Introduction
Methods
Children | Recall Period | Response format | Administration mode |
---|---|---|---|
Exp child/or exp p?ediatrics/or child* or (adolescen* or p?ediatric* or youth* or juvenile or teen* or young people or schoolchild* or school age* or kid*) | Recall period or recall interval or patient recall or recall bias | Response scale or likert scale or visual analog* scale or VAS or numerical rating scale or verbal rating scale or faces scale or dichotomous scale or yes no response or response option* | (Outcome measure adj2 (paper or (paper and pen) or tablet or tablet computer or app or application or telephone or face to face or internet) or (measure adj2 (paper or (paper and pen) or tablet or tablet computer or app or application or telephone or face to face or internet) or (scale adj2 (paper or (paper and pen) or tablet or tablet computer or app or application or telephone or face to face or internet) or (questionnaire adj2 (paper or (paper and pen) or tablet or tablet computer or app or application or telephone or face to face or internet) or (survey adj2 (paper or (paper and pen) or tablet or tablet computer or app or application or telephone or face to face or internet) |
Combined with ‘and’ |
Inclusion and exclusion criteria
Study selection and data extraction
Quality appraisal and data synthesis
Results
Study selection
General Information on Included Studies
Author (date); Country; Study Design; Measurement properties evaluated | Objective | Sample size (N); Setting; Age; Population | Main findings | QualSyst Score (%) |
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Baxter (2011) [16]; USA; Quantitative; Prospective; Feasibility, construct validity, responsiveness | To create and validate a pictorial scale with regular incremental levels between scores depicting increasing nausea intensity (BARF scale) | N = 127; Hospital; 7–18 years; Emergency department and surgery | The Spearman correlation coefficient of the first paired BARF and VAS for nausea scores was 0.93. VAS for nausea and BARF scores (P = .20) were significantly higher in patients requiring antiemetic agents and decreased significantly after treatment, while posttreatment pain scores (P = .47) for patients receiving only antiemetic agents did not. All patients understood the pictorial faces scales | 68 |
Benson (2016) [17]; UK; Quantitative; Prospective; Construct validity | To test items, identified through previous qualitative interviews, that might form the basis of a new Malocclusion Impact Questionnaire for young people | N = 184; Hospital; 10–16 years ; Dental outpatients | Using Rasch analysis it was shown that all but one item had disordered thresholds, indicating response categories were not functioning as expected. The original 5-point response scale format was reduced to 3 points | 60 |
Berntson (2001) [18]; Sweden; Quantitative; Cross-sectional; Acceptability, construct validity reliability | To evaluate the concordance between pain assessments made on a VASa and a 4-point verbal descriptor scale and establish scale preference | N = 12; Hospital; 10–18 years; juvenile arthritis | Slight pain on verbal scale corresponded to a wide interval of 7–65 on VAS suggesting VAS was difficult to interpret. Preference was for VAS (69%) but this did not show the most reliable results | 68 |
Borgers (2003) [19]; Netherlands; Quantitative; Prospective; Feasibility, reliability | To investigate the effects of partially labelled response options and vague quantifiers in response stability compared to completely labelled response options and the use of clearly quantified words in children of different ages | N = 91; Home; 8–16 years; Healthy | No effect on stability over time was found when offering vague quantifiers in the response options (p > 0.05). Young children do not benefit from the extra information of completely labelled response options. Offering different types of response option can lead to substantially different structural models | 75 |
Borgers (2004) [20]; Netherlands; Quantitative; Prospective Feasibility, reliability | To examine the effects of negatively formulated questions, number of response options and offering a neutral midpoint as response option question characteristics on the reliability of responses | N = 222; Home; 8–16 years; Healthy; | Negatively formulated questions had no effect on reliability, although children respond consistently differently to negatively formulated questions as opposed to positively formulated ones. Offering about 4 response options is optimal (reliability increased up to 6, more than 7 caused a decrease) | 80 |
Campbell (2011) [21]; Canada; Quantitative; Cross-sectional; Feasibility | To investigate the utility of a VASa to measure peer conflict resolution knowledge in children with language impairment (LI) and typically developing peers (TLD). Are children with varying language status able to express nuances in social knowledge by marking responses along the full VAS | N = 26; School; 9–12 years; Healthy | Those with TLD used the whole VAS; most (83%) with LI relied solely on scale anchors | 59 |
Castarlenas (2013) [22]; Spain; Quantitative; Cross-sectional; Acceptability, construct validity | To assess whether the NRS-11b is a valid tool with 6–8 year old children when presented verbally | N = 126; School; 6–8 years; Healthy | The NRS-11 showed high convergent construct validity with VASa, FPS-Rc and CASd (r = 0.73–0.86), adequate discriminant validity (z = 2.05–5.55) and adequate criterion validity (r = 0.45–0.70). Preference order = CAS > NRS > FPS-R > VAS | 75 |
Chambers (1998) [23]; Canada; Quantitative; Cross-sectional; Feasibility | To examine the potentially biasing impact of neutral or smiling face as a no pain anchor on children’s reports of pain in response to a series of vignettes | N = 100; Childcare centres; 5–12 years; Healthy | Children who use a smile anchored scale had significantly higher pain scores for no pain and pain negative emotions (p < 0.001) and significantly lower faces pain scores for pain/positive vignettes than children who use a neutral anchored face scale (p < 0.001). Faces scales that use smiling anchors may confound affective states with pain ratings | 63 |
Chambers (1999) [24]; Canada; Quantitative; Cross-sectional; Acceptability, feasibility | To examine the potential for bias in children’s’ self-report of pain when using scales with smiling rather than neutral anchors and to establish preference of type of faces scale | N = 75; Hospital; 5–12 years ; Endocrine/diabetes | Scores across scales were highly correlated (r = 0.81–0.93). There was no age or gender interaction effect. Pain was rated significantly higher when scales with a smiling, rather than neutral, anchor were used (p = 0.001). 52.1% of children preferred scales they perceived to be happy and cartoon-like | 75 |
