Validation of the Premature Infant Pain Profile-Revised (PIPP-R).
OBJECTIVE
To examine the construct validity, inter-rater reliability, and feasibility of the Premature Infant Pain Profile-Revised in infants of varying gestational ages, diagnoses, and procedures.


METHODS
A prospective cross-over study with infants in three gestational age groups (26-31, 32-36, and ≥37 weeks) at three university-affiliated Neonatal Intensive Care Units in Canada. One hundred and ninety five bedside nurses and expert raters rated 202 hospitalized infants' pain during scheduled procedures using the measure. An expert rater and a nurse independently assessed infants' pain scores, using the Premature Infant Pain Profile-Revised, during 246 scheduled pairs of painful and non-painful procedures in the 202 infants. Nurses also completed a feasibility survey on using the measure in a clinical setting. To establish construct validity, pain scores were computed during painful and non-painful procedures. Inter-rater reliability between pain experts and nurses was calculated. A 5-point Likert scale was used to measure feasibility in terms of clarity, ease of use, and time to complete.


RESULTS
Irrespective of gestational age, Premature Infant Pain Profile-Revised scores were significantly higher during painful procedures (mean 6.7 [SD 3.0]) compared to non-painful procedures (mean 4.8 [SD 2.9]). There was a high degree of correlation between nurses' and experts' ratings for painful (all R(2)=0.92, p<0.001) and non-painful (all R(2)=0.87, p<0.001) procedures. Mean scores on all feasibility indicators were equal to or higher than 3.8.


CONCLUSIONS
The Premature Infant Pain Profile Revised has beginning construct validation, inter-rater reliability, and is considered feasible by clinicians. Concurrent validation studies should be considered.
Trillium Health Partners, Mississauga, Ontario, Canada; The University of Toronto, Toronto, Ontario, Canada. Electronic address: sgibbins@cvh.on.ca.
Sharyn
S
Gibbins
The University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada.
Bonnie J
BJ
Stevens
The Hospital for Sick Children, Toronto, Ontario, Canada.
Janet
J
Yamada
The Hospital for Sick Children, Toronto, Ontario, Canada.
Kimberley
K
Dionne
IWK Health Centre, Halifax, Nova Scotia, Canada; Dalhousie University, Halifax, Nova Scotia, Canada.
Marsha
M
Campbell-Yeo
The University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada.
Grace
G
Lee
IWK Health Centre, Halifax, Nova Scotia, Canada.
Kim
K
Caddell
IWK Health Centre, Halifax, Nova Scotia, Canada; McGill University, Montréal, Québec, Canada.
Céleste
C
Johnston
The University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada.
Anna
A
Taddio
D003430:Cross-Sectional Studies; D005104:Expert Testimony; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D064701:Pediatric Nurse Practitioners; D011446:Prospective Studies; D011795:Surveys and Questionnaires
Feasibility; Infant pain; Pain assessment; Premature Infant Pain Profile; Premature Infant Pain Profile-Revised; Validity