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Body Diagram
Availability
Please visit this website for more information about the instrument: Body Diagram
Classification
Exploratory: Cerebral Palsy (CP)   
Short Description of Instrument
The Body Diagram was originally developed and used with an adult population to assess the location, distribution, and intensity of acute and chronic pain (Melzack, 1975). This discriminative tool has been validated with children with chronic pain conditions (O'Donnell & Curley, 1985).
Comments/Special Instructions
Body diagrams are included in the Adolescent Pediatric Pain Tool (Jacob et al., 2014), the Pediatric Pain Questionnaire (Varni, 1987) and the Brief Pain Inventory (Cleeland, 2009).
 
The method in which data is being collected about pain (face to face, telephone, paper or electronic) should be considered when choosing to use a body diagram alone or in combination with additional assessment tools (van Baeyer et al., 2011).
 
CP-specific Pain Categories: Pain Location, Pain Intensity
 
CP-specific ICF Domains: Body Structure and Body Functions (World Health Organization, 2001)
Scoring and Psychometric Properties
Scoring: Several ways of scoring pain charts have been recorded, including informal verbal description of the location indicated on the chart, a grid of squares can be placed over the pain chart and the number of filled-in squared can be counted, and a preselected set of pain locations that are demarcated on a transparent overlay (von Baeyer et al., 2011).
 
Psychometric Properties: By using demarcated scoring templates in conjunction with stringent protocols, von Baeyer et al. (2011) yielded near 100% scoring reliability. The use of a body outline tool to report pain was found to have good content and concurrent validity when comparing the body outline tool to observation and medical records, and good alternate form reliability when comparing the body outline report to pointing (r=.83) (Savedra et al., 1989).  
Rationale/Justification
Strengths:
Based on limited existing data, pain charts seem to be most appropriate for children aged 8 years and older, although younger children can use them with adult assistance. Pain charts offer great flexibility for use of color and symbols to represent not only the presence and absence of pain, but also its quality and intensity (van Baeyer et al., 2011).
 
Scoring pain charts in clinical practice by the informal verbal description of the location indicated on the chart has the advantage of using only that level of specificity needed for diagnosis and treatment.
 
Weaknesses:
Scoring methods vary as to their reliability and validity. Children with greater impairment in gross/fine motor function or communication impairments affecting ability to verbally indicate pain locations may decrease the accuracy of the assessment. Nondemarcated body maps can be subjective and dependent on the scorer (van Baeyer et al., 2011). Specific scoring methods need to be identified and consistent for use in research.  
References
Key Reference:
von Baeyer CL, Lin V, Seidman LC, Tsao JC, Zeltzer LK. Pain charts (body maps or manikins) in assessment of the location of pediatric pain. Pain Manag. 2011 Jan;1(1):61-68.
 
Additional References:
Cleeland C. The Brief Pain Inventory User's Guide., 2009. Brief Pain.
 
Jacob E, Mack AK, Savedra M, Van Cleve L, Wilkie DJ. Adolescent pediatric pain tool for multidimensional measurement of pain in children and adolescents. Pain Manag Nurs. 2014 Sep;15(3):694-706.
 
Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975 Sep;1(3):277-299.
 
O'Donnell PJ, Curley H. Validation of a nonverbal instrument for pain location descriptions in children. Percept Mot Skills. 1985 Jun;60(3):1010.
 
Savedra MC, Tesler MD, Holzemer WL, Wilkie DJ, Ward JA. Pain location: validity and reliability of body outline markings by hospitalized children and adolescents. Res Nurs Health. 1989 Oct;12(5):307-14.
 
Varni JW, Thompson KL, Hanson V. The Varni/Thompson Pediatric Pain Questionnaire. I. Chronic musculoskeletal pain in juvenile rheumatoid arthritis. Pain. 1987 Jan;28(1):27-38.
 
World health Organization (2001). International Classification of Functioning, Disability and Health (ICF) Retrieved 19August2021 https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health
 
Document last updated August 2022