Chambers (2005) [25]; Canada; Quantitative; Cross-sectional; Acceptability, feasibility | To determine whether scales beginning with a smiling rather than neutral “no pain” face would produce higher ratings in the assessment of postoperative pain intensity in children and to compare ratings using different faces. Preference also asked | N = 78; Hospital; 5–13 years ; Post-surgical | Children’s ratings of postoperative pain intensity are influenced by the presence of smiling “no pain” face at the beginning of faces scales, with such scales producing significantly higher ratings than scales with neutral “no pain” faces (p < 0.01). Ratings on the independent CASd measure were more comparable to those provided on faces scales with neutral “no pain” faces. 55.6% preferred Wong Baker faces scale despite it giving the highest pain scores | 83 |
Decruynaere (2009) [26]; Belgium; Quantitative; Cross-sectional; Construct validity, feasibility | To examine with the rating scale model how a sample of healthy children from 4–7 distinguish different faces when rating imaginary painful situations | N = 121/76; Schools and sports centres; 4–7 years ; General | Children performed better on a 3-point faces scale than 6-point scale. Ability improves with age on a 3-point faces scale. 4–5-year-olds could only distinguish 2 response categories | 70 |
Emmott (2017) [27]; Canada; Quantitative; Cross-sectional; Construct validity, feasibility | To evaluate validity and feasibility of 2 simplified pain scales—S-FPS and S-COS in pre-school age children | N = 180; Hospital; 3–6 years ; Venepuncture | The ability to discriminate pain vs no pain was improved with S-FPSd and S-COSf (p = 0.858) compared with FPS-Rc (p = 0.036 with S-FPS and p = 0.022 with C-COS) within 4–6-year olds but not 3-year olds. Quantitative pain rating remains challenging for 3-year-olds | 88 |
Fanciullo (2007) [28]; USA; Quantitative; Cross-sectional; Acceptability, construct validity, feasibility | To determine initial psychometric properties and feasibility of a new Computer Face Scale for measuring children’s pain | N = 54; Hospital; 3–17 years ; Hospitalised in pain/healthy | 76% of children from3 years preferred moveable online faces to select their degree of pain over paper and pen static faces. Paired t tests showed significantly more hospitalised children reported pain than non-hospitalised (p < 0.001). Correlation with Wong-Baker faces scale r = -0.72 | 75 |
Fritz (1994) [29]; USA; Quantitative; Prospective; Feasibility | To determine whether the use of pictorial anchors improved a VASa designed to assess asthma episodes | N = 77; Summer camp; 8–15 years; Asthma | The mean VAS scores increased by 64% using the pictorial VAS while the mean PEFRsg in the 2 years were almost identical, suggesting that changes on the VAS were not due to differences in pulmonary functioning. For boys, the increase in individual mean VAS score in year 2 using the pictorial VAS was 44%; for girls, the increase in individual mean VAS scores was 112%. Use of a pictorial anchor led to greater usage of the full range of the scale | 77 |
Gharaibeh (2002) [30]; Jordan; Quantitative; Cross-sectional; Acceptability, construct validity, reliability | To test the reliability and cultural validity of the following three pain assessment scales: Faces Scale, the Word Description Scale, and the Poker Chip Scale | N = 95; Hospital; 3–14 years; Venepuncture | 55.8% of children preferred the Poker Chip Tool to the Faces Scale and the Word Descriptive Scale. There was significant convergent validity (p < 0.01) and test–retest reliability (p < 0.01) between the three scales | 60 |
Goodenough (1997) [31]; Australia; Quantitative; Cross sectional; Construct validity, feasibility | To compare the utility of the Faces Pain Scale with three other self-report measures (VASa, Poker Chip, VRSh) of pain severity. These four scales were compared and contrasted in terms of the facility of application and comprehension by young children and their relative response frequency distributions | N = 50; Hospital; 4–7 years; Immunisation | Scores on all 4 scales correlated well (r > 0.7). The scales seemed to be measuring the same construct of pain. The faces scale was well understood. 12% had difficulty with the Visual analogue toy scale. The faces pain scale was skewed to low possibly because there are too many response options for the age group causing them to choose the extreme options | 60 |
Gulur (2009) [58]; USA; Quantitative; Prospective; Acceptability, construct validity, reliability | 1) to determine whether children understood the link between the facial expressions of smiling and frowning and the subjective feelings of happiness and pain/hurt. 2) to determine whether children understood that relative degrees of smiling or frowning were linked to relative degrees of happiness and pain/ hurt. 3) to determine the concurrent validity of the Computer Face Scale with the Wong-Baker Faces Scale. 4) to determine the test–retest reliability of the Computer Face Scale | N = 79/50; Hospital; 3–17 years; Study 1 Surgical; Study 2 general inpatients | The computerised scale showed concurrent validity with Wong-Baker faces (r = -0.68). 15-min test–retest reliability r = 0.77. 77% preferred the computerised faces scale. Participants were able to use both scales | 45 |
Gupta (2016) [96]; USA; Qualitative; Cross-sectional; Acceptability, feasibility | To evaluate comprehension and usability of a modified electronic version of the electronic version of the FPS-Rc for children aged 4–17 years with sickle cell disease | N = 22; Unclear; 4–17 years; Sickle cell | Children age 4–6 years were generally unable to demonstrate understanding of the FPS-R and its response scale. Children > 7 years understood the scale and could complete it electronically. Those aged 7–8 years often needed parental assistance | 55 |
Hicks (2001) [32]; Canada; Quantitative; Cross-sectional; Construct validity | 1) to revise the FPSi from 7 faces to 6 to make scores comparable to other measures (0–5 or 0–10). 2) to evaluate the validity of the revised version | N = 76/45; Ear piercing/Hospital; 4–12 years; Healthy/hospital | The validity of the revised scale is supported by a strong positive correlation (r = 0.93) with a VASa measure in healthy children aged 5–12 years. In hospitalised children the revised scale correlated with the VAS (r = 0.92) and CASd (r = 0.84) | 60 |
