Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 19, 2022
Date Accepted: Mar 15, 2023
Development of the Emoji faces pain scale and its validation on mobile device in adult surgery patients: A longitudinal observational study
ABSTRACT
Background:
Measuring pain on digital devices using classic unidimensional pain scales such as the visual analog scale (VAS), numerical rating scale (NRS), and faces pain scale (FPS) has been proven to be reliable and valid. As pictographs are designed in colorful form and conform to the Unicode standard, Emojis are being preloaded on digital devices and are widely used by digital users. Thus, Emojis have the potential to be used as faces of FPS. Designed without additional details, Emojis might be more generalizable to a wider population and more preferred by digital device users. However, which Emojis sequence can best reflect levels of pain out of thousands of existing Emojis needs to be explored.
Objective:
This study was designed to develop an Emoji faces pain scale (Emoji-FPS) as well as to evaluate its reliability, validity, and preference for mobile devices in adult patients who underwent surgery.
Methods:
A modified Delphi technique with two rounds of online surveys was applied to obtain panelists’ consensus on the sequence of Emojis that can best represent six levels of pain. Then, a prospective cohort of patients scheduled to receive perianal surgery were recruited and asked to complete an online questionnaire on a mobile device at five time points (before surgery [T1], wake up after surgery [T2], four hours after surgery [T3], the second day after surgery [T4], and fifteen minutes after T4 [T5]). Four well-validated pain scales (NRS, VAS, Wong-Baker FACES® pain rating scale [Wong-Baker FACES], and Faces Pain Scale-Revised [FPS-R]) were used as reference sales.
Results:
After two rounds of surveys on 40 Delphi panelists, an Emoji-FPS of , , , , , and was finally determined to represent six pain levels from “No Hurt” to “Hurts Worst”. For validation, 300 patients were recruited, and 299 were analyzed, the mean (SD) age of whom was 38.5 (10.5) years, and 106 (35.5%) were women. For concurrent validity, the Emoji-FPS was highly correlated with four reference scales, with a Spearman correlation coefficient ρ ranging from 0.91 to 0.95. Excellent agreements were observed between four versions of Emoji-FPS (iOS, Android, Microsoft, and OpenMoji), with weighted Kappa coefficients ranging from 0.96 to 0.97. For discriminant validity, patients’ mean preoperative Emoji-FPS score (T1) was significantly higher than their postoperative Emoji-FPS score (T4), with a difference of 1.4 (95% CI, 1.3-1.6, P <.001). For test-retest reliability, Emoji-FPS scores measured at T4 and T5 were highly correlated with a ρ of 0.91. The Emoji-FPS was mostly preferred by patients, followed by the Wong-Baker FACES, FPS-R, NRS, and VAS.
Conclusions:
The Emoji-FPS is reliable and valid compared with traditional pain scales in adult surgery patients.
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