Validação da escala da Unesp-Botucatu para avaliação da dor pós-operatória em ovinos
Data
2020-02-21
Autores
Silva, Nuno Emanuel de Oliveira Figueiredo da [UNESP]
Título da Revista
ISSN da Revista
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
É importante desenvolver uma ferramenta com validação estatística robusta para diagnosticar a dor em ovinos e proceder a uma intervenção analgésica eficaz. Este estudo objetivou elaborar um etograma para avaliar o comportamento e validar uma escala para avaliar a dor aguda pós-operatória em ovinos. Realizou-se laparoscopia eletiva em 48 ovinos saudáveis, filmados em quatro momentos, um pré-operatório e três pós-operatórios antes e após a analgesia de resgate analgésico e 24 horas. Os vídeos foram aleatorizados e avaliados duas vezes com intervalo de um mês pelos quatro observadores. A análise estatística foi realizada no software R e as diferenças consideradas significativas quando p <0,05. Baseada na associação múltipla adotou-se uma escala unidimensional. A confiabilidade intra e inter-observador variou de moderada a muito boa (coeficiente de correlação intraclasse ≥ 0,55). A escala apresentou correlação de Spearman > 0.80 com as escalas numérica, descritiva simples e visual analógica e correlação de 0,59 com a escala de expressão facial. Pelo teste de Friedman a escala foi responsiva, pelo aumento e diminuição dos escores de dor de todos os itens após a cirurgia e intervenção analgésica, respectivamente. Todos os itens da escala apresentaram correlação item-total de Spearman aceitável (0,3 - 0,7) e a sua consistência interna foi excelente (α de Cronbach = 0,84). Todos os seus itens apresentaram especificidade < 0.30 e sensibilidade entre 0.67- 0.85, exceto para apetite. Segundo o índice de Youden o ponto de corte foi de ≥ 4 de 12, com zona de incerteza diagnóstica de 2,5 a 3,5, que indica a acurácia da escala. A área sob a curva > 0,95 para todos os avaliadores demonstrou a excelente capacidade discriminatória do instrumento. Classificou-se os escores como dor intensidade leve (0 a 3); moderada (4 e 8) e severa (≥ 9). A escala facial teve boa confiabilidade intraobservador em três avaliadores e a interobservador variou de pobre a moderada; ela foi responsiva e teve muito boa consistência interna (0,79). O seu ponto de corte foi de ≥ 7 de 12, com zona de incerteza diagnóstica de 2,5 a 6,5. Em conclusão, a escala composta da Unesp-Botucatu para avaliação da dor pós-operatória em ovinos é um instrumento válido, confiável, específico, sensível, com excelente consistência interna, acurácia e capacidade discriminatória.
The development of a tool with robust statistical validation is important to diagnose pain in sheep and carry out an effective analgesic intervention. The current study aimed to develop an ethogram to evaluate behavior and validate a scale to evaluate acute postoperative pain in sheep. Elective laparoscopy was performed in 48 healthy sheep, filmed at four moments, one preoperative and three postoperative before and after analgesic rescue analgesia and 24 hours after. The videos were randomized and assessed twice by the four evaluators, with an interval of one month between evaluations. The statistical analysis was performed using R software and differences were considered significant when p <0.05. Based on the multiple association, a unidimensional scale was adopted. The intra- and inter-observer reliability ranged from moderate to very good (intraclass correlation coefficient ≥ 0.55). All items on the scale demonstrated an acceptable Spearman item-total correlation (0.3 - 0.7). The scale presented Spearman correlations > 0.80 with the numerical, simple descriptive, and visual analogue scales, and a correlation of 0.59 with the facial expression scale. According to the Friedman test, the scale was responsive, due to the increase and decrease in pain scores of all items after surgery and analgesic intervention, respectively. The internal consistency was excellent (Cronbach's α = 0.84) and all items presented specificity <0.30 and sensitivity between 0.67-0.85, except for appetite. According to the Youden index, the cut-off point was ≥ 4 out of 12, with a diagnostic uncertainty zone of 2.5 to 3.5, which indicates the accuracy of the scale. The area under the curve > 0.95 for all evaluators demonstrated excellent discriminatory capacity of the instrument. The scores of the scale were classified into three intensities of pain: mild (0 to 3); moderate (4 and 8) and severe (≥ 9). The facial scale had good intra-observer reliability in three evaluators and the interobserver ranged from poor to moderate; it was responsive and had very good internal consistency (0.79). Its cut-off point was ≥ 7 out of 12, with a diagnostic uncertainty range of 2.5 to 6.5. In conclusion, the UnespBotucatu composite scale to assess postoperative pain in sheep is a valid, reliable, specific, sensitive instrument, with excellent internal consistency, accuracy and discriminatory capacity.
The development of a tool with robust statistical validation is important to diagnose pain in sheep and carry out an effective analgesic intervention. The current study aimed to develop an ethogram to evaluate behavior and validate a scale to evaluate acute postoperative pain in sheep. Elective laparoscopy was performed in 48 healthy sheep, filmed at four moments, one preoperative and three postoperative before and after analgesic rescue analgesia and 24 hours after. The videos were randomized and assessed twice by the four evaluators, with an interval of one month between evaluations. The statistical analysis was performed using R software and differences were considered significant when p <0.05. Based on the multiple association, a unidimensional scale was adopted. The intra- and inter-observer reliability ranged from moderate to very good (intraclass correlation coefficient ≥ 0.55). All items on the scale demonstrated an acceptable Spearman item-total correlation (0.3 - 0.7). The scale presented Spearman correlations > 0.80 with the numerical, simple descriptive, and visual analogue scales, and a correlation of 0.59 with the facial expression scale. According to the Friedman test, the scale was responsive, due to the increase and decrease in pain scores of all items after surgery and analgesic intervention, respectively. The internal consistency was excellent (Cronbach's α = 0.84) and all items presented specificity <0.30 and sensitivity between 0.67-0.85, except for appetite. According to the Youden index, the cut-off point was ≥ 4 out of 12, with a diagnostic uncertainty zone of 2.5 to 3.5, which indicates the accuracy of the scale. The area under the curve > 0.95 for all evaluators demonstrated excellent discriminatory capacity of the instrument. The scores of the scale were classified into three intensities of pain: mild (0 to 3); moderate (4 and 8) and severe (≥ 9). The facial scale had good intra-observer reliability in three evaluators and the interobserver ranged from poor to moderate; it was responsive and had very good internal consistency (0.79). Its cut-off point was ≥ 7 out of 12, with a diagnostic uncertainty range of 2.5 to 6.5. In conclusion, the UnespBotucatu composite scale to assess postoperative pain in sheep is a valid, reliable, specific, sensitive instrument, with excellent internal consistency, accuracy and discriminatory capacity.
Descrição
Palavras-chave
Analgesia, Bem-estar, Comportamento, Confiabilidade, Ovelhas, Welfare, Behaviour, Reliability, Ovine