Hunter (2000) [33]; Australia; Quantitative; Cross-sectional, Feasibility | To further investigate the psychometric properties of the faces pain scale | N = 135; School; 3.5–6.5 years; Healthy | All children were capable of making meaningful discriminations. Children had difficulties with the middle of the scale suggesting that it formed an acceptable series but could not be considered an interval scale. The scale is best reserved for school age children | 50 |
Irwin (2009) [95]; USA; Qualitative; Cross-sectional; Feasibility | To conduct cognitive interviews with children and adolescents to gain feedback on items measuring physical functioning, emotional health, social health, fatigue, pain and asthma specific symptoms for PROMIS item bank | N = 77; Hospital/community; 8–17 years; Healthy/asthma | Response options were understood by the majority of participants (up to 5 options). Children could clearly identify variable levels of functioning. Younger children misunderstood the word difficulty, so it was changed to trouble | 65 |
Joffer (2016) [34]; Sweden; Qualitative; Cross-sectional; Feasibility | To explore how adolescents interpret and reason when answering a question on self-rated health | N = 58; School; 12–18 years; Healthy | Participants’ understandings of the response alternative “Neither good, nor bad” varied. Some regarded it as normal and “in the middle”, some as a negative alternative, and others as a passive state. The five response options all demonstrated differences in self-rated health | 60 |
Jung (2018) [35]; Korea; Quantitative; Prospective; Construct validity | To develop and validate the “Pain Block” concrete ordinal scale for 4- to 7-year-old children. Psychometric properties were compared with the FPS-Rc | N = 163; Hospital; 4–7 years; Emergency dept | Agreement between the 2 pain scales was acceptable, with 95% of the values within the predetermined limit (r = 0.82). The pain scores for both pain scales were significantly decreased when analgesics or pain-relieving procedures were administered (p < 0.001). The Pain Block pain scale could be used to assess pain in 4- to 7-year-old children capable of understanding and counting up to the number 5, even if they do not understand the FPS-R pain scale | 68 |
Keck (1996) [36]; USA; Quantitative; Prospective; Acceptability, construct validity, reliability | To investigate the Faces and modified Word Descriptor Scale for concurrent validity, discriminant validity and test retest reliability | N = 118; Hospital; 3–18 years; Haematology and oncology; venepuncture | Both the word descriptor and faces scales demonstrated discriminant validity (p < 0.001 for scores before and after painful procedure) and concurrent validity (r > 0.71) and test–retest reliability (faces r = 0.9 and word scale r = 0.92). All children understood the scales. The majority of children in all age groups preferred the faces scale (65.1%) | 50 |
Klassen (2015) [60]; Canada; Mixed methods; Cross-sectional; Acceptability, construct validity, feasibility, reliability, | 1) to conduct individual cognitive interviews with adolescents age 12–18 with different health conditions to obtain their feedback on the instructions, response options and items of a transition questionnaire (Transition-Q) with a 5-point Likert response option and to identify any missing content and to revise the scale as necessary. 2) conduct a large-scale field test to examine reliability and validity | N = 32/37; Hospital; 12–18 years; Chronic conditions | Item response option thresholds weren’t ordered for 13 of 18 items. Items were rescored in to 3 response options. 14 participants did not like the agree/disagree response format. It was changed to frequency (never, sometimes, often and always). This was preferred by 8/9 in the second round. Cronbach’s ⍺ = 0.85. Test–retest reliability = 0.9 | 90 (quant) 55 (qual) |
Lawford (2001) [37]; UK; Quantitative; Cross-sectional; Feasibility, reliability | To provide an empirical basis for selecting the response format of a QOL measure for 3–8-year olds (4 point Likert scale vs 4 coloured circles) | N = 28; Nursery school; 4–5 years; Healthy | The Likert scale took significantly longer to complete (p < 0.005). The coloured circle format had higher internal consistency than the Likert scale (⍺ = 0.7 vs 0.48) | 65 |
Leske (2015) [38]; USA; Quantitative; Cross-sectional; Construct validity | To use Rasch analysis to refine the Intermittent Exotropia Questionnaire, removing items that do not contribute meaningful information and ensure response options are properly interpreted | N = 575; Eye clinics; 8–17 years; Intermittent exotropia | Performance of the child and adult versions were enhanced by reducing the number of response options from 5 to 3 | 80 |
Locker (2007) [39]; Canada; Quantitative; Cross-sectional; Construct validity | To assess the performance of negatively and positively worded items in questionnaires to measure child perceptions of child oral health-related quality of life | N = 91; Dental clinics; 10–14 years; Dental/oro-facial | Positively worded items elicited significantly more ‘don’t know’ responses and missing values. The performance of positively worded items was unsatisfactory | 85 |
Luffy (2003) [57]; USA; Quantitative; Cross-sectional; Acceptability, construct validity, reliability | To compare the validity, reliability and preference of pain intensity measurement tools—the African American Oucher scale, Wong-Baker Faces scale and VASa | N = 100; Outpatient clinics; 3–18 years; Sickle cell | Faces and African American Oucher are valid (no significant difference in scores between Oucher and Wong-Baker faces) and reliable (test–retest p < 0.005) tools for measuring pain in children. The VAS was not. 56% preferred the faces scale | 50 |
Maïano (2009) [40]; France; Quantitative; Cross-sectional; Construct validity, reliability | To test the factor validity and reliability of 2 versions (graphical scale vs Likert scale) of the Very Short Form of the Physical Self-Inventory (PSI-VSF), with a sample of adolescents with mild to moderate intellectual disability | N = 342; School; 12–18 years; Learning difficulties | Both versions showed good structural validity, with the graphical version being superior. The graphical faces scale version had higher internal consistency (⍺ = 0.7–0.74 vs 0.65–0.67) than the Likert scale | 80 |
