• Marília Caseiro, Arthur Woznowski-Vu, Anamaria S De Oliveira, Reis Felipe J J FJJ Federal Institute of Rio de Janeiro, Postgraduation Progam - Clinical Medicine Department of Federal University of Rio de Janeiro, Rio de Janeiro, Bra, and Timothy H Wideman.
• São Paulo University, São Paulo, Brazil.
• Pain Pract. 2019 Jul 1; 19 (6): 602-608.

BackgroundComputerized methods to analyze pain drawings (PDs) have been developed and may aid to measure the pain area more precisely.ObjectiveThe aim of this study was to verify whether examiners can reproduce the patient's PDs with acceptable reliability.MethodsThis was an intra-rater and inter-rater reliability study. The protocol consisted of 4 steps: (1) scanning of paper PDs; (2) sharing the digitalized PD images between examiners; (3) reproducing the PD images in the sketching application; and (4) calculating the pain area in pixels and percentages. We calculated intraclass correlation coefficients (ICCs; 2,1), the standard error of the measurement (SEM), and the smallest detectable difference (SDD).ResultsReliability was tested using 31 PDs from 17 patients in our database (11 female [64.7%], mean age: 53.23 ± 11.57 years). Intra-rater reliability varied from ICC (2,1) = 0.991 (95% confidence interval [CI] = 0.982 to 0.996; SEM = 3,432.45; SDD = 162.39 pixels; P < 0.001) to ICC (2,1) = 0.992 (95% CI = 0.978 to 0.997; SEM = 3,412.96; SDD = 161.93 pixels; P < 0.001). Inter-rater reliability for the measurement between all examiners was considered excellent (ICC [2,1] = 0.976; 95% CI = 0.956 to 0.987; SEM =8,580.75; SDD = 256.76 pixels; P < 0.001), being higher between Examiners A and C (ICC [2,1] = 0.970; 95% CI = 0.936 to 0.986; SEM = 6,453.34; SDD = 222.67 pixels; P < 0.001).ConclusionOur results show that intra- and inter-rater reliabilities were excellent when an examiner reproduced the paper PDs into digitalized PDs. This process gives clinicians and researchers the opportunity to analyze pain extent more precisely using a computerized method.© 2019 World Institute of Pain.

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