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J Pediatr (Rio J). 2008 Jul-Aug;84(4):344-9.doi:10.2223/JPED.1809.

Cross-cultural adaptation and translation of two pain assessment tools in children and adolescents.

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Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.



To translate, back-translate and cross-culturally adapt the content of the FLACC (Face, Legs, Activity, Cry, Consolability) and Faces Pain Scale-Revised (FPS-R) scales for the evaluation of pain in Brazilian young students and adolescents.


The original scales in English were translated into Brazilian Portuguese. Scales thus obtained were back translated and reviewed. Cross-cultural adaptation included the submission of the reviewed version of the scales to 12 experts to obtain data on comprehensibility, appropriateness and acceptability. A pretest was carried out in a convenience sample (20 patients and 22 health care professionals) to assess the content of the scales. The cancer patients, 7-17 years of age, were receiving care at the outpatient department or in the pediatric ward of the National Cancer Institute.


After inclusion of the recommendations made by the different professionals who participated in the processes of translation, back-translation and content evaluation of the scales, pretesting showed that 90% and 100% of participants, respectively, understood the content of the scales; the mean score for comprehension ranged from 8.8 to 10.0 in a scale ranging from 1 to 10, with higher scores indicating better understanding.


Both scales were found to be easily comprehensible for the evaluation of pain in Brazilian children and adolescents with cancer.

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