Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar 13;13(3):e0194094.
doi: 10.1371/journal.pone.0194094. eCollection 2018.

Verifying the validity and reliability of the Japanese version of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale

Yujiro Matsuishi  1   2 , Haruhiko Hoshino  1   2 , Nobutake Shimojo  1 , Yuki Enomoto  1   3 , Takahiro Kido  1   3 , Tetsuya Hoshino  1 , Masahiko Sumitani  4 , Yoshiaki Inoue  1
Affiliations

Verifying the validity and reliability of the Japanese version of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale

Yujiro Matsuishi et al. PLoS One. .

Abstract

Background: Pediatric patients, especially in the preverbal stage, cannot self-report intensity of pain therefore several validated observational tools, including the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale, have been used as a benchmark to evaluate pediatric pain. Unfortunately, this scale is currently unavailable in Japanese, precluding its widespread use in Japanese hospitals.

Objectives: To translate and verify the validity and reliability of the Japanese version of the FLACC Behavioral Scale.

Method: Back-translation was first conducted by eight medical researchers, then an available sample of patients at the University of Tsukuba Pediatric Intensive Care Unit (from May 2017 to August 2017) was enrolled in a clinical study. Two researchers evaluated the validity of the translated FLACC Behavioral Scale by weighted kappa coefficient and intraclass correlation coefficients (ICC). Observational pain was simultaneously measured by the visual analog scale (VAS obs) and reliability was evaluated by correlation analysis.

Result: The original author approved the translation. For the clinical study, a total of 121 observations were obtained from 24 pediatric patients. Agreement between observers was highly correlated for each of the FLACC categories (Face: κ = 0.85, Leg: κ = 0.74, Activity: κ = 0.89, Cry: κ = 0.93, Consolability: κ = 0.93) as well as the total score (Total: κ = 0.95,). Correlation analysis demonstrated a good criterion validation between the FLACC scale and the VAS obs. (r = 0.96).

Conclusion: Our Japanese version of the FLACC Behavioral Scale shows high validity and reliability.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Back translation method.
Flow of the back translation method used to translate the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale.
Fig 2
Fig 2. Criterion validity on Japanese version of FLACC Behavioral Scale.
Correlation analysis between observational visual analog scale (VAS obs) and FLACC Behavioral Scale. FLACC Behavioral Scale score significantly correlated with VAS obs. (r = 0.96).
See this image and copyright information in PMC

References

    1. Barker DP, Rutter N. Exposure to invasive procedures in neonatal intensive care unit admissions. Arch Dis Child Fetal Neonatal Ed. 1995;72(1):F47–8. - PMC - PubMed
    1. Carbajal R, Rousset A, Danan C. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA. 2008;300(1):60–70. doi: 10.1001/jama.300.1.60 - DOI - PubMed
    1. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 23(3):293–7. - PubMed
    1. Kabes AM, Graves JK, Norris J. Further validation of the nonverbal pain scale in intensive care patients. Crit Care Nurse. 2009;29(1):59–66. doi: 10.4037/ccn2009992 - DOI - PubMed
    1. Matsuishi Y, Hoshino H, Shimojo N, Enomoto Y, Kido T, Jesmin S, et al. Development of the Japanese version of the Preschool Confusion Assessment Method for the ICU. Acute Med Surg. 2017;1–4. - PMC - PubMed

Publication types

LinkOut - more resources