Measurement properties of the Premature i=Infant Pain Profile-Revised applied at the bedside by physical therapists in the NICU

Abstract

Background

It is essential to accurately assess distress and pain in neonatal intensive care unit (NICU); however, few instruments have had their measurement properties tested for the Brazilian population.

Objective

To analyze the intra- and inter-examiner reliability, internal consistency, and responsiveness of the Brazilian Portuguese version of the Premature Infant Pain Profile-Revised (PIPP-R) scale in Brazilian neonates.

Methods

This is a methodological study conducted in the NICU. Neonates with a gestational age of 24–42 weeks who were not under the effect of muscle block or analgesia at the time of evaluation were included. Inter-examiner reliability was assessed at bedside by two trained evaluators who independently assessed the neonates at bedside and in real time using the PIPP-R. Procedures were filmed and used for intra-examiner reliability assessment after 10–14 days. The Intraclass Correlation Coefficient (ICC) was used to determine intra- and inter-examiner reliability. Responsiveness was assessed by comparing the total scores before and after painful procedures using a paired t-test, followed by an effect size analysis.

Results

A total of 119 assessments were performed on 15 neonates. The PIPP-R demonstrated excellent intra- and inter-examiner reliability (ICC > 0.9), and successfully detected changes after an acute painful procedure (p = 0.003; effect size = 0.8).

Conclusion

Excellent intra- and inter-examiner reliability, and sensitivity to changes over time were observed by using the PIPP-R at bedside, indicating that this is a suitable instrument for clinical use.