Gélinas et al.,((55 Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the Critical-Care Pain Observation Tool in adult patients. Am J Crit Care. 2006;15(4):420-7.)) Canada |
Validate the CPOT during painful and nonpainful procedures |
Quantitative observational study The CPOT was administered at 3 timepoints: at rest, during a painful procedure and 20 minutes after the procedure (9 assessments) MQ = 9 |
Convenience sample of 105 critically ill adult patients admitted to the ICU for cardiac surgery |
The CPOT showed good interrater reliability (ICC = 0.52-0.88), adequate content validity (0.88 - 1.0) and criterion validity (patients who reported pain: 1.62 - 3.65) The results show the need to validate the CPOT in different critically ill patient populations |
Morete et al.,((77 Morete MC, Mofatto SC, Pereira CA, Silva AP, Odierna MT. Tradução e adaptação cultural da versão portuguesa (Brasil) da escala de dor Behavioural Pain Scale. Rev Bras Ter Intensiva. 2014;26(4):373-8.)) Brazil |
Translate and culturally adapt the BPS to Brazilian Portuguese and perform validation |
Methodological study with quantitative analysis The cultural adaptation of the BPS to Brazil and the study of its psychometric properties were performed MQ = 10 |
Convenience sample of 100 adult patients admitted to the ICU, undergoing IMV and with or without sedation and analgesia |
The BPS showed easy application and reproducibility, with adequate agreement between the two evaluators (ICC = 0.807, 95% CI = 0.727 - 0.866) and with adequate internal consistency (α= 0.501), and its adaptation to Brazil was satisfactory |
Nürnberg et al.,((1313 Nürnberg Damström D, Saboonchi F, Sackey PV, Björling G. A preliminary validation of the Swedish version of the Critical-Care Pain Observation Tool In Adults. Acta Anaesthesiol Scand. 2011;55(4):379-86.)) Sweden |
Validate the Swedish version of the CPOT during painful and nonpainful procedures |
Observational descriptive study 240 independent observations were performed by two team members before, during and 15 minutes after painful and nonpainful procedures MQ = 10 |
Convenience sample of 40 conscious and unconscious intubated adult patients admitted to the ICU |
The validation of the CPOT showed good interrater reliability (ICC = 0.84), internal consistency evaluated during the assessments (between: α = 0.31 - 0.81) and adequate discriminant validity |
Rijkenberg et al.,((1414 Rijkenberg S, Stilma W, Endeman H, Bosman RJ, Oudemans-van Straaten HM. Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. J Crit Care. 2015;30(1):167-72.)) the Netherlands |
Compare the discriminant validity and reliability of the CPOT and BPS simultaneously in patients under IMV admitted to an adult ICU |
Observational prospective study Assessment of pain in patients undergoing IMV using the BPS and CPOT at rest, shortly before and during painful and nonpainful procedures MQ = 10 |
Convenience sample of 68 patients admitted to the ICU under IMV The sample was divided into three subgroups according to RASS scores |
Both scales (BPS and CPOT) were reliable and valid for pain assessment in the ICU There was good interrater reliability (ICC = 0.75 for the CPOT and ICC = 0.75 for the BPS); good internal consistency (α = 0.71 for the CPOT and 0.70 for the BPS) Although most of the indicators in both scales increased with a painful procedure, only those in the BPS increased in association with a nonpainful procedure |
Liu et al.,((1515 Liu Y, Li L, Herr K. Evaluation of two observational pain assessment tools in Chinese critically ill patients. Pain Med. 2015;16(8):1622-8.)) China |
Evaluate and compare the reliability and validity of the BPS and the CPOT for pain assessment in intubated and nonintubated critically ill patients |
Observational prospective study A total of 608 pain assessments were performed using the CPOT and BPS (BPS and BPS-NI) before and during painful and nonpainful procedures MQ = 9 |
Convenience sample of 117 critically ill adult patients admitted to the ICU |
The BPS and CPOT were found to be reliable and valid to assess pain in intubated and nonintubated patients The results showed good interrater reliability (ICC = 0.973 for the CPOT and ICC = 0.955 for the BPS); good internal consistency (α = 0.795 for the CPOT and 0.791 for the BPS) and reliability of 0.950 (CPOT) and 0.941 (BS) |
Al Darwish et al.,((1616 Al Darwish ZQ, Hamdi R, Fallatah S. Evaluation of pain assessment tools in patients receiving mechanical ventilation. AACN Adv Crit Care. 2016;27(2):162-72.)) Saudi Arabia |
Determine the reliability and validity of nonverbal pain assessment tools in critically ill patients (BPS, NVPS and CPOT) |
Descriptive observational study with quantitative analysis Three pain assessment instruments – the BPS, CPOT, NVPS – were administered before, during and after painful and nonpainful procedures for a total of 240 evaluations MQ = 9 |
