Validation of an Electronic Visual Analog Scale App for Pain Evaluation in Children and Adolescents With Symptomatic Hypermobility: Cross-sectional Study

Muhammad Maarj; Verity Pacey; Louise Tofts; Matthew Clapham; Xavier Gironès Garcia; Andrea Coda

doi:10.2196/41930

Validation of an Electronic Visual Analog Scale App for Pain Evaluation in Children and Adolescents With Symptomatic Hypermobility: Cross-sectional Study

JMIR Pediatr Parent. 2022 Oct 26;5(4):e41930. doi: 10.2196/41930.

Authors

Muhammad Maarj¹, Verity Pacey², Louise Tofts², Matthew Clapham³, Xavier Gironès Garcia⁴, Andrea Coda^{1

3}

Affiliations

¹ School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia.
² Department of Health Sciences, Macquarie University, Sydney, Australia.
³ Hunter Medical Research Institute, Equity in Health and Wellbeing Research Program, New Lambton Heights, New South Wales, Australia.
⁴ Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Spain.

PMID: 36287606
PMCID: PMC9647467
DOI: 10.2196/41930

Abstract

Background: Rapid advances in mobile apps for clinical data collection for pain evaluation have resulted in more efficient data handling and analysis than traditional paper-based approaches. As paper-based visual analogue scale (p-VAS) scores are commonly used to assess pain levels, new emerging apps need to be validated prior to clinical application with symptomatic children and adolescents.

Objective: This study aimed to assess the validity and reliability of an electronic visual analogue scale (e-VAS) method via a mobile health (mHealth) App in children and adolescents diagnosed with hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (HSD/HEDS) in comparison with the traditional p-VAS.

Methods: Children diagnosed with HSD/HEDS aged 5-18 years were recruited from a sports medicine center in Sydney (New South Wales, Australia). Consenting participants assigned in random order to the e-VAS and p-VAS platforms were asked to indicate their current lower limb pain level and completed pain assessment e-VAS or p-VAS at one time point. Instrument agreement between the 2 methods was determined from the intraclass correlation coefficient (ICC) and through Bland-Altman analysis.

Results: In total, 43 children with HSD/HEDS aged 11 (SD 3.8) years were recruited and completed this study. The difference between the 2 VAS platforms of median values was 0.20. Bland-Altman analysis revealed a difference of 0.19 (SD 0.95) with limits of agreement ranging -1.67 to 2.04. An ICC of 0.87 (95% CI 0.78-0.93) indicated good reliability.

Conclusions: These findings suggest that the e-VAS mHealth App is a validated tool and a feasible method of collecting pain recording scores when compared with the traditional paper format in children and adolescents with HSD/HEDS. The e-VAS App can be reliably used for pediatric pain evaluation, and it could potentially be introduced into daily clinical practice to improve real-time symptom monitoring. Further research is warranted to investigate the usage of the app for remote support in real clinical settings.

Keywords: Ehlers-Danlos syndrome; adolescent; child; children; digital health tool; hypermobile; hypermobility; hypermobility syndrome; mHealth; measure; mobile app; mobile application; mobile health; pain; pain measurement; pain severity; pediatric; scale; validate; validation; visual analogue scale; youth.

©Muhammad Maarj, Verity Pacey, Louise Tofts, Matthew Clapham, Xavier Gironès Garcia, Andrea Coda. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org), 26.10.2022.