{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T17:27:00Z","timestamp":1768411620596,"version":"3.49.0"},"reference-count":36,"publisher":"BMJ","issue":"9","funder":[{"name":"Murdoch Childrens Research Institute"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,6,29]]},"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Infants and children are frequently exposed to painful medical procedures such as immunisation, blood sampling and intravenous access. Over 40 scales for pain assessment are available, many designed for neonatal or postoperative pain. What is not well understood is how well these scales perform when used to assess procedural pain in infants and children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The aim of this study was to test the psychometric and practical properties of the Face, Legs, Activity, Cry and Consolability (FLACC) scale, the Modified Behavioural Pain Scale (MBPS) and the Visual Analogue Scale (VAS) observer pain scale to quantify procedural pain intensity in infants and children aged from 6\u201342 months to determine their suitability for clinical and research purposes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A prospective observational non-interventional study conducted at a single centre. The psychometric and practical performance of the FLACC scale, MBPS and the VAS observer pain scale and VAS observer distress scale used to assess children experiencing procedural pain will be assessed. Infants and young children aged 6\u201342 months undergoing one of four painful and\/or distressing procedures were recruited and the procedure digitally video recorded. Clinicians and psychologists will be recruited to independently apply the scales to these video recordings to establish intrarater and inter-rater reliability, convergent validity responsiveness and specificity. Pain score distributions will be presented descriptively; reliability will be assessed using the intraclass correlation coefficient and Bland-Altman plots. Spearman correlations will be used to assess convergence and linear mixed modelling to explore the responsiveness of the scales to pain and their capacity to distinguish between pain and distress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval was provided by the Royal Children\u2019s Hospital Human Research Ethics Committee, approval number 35220B. The findings of this study will be disseminated via peer-reviewed journals and presented at international conferences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-016225","type":"journal-article","created":{"date-parts":[[2017,9,7]],"date-time":"2017-09-07T20:10:11Z","timestamp":1504815011000},"page":"e016225","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Procedural Pain Scale Evaluation (PROPoSE) study: protocol for an evaluation of the psychometric properties of behavioural pain scales for the assessment of procedural pain in infants and children aged 6\u201342 months"],"prefix":"10.1136","volume":"7","author":[{"given":"Dianne J","family":"Crellin","sequence":"first","affiliation":[{"name":"Department of Nursing, The University of Melbourne, Melbourne, Australia"},{"name":"Clinical Sciences, Murdoch Children\u2019s Research Institute (MCRI), Melbourne, Australia"},{"name":"Royal Children\u2019s Hospital, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Nursing, The University of Melbourne, Melbourne, Australia"},{"name":"Clinical Sciences, Murdoch Children\u2019s Research Institute (MCRI), Melbourne, Australia"},{"name":"Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Royal Children\u2019s Hospital, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tibor","family":"Schuster","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Biostatistics Unit, MCRI, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Santamaria","sequence":"additional","affiliation":[{"name":"Department of Nursing, The University of Melbourne, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franz E","family":"Babl","sequence":"additional","affiliation":[{"name":"Clinical Sciences, Murdoch Children\u2019s Research Institute (MCRI), Melbourne, Australia"},{"name":"Royal Children\u2019s Hospital, Melbourne, Australia"},{"name":"Department of Paediatrics, The University of Melbourne, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,9,6]]},"reference":[{"key":"2025120600093817000_7.9.e016225.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2010.00983.x"},{"issue":"Pt 2","key":"2025120600093817000_7.9.e016225.2","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.expneurol.2015.07.017","article-title":"The long-term impact of early life pain on adult responses to anxiety and stress: historical perspectives and empirical evidence","volume":"275 Pt 2","author":"Victoria","year":"2016","journal-title":"Exp Neurol"},{"key":"2025120600093817000_7.9.e016225.3","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e3181b99f35"},{"key":"2025120600093817000_7.9.e016225.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2012.12.006"},{"key":"2025120600093817000_7.9.e016225.5","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e31823ed4ab"},{"key":"2025120600093817000_7.9.e016225.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jen.2010.03.007"},{"key":"2025120600093817000_7.9.e016225.7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/EJA.0b013e3283418fb0","article-title":"Quality of pain management in the emergency department: results of a multicentre prospective study","volume":"28","author":"Gu\u00e9ant","year":"2011","journal-title":"Eur J Anaesthesiol"},{"key":"2025120600093817000_7.9.e016225.8","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/j.1742-6723.2009.01184.x","article-title":"Pain management practices in paediatric emergency departments in Australia and New Zealand: a clinical and organizational audit by National Health and Medical Research Council's National Institute of Clinical Studies and Paediatric Research in Emergency Departments International Collaborative","volume":"21","author":"Herd","year":"2009","journal-title":"Emerg Med Australas"},{"key":"2025120600093817000_7.9.e016225.9","doi-asserted-by":"crossref","unstructured":"Robb AL , Ali S , Poonai N , et al . 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