title: Validation of the Individualized Numeric Rating Scale (INRS): a pain assessment tool for nonverbal children with intellectual disability.
abstract: Clinical observations suggest that nonverbal children with severe intellectual disability exhibit pain in a wide variety yet uniquely individual ways. Here, we investigate the feasibility and describe the initial psychometrics properties of the Individualized Numeric Rating Scale (INRS), a personalized pain assessment tool for nonverbal children with intellectual disability based on the parent's knowledge of the child. Parents of 50 nonverbal children with severe intellectual disability scheduled for surgery were able to complete the task of describing then rank ordering their child's usual and pain indicators. The parent, bedside nurse and research assistant (RA) triad then simultaneously yet independently scored the patient's post-operative pain using the INRS for a maximum of two sets of pre/post paired observations. A total of 170 triad assessments were completed before (n=85) and after (n=85) an intervention to manage the child's pain. INRS inter-rater agreement between the parents and research nurse was high (ICC 0.82-0.87) across all ratings. Parent and bedside nurse agreement (ICC 0.65-0.74) and bedside nurse and research nurse agreement (ICC 0.74-0.80) also suggest good reliability. A moderate to strong correlation (0.63-0.73) between INRS ratings and NCCPC-PV total scores provides evidence of convergent validity. These results provide preliminary data that the INRS is a valid and reliable tool for assessing pain in nonverbal children with severe intellectual disability in an acute care setting.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, MA, USA Department of Perioperative Nursing, Children's Hospital Boston, MA, USA Harvard Medical School, Boston, MA, USA Critical Care and Cardiovascular Nursing Program, Children's Hospital Boston, MA, USA Faculty of Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Solodiuk
authors.forename: Jennifer
authors.initials: J
authors.lastname: Scott-Sutherland
authors.forename: Margie
authors.initials: M
authors.lastname: Meyers
authors.forename: Beth
authors.initials: B
authors.lastname: Myette
authors.forename: Christine
authors.initials: C
authors.lastname: Shusterman
authors.forename: Victoria E
authors.initials: VE
authors.lastname: Karian
authors.forename: Sion Kim
authors.initials: SK
authors.lastname: Harris
authors.forename: Martha A Q
authors.initials: MAQ
authors.lastname: Curley
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000150:complications*; D008297:Male; D010146:Pain / Q000150:complications* / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods*; D018579:Patient Selection; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index