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Pediatric Pain Profile (PPP)
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Supplemental: Cerebral Palsy (CP)
Short Description of Instrument
The Pediatric Pain Profile (PPP) is a 20-item behavior rating scale designed to assess pain in children with severe physical and learning impairments (Hunt et al., 2004).
The PPP takes 2-3 minutes to complete (Hunt et al., 2004).
Comments/Special Instructions
The PPP is intended for completion by a parent or other proxy.
CP-specific Pain Categories: Pain Interference and Pain Behavior
CP-specific ICF Domains: Body Structures, Body Functions, Activity and Participation (World Health Organization, 2001).
Scoring and Psychometric Properties
Scoring: Each item of the 20-item PPP is scored on a four-point ordinal scale (0 to 3) according to the extent to which the behavior occurs within a given period. The score on each item is added to produce a score within the range 0 to 60 (Hunt et al., 2004).
A score of 14 or above suggests there may be significant pain that needs to be addressed.
Psychometric Properties: PPP demonstrated a high internal consistency ranging from 0.75 to 0.89 (Cronbach's alpha) and interrater reliability (comparing parental response to responses provided by a medical professional identified by the parent) of 0.74 (intraclass correlation). Importantly, no significant difference between overall PPP score was found for parents compared to medical professionals, nor was there a significant difference in scores based on familiarity with the child. A PPP score of 14 indicated a child had significant pain with a high sensitivity (1.00) and specificity (0.91) (Hunt et al., 2004).
Cronbach's alpha statistic was calculated as a measure of the scale's internal consistency. Alpha was 0.75 for the child 'at best', 0.82 for Pain A (most troublesome pain) and 0.86 for Pain B (second pain). Correlation of each separate item with the total pain score (item-total correlation) was between 0.3 and 0.7 for 75% of items for Pain A assessments and 85% of Pain B assessments (Hunt et al., 2004).
PPP score was also assessed after administration of an analgesic with significant improvement in score (paired-sample t-tests, p<0.001).  Interrater reliability also remained high at 0.87. Furthermore, a PPP score of 14 indicated a child had significant pain after analgesic administration with a high sensitivity (0.95) and specificity (1.00). Though there was no significant difference in mean pre- and postoperative scores, highest PPP score occurred in the first 24 hours after surgery in 14 (47%) children. Results suggest that the PPP is reliable and valid and has potential for use both clinically and in intervention research (Hunt et al., 2004).
Strengths: This measure is unique in its global assessment of chronic pain in children with profound physical, intellectual, and communication impairments. The PPP has been found to have excellent internal consistency and high interrater reliability, even when performed by a person unfamiliar with the child. In addition to good levels of interrater reliability, the Hunt et al. (2004) study demonstrated that the PPP has face, concurrent, and construct validity with scores increasing in line with the observer's global rating of the child's pain and decreasing when analgesics were administered for pain (Hunt et al., 2004).
Ease of administration facilitates the use of the PPP for pain assessment in varied settings and longitudinally in children with profound impairments.
Weaknesses: In the absence of any criterion-standard measures for pain in this group of children, Hunt et al. (2004) showed that in assessing the concurrent validity of the PPP, compared the PPP score with the observers' global impressions of the children's pain on a verbal rating scale. However, several studies have identified differences between the ratings of a child's pain by parents and professional caregivers and the self-reports of the children themselves (Chambers et al., 1998; Cleary et al., 2002). Furthermore, it is not clear if the participants in the validation studies were representative of differing ethnicities or cultures, which may influence pain perception and reporting.
Key Reference:
Hunt A, Goldman A, Seers K, Crichton N, Mastroyannopoulou K, Moffat V, Oulton K, Brady M. Clinical validation of the paediatric pain profile. Dev Med Child Neurol. 2004 Jan;46(1):9-18.
Additional References:
Hunt A, Mastroyannopoulou K, Goldman A, Seers K. Not knowing--the problem of pain in children with severe neurological impairment. Int J Nurs Stud. 2003 Feb;40(2):171-183.
Hunt A, Wisbeach A, Seers K, Goldman A, Crichton N, Perry L, Mastroyannopoulou K. Development of the paediatric pain profile: role of video analysis and saliva cortisol in validating a tool to assess pain in children with severe neurological disability. J Pain Symptom Manage. 2007 Mar;33(3):276-289.
Health measurement scales: a practical guide to their development and use (5th edition). Aust N Z J Public Health. 2016 Jun;40(3):294-5.
World health Organization (2001). International Classification of Functioning, Disability and Health (ICF) Retrieved 19August2021
Document last updated August 2022