McGrath (1996) [55]; Canada; Quantitative; Cross-sectional; Construct validity, feasibility | To determine the validity of the CASd as a pain measure for children by evaluating the psychometric properties of the scale and comparing them to the properties of the VASa | N = 104; 5–16 years; Routine check-up/pain clinics; Healthy/recurrent headache | There was no significant difference in pain scores between the VAS and CAS for the same event. Higher mean scores were reported for severe tissue damage injuries such as broken bones than for minor bruises. 87% found the CAS very easy to use whereas 22% found the VAS easy to use | 70 |
Miro (2004) [41]; Spain; Quantitative; Prospective; Acceptability, construct validity, reliability | 1) determine the initial psychometric properties of the Catalan version of the FPS-Rc 2) compare patients’ opinion of the FPS-R with the CASd | N = 371; Hospital/school; 7–15 years; Hospitalised/healthy | Correlations between the FPS-R and CAS ranged from r = 0.83–0.9. Relationship between pain and affective state r = 0.32. Test–retest ranged from r = 0.26–0.7. The proportion of children that preferred the FPS-R was significantly higher than the proportion that preferred the CAS (66–68%) | 46 |
Morley (2014) [42]; Canada; Qualitative—cognitive interviews; Cross-sectional; Feasibility, acceptability | To cognitively test the Pediatric Advanced Care Quality of Life Scale (PAC-QoL) to establish whether the items and response options were understood | N = 34; Hospital; 8–18 years; Oncology; | Response scale was accurately interpreted in 88–93% of cases. When participants had trouble distinguishing between responses it involved options in the middle of the 4-point scale (sometimes and often) | 65 |
O’Sullivan (2014) [43]; Canada; Qualitative; Cross-sectional; Feasibility | To evaluate and refine a new instrument for cancer symptom screening (SSPedi), including evaluating understanding of the response scale | N = 30; Hospital; 8–18 years; Oncology | Response options (5-point Likert) were understood by 90% of children | 60 |
Ogden (2008) [44]; UK; Mixed methods; Cross-sectional; Acceptability, feasibility | To identify changes needed to adapt the IMPACT instrument for use in British children with inflammatory bowel disease and to see whether children preferred the Likert scale or the VASa | N = 20; Outpatients; 8–16 years; Gastroenterology | Participants distinguished between the responses in the Likert scale and related their answers to the response options proficiently. Some children only guessed that ‘moderate’ meant ‘in the middle’ because of its position in the scale (5 point). 75% preferred the Likert scale to the VAS as it was easier and quicker to complete (p < 0.01) | 55 quant 45 qual |
Okanda (2010) [45]; Japan; Quantitative; Cross-sectional; Feasibility | To investigate whether 3–6-year-old children exhibit a ‘yes’ bias to various yes–no questions and whether their knowledge status affects the production of a yes bias | N = 135; Kindergarten/ nursery; 3–6 years; Healthy | 3-year-olds had a strong tendency to exhibit a yes bias to both preference-object and knowledge object yes–no questions (even though they know the answer, p < 0.01). 4-year-olds could appropriately answer preference questions but showed a yes bias to knowledge questions (p < 0.1). 5- and 6-year-olds did not show a response bias to yes questions but showed a weak tendency to say yes to knowledge questions regarding familiar objects | 55 |
Ortqvist (2012) [46]; USA; Qualitative; Cross-sectional; Feasibility | To examine how well the Knee Injury Osteoarthritis Outcome Score for Children (KOOS-Child) is understood | N = 34; Outpatient clinics; 10–16 years; Knee injury | Most children understood how to use a 5-point Likert response scale. The response option ‘moderate’ was persistently perceived as confusing. Most could interpret the meaning of the word by its location in the scale but could not define the word and suggested replacing it with the word ‘some’ | 70 |
Pagé (2012) [56]; Canada; Quantitative; Prospective; Acceptability, construct validity, feasibility | To evaluate the convergent and discriminant validity of the NRSb for pain intensity and unpleasantness in children after surgery | N = 83/69; Hospital; 8–18 years; Orthopaedic/general surgery | The NRS correlated highly with the VRSh and FPS-Rc (p < 0.001). Scores were significantly higher at 48–72 h post-surgery than at 2 weeks (p < 0.001). Children found the faces scale easiest to use (51%). The VRS was least liked (13%) and hardest to use | 82 |
Rebok (2001) [92]; USA; Qualitative—cognitive interviews; Cross-sectional; Acceptability, feasibility | (1) to determine whether children can answer health survey items. (2) to test the feasibility of a pictorial questionnaire format using cartoon drawings of a child. (3) to examine several types and numbers of response formats to see which are preferred and most easily understood. (4) to test children’s understanding of specific concepts of health and wording of different response formats | N = 114; School/kindergarten; 5–11 years; Healthy | 74% preferred circle responses to VASa, with 68% preferring graduated circles. 74% preferred 4 rather than 3 circles. 100% preferred a horizontal presentation. Younger children gave a significantly higher number of extreme responses. Younger children effectively reduced a 5-point response format to 3 points by using only the middle and extremes. 67% preferred the 5-point response format (rather than 4 point) | 70 |
Shields (2003) [47]; USA; Quantitative; Cross-sectional; Feasibility | To identify demographic and cognitive variables that would maximise the accuracy of predicting children’s abilities to use a VASa | N = 40; Kindergarten; 5–7 years; Healthy | Only 42% of participants could use a VAS. Cognitive ability (IQ ≥ 100) combined with chronological age (≥ 5.6 years) was the best predictor of accurate use | 80 |
Shields (2005) [48]; USA; Quantitative; Cross-sectional; Feasibility | To determine whether age, combined with estimated IQ, is an accurate predictor of a child’s successful use of a VASa in a non-clinical situation vs an acute, clinically emergent situation | N = 104; Hospital; 5–11 years; Healthy/lacerations | Estimated IQ and the ability to do a seriation task were the best predictors of 5–6-year-olds ability to accurately use the VAS (p < 0.001). Estimated IQ was not as important as chronological age and ability to perform a seriation task in those 7 years and over | 83 |
