Descrição
Introduction: As pain is both subjective and multidimensional, its assessment is challenging especially in children with cancer. The Adolescent Pediatric Pain Tool is a measure with 3 components: a word graphic rating scale (pain intensity), a body outline diagram (pain location) and a list of pain descriptors (pain quality).
Aims: To culturally validate the APPT to european Portuguese and to examine the psychometrics properties of the translated version.
Methods: Methodological study conducted in two phases.Phase 1 included the translation and back translation of the tool and its validation by a pannel of experts and the author of the original version. The semantic and cultural validation of the list of descriptors was performed through Q-sort method with 48 portuguese children, equaly distributed by age (8-12yo; 13-17yo), sex and health condition (healthy/cancer). Children were given 67 cards with printed descriptors and were asked to sort them in three groups: words that I know and use to describe pain, words that I know but don't use to describe pain and words that I don?t know. To be included on the final list of pain descriptors, a criterion was set of at least 75% of the children knowing the word.
Phase 2 examined the psychometric properties of the APPT. One hundred portuguese cancer children equaly distributed by age (8-12yo; 13-17yo) and sex were included. Children were asked to report their present pain or their last pain episode.
Outcome measures: For phase 1, demographic data and percentage of words known, not known and used to describe pain were calculated. For phase 2, demographic data, number of pain sites and surface area, pain intensity and quality scores (total, sensory, evaluative, affective and temporal) were obtained. Psychometric properties were established by calculating the correlation between location, intensity and quality scores (Spearman test) and by testing the differences between age groups and sex (Mann-Whitney U test). Construct validity of the theoretically organized dimensions was assessed using optimal scaling method.
Results: In Phase 1, out of the 67 descriptors presented, 9 were unknown to 75% or more children. These decriptors were replaced by semantically equivalent words. These new words, along with a word that was suggested by some children were again submitted to the Q-sort and since they were known by more than 75% of the children, they were included on the final list.
Analysis of psychometric properties revealed that the three components of the APPT are positive and significantly correlated to each other (rs= 0,21 to 0,34, p<0.05) as well as quality scores (rs=0,39 to 0,89, p=0,00). Pain location, intensity and quality did not differ by age groups or sex. Factor analysis did not fit the predicted model.
Conclusion: The Portuguese (PT) version of the APPT is a validated and reliable tool to assess pain in portuguese children with cancer. Future psychometric studies should employ longitudinal data to evaluate the fitness of a short form of the tool. This multidimensional pain assessment tool is useful in both clinical practice and research, allowing multiple features of the pain experience to be examined.
â—ÂÂ Acknowledgements
[PTDC/PSI-PCL/114652/2009]
; Batalha, Luís Manuel da Cunha 
