• Cristini Klein, Wolnei Caumo, Céline Gélinas, Valéria Patines, Tatiana Pilger, Alexandra Lopes, Fabiane Neiva Backes, Débora Feijó Villas-Boas, and Vieira Silvia Regina Rios SRR Department of Intensive Care Medicine, Clinicas Hospital from Porto Alegre (HCPA), Porto Alegre, Brazil; Post Graduate Program in Medical Sc.
• Department of Intensive Care Medicine, Clinicas Hospital from Porto Alegre (HCPA), Porto Alegre, Brazil; Post Graduate Program in Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratory of Pain & Neuromodulation, HCPA/UFRGS, Porto Alegre, Brazil. Electronic address: ckklein@hcpa.edu.br.
• J Pain Symptom Manage. 2018 Oct 1; 56 (4): 594-601.

ContextThe Behavioral Pain Scale (BPS) or the Critical-Care Pain Observation Tool (CPOT) are recommended in practice guidelines for pain assessment in critically ill adults unable to self-report. However, their use in another language requires cultural adaptation and validation testing.ObjectivesCross-cultural adaptation of the CPOT and BPS English versions into Brazilian Portuguese, and their validation by comparing behavioral scores during rest, standardized nociceptive stimulation by pressure algometry (SNSPA), and turning were completed. In addition, we explored clinical variables that could predict the CPOT and BPS scores.MethodsA prospective cohort study was conducted with 168 medical-surgical critically ill adults unable to self-report in the intensive care unit. Two nurses were trained to use the CPOT and BPS Brazilian Portuguese versions at the following assessments: 1) baseline at rest, 2) after SNSPA with a pressure of 14 kgf/cm2, 3) during turning, and 4) 15 minutes after turning.ResultsInter-rater reliability of nurses' CPOT and BPS scores was supported by high weighted kappa >0.7. Discriminative validation was supported with higher CPOT and BPS scores during SNSPA or turning in comparison to baseline (P < 0.001). The Glasgow Coma Scale score was the only variable that predicted CPOT and BPS scores with explained variance of 44.5% and 55.2%, respectively.ConclusionThe use of the Brazilian CPOT and BPS versions showed good reliability and validity in critically ill adults unable to self-report. A standardized procedure, the SNSPA, was used for the first time in the validation process of these tools and helped us improve the validation process.Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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