Respuesta a: Sobre la ubicuidad del coeficiente alfa en los estudios de validación / Response to: About the ubiquity of the alpha coefficient in the validation studies

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Fiabilidad interobservador y consistencia interna de la Behavioral Pain Scale en pacientes con ventilación mecánica / Intraobserver reliability and internal consistency of the Behavioral Pain Scale in mechanically-ventilated patients

Antecedentes: La Behavioral Pain Scale (BPS) es un instrumento de evaluación del dolor poco extendido que a menudo crea controversia entre los distintos observadores. Objetivo: Evaluar la fiabilidad interobservador y la consistencia interna de la escala BPS en la valoración del dolor. Método: Estudio observacional y prospectivo en 34 pacientes con ventilación mecánica realizado en un Servicio de Medicina Intensiva entre abril y junio de 2012. Las variables analizadas fueron: características demográficas, motivo de ingreso, estado clínico, dolor y nivel de sedación. La evaluación del dolor la realizaban 2 enfermeras de manera independiente, en reposo (T1) y durante una movilización (T2), mediante la escala BPS. Se evaluó la consistencia interna con el alfa de Cronbach y la fiabilidad interobservador con el coeficiente de correlación intraclase (CCI), con un intervalo de confianza (IC) del 95%. Este estudio fue aprobado por el Comité Ético de Investigación Clínica. Resultados: Se realizaron 128 evaluaciones de dolor. En el análisis de fiabilidad, el alfa de Cronbach de la puntuación total de la BPS en reposo fue de 0,66 (IC 95%: 0,33-0,83) y durante la movilización de 0,73 (IC 95%: 0,50-0,87). El CCI de la puntuación total de la BPS fue de 0,50 (IC 95%: 0,19-0,71) en reposo y de 0,58 (IC 95%: 0,31-0,77) durante la movilización. Conclusiones: El nivel de consistencia interna de la escala es adecuado y la concordancia interobservador moderada. Para que la BPS resulte útil en la práctica clínica es imprescindible que las enfermeras dispongan de experiencia previa con un uso reglado de esta herramienta

Background: The Behavioral Pain Scale (BPS) is a tool of pain assessment that often gives contradictory results when used by different raters. Objective: To assess internal consistency and interrater reliability of BPS scale in the pain assessment performed by intensives care nurses. Methods: A prospective observational study in 34 mechanically-ventilated patients, carried out in an Intensive Care Unit from April to June 2012. Variables analyzed included demographic characteristics, diagnosis of referral, clinical status, pain and sedation level. Pain was assessed by two nurses independently at rest (T1) and during a mobilization procedure (T2) using the BPS scale. Internal consistency was calculated by Cronbach's alpha, and intraobserver reliability was determined with the intraclass correlation coefficient (ICC), with a confidence interval (CI) of 95%. This study was approved by the Ethical Committee for Clinical Research. Results: One-hundred and twenty-eight pain assessments were performed. The Cronbach's alpha of total BPS score at rest was 0.66 (95% CI: 0.33 to 0.83) and during mobilization of 0.73 (95% CI: 0.47 to 0.87). The CCI of total BPS score was 0.50 (95% CI: 0.19 to 0.71) at rest and 0.58 (95% CI: 0.31 to 0.77) during mobilization. Conclusions: The level of internal consistency of the scale is appropriate and moderate interrater agreement. For the BPS useful in clinical practice, it is imperative that nurses have prior experience with a regulated use of this tool

[Intraobserver reliability and internal consistency of the Behavioral Pain Scale in mechanically-ventilated patients]. / Fiabilidad interobservador y consistencia interna de la Behavioral Pain Scale en pacientes con ventilación mecánica.

BACKGROUND: The Behavioral Pain Scale (BPS) is a tool of pain assessment that often gives contradictory results when used by different raters. OBJECTIVE: To assess internal consistency and interrater reliability of BPS scale in the pain assessment performed by intensives care nurses. METHODS: A prospective observational study in 34 mechanically-ventilated patients, carried out in an Intensive Care Unit from April to June 2012. Variables analyzed included demographic characteristics, diagnosis of referral, clinical status, pain and sedation level. Pain was assessed by two nurses independently at rest (T1) and during a mobilization procedure (T2) using the BPS scale. Internal consistency was calculated by Cronbach's alpha, and intraobserver reliability was determined with the intraclass correlation coefficient (ICC), with a confidence interval (CI) of 95%. This study was approved by the Ethical Committee for Clinical Research. RESULTS: One-hundred and twenty-eight pain assessments were performed. The Cronbach's alpha of total BPS score at rest was 0.66 (95%CI: 0.33 to 0.83) and during mobilization of 0.73 (95%CI: 0.47 to 0.87). The CCI of total BPS score was 0.50 (95%CI: 0.19 to 0.71) at rest and 0.58 (95%CI: 0.31 to 0.77) during mobilization. CONCLUSIONS: The level of internal consistency of the scale is appropriate and moderate interrater agreement. For the BPS useful in clinical practice, it is imperative that nurses have prior experience with a regulated use of this tool.