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Journal ArticleDOI

A critical review of visual analogue scales in the measurement of clinical phenomena

01 Aug 1990-Research in Nursing & Health (Res Nurs Health)-Vol. 13, Iss: 4, pp 227-236
TL;DR: The VAS method has potential utility for the measurement of a variety of clinical phenomena of interest to nurse investigators and conceptual, psychometric, and statistical aspects of the VAS are considered.
Abstract: Visual analogue scales (VAS) have been used in the social and behavioral sciences to measure a variety of subjective phenomena. The VAS method has potential utility for the measurement of a variety of clinical phenomena of interest to nurse investigators. In this review a description of the various forms of the VAS and an historical overview of their development are presented. In addition, conceptual, psychometric, and statistical aspects of the VAS are considered. Finally, strengths and limitations of the VAS method are addressed.
Citations
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Journal ArticleDOI
TL;DR: Although immediate negative behavioral responses develop in a relatively large number of young children following surgery, the magnitude of these changes is limited, and long-term maladaptive behavioral responses developed in only a small minority.
Abstract: Objective: To determine predictors and behavioral outcomes of preoperative anxiety in children undergoing surgery. Design: A prospective, longitudinal study. Setting: A university children's hospital. Participants: One hundred sixty-three children, 2 to 10 years of age (and their parents), who underwent general anesthesia and elective surgery. Main Outcome Measures: In the preoperative holding area, anxiety level of the child and parents was determined using self-reported and independent observational measures. At separation to the operating room, the anxiety level of the child and parents was rated again. Postoperative behavioral responses were evaluated 3 times (at 2 weeks, 6 months, and 1 year). Results: A multiple regression model (R 2 =0.58, F=6.4, P =.007) revealed that older children and children of anxious parents, who received low Emotionality, Activity, Sociability, and Impulsivity (EASI) ratings for activity, and with a history of poor-quality medical encounters demonstrated higher levels of anxiety in the preoperative holding area. A similar model (R 2 =0.42, F=8.6, P =.001) revealed that children who received low EASI ratings for activity, with a previous hospitalization, who were not enrolled in day care, and who did not undergo premedication were more anxious at separation to the operating room. Overall, 54% of children exhibited some negative behavioral responses at the 2-week follow-up. Twenty percent of the children continued to demonstrate negative behavior changes at 6-month follow-up, and, in 7.3% of the children, these behaviors persisted at 1-year follow-up. Nightmares, separation anxiety, eating problems, and increased fear of physicians were the most common problems at 2-week follow-up. Multivariate analysis demonstrated that child's age, number of siblings, and immediate preoperative anxiety of the child and mother predicted later behavioral problems. Conclusions: Variables such as situational anxiety of the mother, temperament of the child, age of the child, and quality of previous medical encounters predict a child's preoperative anxiety. Although immediate negative behavioral responses develop in a relatively large number of young children following surgery, the magnitude of these changes is limited, and long-term maladaptive behavioral responses develop in only a small minority. Arch Pediatr Adolesc Med. 1996;150:1238-1245

642 citations

Journal ArticleDOI
TL;DR: Both distress and well-being are related to medical student empathy, and efforts to reduce student distress should be part of broader efforts to promote student well- Being, which may enhance aspects of professionalism.
Abstract: To determine whether lower levels of empathy among a sample of medical students in the United States are associated with personal and professional distress and to explore whether a high degree of personal well-being is associated with higher levels of empathy. Multi-institutional, cross-sectional survey. All medical schools in Minnesota (a private medical school, a traditional public university, and a public university with a focus in primary care). A total of 1,098 medical students. Validated instruments were used to measure empathy, distress (i.e., burnout and symptoms of depression), and well-being (high quality of life). Medical student empathy scores were higher than normative samples of similarly aged individuals and were similar to other medical student samples. Domains of burnout inversely correlated with empathy (depersonalization with empathy independent of gender, all P < .02, and emotional exhaustion with emotive empathy for men, P = .009). Symptoms of depression inversely correlated with empathy for women (all P ≤ .01). In contrast, students’ sense of personal accomplishment demonstrated a positive correlation with empathy independent of gender (all P < .001). Similarly, achieving a high quality of life in specific domains correlated with higher empathy scores (P < .05). On multivariate analysis evaluating measures of distress and well-being simultaneously, both burnout (negative correlation) and well-being (positive correlation) independently correlated with student empathy scores. Both distress and well-being are related to medical student empathy. Efforts to reduce student distress should be part of broader efforts to promote student well-being, which may enhance aspects of professionalism. Additional studies of student well-being and its potential influence on professionalism are needed.

