Instrumentos de avaliação da dor crônica em crianças hospitalizadas: uma revisão sistemática das propriedades de medida

Abstract

Introduction: The evaluation of chronic pain in hospitalized children is an extremely challenging task for caregivers, researchers and health professionals. In addition to the difficulties inherent in the lack of neuropsychomotor maturation, these children may still present cognitive alterations, limiting the interpretation and reliability of pain assessment instruments. The imprecision of these instruments affect the efficacy of pain management, since they may not be reliable to measure the construct that is intended. Objective: Systematically synthesize and analyze the quality of the properties of instrument measures applied in the evaluation of chronic pain in hospitalized children. Methodology: Systematic review conducted according to the

recommendations of the Preferred Reporting Items for Systematic reviews and Meta- Analyzes (PRISMA). We included studies that addressed instruments for chronic pain

evaluation in hospitalized children ≥ 2 years and <12 years, and that presented in their results the evaluation of at least one measurement property. The Pubmed, Web of Science, Cochrane, Cinahl, PsycNET, Embase, and Google Scholar databases were searched by independent reviewers. The quality of included studies was assessed using the (1) COnsensus-based Bias Risk checklist (COSMIN), (2) criteria for good measurement properties, and COSMIN ́s GRADE approach. Data extraction was performed using a standardized tool from the Joanna Briggs Institute (JBI) and adapted to the specific elements of a psychometric review. Results: Two studies were included

in the review, which evaluated the Pain Experience Questionnaire for Children (PEQ- C) and the Hétero Evaluation Douleur Enfant (HEDEN). The measurement properties

evaluated were structural validity, internal consistency, reliability, criterion validity and construct validity. Most properties presented very good classification, according to the Risk of Bias checklist and insufficient classification, according to the criteria for good measurement properties. Evidence was classified according to the GRADE approach as moderate in most evaluations. Conclusion: Despite the existence of a large number of pain assessment instruments, few are specifically directed to chronic pain in hospitalized children. In this sense, there is a need for further studies on the subject, following the recommendations for validation and evaluation of recognized psychometric properties.