Validação clínica das escalas curta e longa da UNESP-Botucatu para avaliar a dor aguda em gatos
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2020-08-26
Autores
Belli, Maíra
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Universidade Estadual Paulista (Unesp)
Resumo
A escala multidimensional para avaliação de dor da UNESP-Botucatu (EMAD U-B) é um instrumento validado, demonstrando validade, confiabilidade e sensibilidade. Entretanto, a escala ainda possui algumas limitações pois não foi testada em grupo controle ou placebo negativo e seu uso foi específico para ovariohisterectomia, além de ser uma escala longa e dificultar uma abordagem rápida para seu uso na rotina clínica. Este estudo teve por objetivo preencher essas limitações, validando clinicamente a escala original e sua versão curta (UCAPS) para diversas condições que cursam com dor clínica e pós operatória de cirurgias ortopédicas e de tecidos moles. Além disso, comparou-se ambas com outro instrumento validado, a escala multidimensional de dor de Glasgow para felinos (CMPS-Feline). O estudo foi composto por 52 gatos, sendo dez clinicamente saudáveis e sem dor (grupo saudável – controle) e 42 com dor (20 – grupo clínico e 22 - grupo cirurgia, sendo 12 cirurgias ortopédicas e dez cirurgias de tecidos moles). Os gatos do grupo saudável foram avaliados a cada 30 minutos, por 2 horas, os do grupo cirurgia foram avaliados antes da cirurgia e a cada hora até 6 horas após. Avaliou-se o grupo clínico imediatamente antes e 20 minutos após a analgesia. Três avaliadoras presenciais aferiram a dor primeiramente pelas escalas analógica visual (EAV), numérica (EN), descritiva simples (EDS), nesta ordem, seguido da UCAPS, EMAD U-B e a CMPS-Feline em ordem aleatória para cada animal. Para o grupo cirurgia realizou-se resgate analgésico quando o escore da UCAPS era ≥4. Caso o escore fosse abaixo de 4 pontos e o animal demonstrasse desconforto, o resgate analgésico era feito. Para o grupo clínico, todos os animais receberam resgate. A confiabilidade interobservador baseada no coeficiente intraclasse da UCAPS e EMAD U-B foi boa (> 0,77), exceto para a UCAPS entre o avaliador 3 e os demais, que foi moderado (0,68 e 0,72). A correlação da UCAPS com a EMAD U-B foi muito forte (correlação de Spearman 0,85) e a correlação destas com a CMPS-Feline foi forte (0,77 e 0,78, respectivamente). Todas as escalas demonstraram validade do constructo, tanto para responsividade caracterizada pelos maiores escores dos gatos com dor clínica e pós-operatória em relação ao grupo controle, segundo o teste de Mann-Whitney, quanto na redução dos escores após o resgate analgésico, de acordo com o teste de Wilcoxon A sensibilidade e especificidade da UCAPS foi boa (>80%) e a especificidade da EMAD foi moderada (72%). Conclui-se que a UCAPS e a sua versão original, EMAD U-B, são ferramentas que apresentam validação clínica confirmada pela reprodutibilidade, validades de constructo e critério concorrente, sensibilidade e especificidade, para avaliar dor em gatos submetidos a diversas causas de dor clínica e pós-operatória de cirurgias ortopédicas e de tecidos moles.
