Cross-cultural adaptation of distress assessment instrument in children undergoing painful procedures

  • Nátali Castro Antunes Caprini Oliveira Ribeirão Preto Medical School, University of São Paulo
  • Wendy M Pinder Department of Psychology, University of Maryland - Baltimore, USA
  • Lynn M Dahlquist Department of Psychology, University of Maryland - Baltimore, USA
  • Maria Beatriz M Linhares Ribeirão Preto Medical School, University of São Paulo
Keywords: Distress, Pain, Measure, Cross-Cultural Adaptation.


The study aimed to translate, back-translate to the Portuguese-Brazil language and cross-culturally adapt the content of OSBD scale for the evaluation of distress in painful contexts in children. In first step, two forward translations were made of the instrument from English to Portuguese. A consensus of these translations was obtained in second step. A native English speaker back-translated the preliminary version of the scale in Portuguese into the original English (Step 3). In step 4, an expert in the use of the OSBD reviewed the backtranslated version. Then, the Portuguese version of the OSBD was submitted to a committee of experts. The final step was the pretest. Pretesting showed that the scale was useful and comprehensible for the evaluation of pain-associated distress in Brazilian children.


Beaton, D.E., Bombardier, C., Guillemin, F., Ferraz, M.B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25, 3186-3191.

Birnie, K.A., Chambers, C.T., Fernandez, C.V., Forgeron, P.A., Latimer, M.A., McGrath, P.J. … Finley, G.A. (2014). Hospitalized children continue to report undertreated and preventable pain. Pain Res Manag 19(4), 198-204.

Cohen, L.L., Lemanek, K., Blount R.L., Dahlquist, L.M., Lim, C.S., Palermo, T.M. ... Zelter, L. (2008). Evidence-based assessment of pediatric pain. J Pediatr Psychol 33, 939-955. doi: 10.1093/jpepsy/jsm103.

Cronbach, L.J., Meehl, P.E. (1955). Construct validity in psychological tests. Psychol Bull 52, 281-302.

Dworkin, R.H., Turk, D.C., Farrar, J.T., Haythornthwaite, J.A., Jensen, M.P., Katz, N.P. … Witter, J. (2005). Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 113(1-2), 9-19. doi: 10.1016/j.pain.2004.09.012.,%202005.pdf.

Elliott, C.H., Jay, S.M., Woody P. (1987). An observation scale for measuring children’s distress during medical procedures. J Pediatr Psychol 12, 543-551. doi: 10.1093/jpepsy/12.4.543.

Howard, R.F. (2003). Current status of pain management in children. J Am Med Assoc 290(18), 2464-2469. doi: 10.1001/jama.290.18.2464.

Howard, R.F. (2005). Developmental factors and acute pain in children. In Pain 2005: An Updated Review, D.M. Justins, ed. (Seattle: IASP Press) pp. 283-290.

Kennedy, R.M., Luhmann, J., Zempsky, W.T. (2008). Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics 122(Suppl. 3), S130-S133. doi: 10.1542/peds.2008-1055e.

McGrath, P.J., Walco, G.A., Turk, D.C., Dworkin, R.H., Brown, M.T., Davidson, K. … Zeltzer, L. (2008). Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. J Pain 9(9), 771-783. doi: 10.1016/j.pain.2008.04.007.

Noel, M., Chambers, C.T., McGrath, P.J., Klein, R.M., Stewart, S.H. (2012). The influence of children’s pain memories on subsequent pain experience. Pain 153, 1563-1572. doi: 10.1016/j.pain.2012.02.020.

Pretzlik, U., Sylva, K. (1999). Paediatric patients' distress and coping: an observational measure. Arch Dis Child 81, 528-530. doi:10.1136/adc.81.6.528.

Sil, S., Dahlquist, L.M., Burns, A.J. (2013). Videogame distraction reduces pain and behavioral distress in a preschool-aged child undergoing repeated burn dressing changes: A single-subject design. J Pediatr Psychol 38, 330-341. doi: 10.1093/jpepsy/jss128.

Taylor, E.M., Boyer, K., Campbell, F.A. (2008). Pain in hospitalized children: a prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital. Pain Res Manag 13(1), 25-32.

Valeri, B.O., Holsti, L., Linhares, M.B.M. (2015). Neonatal pain and developmental outcomes in children born preterm: a systematic review. Clin J Pain 31(4), 355-362. doi: 10.1097/AJP.0000000000000114.

von Baeyer, C.L., Spagrud, L.J. (2007). Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain 127, 140-150. doi:10.1016/j.pain.2006.08.014.,%202007.pdf.

Wohlheiter, K.A., Dahlquist, L.M. (2013). Interactive versus passive distraction for acute pain management in young children: The role of selective attention and development. J Pediatr Psychol 38, 202-212. doi: 10.1093/jpepsy/jss108.

How to Cite
Oliveira, N. C. A. C., Pinder, W. M., Dahlquist, L. M., & Linhares, M. B. M. (2018). Cross-cultural adaptation of distress assessment instrument in children undergoing painful procedures. Revista Interamericana De Psicologia/Interamerican Journal of Psychology, 51(3).