Convenience sample of 47 critically ill noncommunicating patients undergoing IMV admitted to the ICU |
The BPS was the most valid and appropriate instrument to assess pain in noncommunicating patients admitted to the ICU due to the characteristics of its subscales; however, the CPOT was considered an appropriate alternative. The results showed good interrater reliability (ICC = 0.80) and good internal consistency (α = 0.95 (CPOT); 0.95 (BPS); 0.86 (NVPS)) The NVPS was not sensitive to assess pain in these patients |
Rahu et al.,((1717 Rahu MA, Grap MJ, Ferguson P, Joseph P, Sherman S, Elswick RK Jr. Validity and sensitivity of 6 pain scales in critically ill, intubated adults. Am J Crit Care. 2015;24(6):514-23.)) United States |
Identify the most appropriate scale for pain assessment in intubated patients Determine the validity and sensitivity of six pain scales |
Descriptive study Observations were made by two independent investigators in communicating and noncommunicating intubated patients before and during nonpainful and painful procedures using six scales (NVPS; BPS; Comfort; Faces; Face, Legs, Activity, Cry, Consolability; NRP) MQ = 9 |
Convenience sample of 50 communicating patients and 100 patients who were unable to communicate verbally who were intubated and undergoing IMV |
All pain scales had moderate to high correlation with the self-report of patients during endotracheal suction (painful procedure) All scales were sensitive in obtaining the patient's pain response in all phases (p < 0.001) Both the patients and the investigators assessed the highest pain on the Faces scale, which reveals that some caution in its use is necessary |
Chanques et al.,((1818 Chanques G, Pohlman A, Kress JP, Molinari N, de Jong A, Jaber S, et al. Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report. Crit Care. 2014;18(5):R160.)) United States |
Compare the psychometric properties of three pain assessment scales (the BPS/BPS-NI, CPOT and NVPS) in intubated and nonintubated patients unable to self-report pain |
A total of 258 assessments of pain, sedation (RASS) and delirium (CAM-ICU) were performed by at least one investigator and one nurse in 30 patients before, during and 10 minutes after routine procedures MQ = 10 |
Convenience sample of 30 adult patients; RASS > -4 in patients who were unable to self-report their pain intensity |
The three scales showed good psychometric properties in the assessment of pain in intubated and nonintubated patients unable to self-report their pain intensity The BPS and CPOT showed better reliability (κ = 0.81 for both) and internal consistency (α = 0.80 - BPS; α = 0.81 - CPOT). The BPS was classified as the most feasible scale, with the highest score on the category of "easiest to remember" |
Bourbonnais et al.,((1919 Bourbonnais FF, Malone-Tucker S, Dalton-Kischei D. Intensive care nurses' assessment of pain in patients who are mechanically ventilated: how a pilot study helped to influence practice. Can J Crit Care Nurs. 2016;27(3):24-9.)) Canada |
Determine the appropriateness of the CPOT as an instrument for assessing pain in adult patients under IMV admitted to the ICU |
Descriptive study Applied a data collection instrument (CPOT, record of sedation, analgesia and performed interventions, and open questions to nurses related to the use of CPOT) MQ = 9 |
Convenience sample of 23 nurses who used the CPOT to assess 23 patients |
Each patient was assessed five times, for a total of 115 evaluations 75 assessments indicated that the patient presented pain (mean = 3.03) Pain assessment and identification of pain episodes occurred more frequently when the CPOT was applied Nurses stated that the scale was easy to use and that it would be useful to apply it in practice for the identification of pain in patients undergoing IMV admitted to the ICU |
Vadelka et al.,((2020 Vadelka A, Busnelli A, Bonetti L. [Comparison between two behavioural scales for the evaluation of pain in critical patients, as related to the state of sedation: an observational study]. Scenario. 2017;34(2):4-14. Italian.)) Italy |
Analyze the degree of compatibility between the CPOT and the BPS/BPS-NI when evaluating pain |
Cross-sectional observational study A total of 528 pain assessments were performed on patients admitted to the ICU before and after two procedures (one painful and one nonpainful) MQ = 9 |
Convenience sample of 33 patients admitted to the ICU |
Both tools were considered valid and reliable, capable of detecting the intensity of pain in critically ill patients even under high levels of pharmacological sedation There were no significant differences (p > 0.05) between patients with different levels of sedation or analgesia |