Stanford (2006) [49]; Canada; Quantitative; Cross-sectional; Feasibility | To examine variations in 3- to 6-year-old children’s ability to accurately use a common self-report scale to rate pain in hypothetical vignettes (faces pain scale revised) | N = 112; Community; 3–6 years; Healthy | 5- and 6-year-old children were significantly more accurate (40% errors) in their use of the FPS-Rc in response to the vignettes than 4-year-old children, who in turn were significantly more accurate than 3-year-old children (60% errors). Over half of 6-year-olds demonstrated difficulty using the FPS-R in response to the vignettes. Child age was the only significant predictor of children’s ability to use the scale in response to the vignettes (p < 0.001). The ability to use the scale improved with age | 65 |
Staphorst (2017) [50]; Netherlands; Mixed methods; Cross-sectional; Acceptability, construct validity feasibility | To develop a generic, short and child-friendly instrument: the DISCO-RC questionnaire (DISCOmfort in Research with Children) | N = 46; Outpatients; 6–18 years; Unclear | Children preferred a 5-point Likert scale as a response option. The 5-point Likert scale coloured numeric VASa and simple VAS were strongly correlated (r = 0.76 – 0.99) | 60 (quant) 65(qual) |
Tesler (1991) [51]; USA; Quantitative; Cross sectional; Acceptability, construct validity, reliability, responsiveness | A program of studies designed to select and test a pain intensity scale for inclusion in a multidimensional pain assessment tool for children, focusing on determining each scale’s reliability, validity, ease of use and preference.5 scales were tested: a word graphic scale. VASa, graded graphic rating scale, 0–10 magnitude estimation scale and CASd | N = 1223; Hospital, outpatient, school; 8–18 years; Acute/healthy/chronic illness | Convergent validity for the 5 scales was supported (r = 0.66–0.84). The word graphic rating scale (Likert) was preferred by 47% of sick children. When used in a multidimensional pain assessment tool it showed test–retest reliability (r = 0.68–0.97) also showed sensitivity to change (p = 0.002) | 65 |
Tomlinson (2019) [93]; Canada; Qualitative; Cross-sectional; Feasibility | To develop a new self-report symptom screening tool for children receiving cancer treatments who are 4–7 years of age (mini-SSPedi), based on SSPedi | N = 100; Hospital; 4–7 years; Oncology | Dichotomous response scale (yes/no) was understood by all participants. 80% understood the Wong-Baker faces, 70% understood FPS-Rc and 65% understood the pieces of hurt scales | 60 |
van Laerhoven[59] (2004); Netherlands; Quantitative; Cross-sectional; Acceptability, feasibility | To examine which response options children prefer and which they find easiest to use (VASa vs Likert). To examine the relative reliability of the different response options | N = 122; Outpatients; 6–12 years; Not specified | Children preferred the Likert scale. They considered the Likert scale easiest to fill out. Results of the different response options correlated strongly with each other (r = 0.67– 0.90) | 59 |
von Baeyer (2013) [52]; Canada; Quantitative; Cross sectional; Feasibility | To evaluate a binary question followed by simple response options for pain assessment in young children (FPS-R) | N = 184; Preschool/day care; 3–5 years; Healthy | 3- and 4-year-olds performed significantly better using the simplified task than the FPS-Rc (p < 0.001). The simplified pain task made no difference to the 5-year olds who had almost identical mean scores using both methods. Response bias is common in children under 5 | 68 |
Vreeman (2014) [94]; Kenya; Qualitative—cognitive interviews; Cross-sectional; Acceptability, feasibility | To improve the understandability of paediatric antiretroviral adherence measurement items through cognitive interviewing with paediatric caregivers and HIV-infected adolescents | N = 10; HIV clinic; 13–18 years; HIV | Participants inconsistently quantified the differences between 4-point Likert response options. Visual analogue scales and the addition of a response option to give 5-points yielded more divergence and were considered hard to understand. It was suggested that VASa would require pictorial cues to orientate the participant to scale meaning | 70 |
Watson (2006) [53]; USA; Quantitative; Cross-sectional; Feasibility | To evaluate the psychometric properties of the fruit and vegetable self-efficacy (FVSEQ) questionnaire | N = 1477; School; 9–10 years; General | Item response modelling showed that the 5-point response scale was not fully utilised | 86 |
West (1994) [54]; USA; Quantitative; Cross-sectional; Feasibility, construct and convergent validity | To identify a clinically feasible and accurate method of measuring pain intensity in paediatric oncology patients in the ITU (FPS and Poker chip) | N = 30; Intensive care; 5–13 years; Oncology | Pain rating scales on the two tools were correlated (faces pain scale and Poker Chip, r = 0.67). 91.6% preferred the faces pain scale to the poker chip tool | 50 |
Author (date); Country; Study Design; Measurement properties evaluated | Objective | Sample size (N); Setting; Age; Population | Main findings | QualSyst Score (%) |
---|---|---|---|---|
Chogle (2012) [61]; USA; Quantitative; Prospective; Acceptability, feasibility | To assess ability to accurately recall abdominal pain in children—comparison of daily reports vs one-month recall | N = 63; Outpatients; 8–17 years; Functional gastro-intestinal disorders | Most children reported a lower frequency of abdominal pain by recall than daily diaries (r = 0.4; CI 0.17–0.59%). Children 8–11 years had a higher correlation (r = 0.59) than those 12–18 (r = 0.26). Similar correlations were found to just the past 7 days (r = 0.47) | 68 |
Heyer (2014) [62]; USA; Quantitative; Prospective; Feasibility, reliability | To compare the 90 day and 30-day recall of paediatric migraine disability assessment (PedMIDAS) elements and headache frequency against daily entries from an internet headache diary | N = 52; Outpatients; 10–18 years; Migraine | Reliability improved at 30-day recall compared to 90 days. 90-day diary: PedMIDAD r = 0.65; headaches r = 0.8330-day diary: PedMIDAD r = 086; headaches r = 0.88. Age and confidence in ability to answer were poor predictors of recall accuracy | 86 |
Irwin (2009) [95]; USA; Qualitative; Cross-sectional; Feasibility | To conduct cognitive interviews with children and adolescents to gain feedback on items measuring physical functioning, emotional health, social health, fatigue, pain and asthma specific symptoms for PROMIS item bank | N = 100; Hospital; 4–7 years; Oncology | All children reported that the 7-day recall period meant the past 7 days and responded to items accordingly | 60 |
