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Pain Pract. 2019 Jul;19(6):602-608. doi: 10.1111/papr.12780. Epub 2019 Apr 11.

From Paper to Digitalized Body Map: A Reliability Study of the Pain Area.

Author information

São Paulo University, São Paulo, Brazil.
School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto School of Medicine, São Paulo University, São Paulo, Brazil.
Federal Institute of Rio de Janeiro, Postgraduation Progam - Clinical Medicine Department of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.



Computerized methods to analyze pain drawings (PDs) have been developed and may aid to measure the pain area more precisely.


The aim of this study was to verify whether examiners can reproduce the patient's PDs with acceptable reliability.


This 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).


Reliability 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).


Our 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.


pain; pain measurement; reproducibility of results

[Indexed for MEDLINE]

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