516 citations

Journal ArticleDOI
TL;DR: It is concluded that in a population with acute LBP, both the TSK and the FABQ are reliable measures of pain-related fear, and in the clinical setting they may provide the practitioner a means of identifying pain- related fear in a patient with acuteLBP.

468 citations

Journal ArticleDOI
01 Apr 1999-Pain
TL;DR: Both pain intensity and self efficacy contribute to the development of disability and depression in patients with chronic pain, and the lack of belief in ones own ability to manage pain, cope and function despite persistent pain, is a significant predictor of the extent to which individuals with Chronic pain become disabled and/or depressed.
Abstract: To clarify the relationships between physical, and psychosocial components of chronic pain, a path analytic model was tested conceptualizing self efficacy as a mediator of disability. In turn, disability was hypothesized to mediate depression. This model could help explain the circumstances under which disability develops and why so many chronic pain patients become depressed. Questionnaires from 126 chronic pain patients (without prior depression) were reviewed from three pain clinics. Hypothesized and alternate models were tested using separate regression equations to identified models which best fit these data. Regression analysis supported that self efficacy partially mediates the relationship between pain intensity and disability. This model accounted for 47% of the explained variance in disability ( P R 2 =0.56), with gender and pain location paths remaining significant. In separate regression analyses, disability was found to partially mediate the relationship between pain intensity and depression (b=0.47–0.33). This model accounted for 26% of the explained variance in depression. The addition of self efficacy to this model supported it as a stronger mediator ( R 2 =0.32), and suggested that support for disability as a mediator of depression was a spurious finding. Both pain intensity and self efficacy contribute to the development of disability and depression in patients with chronic pain. Therefore, the lack of belief in ones own ability to manage pain, cope and function despite persistent pain, is a significant predictor of the extent to which individuals with chronic pain become disabled and/or depressed. Nevertheless, these mediators did not eliminate the strong impact that high pain intensity has on disability and depression. Therefore, therapy should target multiple goals, including: pain reduction, functional improvement and the enhancement of self efficacy beliefs.

451 citations

References
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Journal ArticleDOI
TL;DR: This transmutability of the validation matrix argues for the comparisons within the heteromethod block as the most generally relevant validation data, and illustrates the potential interchangeability of trait and method components.
Abstract: Content Memory (Learning Ability) As Comprehension 82 Vocabulary Cs .30 ( ) .23 .31 ( ) .31 .31 .35 ( ) .29 .48 .35 .38 ( ) .30 .40 .47 .58 .48 ( ) As judged against these latter values, comprehension (.48) and vocabulary (.47), but not memory (.31), show some specific validity. This transmutability of the validation matrix argues for the comparisons within the heteromethod block as the most generally relevant validation data, and illustrates the potential interchangeability of trait and method components. Some of the correlations in Chi's (1937) prodigious study of halo effect in ratings are appropriate to a multitrait-multimethod matrix in which each rater might be regarded as representing a different method. While the published report does not make these available in detail because it employs averaged values, it is apparent from a comparison of his Tables IV and VIII that the ratings generally failed to meet the requirement that ratings of the same trait by different raters should correlate higher than ratings of different traits by the same rater. Validity is shown to the extent that of the correlations in the heteromethod block, those in the validity diagonal are higher than the average heteromethod-heterotrait values. A conspicuously unsuccessful multitrait-multimethod matrix is provided by Campbell (1953, 1956) for rating of the leadership behavior of officers by themselves and by their subordinates. Only one of 11 variables (Recognition Behavior) met the requirement of providing a validity diagonal value higher than any of the heterotrait-heteromethod values, that validity being .29. For none of the variables were the validities higher than heterotrait-monomethod values. A study of attitudes toward authority and nonauthority figures by Burwen and Campbell (1957) contains a complex multitrait-multimethod matrix, one symmetrical excerpt from which is shown in Table 6. Method variance was strong for most of the procedures in this study. Where validity was found, it was primarily at the level of validity diagonal values higher than heterotrait-heteromethod values. As illustrated in Table 6, attitude toward father showed this kind of validity, as did attitude toward peers to a lesser degree. Attitude toward boss showed no validity. There was no evidence of a generalized attitude toward authority which would include father and boss, although such values as the VALIDATION BY THE MULTITRAIT-MULTIMETHOD MATRIX