Jacobson (2015) [67]; USA; Qualitative; Cognitive interviews; Cross-sectional; Feasibility | To develop and evaluate item candidates for new PROMIS Pediatric Pain Quality and Pain Behavior item banks, and Pain Intensity items | N = 34; Hospital; 8–18 years; Chronic pain | Participants from 8–18 years old understood that the recall period referred to the past week. There was a need to reiterate the 7-day time period to some younger children | 70 |
Okupa (2013) [63]; USA; Quantitative; Prospective; Feasibility, reliability | To compare daily diaries vs retrospective questionnaires to assess asthma control | N = 88; Asthma Research and Education Network Centres; 6–17 years; Asthma | Asthma control days correlated better with daily diary information from the last 2 weeks of a 4-week recall (r = 0.46) than from the first 2 weeks | 68 |
Ravens-Sieberer (2014) [66]; USA; Qualitative; Cognitive interviews; Acceptability and feasibility | To (1) conceptualize children’s subjective well-being and (2) produce item pools with excellent content validity for calibration and use in computerized adaptive testing | N = 37; Not stated; 8–17 years; Healthy and chronic conditions | Cognitive interviews supported children’s capacity to use a 7-day recall period for positive affect and a 4 week recall period for life satisfaction | 65 |
Rebok (2001) [92]; USA; Qualitative—cognitive interviews; Cross-sectional; Acceptability, feasibility | 1) to determine whether children can answer health survey items. 2) to test the feasibility of a pictorial questionnaire format using cartoon drawings of a child. 3) to examine several types and numbers of response formats to see which are preferred and most easily understood. 4) to test children’s understanding of specific concepts of health and wording of different response formats | N = 114; School/kindergarten; 5–11 years; Healthy | 80% of participants could accurately use a 4 week recall period. Younger children did not understand the concept of a week and may not have used the 4-week time interval appropriately | 70 |
Self (2015) [64]; USA; Quantitative; Prospective; Feasibility, reliability | To evaluate correspondence between retrospective questionnaire and prospective diary data for children and adolescents with IBS | N = 50; Outpatients; 8–18 years; Irritable bowel | For pain days ICC = 0.83 and days without bowel movement ICC = 0.74. Maximum pain score ICC = 0.8 and days with diarrhoea = -0.03. Although under conditions likely to facilitate agreement and with individual variation observed. Age was not significantly related to difference scores | 70 |
Tomlinson (2019) [93]; Canada; Qualitative—cognitive interviews; Cross-sectional; Feasibility | To develop a new self-report symptom screening tool for children receiving cancer treatments who are 4–7 years of age (mini-SSPedi), based on SSPedi | N = 100; Hospital; 4–7 years; Oncology | Only 40% understood the time frame yesterday, so today was chosen for the measure | 60 |
van den Brink(2001) [65]; Netherlands; Quantitative; Prospective; Feasibility, reliability | To investigate whether children and adolescents can recall prior headache complaints accurately and to study whether age, gender, headache severity, preferred coping strategies, depression, somatization, and trait anxiety are related to recall errors, causing recall bias | N = 100; School; 9–16 years; Headache | Compared to daily diary, retrospective questions led to overestimation of headache intensity and duration (r = 0.16). Lower age and increased headache severity were statistically related to recall errors | 50 |
Vreeman (2014) [94]; Kenya; Qualitative; Cross-sectional; Acceptability, feasibility | To improve the understandability of paediatric antiretroviral adherence measurement items through cognitive interviewing with paediatric caregivers and HIV-infected adolescents | N = 10; HIV clinics; 13–18 years; HIV | Adolescents preferred either a 24-h recall period for ease of remembering or a 1 month recall as clinic appointments were monthly | 70 |
Author (date); Country; Study Design; Measurement properties evaluated | Objective | Sample size (N); Setting; Age; Population | Main findings | QualSyst Score (%) |
---|---|---|---|---|
Bender (2007) [68]; USA; Quantitative; Prospective; Reliability | To test the effect of reporting mode on accuracy of inhaled cortico-steroid adherence reporting in children with asthma and their parents under conditions similar to those of an asthma clinical trial | N = 104; Outpatients; 8–18 years; Asthma | All methods led to over-reporting compared to electronic device on asthma pump. More than half of children over- reported adherence by > 25% Discrepancy was greatest in computer interview condition | 77 |
Castarlenas (2015) [69] Spain; Quantitative; Cross-sectional; Acceptability, construct validity | To examine the agreement between verbally and electronically administered NRS-11b (eNRS) for pain | N = 191; School; 12–18 years; Healthy | Bland Altman LOA fell outside the a priori limit for 95%. LOA at 80% fell inside the maximum limit established a priori. K-coefficients ranged from 0.786–0.912 indicating almost perfect agreement. 83% preferred the eNRS | 77 |
Eaton (2010) [89]; USA; Quantitative; Cross-sectional; Construct validity, feasibility | To examine whether paper and pencil surveys and web surveys yield equivalent risk behaviour prevalence estimates when using the Youth Risk Behaviour Survey | N = 5227; School; Unclear; Healthy | Prevalence estimates from paper and pencil and web-based surveys were generally equivalent. Questionnaire mode was only significantly (p < 0.05) associated with 7 of 74 risk behaviours | 82 |
Fouladi (2006) [70]; USA; Quantitative; Cross-sectional; Construct validity, feasibility | To examine systematic differences in the responses of 4th, 5th, and 6th graders to measures of stress, coping, and humour among three modes of assessment: paper-and-pencil questionnaires, computer-assisted self-interviewing (CASI), or a combination of paper-and-pencil and CASI. Scales used – feel bad scale, school agers coping strategies inventory, the multi-dimensional sense of humour scale | N = 1245; School; 9–12 years; General | CASI means and medians were higher (p < 0.002) and correlations between CASI measures tended to be lower than those obtained with paper and pencil and mixed modes. CASI variances were lower | 65 |
