Cited by 2,580Psychometric Methodologies and TestingHealth Education and ValidationPain Management and Opioid Use

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

Wewers, Mary Ellen, Lowe, Nancy K.·1990·Research in Nursing & Health

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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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Mechanical treatment of plantar fasciitis. A prospective study.
Martin, J. E., Hosch, J. C., Goforth, W., Murff, R. T., Lynch, D., & Odom, R. (2001) · Journal of the American Podiatric Medical Association (Print) · doi:10.7547/87507315-91-2-55 · Cited by 176
Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial
Ceccaroni, M., Clarizia, R., Bruni, F., D’Urso, E., Gagliardi, M. L., Roviglione, G., Minelli, L., & Ruffo, G. (2012) · Surgical Endoscopy · doi:10.1007/s00464-012-2153-3 · Cited by 177
The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study
Barbaros, U., Asoglu, O., Seven, R., Erbil, Y., Dinççağ, A., Deveci, U., Özarmağan, S., & Mercan, S. (2007) · Hernia · doi:10.1007/s10029-006-0160-9 · Cited by 175
“The visual analogue scale deWned by Wewers [ 4 ] was used for the evaluation of the degree of pain.”
Method
Mood states of oncology outpatients: Does pain make a difference?
Glover, J., Dibble, S. L., Dodd, M. J., & Miaskowski, C. A. (1995) · Journal of Pain and Symptom Management · doi:10.1016/0885-3924(94)00073-t · Cited by 168
Virtual reality and stimulation of touch and smell for inducing relaxation: A randomized controlled trial
Serrano, B., Baños, R., & Botella, C. (2015) · Computers in Human Behavior · doi:10.1016/j.chb.2015.08.007 · Cited by 175
“Visual Analogue Scale : VAS (Gross & Levenson, 1995; Wewers & Lowe, 1990).”
Preoperative preparation in children: a cross-sectional study.
Kain, Z., Mayes, L., & Caramico, L. (1996) · Journal of clinical anesthesia · doi:10.1016/0952-8180(96)00115-8 · Cited by 174
Hallux Valgus Correction Comparing Percutaneous Chevron/Akin (PECA) and Open Scarf/Akin Osteotomies
Lee, M., Walsh, J., Smith, M. M., Ling, J. S., Wines, A., & Lam, P. (2017) · Foot & ankle international · doi:10.1177/1071100717704941 · Cited by 170
The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy
Ali, A., Altun, D., Oğuz, B., Ilhan, M., Demircan, F., & Koltka, K. (2014) · Journal of Anesthesia · doi:10.1007/s00540-013-1712-7 · Cited by 170
“This test, which has been used for many years, was previously validated and its reliability was determined [9].”
Method
Patient-reported outcome measures in arthroplasty registries
Rolfson, O., Bohm, É., Franklin, P. D., Lyman, S. L., Denissen, G., Dawson, J., Dunn, J. A., Chenok, K. E., Dunbar, M., Overgaard, S., et al. (2016) · Acta Orthopaedica · doi:10.1080/17453674.2016.1181816 · Cited by 339
“Submit your article to this journal Article views: 818 View related articles View Crossmark data Citing articles: 3 View citing articles Patient-reported outcome measures in arthroplasty registries”
Endovascular Treatment of Pelvic Congestion Syndrome: Visual Analog Scale (VAS) Long-Term Follow-up Clinical Evaluation in 202 Patients
Laborda, A., Medrano, J., de Blas, I., Urtiaga, I., Carnevale, F., & de Gregorio, M. A. (2013) · Cardiovascular and Interventional Radiology · doi:10.1007/s00270-013-0586-2 · Cited by 167
“Regarding symptoms and clinical evolution, some authors, using VAS, reported average scores of more than 7 points before embolization to 3.5 points 12 months after treatment, achieving clinical improvement in 80–85 % of patients, no changes in 10–17 %, and worsening in \5 % of patients [18–20].”
MethodInfluential
Phonophoresis versus ultrasound in the treatment of common musculoskeletal conditions.
Klaiman, M. D., Shrader, J., Danoff, J., Hicks, J., Pesce, W. J., & Ferland, J. (1998) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199809000-00002 · Cited by 165
Voice evaluation before and after laser excision vs. radiotherapy of T1A glottic carcinoma.
Rydell, R., Schalén, L., Fex, S., & Elner, Å. (1995) · Acta Oto-Laryngologica · doi:10.3109/00016489509139367 · Cited by 165
Post-Surgical Clinical Monitoring of Soft Tissue Wound Healing in Periodontal and Implant Surgery
Pippi, R. (2017) · International Journal of Medical Sciences · doi:10.7150/ijms.19727 · Cited by 164
The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics.
Cuff, D., Virani, N., Levy, J. C., Frankle, M., Derasari, A., Hines, B., Pupello, D. R., Cancio, M., & Mighell, M. (2008) · Journal of Bone and Joint Surgery-british Volume · doi:10.1302/0301-620x.90b3.19408 · Cited by 163
