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Comparison of Average Weekly Pain Using Recalled Paper and Momentary Assessment Electronic Diary Reports in Children With Arthritis

Stinson, Jennifer N. RN, PhD, CPNP*,†,‡; Jibb, Lindsay A. RN, MSc*,†; Lalloo, Chitra BHSc§; Feldman, Brian M. MD, MSc, FRCPC†,‡,∥,¶,#; McGrath, Patrick J. OC, PhD, FRSC**,††; Petroz, Guy C. MD†,‡; Streiner, David PhD, CPsych‡‡,§§; Dupuis, Annie PhD; Gill, Navreet RN, MN*; Stevens, Bonnie J. RN, PhD*,†

doi: 10.1097/AJP.0000000000000072
Original Articles

Objective: The current study investigated the construct validity of a multidimensional pain diary for youth with juvenile idiopathic arthritis and also compared participants’ responses on electronic and retrospective diary measures. The purpose of the latter part of this study was to compare absolute agreement, between-person and within-person consistency and judged change in weekly pain between these 2 methods of assessing pain.

Methods: A total of 70 adolescents with juvenile idiopathic arthritis completed both weekly recalled and momentary reports of pain over a 2-week period and assessed their change in pain over the 2-week period using a 5-point global change in pain scale. The Pearson correlations and intraclass correlation coefficients were computed to demonstrate 3 different ways of comparing the measures on both between-person and within-person basis.

Results: Momentary ratings of pain episodes were consistently greater than weekly ratings of recalled pain. Moderate to strong consistency and agreement correlations were computed for between-person momentary and recalled pain intensity. However, these correlations were much weaker when the within-person data were analyzed. The judged change in pain across weeks was significantly associated with computed change in both average momentary and recalled pain.

Discussion: This is one of the few studies to explore the relationship between the measurement methods of pain recall and momentary assessment in adolescents. The poor within-person correlations observed have important implications for research design and practice in pediatric pain.

*Lawrence S. Bloomberg Faculty of Nursing

Departments of Anaesthesia



Institute of Health Policy Management & Evaluation

#Dalla Lana School of Public Health, University of Toronto

The Hospital for Sick Children, Child Health Evaluative Sciences

§§Baycrest Centre for Geriatric Care, Toronto

§Medical Sciences Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, ON

**Department of Psychology, Dalhousie University, Halifax, Nova Scotia

††IWK Health Centre, Halifax, NS, Canada

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Funding is gratefully acknowledged from the University of Toronto Centre for the Study of Pain AstraZeneca Award (Toronto, Ontario, Canada). J.N.S.’s work was supported by a Canadian Nurses Foundation (Ottawa, Ontario, Canada)/Hospital for Sick Children (Toronto, Ontario, Canada)/Canadian Institutes of Health Research Doctoral Fellowship (Ottawa, Ontario, Canada), Hospital for Sick Children Clinician Scientist Training Fellowship (Toronto, Ontario, Canada), and Pain in Child Health CIHR Strategic Training Program (Halifax, Nova Scotia, Canada). B.M.F. and P.J.M. hold Canada Research Chairs (Ottawa, Ontario, Canada). B.J.S. holds the Signy Hildur Eaton Chair in Paediatric Nursing Research at the Hospital for Sick Children (Toronto, Ontario, Canada). The remaining authors declare no conflict of interest.

Reprints: Jennifer Stinson, RN, PhD, CPNP, Chronic Pain Program, Department of Anaesthesia, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8 (e-mail:

Received April 1, 2013

Received in revised form February 12, 2014

Accepted January 9, 2014

© 2014 by Lippincott Williams & Wilkins