neonatal Intensive Care Units.
- 195 nurses and expert raters assessed pain in 202 infants using the Premature Infant Pain Profile-Revised during procedures.
- Feasibility assessed via nurse surveys; construct validity by comparing pain scores during painful vs. non-painful procedures.
Main Results:
- Premature Infant Pain Profile-Revised scores were significantly higher during painful procedures (mean 6.7) than non-painful procedures (mean 4.8).
- High correlation between nurse and expert pain ratings for both painful (R²=0.92) and non-painful (R²=0.87) procedures.
- Feasibility indicators scored ≥3.8, indicating good clinical usability.
Conclusions:
- The Premature Infant Pain Profile-Revised demonstrates initial construct validity and strong inter-rater reliability.
- The measure is considered feasible for use by clinicians in neonatal intensive care settings.
- Further concurrent validation studies are recommended.
Objectives:
To examine the construct validity, inter-rater reliability, and feasibility of the Premature Infant Pain Profile-Revised in infants of varying gestational ages, diagnoses, and procedures.
Methods:
A prospective cross-over study with infants in three gestational age groups (26-31, 32-36, and ≥37 weeks) at three university-affiliated Neonatal Intensive Care Units in Canada. One hundred and ninety five bedside nurses and expert raters rated 202 hospitalized infants' pain during scheduled procedures using the measure. An expert rater and a nurse independently assessed infants' pain scores, using the Premature Infant Pain Profile-Revised, during 246 scheduled pairs of painful and non-painful procedures in the 202 infants. Nurses also completed a feasibility survey on using the measure in a clinical setting. To establish construct validity, pain scores were computed during painful and non-painful procedures. Inter-rater reliability between pain experts and nurses was calculated. A 5-point Likert scale was used to measure feasibility in terms of clarity, ease of use, and time to complete.
Results:
Irrespective of gestational age, Premature Infant Pain Profile-Revised scores were significantly higher during painful procedures (mean 6.7 [SD 3.0]) compared to non-painful procedures (mean 4.8 [SD 2.9]). There was a high degree of correlation between nurses' and experts' ratings for painful (all R(2)=0.92, p<0.001) and non-painful (all R(2)=0.87, p<0.001) procedures. Mean scores on all feasibility indicators were equal to or higher than 3.8.
Discussion:
The Premature Infant Pain Profile Revised has beginning construct validation, inter-rater reliability, and is considered feasible by clinicians. Concurrent validation studies should be considered.
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