ArticlePloS one2018
Verifying the validity and reliability of the Japanese version of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Clinical rating scales for assessing pain in newborn infants.The Cochrane database of systematic reviews · 2025Pooled it
- Trial
- Delirium and Iatrogenic Withdrawal Profiles in the Pediatric Intensive Care Unit (PICU): A Latent Profile Analysis of Nurse-Administered Bedside Scales.Journal of clinical medicine · 2026Article
- Applicability, Validity, and Reliability of the Japanese Version of the Behavioral Pain Scale for Critically Ill Mechanically Ventilated Pediatric Patients: A Prospective Cross-Sectional Observational Study.Children (Basel, Switzerland) · 2026Article
- A Comprehensive Evidence-Based Review of Non-Pharmaceutical Interventions for Neonatal Pain.Journal of pain research · 2026Review
- Article
- Validity and reliability of the Critical-Care Pain Observation Tool (CPOT) for critically ill pediatric patients.PloS one · 2025Observational
- Analgesic Potential Comparison Between Piperine-Combined Curcumin Patch and Non-Piperine Curcumin Patch: A Pragmatic Trial on Post-Cleft Lip/Palate Surgery Pediatric Patients.Journal of pain research · 2024Article
- Pain Management in Pediatric Burns: A Review of the Science behind It.Global health, epidemiology and genomics · 2023Review
- A Systematic Review of the Measurement Properties of Face, Legs, Activity, Cry and Consolability Scale for Pediatric Pain Assessment.Journal of pain research · 2023Review
- Pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patients.Scientific reports · 2022Article
- Predictive factors of first dosage intravenous immunoglobulin-related adverse effects in children.PloS one · 2020Article
- Article
- Verifying the Japanese version of the Preschool Confusion Assessment Method for the ICU (psCAM-ICU).Acute medicine & surgery · 2019Article
- Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPediatric patients, especially in the preverbal stage, cannot self-report intensity of pain therefore several validated observational tools, including the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale, have been used as a benchmark to evaluate pediatric pain. Unfortunately, this scale is currently unavailable in Japanese, precluding its widespread use in Japanese hospitals.
objectivesTo translate and verify the validity and reliability of the Japanese version of the FLACC Behavioral Scale.
methodBack-translation was first conducted by eight medical researchers, then an available sample of patients at the University of Tsukuba Pediatric Intensive Care Unit (from May 2017 to August 2017) was enrolled in a clinical study. Two researchers evaluated the validity of the translated FLACC Behavioral Scale by weighted kappa coefficient and intraclass correlation coefficients (ICC). Observational pain was simultaneously measured by the visual analog scale (VAS obs) and reliability was evaluated by correlation analysis.
resultThe original author approved the translation. For the clinical study, a total of 121 observations were obtained from 24 pediatric patients. Agreement between observers was highly correlated for each of the FLACC categories (Face: κ = 0.85, Leg: κ = 0.74, Activity: κ = 0.89, Cry: κ = 0.93, Consolability: κ = 0.93) as well as the total score (Total: κ = 0.95,). Correlation analysis demonstrated a good criterion validation between the FLACC scale and the VAS obs. (r = 0.96).
conclusionOur Japanese version of the FLACC Behavioral Scale shows high validity and reliability.
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