Geerdink (2009) [71]; Netherlands; Quantitative; Cross-sectional; Acceptability, construct validity, feasibility | To develop a reliable and user-friendly digital child health assessment questionnaire (CHAQ) to complete systematically at the outpatient paediatric rheumatology clinic | N = 51; Outpatients; Unclear; Juvenile arthritis | Correlation between the digital and paper versions was high (r = 0.974). No statistically significantly differences in median outcome were found in visual analogue scale (VAS) pain (25.6 vs 25.9 mm) and VAS well-being (20.1 vs 19.5 mm). Although the mean time (5.06 min) to complete the digital CHAQ was significantly longer than the mean time (3.75 min) to complete the paper form, the majority of patients (75%) preferred the digital version. User-friendliness received maximum positive score | 59 |
Jensen (2010) [72]; Denmark; Quantitative; Prospective; Acceptability | To examine the assessments and priorities by children and adolescents of health care in a paediatric outpatient clinic, to examine the influence of the time factor on assessments and priorities by children and adolescents of health care, and to determine their preferred method of evaluation | N = 346; Outpatients; 11–17 years; Range of diagnoses | 50.1% of children and adolescents preferred to complete an electronic questionnaire to a paper one. They did not want to receive questionnaires by email | 45 |
Jones (2010) [73]; New Zealand; Quantitative; Prospective; Acceptability, construct validity, reliability | To investigate the reliability and validity of a computerised anxiety assessment (smiley faces program revised (SFP-R)) and to explore children’s preferences for the method of anxiety assessment | N = 206; School; 5–13 years; Healthy | The online SFP-R demonstrated good reliability (⍺ = 0.75) and strong convergent validity with the modified children’s dental anxiety scale (r = 0.75). Test–retest reliability r = 0.67. Children preferred the computerised assessment to pen and paper methods | 54 |
Knight (2007) [74]; USA; Quantitative; Cross-sectional; Acceptability | To determine adolescents’ preferences for method of substance abuse screening | N = 2133; Outpatients; 12–18 years; General medicine | Paper was the preferred method (mean rank (MR) = 2.92, 95%CI 2.87–2.96) vs. computer (MR = 2.38, 2.33–2.43), nurse (MR = 2.43, 2.39–2.47), and doctor (MR = 2.30, 2.25–2.35). Participants stated they were more likely to be honest with paper followed by computer, rather than responding to questions administered by a doctor or nurse. Those reporting on the computer were significantly more likely to report drug and alcohol use | 67 |
Lloyd (2011) [75]; UK; Quantitative; Cross-sectional; Construct validity, feasibility, Reliability, | To examine the psychometric properties of an Internet version of a children and young persons’ quality of life measure (Kid’s Life and Times) originally designed as a paper questionnaire | N = 3440; School; 10–11 years; Healthy | Exploratory principal component analysis supported 5 components, in line with the paper version. Items loaded on to the expected components. Internal consistency was similar to that reported for the paper version (⍺ all > 0.76). Domain scores were similar to those reported in the literature for the paper version. Non-response was lower with the online version (1% vs 1.72–3.83%) | 72 |
Magnus (2016) [90]; USA; Quantitative; Cross-sectional; Construct validity | To test the equivalence of scores obtained with the PROMIS paediatric depressive symptoms, fatigue and mobility measures across computer and telephone administration | N = 377; Home; 8–17 years; Healthy | There were high correlations between the two modes of administration (0.71–0.94), although fatigue scores were affected by mode of administration, but the differences in scores were sufficiently small that they would not affect overall interpretation of results | 77 |
Mangunkusumo (2005) [76]; Netherlands; Quantitative; Cross-sectional; Acceptability, construct validity | To assess whether scores of an internet administered adolescent health questionnaire (KIVPA) are equivalent to those obtained via paper and pencil. To compare adolescents’ evaluation of administration modes | N = 565; School; 13–17 years; Healthy | Internet questionnaire generally resulted in equal scores to pen and paper mode. Adolescents in the internet one-item mode group more frequently reported satisfaction with appearance compared with the Internet multiple items mode (p ≤ .01). The internet group had more adolescents reporting that they had a sufficient number of friends compared to the paper mode (p ≤ .01) | 77 |
Mangunkusumo (2006) [77]; Netherlands; Quantitative; Cross-sectional; Construct validity, feasibility | To compare the feasibility, presence of score differences and subjective evaluations by children between Internet and identical paper questionnaires (International study of asthma and allergies in childhood questionnaire) | N = 249; School; 10–12 years; Healthy | There were similar mean scores between administration modes. ICC 0.64–0.9. One third of items showed moderate agreement between modes (kappa 0.43–0.6). The remaining items had very good agreement (kappa 0.61–0.95). There were fewer missing data with the internet version | 82 |
Mauz (2018) [78]; Germany; Cross-sectional; Acceptability, construct validity, feasibility | To determine whether prevalence rates or mean values of self-reported health indicators for children and adolescents age 11–17 years differ between self-administered paper-based questionnaires and self-administered web-based questionnaires (German Health Interview and Examination Survey for Children and Adolescents) | N = 1194; Home; 11–17 years; Healthy | Most questions showed mode equivalence except for alcohol consumption. Higher levels of consumption were reported online (p < 0.001). Male adolescents preferred the online mode. Those choosing the web-based response format were more likely to have higher household income and higher educational attainment (actual data not reported) | 71 |
McCabe (2005) [79]; USA; Quantitative; Cross-sectional; Construct validity, feasibility | To examine the feasibility and mode effects of using a web form vs paper form survey to collect alcohol and tobacco data from 3rd and 4th grade students | N = 323; School; Not specified (3/4 grade); Healthy | There were minimal differences between survey modes. (future alcohol use and lifetime alcohol use showed significant difference, p < 0.05)) | 55 |