15,795 citations

Journal ArticleDOI
01 Sep 1983-Pain
TL;DR: Visual analogue scales (VAS) of sensory intensity and affective magnitude were validated as ratio scale measures for both chronic and experimental pain, demonstrating the valid use of VAS for the measurement of and comparison between chronic pain and experimental heat pain.
Abstract: Visual analogue scales (VAS) of sensory intensity and affective magnitude were validated as ratio scale measures for both chronic and experimental pain. Chronic pain patients and healthy volunteers made VAS sensory and affective responses to 6 noxious thermal stimuli (43, 45, 47, 48, 49 and 51 degrees C) applied for 5 sec to the forearm by a contact thermode. Sensory VAS and affective VAS responses to these temperatures yielded power functions with exponents 2.1 and 3.8, respectively; these functions were similar for pain patients and for volunteers. The power functions were predictive of estimated ratios of sensation or affect produced by pairs of standard temperatures (e.g. 47 and 49 degrees C), thereby providing direct evidence for ratio scaling properties of VAS. Vas sensory intensity responses to experimental pain, VAS sensory intensity responses to different levels of chronic pain, and direct temperature (experimental pain) matches to 3 levels of chronic pain were all internally consistent, thereby demonstrating the valid use of VAS for the measurement of and comparison between chronic pain and experimental heat pain.

3,440 citations

Journal ArticleDOI
01 Jun 1976-Pain
TL;DR: Most patients could readily use visual analogue and graphic rating scales despite having no previous experience and use of these scales is the best available method for measuring pain or pain relief.
Abstract: Of the different types of visual analogue and graphic rating scales tested in a series of experiments, only two were satisfactory: these were the visual analogue scale and the graphic rating scales used horizontally with the words spread out along the whole length of the line. Other types of scale used gave distributions of results which were not uniform. Unusual distribution of results occurred when patients selected a position adjacent either to descriptive terms or preferred numbers. In some experiments, the distribution of results was determined by the nature of the experiment. Alternation of the ends of a scale did not affect the results. The behaviour of the graphic rating scale was different in patients accustomed to completing it and in those not so accustomed. The results of pain severity measured by these methods showed a very good correlation with pain severity measured by the simple descriptive pain scale. Changes in visual analogue scores also correlated well with changes in simple descriptive pain scores. The visual analogue and graphic rating scales were more sensitive than the traditional simple descriptive pain scale. Most patients could readily use visual analogue and graphic rating scales despite having no previous experience. The failure rate was slightly lower with the graphic rating method. Use of these scales is the best available method for measuring pain or pain relief.

2,510 citations

Journal ArticleDOI
TL;DR: Good correlation has been shown between pain scores derived from 4 different rating scales and an 11-point numerical rating scale performs better than both a 4-point simple descriptive scale or a continuous (visual analogue) scale.
Abstract: Good correlation has been shown between pain scores derived from 4 different rating scales. The correlation was maintained when presentation of the scales was separated by a series of questions and by physical examination. There is good evidence that the 4 scales are measuring the same underlying pain variable as they calibrate well. There is also evidence that an 11-point (0-10) numerical rating scale performs better than both a 4-point simple descriptive scale or a continuous (visual analogue) scale.

1,675 citations