title: The impact of item order and sex on self-report of pain intensity in children.
abstract: OBJECTIVE
  When questionnaires are used for pain assessment, the order effect must be taken into consideration; that is, whether the answer to a pain item is influenced by answers given to previous items. This study aimed to evaluate possible order effects in children and adolescents when answering pain items. Furthermore, the possible influence of sex on order effects was analyzed.
  
  
  METHODS
  Three pain items (worst, at movement, and at rest) were given in 6 different orders. Two hundred and 46 postoperative hospitalized children and adolescents (age range of 11-18 years, mean of 14.4 years; female: 41%, duration of surgery range of 2-274 min) participated in this study. Each item order was answered by 40-43 children and adolescents.
  
  
  RESULTS
  While there were no general order effects, we observed a sex-specific order effect. The position of pain at rest (p = .034) and pain on movement (p = .036) items had different influences on worst pain values in female patients compared to male patients. A sex-specific influence on pain at rest values was only caused by the position of pain on movement items (p = .036).
  
  
  CONCLUSIONS
  The fact that male and female pediatric patients are differently influenced by the order of pain items has to be considered in planning a questionnaire. As more specific items (pain on movement) are less influenced by the item order effect, they should be preferred.
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz.
authors.forename: Alexander
authors.initials: A
authors.lastname: Avian
authors.affiliation: Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Messerer
authors.affiliation: Department of Orthopedics and Orthopedic Surgery, Medical University of Graz.
authors.forename: Annelie
authors.initials: A
authors.lastname: Weinberg
authors.affiliation: Department of Anesthesiology and Intensive Care, Jena University Hospital.
authors.forename: Winfried
authors.initials: W
authors.lastname: Meissner
authors.affiliation: Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Schneider
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz.
authors.forename: Andrea
authors.initials: A
authors.lastname: Berghold
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009068:Movement; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000523:psychology; D057566:Self Report; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires