Translation and cultural adaptation of an objective pain assessment tool for Finnish ICU patients

Abstract

The purpose of this study was to culturally validate three pain measurement instruments [Behavioral Pain Scale (BPS), the Critical-Care Pain Observation Tool (CPOT) and the Nonverbal Adult Pain Assessment Scale (NVPS)] for sedated intensive care patients and in doing so to prepare the tools for psychometric testing in the Finnish intensive care environment. Most patients feel pain during their stay in an intensive care unit. Pain recognition and assessment is the first step towards effective pain management. The BPS, CPOT and NVPS are the most valid and reliable pain assessment instruments developed to objectively assess pain in sedated intensive care patients. The translation and cultural adaptation of the instruments were done according to the guidelines of the International Society for Pharmacoeconomics and Outcomes (ISPOR). The process included 10 phases aiming to produce semantically correct Finnish versions of the pain assessment instruments. This translation process was chosen due to its rigorousness and systematic approach. The 10-step translation and cultural validation process were successfully conducted, although it was complex and time-consuming. The resulting Finnish versions of the three pain assessment instruments showed good evidence of content and conceptual equivalence. Although further work is needed to test these instruments in the Finnish intensive care context, the current Finnish versions are potential instruments for clinicians to use. Deciding when this high-quality process is needed requires thorough consideration. However, it is worthwhile to use it when implementing new instruments at a national level. We need a valid, reliable and feasible instrument for pain assessment in sedated intensive care patients in Finland. The next step in our process is conducting psychometric testing of these three instruments to choose the tool with the best properties to be implemented in clinical practice.