Academic journal article Journal of Nursing Measurement

A New Faces Scale in Pain Measurement: A Test of Bias from Current Mood, Trait Affectivity, and Scale Range

Academic journal article Journal of Nursing Measurement

A New Faces Scale in Pain Measurement: A Test of Bias from Current Mood, Trait Affectivity, and Scale Range

Article excerpt

Background and Purpose: Faces pain rating scales used among children have been criticized to confound affective states with pain when smiling faces are included. This experimental study is an attempt to examine the possible confounding of affective states with pain when smiling faces are used as part of a faces scale. The meaning of the faces was tested to depend on current mood, current pain, trait affectivity, and inclusion versus exclusion of smiling faces. Methods: Sixty-four participants made 6,720 twocategorical pain judgments on faces with different mouth curvature. Results: In multilevel regression analysis, current level of pain and negative trait affectivity biased faces' meaning only when the smiling faces were excluded from the scale. Conclusions: In adults, the new full range faces pain scale including a midpoint neutral face and smiling faces was more robust than the restricted scale. The faces scale that was tested in this study is not applicable for patient measurement but it is an interesting tool for psychological research.

Keywords: faces scales; neuroticism; pain assessment; range effects

Pain ratings are valuable information in medical diagnosis and are among the most important outcome variables in medical intervention (Häfeli et al., 2008; Zanoli, Strömqvist, Jönsson, Padua, & Romanini, 2002). Measurement of pain, therefore, is also a key issue in nursing (Elfering, 2006). Standardized self-report questionnaires on pain include different scale formats with visual analogue scales (VAS), graphic rating scales (GRS), numerical rating scales (NRS), and verbal rating scales (VRS), each with specific advantages with respect to reliability, validity, and sensibility, as discussed elsewhere (Häfeli & Elfering, 2006; Mannion, Balagué, Pellisé, & Cedraschi, 2007). However, all these scales that include verbal descriptors, labels, and numbers depend on patients' language ability and cognitive ability; and therefore, their validity can differ in very young patients (Stinson, Kavanagh, Yamada, Gill, & Stevens, 2006), deaf patients (Palese, Salvador, & Cozzi, 2011), or in patients with cognitive impairment (Benaim et al., 2007; Stuppy, 1998). For instance, in young children, faces as response options seem to be more appropriate than other types of scales (Bieri, Reeve, Champion, Addicoat, & Ziegler, 1990; Hicks, von Baeyer, Spafford, van Korlaar, & Goodenough, 2001; Kuttner & LePage, 1989; Maunuksela, Olkkola, & Korpela, 1987; Perrott, Goodenough, & Champion, 2004; Stinson et al., 2006; Wong & Baker, 1988).

BACKGROUND AND CONCEPTUAL FRAMEWORK

Using a faces scale, young patients can choose a face out of various faces to match their intensity of pain. Many of these faces scales, for example, the Wong-Baker FACES Pain Rating Scale (WBFPRS; Wong & Baker, 1988) include smiling and crying faces. Chambers and others criticized the use of smiling faces for children because inclusion of smiling faces confounds non-noxious affective states with measurement of pain ("having no pain does not mean to be happy"; Chambers, Giesbrecht, Craig, Bennett, & Huntsman, 1999; Chambers, Hardial, Craig, Court, & Montgomery, 2005; Chambers & Johnston, 2002). Instead, Chambers et al. (1999) would suggest the use of a scale that excludes smiling faces but begins with a "neutral face" as a more appropriate choice option for having no pain. Thereby, the neutral face is thought to represent a pain-free status where the confounding influence of unhappiness, fear, and anger is lower than in smiling faces. To the extent that Chambers and colleagues are right-and recent results confirmed their view (Chambers et al., 2005; Tomlinson, von Baeyer, Stinson, & Sung, 2010)-current mood should bias the understanding of faces in a pain rating scale that includes smiling faces and faces with downturned mouth, but not in the scale that excludes smiling faces. Furthermore, when the scale includes no smiling faces the meaning of the neutral face should be expected to indicate "no pain," and the neutral face indication of pain should be unrelated to current affectivity. …

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