The association between neck pain intensity, physical functioning, depressive symptomatology and time-to-claim-closure after whiplash.
Côté, P., Hogg-Johnson, S., Cassidy, J., Carroll, L., & Frank, J. (2001) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00319-x · Cited by 163
Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients
Gagliese, L., & Katz, J. (2003) · Pain · doi:10.1016/s0304-3959(02)00327-5 · Cited by 161
“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).”
Background
Remote Ischemic Limb Preconditioning After Subarachnoid Hemorrhage
Koch, S., Katsnelson, M. J., Dong, C., & Perez-Pinzon, M. (2011) · Stroke · doi:10.1161/strokeaha.110.605840 · Cited by 160
The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial.
Hattan, J., King, L., & Griffiths, P. (2002) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.2002.02083.x · Cited by 160
A visual analogue thermometer for measuring pain intensity.
Choinière, M., & Amsel, R. (1996) · Journal of Pain and Symptom Management · doi:10.1016/0885-3924(95)00204-9 · Cited by 158
Risk factors for anxiety at induction of anesthesia in children: a prospective cohort study
Davidson, A., Shrivastava, P., Jamsen, K., Huang, G. H., Czarnecki, C., Gibson, M. A., Stewart, S., & Stargatt, R. (2006) · Paediatric anaesthesia · doi:10.1111/j.1460-9592.2006.01904.x · Cited by 156
The Well-Being and Personal Wellness Promotion Strategies of Medical Oncologists in the North Central Cancer Treatment Group
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 159
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
Phase III, randomized, double-blind, placebo-controlled study of long-acting methylphenidate for cancer-related fatigue: North Central Cancer Treatment Group NCCTG-N05C7 trial.
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
Logistic quantile regression for bounded outcomes
Bottai, M., Cai, B., & Mckeown, R. (2010) · Statistics in Medicine · doi:10.1002/sim.3781 · Cited by 153
“Many bounded outcomes, such as the visual analog scale, are subjective assessments that yield ordinal rather than interval/ratio data [31, 32].”
Background
The Effects of Music Interventions on Postoperative Pain and Sleep in Coronary Artery Bypass Graft (CABG) Patients
Zimmerman, 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
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
“We employed a visual analogue scale (VAS) and a multidimensional scoring system to assess the severity of dysmenorrhea experienced by the responder [10,11].”
Method
Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients.
Canbulat, 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).”
Method
Phase 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
Comparison of clinical efficacy of a dentifrice containing calcium sodium phosphosilicate to a dentifrice containing potassium nitrate and to a placebo on dentinal hypersensitivity: a randomized clinical trial.
Pradeep, A., & Sharma, A. (2010) · The Journal of Periodontology · doi:10.1902/jop.2010.100056 · Cited by 146
Assessing Antiretroviral Adherence via Electronic Drug Monitoring and Self-Report: An Examination of Key Methodological Issues
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
“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, &”
Background
Effects of Behavioral Interventions on Disruptive Behavior and Affect in Demented Nursing Home Residents
Beck, 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
“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.”
Method
The effect of three different methods on venipuncture pain and anxiety in children: Distraction cards, virtual reality, and Buzzy® (randomized controlled trial).
Erdoğan, B., & Özdemir, A. A. (2021) · Journal of pediatric nursing · doi:10.1016/j.pedn.2021.01.001 · Cited by 144
Recovery of Sensory and Motor Function After Nerve Repair
Rosén, B. (1996) · Journal of Hand Therapy · doi:10.1016/s0894-1130(96)80037-8 · Cited by 139
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
“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
“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].”
Background
Precontoured 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
DOI: 10.1002/nur.4770130405
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 6015 d)
Locations: Research in Nursing & Health (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Health Sciences › Nursing › Research and Theory › 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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A critical review of visual analogue scales in the measurement of clinical phenomena

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