Verifying the validity and reliability of the Japanese version of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale

Yujiro Matsuishi; Haruhiko Hoshino; Nobutake Shimojo; Yuki Enomoto; Takahiro Kido; Tetsuya Hoshino; Masahiko Sumitani; Yoshiaki Inoue

doi:10.1371/journal.pone.0194094

Verifying the validity and reliability of the Japanese version of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale

PLoS One. 2018 Mar 13;13(3):e0194094. doi: 10.1371/journal.pone.0194094. eCollection 2018.

Authors

Yujiro Matsuishi^{1

2}, Haruhiko Hoshino^{1

2}, Nobutake Shimojo¹, Yuki Enomoto^{1

3}, Takahiro Kido^{1

3}, Tetsuya Hoshino¹, Masahiko Sumitani⁴, Yoshiaki Inoue¹

Affiliations

¹ Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
² Pediatric Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.
³ University of Tsukuba Hospital, Department of Pediatrics, Tsukuba, Ibaraki, Japan.
⁴ Department of Anesthesiology and Pain Relief Center, University of Tokyo Hospital, Tokyo, Japan.

Abstract

Background: Pediatric patients, especially in the preverbal stage, cannot self-report intensity of pain therefore several validated observational tools, including the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale, have been used as a benchmark to evaluate pediatric pain. Unfortunately, this scale is currently unavailable in Japanese, precluding its widespread use in Japanese hospitals.

Objectives: To translate and verify the validity and reliability of the Japanese version of the FLACC Behavioral Scale.

Method: Back-translation was first conducted by eight medical researchers, then an available sample of patients at the University of Tsukuba Pediatric Intensive Care Unit (from May 2017 to August 2017) was enrolled in a clinical study. Two researchers evaluated the validity of the translated FLACC Behavioral Scale by weighted kappa coefficient and intraclass correlation coefficients (ICC). Observational pain was simultaneously measured by the visual analog scale (VAS obs) and reliability was evaluated by correlation analysis.

Result: The original author approved the translation. For the clinical study, a total of 121 observations were obtained from 24 pediatric patients. Agreement between observers was highly correlated for each of the FLACC categories (Face: κ = 0.85, Leg: κ = 0.74, Activity: κ = 0.89, Cry: κ = 0.93, Consolability: κ = 0.93) as well as the total score (Total: κ = 0.95,). Correlation analysis demonstrated a good criterion validation between the FLACC scale and the VAS obs. (r = 0.96).

Conclusion: Our Japanese version of the FLACC Behavioral Scale shows high validity and reliability.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Behavior Rating Scale / standards*
Child
Child, Preschool
Face
Facial Expression
Female
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Japan
Male
Pain
Pain Measurement / methods*
Pain Measurement / standards*
Psychometrics / methods
Reproducibility of Results
Translating

Grants and funding

This study was supported by the Health Labour Science Research Grant from the Japanese Ministry of Health, Labour and Welfare (H26-Kakushintekigan-ippan-060) to MS. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.