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A Comparison of Observers' and Self-Report Pain Ratings for Children With Cerebral Palsy

Hadden, Kellie L. PhD*; LeFort, Sandra PhD, RN; O'Brien, Michelle BSc, PT; Coyte, Peter C. PhD§; Guerriere, Denise N. PhD, RN§

Journal of Developmental & Behavioral Pediatrics: January 2015 - Volume 36 - Issue 1 - p 14–23
doi: 10.1097/DBP.0000000000000118
Original Article

Objectives: This study aimed to examine (1) the relationship between children's self-reports of pain and their different care providers' pain ratings, (2) the relationship between different care providers' ratings of pain in children with cerebral palsy (CP), and (3) whether the child's level of disability influences care providers' pain ratings.

Methods: Sixty-three children with CP were separated into 2 groups according to whether they were able to pass a self-report training task. Pain was rated using a Numerical Rating Scale and the Non-Communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV). Children were observed during their regular physiotherapy sessions at 3 separate time segments (Baseline, Stretch Procedure, and Recovery).

Results: As anticipated, results showed that all observers reported significantly higher pain scores during a physiotherapy stretching procedure than the baseline and recovery segments. Observers' NCCPC-PV scores were significantly higher during the stretch procedure for the children who did not pass the self-report training task. Findings also indicated that parents tended to report significantly lower pain scores compared with both their children and other observers.

Conclusions: The findings bring into question the accuracy of single-observer pain ratings for children with CP and possess implications for the management of pain in children with CP.

*Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada;

School of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada;

Janeway Children's Hospital and Rehabilitation Center, St. John's, NL, Canada;

§Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Address for reprints: Kellie L. Hadden, PhD, Department of Psychology, Memorial University of Newfoundland, St. John's, NL A1B 3X9, Canada; e-mail:

Denise N. Guerriere is currently affiliated wtih the Canadian Centre for Health Economics, Toronto, Ontario, Canada.

This investigation has been supported by grants to the first author as primary investigator from the Canadian Institutes of Health Research (CIHR) Regional Partnership Program, The Newfoundland & Labrador Centre for Applied Health Research, Canada-Newfoundland Comprehensive Economic Development Agreement, Province of Newfoundland: Department of Health and Community Services, Canadian Pain Society/Pfizer Award, and The Janeway Children's Hospital Foundation. The authors would like to thank the assistance of Sheryl Faseruk, and Amanda Rivis. We would also like to thank all the families and the physiotherapists who participated in this study.

Disclosure: The authors declare no conflict of interest.

Received July , 2014

Accepted October , 2014

© 2015 by Lippincott Williams & Wilkins