Translation, Cross-Cultural Adaptation, and Validation of the Portuguese Version of the Rotterdam Elderly Pain Observation Scale

Julieta Seixas-Moizes; Anneke Boerlage; Érica Negrini Lia; Lucas Emmanuel Lopes E Santos; Miriane Lucindo Zucoloto; Fabíola Dach; Priscila Colavite Papassidero; Laís Almeida Leal Wichert-Ana; Oscar Della Pasqua; Marianne Louise Wiesebron; Tatiana Reis Icuma; Vera Lucia Lanchote; Eduardo Barbosa Coelho; Dick Tibboel; Lauro Wichert-Ana

doi:10.1159/000520455

Translation, Cross-Cultural Adaptation, and Validation of the Portuguese Version of the Rotterdam Elderly Pain Observation Scale

Dement Geriatr Cogn Dis Extra. 2021 Dec 20;11(3):314-323. doi: 10.1159/000520455. eCollection 2021 Sep-Dec.

Authors

Julieta Seixas-Moizes¹, Anneke Boerlage², Érica Negrini Lia^{1

3}, Lucas Emmanuel Lopes E Santos¹, Miriane Lucindo Zucoloto⁴, Fabíola Dach⁵, Priscila Colavite Papassidero⁵, Laís Almeida Leal Wichert-Ana⁵, Oscar Della Pasqua^{6

7}, Marianne Louise Wiesebron⁸, Tatiana Reis Icuma⁴, Vera Lucia Lanchote⁹, Eduardo Barbosa Coelho¹⁰, Dick Tibboel², Lauro Wichert-Ana¹

Affiliations

¹ Department of Radiology, Hematology, and Oncology, University of São Paulo, Ribeirão Preto, Brazil.
² Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands.
³ Department of Dentistry, Health Sciences School, University of Brasília (UNB), Brasília, Brazil.
⁴ Department of Social Medicine, University of São Paulo, Ribeirão Preto, Brazil.
⁵ Department of Neurosciences and Behavioral Sciences, University of São Paulo, Ribeirão Preto, Brazil.
⁶ Division of Pharmacology, Leiden Academic Centre for Drug Research, University of Leiden, Leiden, The Netherlands.
⁷ Clinical Pharmacology & Therapeutics, School of Life and Medical Sciences, University College London, London, United Kingdom.
⁸ Department of Latin American Studies, University of Leiden, Leiden, The Netherlands.
⁹ Department of Clinical Analysis, Food Science and Toxicology, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
¹⁰ Internal Medicine of the Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.

Abstract

Introduction: This study reports on the translation, cultural adaptation, and validation of a Portuguese version of the Rotterdam Elderly Pain Observation Scale (REPOS), a Dutch scale to assess pain in patients who cannot communicate, with or without dementia.

Methods: This is a multicenter study in pain and neurological units involving Brazil (clinical phase) and the Netherlands (training phase). We performed a retrospective cross-sectional, 2-staged analysis, translating and culturally adapting the REPOS to a Portuguese version (REPOS-P) and evaluating its psychometric properties. Eight health professionals were trained to observe patients with low back pain. REPOS consists of 10 behavioral items scored as present or absent after a 2-min observation. The REPOS score of ≥3 in combination with the Numerical Rating Scale (NRS) of ≥4 indicated pain. The Content Validity Index (CVI) in all items and instructions showed CVI values at their maximum. According to the higher correlation coefficient found between NRS and REPOS-P, it may be suggested that there was an adequate convergent validity.

Results: The REPOS-P was administered to 80 patients with a mean age of 60 years (SD 11.5). Cronbach's alpha coefficient showed a moderate internal consistency of REPOS-P (α = 0.62), which is compatible with the original study of REPOS. All health professionals reached high levels of interrater agreement within a median of 10 weeks of training, assuring reproducibility. Cohen's kappa was 0.96 (SD 0.03), and the intraclass correlation coefficient was 0.98 (SD 0.02), showing high reliability of REPOS-P scores between the trainer (researcher) and the trainees (healthcare professionals). The Pearson correlation coefficient was 0.95 (95% confidence interval 0.94-0.97), showing a significant correlation between the total scores of REPOS-P and NRS.

Conclusion: The REPOS-P was a valuable scale for assessing elderly patients with low back pain by different healthcare professionals. Short application time, ease of use, clear instructions, and the brief training required for application were essential characteristics of REPOS-P.

Keywords: Elderly; Pain; Pain assessment; Validation studies.