Severgnini et al.,((2121 Severgnini P, Pelosi P, Contino E, Serafinelli E, Novario R, Chiaranda M. Accuracy of critical care pain observation tool and behavioral pain scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study. J Intensive Care. 2016; 4:68.)) Italy |
Compare the CPOT and BPS for the assessment of pain in conscious and unconscious patients |
Observational study A total of 303 consecutive observations were performed over 3 days after admission to the ICU Measurements with both scales were obtained 1 minute before, during and 20 minutes after nursing procedures The VAS score was recorded, whenever possible, only in conscious patients MQ = 10 |
Convenience sample of 101 patients (conscious: n = 41; unconscious: n = 60) |
Both the BPS and CPOT can be used to assess pain intensity in critically ill conscious and unconscious patients undergoing mechanical ventilation but have different sensitivities and specificities Comparison of the CPOT and BPS at three different times using Cohen's kappa (before k = 0.69, during = 0.64 and after = 0.66) showed good correlation (k > 0.6) This study suggests that the CPOT is equivalent to the BPS because no scale has better sensitivity and specificity The criterion validity between the VAS and BPS (rs = 0.56; p < 0.0001) and the VAS and CPOT (rs = 0.48; p <0.0001) showed a strong correlation |
Hylén et al.,((2222 Hylén M, Akerman E, Alm-Roijer C, Idvall E. Behavioral Pain Scale - Translation, reliability, and validity in a Swedish context. Acta Anaesthesiol Scand. 2016;60(6):821-8.)) Sweden |
Translate and validate the BPS for critically ill patients |
Observational descriptive study with quantitative analysis The scale was applied before and after procedures considered potentially painful (repositioning) MQ = 9 |
Convenience sample of 20 critically ill patients admitted to the ICU (10 intubated and 10 nonintubated patients) |
The Swedish version of the BPS is adequate for pain assessment in patients unable to self-report pain The discriminant validity for the assessments before, during and after the procedure obtained a percentage agreement of 28%, with 95% CI (relative position of -0.08 to +0.02; relative concentration of -0.06 to +0.08; relative variance of classification of 0.000 - 0.002) and a reliability of 85%. |
Frandsen et al.,((2323 Frandsen JB, O'Reilly Poulsen KS, Laerkner E, Stroem T. Validation of the Danish version of the Critical Care Pain Observation Tool. Acta Anaesthesiol Scand. 2016;60(9):1314-22.)) Denmark |
Validate the Danish version of the CPOT for patients admitted to the ICU without a sedation protocol |
Quantitative, descriptive, observational study Patients were observed before, during and 15 minutes after nonpainful and a painful procedures (6 observations performed by two independent observers). MQ = 10 |
Convenience sample of 70 critically ill patients admitted to the ICU and undergoing mechanical ventilation without sedation |
CPOT shows good reliability and interrater agreement (ICC > 0.90), internal consistency (α> 0.70) and significant correlation between the CPOT values and the reported pain (p < 0.05) |
Linde et al.,((2424 Linde SM, Badger JM, Machan JT, Beaudry J, Brucker A, Martin K, et al. Reevaluation of the Critical-Care Pain Observation Tool in intubated adults after cardiac surgery. Am J Crit Care. 2013;22(6):491-7.)) Iceland |
Validate the CPOT for pain assessment during painful and nonpainful procedures |
Observational descriptive study Observational data were collected during painful procedure and a nonpainful procedure MQ = 9 |
Convenience sample of 30 intubated patients after cardiac surgery |
The results support the viability and reliability of the CPOT in the assessment of pain in adult patients The mean CPOT scores showed a significant increase only during the painful procedure (+3.04; 95% CI 2.11 - 3.98; p < 0.001) |
Topolovec-Vranic et al.,((2525 Topolovec-Vranic J, Gélinas C, Li Y, Pollmann-Mudryj MA, Innis J, McFarlan A, et al. Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag. 2013;18(6):e107-14.)) Canada |
Evaluate the validity and clinical utility of the NVPS-R and the CPOT in a trauma and neurosurgical patient population |
Prospective descriptive study Assessment of pain using the NVPS-R and CPOT at three separate times: before, during and after a painful and a nonpainful procedure MQ = 9 |
23 nurses (12 assessed patient pain using the CPOT and 11 using the NVPS-R) Convenience sample of 66 patients admitted to the adult ICU (34 communicating and 32 noncommunicating patients) |
The CPOT has a greater validity than the NVPS-R for pain assessment in critically ill noncommunicating patients, particularly those with neurological and trauma injuries The interrater reliability was higher for the CPOT (0.60 - 0.97) than for the NVPS-R (0.34 - 0.92). The self-reported pain and assessment performed by nurses showed a moderate correlation in both scales (NVPS-R: σ = 0.313 and p < 0.001; CPOT: σ = 0.435 and p < 0.001). |