A critical review of visual analogue scales in the measurement of clinical phenomena
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.
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At 3- and 6-months follow-up, the patient reported no respiratory distress and no pelvic and/or thoracic pain (VAS score = 1 for all parameters).
“At 3- and 6-months follow-up the patient reported no respiratory distress.”
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“This test, which has been used for many years, was previously validated and its reliability was determined [9].”
MethodPatient-reported outcome measures in arthroplasty registries
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“VAS ratings require quantification of pain intensity and abstract reasoning to determine the length of the line that corresponds to the intensity of pain (Ohnhaus and Adler, 1975; Wewers and Lowe, 1990).”
BackgroundRemote Ischemic Limb Preconditioning After Subarachnoid Hemorrhage
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Shanafelt, T. D., Novotny, P. J., Johnson, M. E., Zhao, X., Steensma, D. P., Lacy, M. Q., Rubin, J., & Sloan, J. A. (2005) · Oncology · doi:10.1159/000084519 · Cited by 155 · see citing works
Impact of pain on health-related quality of life in patients with inflammatory bowel disease
Schirbel, A. (2010) · World Journal of Gastroenterology · doi:10.3748/wjg.v16.i25.3168 · Cited by 163 · see citing works
Moraska, A. R., Sood, A., Dakhil, S., Sloan, J., Barton, D., Atherton, P., Suh, J. J., Griffin, P. C., Johnson, D. B. F., Ali, A., et al. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2010.28.1444 · Cited by 154 · see citing works
Logistic quantile regression for bounded outcomes
Bottai, M., Cai, B., & Mckeown, R. (2010) · Statistics in Medicine · doi:10.1002/sim.3781 · Cited by 153 · see citing works
“Many bounded outcomes, such as the visual analog scale, are subjective assessments that yield ordinal rather than interval/ratio data [31, 32].”
BackgroundZimmerman, L., Nieveen, J., Barnason, S., & Schmaderer, M. (1996) · Research and Theory for Nursing Practice · doi:10.1891/0889-7182.10.2.153 · Cited by 149 · see citing works
Prevalence and predictors of dysmenorrhea among students at a university in Turkey
Ozerdogan, N., Sayiner, D., Ayrancı, U., Unsal, A., & Giray, S. (2009) · International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · doi:10.1016/j.ijgo.2009.05.010 · Cited by 148 · see citing works
“We employed a visual analogue scale (VAS) and a multidimensional scoring system to assess the severity of dysmenorrhea experienced by the responder [10,11].”
MethodCanbulat, N., Ayhan, F., & Inal, S. (2015) · Pain Management Nursing · doi:10.1016/j.pmn.2014.03.003 · Cited by 146
“The VAS score is determined by measuring in millimeters from the left-hand end of the line to the point that the child marks (Wewers & Lowe 1990).”
MethodPhase 2 Study of Intralesional PV-10 in Refractory Metastatic Melanoma
Thompson, J. F., Agarwala, S. S., Smithers, B. M., Ross, M. I., Scoggins, C. R., Coventry, B. J., Neuhaus, S. J., Minor, D. R., Singer, J. M., & Wachter, E. A. (2014) · Annals of Surgical Oncology · doi:10.1245/s10434-014-4169-5 · Cited by 152 · see citing works
Pradeep, A., & Sharma, A. (2010) · The Journal of Periodontology · doi:10.1902/jop.2010.100056 · Cited by 146 · see citing works
Pearson, C., Simoni, J., Hoff, P. D., Kurth, A., & Martin, D. P. (2007) · Aids and Behavior · doi:10.1007/s10461-006-9133-3 · Cited by 145 · see citing works
“In some versions of the VAS there are no demarcations or anchors (other than the endpoints) on the line (Wewers and Lowe, 1990); in others, there are demarcations at intervals of 10% (Walsh, Mandalia, &”
BackgroundBeck, C. K., Vogelpohl, T. S., Rasin, J. H., Uriri, J. T., O???Sullivan, P., Walls, R., Phillips, R., & Baldwin, B. (2002) · Nursing Research · doi:10.1097/00006199-200207000-00002 · Cited by 143 · see citing works
“The Positive Visual Analogue Scale (PVAS) and Negative Visual Analogue Scale (NVAS) (Lee & Kieckhefer, 1989; Wewers & Lowe, 1990) are two 10- centimeter lines on separate pages for rating positive and negative affect.”
MethodErdoğan, B., & Özdemir, A. A. (2021) · Journal of pediatric nursing · doi:10.1016/j.pedn.2021.01.001 · Cited by 144 · see citing works
Recovery of sensory and motor function after nerve repair. A rationale for evaluation.
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Intranasal oxytocin modulates EEG mu/alpha and beta rhythms during perception of biological motion
Perry, A., Bentin, S., Shalev, I., Israel, S., Uzefovsky, F., Bar-On, D., & Ebstein, R. P. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2010.04.011 · Cited by 143 · see citing works
“To make sure that there were no effects of participants’ current state, participants were interrogated with a visual analogue scale (VAS), before and after each session (4 times altogether), with 8 scales that evaluated working abilities, drowsiness, sadness, anxiety, anger, communicativeness, and concentration (e.g.…”
The PROMIS Physical Function Correlates With the QuickDASH in Patients With Upper Extremity Illness
Overbeek, C., Nota, S. P. F. T., Jayakumar, P., Hageman, M., & Ring, D. (2015) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-014-3840-2 · Cited by 140 · see citing works
“The numeric rating scale for pain is an 11-point ordinal pain intensity scale anchored at each end by opposite statements, which are ‘‘no pain’’ (0) versus ‘‘worst possible pain’’ (10) [23, 40].”
BackgroundPrecontoured Plating of Clavicle Fractures: Decreased Hardware-related Complications?
Vanbeek, C., Boselli, K. J., Cadet, E., Ahmad, C., & Levine, W. (2011) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-011-1868-0 · Cited by 140
“log scale (VAS) pain score [28], American Shoulder and Elbow Surgeons (ASES) questionnaire [23], and Simple Shoulder Test (SST) [7].”
- Authors
- Wewers, M. E., & Lowe, N. K.
- Affiliations
- The Ohio State University (US)
- Corresponding author
- Wewers, Mary Ellen
- ORCID
- Lowe, Nancy K.
- Venue
- Research in Nursing & Health
- Publisher
- Wiley
- Published
- 1990-08
- Volume
- 13
- Issue
- 4
- Pages
- 227-236
- ISSN
- 0160-6891 (ISSN-L)
- 1098-240X
- OpenAlex
- W2120263268
- Cited by
- 2,580
- References
- 0
- Citations by year
- 2026: 74 · 2025: 104 · 2024: 87 · 2023: 149 · 2022: 112 · 2021: 160 · 2020: 123 · 2019: 132 · 2018: 137 · 2017: 142 · 2016: 154 · 2015: 143 · 2014: 147 · 2013: 139 · 2012: 128
- FWCI
- 5.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Research in Nursing & Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Education › Health Education and Validation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- visual analogue scale, subjective indicators, clinical phenomena, psychometrics, measurement validity, measurement reliability, patient-reported outcomes
- MeSH terms
- Humans, Pain Measurement, Psychometrics, Reproducibility of Results, Nursing Research, Clinical Nursing Research
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