Zhongguo quanke yixue (Dec 2022)
Psychometric Properties of the Pain Assessment Scales in Newborns: an Overview of Systematic Review
Abstract
Background Timely and accurate pain assessment is essential for safe and effective management of pain in neonates. Scholars at home and abroad have developed more than 40 pain assessment scales for different neonatal groups and types of pain. However, the reliability and stability of the outcomes vary significantly. In addition, existing single studies or systematic reviews (SRs) can only provide unsystematic evidence of a particular scale or specific psychometric properties, which is not conducive to clinical decision-making. Objective To overview the SRs of psychometric properties of neonatal pain assessment scales, providing clinical practitioners and researchers with evidence for the best pain assessment scale. Methods Databases including CNKI, SinoMed, Wanfang DATA, VIP, PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched for SRs about psychometric properties of neonatal pain assessment scales. By screening the references of the included SRs, their associated studies were found. Two researchers independently performed literature screening, and data extraction, then assessed the methodological quality using the JBI systematic review critical appraisal tool, risk of bias using the ROBIS, the reporting quality using the PRISMA statement, and the evidence quality using CERQual. Results A total of seven SRs were included. According to the JBI and ROBIS tools, four SRs were of high quality and had a low risk of bias, while three were of relatively low quality and had an increased risk of bias. With the PRISMA checklist, 5 SRs were fairly complete with over 60% of report completion rate (RCR) , 1 SR had certain reporting deficiencies with 45.95% of RCR, and 1 SR had serious information missing with 10.81% of RCR. The results of CERQual showed that there were 22 pieces of evidence in total, including two pieces of high quality (9.09%) , eight pieces of moderate quality (36.36%) , nine pieces of low quality (40.91%) , and three pieces of critically low quality (13.64%) . A synthesis of evidence showed that there were 25 scales with good internal consistency, inter-rater reliability, construct validity, and interpretability. Those scales could be used to measure acute pain, persistent pain, postoperative pain, or mechanically ventilated pain in preterm and/or term infants. Conclusion No single pain assessment scale is available to assess all types of pain in neonates. It is recommended that the selection of validated scales for periodic dynamic pain assessment in neonates should be based on clinical situations such as age and pain type. More high-quality, well-designed studies are needed to examine the reliability and stability of the existing scales for measuring different kinds of pain in neonates in China and to explore the feasibility of expanding their applications.
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