Moskowitz (2004) [80]; USA; Quantitative; Cross-sectional; Construct validity, feasibility | To assess the effect of telephone audio computer-assisted self-interviewing (A-CASI) and computer-assisted telephone interviewing (T-ACASI), on self-reports of smoking behaviour and smoking susceptibility among adolescents 12–17 years of age (adapted from Youth Attitudes and Practices Survey) | N = 2444; Home; 12–17 years; Healthy | Adjusted estimates of current smoking were higher in the self-administered T-ACASI (8.3% vs 4.5%). The commitment not to smoke among those who had never smoked was also higher in the T-ACASI (45% vs 34.9%). Parental presence was negatively associated with smoking. T-ACASI survey had more missing data than CATI | 77 |
Nitikman (2017) [81]; Canada; Quantitative; Prospective; Construct validity, feasibility, reliability | To validate and test the reliability of using the Internet as a method of administering health-related quality of life questionnaires in a paediatric spine population (Scoliosis Research Society 30 (SRS-30) and Pediatric Outcomes Data Collection Instrument (PODCI)) | N = 96; Outpatients; 11–18 years; Scoliosis | There was no significant difference in scores between methods of administration at the 2 time points (p = 0.206). Patients expressed a preference for the internet option (84%) | 63 |
Raat (2007) [82]; Netherlands; Quantitative; Cross-sectional; Construct validity, feasibility, reliability | To evaluate the indicators of feasibility, reliability and validity of the Child Health Questionnaire-Child Form (CHQ-CF). To compare the results in those of those who complete the standard paper version compared to an internet version | N = 933; School; 13–17 years; Healthy | The internet version resulted in fewer missing answers. All scales clearly discriminated between adolescents with no, a few or many self-reported chronic conditions. The paper administration resulted in statistically significant, higher scores on 4 of 10 CHQ-CF scales compared with the internet administration (P < 0.05), but Cohen’s effect sizes d were ≤ 0.21. Mode of administration interacted significantly with age (P < 0.05) on four CHQ-CF scales, but Cohen’s effect sizes for these differences were also ≤ 0.21 | 96 |
Raat (2007) [83]; Netherlands; Quantitative; Cross-sectional; Construct validity, feasibility | To compare the results from written and internet questionnaires about respiratory symptoms to find out if both forms yielded the same responses (International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire) | N = 933; School; 13–17 years; Healthy | The Internet version showed fewer missing answers not statistically significant). The respiratory items did not show statistically significant score differences between the Internet and written modes of administration. Both approaches yielded equal results | 96 |
Robles (2015) [84]; Spain; Quantitative; Cross sectional; Construct validity, feasibility, | To develop web-based Spanish and Catalan versions of the EQ-5D-Y, and to compare scores and psychometric properties with the paper version | N = 715; School; 8–18 years; Healthy | Both formats of EQ-5D-Y showed low percentages of missing values (n = 2, and 4 to 9 for web and paper versions respectively), and a high ceiling effect by dimension (range from 79 to 96%). Percent agreement for EQ-5D-Y dimensions on the web and paper versions was acceptable (range 89% to 97%), and k ranged from 0.55 (0.48–0.61, usual activities dimension) to 0.75 (0.68–0.82, mobility dimension). Mean score difference on the VAS was 0.07, and the ICC for VAS scores on the two formats was 0.84 (0.82–0.86). Both formats showed acceptable ability to discriminate according to self-perceived health, reporting chronic conditions, and mental health status | 83 |
Sun (2015) [91]; Canada; Quantitative; Longitudinal; Acceptability, construct validity, feasibility | To evaluate agreement between electronic (called Panda) and paper versions of the faces pain scale revised (FPS-R) and colour analogue scale (CAS) | N = 62; Hospital; 4–18 years; Surgical | Panda scores correlated strongly with original scores at T0 and T30 (r > 0.93 for FPS-R; r > 0.87 for CAS). Most participants expressed a preference for the iPod Panda version (76–81%) | 67 |
Trapl (2013) [85]; USA; Quantitative; Cross sectional; Acceptability, feasibility | To examine the impact of 3 data collection modes (paper, PDA, audiPDA (APDA)) on the number of questions answered, data quality, and student preference | N = 275; School; Not specified (7th grade); Healthy | APDA respondents completed significantly more questions compared to paper and PDA (p < 0.001). PDA and APDA had significantly fewer missing data than did paper (p < 0.001). No differences were found for student evaluation | 63 |
Varni (2009) [86]; USA; Quantitative; Cross-sectional; Construct validity | To implement the multigroup confirmatory factor analysis (CFA) method for invariance testing across mode of administration for children’s self-reported health-related quality of life (in person, mail and telephone) using PedsQLTM 4.0 Generic Core Scales | N = 3741; Home or clinic; 5–18 years; Chronic illness | Strong factorial invariance across the mode of administration groups was demonstrated based on stability of the Comparative Fit Index (CFI) between the models, and several additional indices of practical fit including the Root Mean Squared Error of Approximation (RMSEA), the Non-Normed Fit Index (NNFI), and the Parsimony Normed Fit Index (PNFI). Children across the three modes of administration groups interpreted items on the PedsQLTM 4.0 Generic Core Scales in a similar manner | 75 |
Wood (2011) [87]; France; Quantitative; Cross-sectional; Acceptability, construct validity, feasibility | To compare concordance and preference for electronic and paper versions of the faces pain scale revised, and to determine whether the electronic version can be used by children 4 years and over | N = 234; Hospital; 4–12 years; Inpatients | Overall weighted kappa = 0.846 and Spearman’s correlation between scores on the 2 versions was 0.91. The mean difference between scores was neither clinically nor statistically significant. 83.2% chose the same face on both versions. The PDA was preferred by 87.4% of participants | 88 |
Young (2009) [88]; Canada; Quantitative; Prospective; Construct validity, feasibility | To test the impact of web administration on well-established measures of children’s physical function and quality of life using the ASK and PedsQL measures | N = 91 time 1 N = 69 time 2; Hospital; 8–14 years; Chronic illness | Both measures were highly reliable in web and paper format. Inter-method ICC = 0.98 for ASK and 0.64 for PedsQL compared to ICC of 0.99 and 0.94 respectively for paper formats. The web ASK seems to be valid compared to paper format. Consistency in administration mode may be more important when using the PedsQL | 88 |