The UNESP-Botucatu multidimensional pain assessment scale (EMAD U-B) is a validated instrument, demonstrating validity, reliability, and sensitivity. However, the scale still has some limitations as it has not been tested with a negative control or placebo group and its use was tested specifically for ovariohysterectomy, in addition to being a long scale, which hinders a quick approach for its use in the clinical routine. This study aimed to fill these limitations, by clinically validating the original scale and its short version (UCAPS) for several conditions that present clinical and postoperative pain in orthopedic and soft tissue surgeries. In addition, both scales were compared with another validated instrument, the Glasgow multidimensional feline pain scale (CMPS-Feline). The study consisted of 52 cats, ten of which were clinically healthy and without pain (healthy group - control) and 42 with pain (20 - clinical group and 22 - surgery group, with 12 orthopedic surgeries and ten soft tissue surgeries). Cats in the healthy group were evaluated every 30 minutes for 2 hours. Cats in the surgery group were evaluated before surgery and every hour after for up to 6 hours. The clinical group was evaluated immediately before and 20 minutes after analgesia. Three presential evaluators first measured pain using the visual analog (VAS), numerical (NS), and simple descriptive (SDS) scales, in this order, followed by the UCAPS, EMAD U-B, and CMPS-Feline in random order for each animal. For the surgery group, rescue analgesia was performed when the UCAPS score was ≥4. If the score was below 4 points and the animal showed discomfort, rescue analgesia was performed. For the clinical group, all animals received rescue analgesia regardless of the score. Interobserver reliability based on the intraclass coefficient of UCAPS and EMAD U-B was good (> 0.77), except for the UCAPS between evaluator 3 and the other evaluators, which was moderate (0.68 and 0.72). The correlation between UCAPS and EMAD UB was very strong (Spearman correlation 0.85) and their correlation with CMPS-Feline was strong (0.77 and 0.78, respectively). All scales demonstrated construct validity, both through responsiveness, characterized by the higher scores of cats with clinical and postoperative pain compared to the control group, according to the Mann-Whitney test, and the reduction in scores after rescue analgesia, according to the Wilcoxon test. The sensitivity and specificity of the UCAPS was good (> 80%) and the specificity of the EMAD U-B was moderate (72%). It is concluded that the UCAPS and its original version, the EMAD U-B, are tools that present clinical validation confirmed by the reproducibility and construct and concurrent criterion validity, sensitivity and specificity, to evaluate pain in cats submitted to several causes of clinical and post-operative pain after orthopedic and soft tissue surgery.
The UNESP-Botucatu multidimensional pain assessment scale (EMAD U-B) is a validated instrument, demonstrating validity, reliability, and sensitivity. However, the scale still has some limitations as it has not been tested with a negative control or placebo group and its use was tested specifically for ovariohysterectomy, in addition to being a long scale, which hinders a quick approach for its use in the clinical routine. This study aimed to fill these limitations, by clinically validating the original scale and its short version (UCAPS) for several conditions that present clinical and postoperative pain in orthopedic and soft tissue surgeries. In addition, both scales were compared with another validated instrument, the Glasgow multidimensional feline pain scale (CMPS-Feline). The study consisted of 52 cats, ten of which were clinically healthy and without pain (healthy group - control) and 42 with pain (20 - clinical group and 22 - surgery group, with 12 orthopedic surgeries and ten soft tissue surgeries). Cats in the healthy group were evaluated every 30 minutes for 2 hours. Cats in the surgery group were evaluated before surgery and every hour after for up to 6 hours. The clinical group was evaluated immediately before and 20 minutes after analgesia. Three presential evaluators first measured pain using the visual analog (VAS), numerical (NS), and simple descriptive (SDS) scales, in this order, followed by the UCAPS, EMAD U-B, and CMPS-Feline in random order for each animal. For the surgery group, rescue analgesia was performed when the UCAPS score was ≥4. If the score was below 4 points and the animal showed discomfort, rescue analgesia was performed. For the clinical group, all animals received rescue analgesia regardless of the score. Interobserver reliability based on the intraclass coefficient of UCAPS and EMAD U-B was good (> 0.77), except for the UCAPS between evaluator 3 and the other evaluators, which was moderate (0.68 and 0.72). The correlation between UCAPS and EMAD UB was very strong (Spearman correlation 0.85) and their correlation with CMPS-Feline was strong (0.77 and 0.78, respectively). All scales demonstrated construct validity, both through responsiveness, characterized by the higher scores of cats with clinical and postoperative pain compared to the control group, according to the Mann-Whitney test, and the reduction in scores after rescue analgesia, according to the Wilcoxon test. The sensitivity and specificity of the UCAPS was good (> 80%) and the specificity of the EMAD U-B was moderate (72%). It is concluded that the UCAPS and its original version, the EMAD U-B, are tools that present clinical validation confirmed by the reproducibility and construct and concurrent criterion validity, sensitivity and specificity, to evaluate pain in cats submitted to several causes of clinical and post-operative pain after orthopedic and soft tissue surgery.
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Palavras-chave
Analgesia, Bem-estar, Confiabilidade, Cuidados Pós-Operatórios, Escala de dor, Ortopedia, Validade, Animal welfare, Orthopedics, Pain scale, Postoperative care