Cultural adaptation and validation of the portuguese version of the Face, Legs, Activity, Cry, Consolability – Revised (FLACC-R) scale

Abstract

Context: Children with multiple disabilities have nonspecific pain behaviors because of their cognitive and neuromuscular limitations. These behaviors are difficult to diagnose and interpret, which has led to under-treatment of pain in these children. Aim: To translate and validate both semantically and culturally the Face, Legs, Activity, Cry, Consolability – Revised (FLACC-R) Scale into Portuguese and assess its psychometric properties (validity and reliability) in children with multiple disabilities aged between 4 and 18 years. Methodology: Methodological study, including the development of panels, in which the scale was applied simultaneously and independently to 40 children who had been selected using random sampling. Results: The process of cultural validation was straightforward, despite the need to gain consensus on some expressions used in the indicators face, activity and consolability. Internal consistency using Cronbach’s alpha was 0.76. The level of agreement between observers using Kappa values ranged from 0.69 to 0.76. The intraclass correlation coefficient was 0.97. Conclusion: The FLACC-R/PT proved to be a valid and reliable instrument when used with children with multiple disabilities aged 4-18 years who were hospitalized in medical wards. However, recommendations include further studies and the application of the scale by nurses with training in pain assessment.