Pain in critically ill adults with burns should be assessed using structured pain behavioural observation measures. This study tested the clinimetric qualities and usability of the behaviour pain scale (BPS) and the critical-care pain observation tool (CPOT) in this population. This prospective observational cohort study included 132 nurses who rated pain behaviour in 75 patients. The majority of nurses indicated that BPS and CPOT reflect background and procedural pain-specific features (63–72 and 87–80%, respectively). All BPS and CPOT items loaded on one latent variable (≥0.70), except for compliance ventilator and vocalisation for CPOT (0.69 and 0.64, respectively). Internal consistency also met the criterion of ≥0.70 in ventilated and non-ventilated patients for both scales, except for non-ventilated patients observed by BPS (0.67). Intraclass correlation coefficients (ICCs) of total scores were sufficient (≥0.70), but decreased when patients had facial burns. In general, the scales were fast to administer and easy to understand. Cut-off scores for BPS and CPOT were 4 and 1, respectively. In conclusion, both scales seem valid, reliable, and useful for the measurement of acute pain in ICU patients with burns, including patients with facial burns. Cut-off scores associated with BPS and CPOT for the burn population allow professionals to connect total scores to person-centred treatment protocols.
Psychophysiological measurements have so far been used to express player experience quantitatively in game genres such as shooter games and race games. However, these methods have not yet been applied to casual video games. From a development point of view, games developed in the casual sector of the games industry are characterized by very short production cycles which make them ill-suited for complex and lengthy psychophysiological testing regimes. This paper discusses some methodological innovations that lead to the application of psychophysiological measurements to enhance the design of a commercially released casual game for the Apple iPad, called 'Gua-Le-Ni'; or, The Horrendous Parade'. The game was tested in different stages of its development to dry-run a cycle of design improvements derived from psychophysiological data. The tests looked at the correlation between stress levels and the contraction of facial muscles with in-game performance in order to establish whether 'Gua-Le-Ni' offered the cognitive challenge, the learning curve, and the enjoyment the designers had in mind for this product. In this paper, we discuss the changes that were made to the game and the data-analysis that led to these changes.
