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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Background
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Background
Energetic, Visual and Non-Visual Aspects of Office Lighting
Linhart, F. (2010) · Infoscience (Ecole Polytechnique Fédérale de Lausanne) · doi:10.5075/epfl-thesis-4634 · Cited by 18
“239 C.4 Karolinska Sleepiness Scale for Chronobiological Study . . . . . . . . . . 244 C.5 VAS-MWT for Chronobiological Study . . . . . . . . . . . . . . . . . . . 245 C.6 Analog OLS for Chronobiological Study . . . . . . . . . . . . . . . . . . 246 C.7 Visual Comfort Scale for Chronobiological Study . . . . . . . . .…”
Influential
Solution-Focused Group Therapy for Patients on Long-Term Sick Leave: A Comparative Outcome Study
Thorslund, K. W. (2007) · Journal of Family Psychotherapy · doi:10.1300/j085v18n03_02 · Cited by 18
“Correlations varied between 0.42 and 0.91 (Wewers & Lowe, 1990).”
BackgroundInfluential
Effect of whitening toothpastes on tooth staining using two different colour-measuring devices — a 12-week clinical trial
Raoufi, S., & Birkhed, D. (2010) · International Dental Journal · doi:10.1016/s0020-6539(20)34254-4 · Cited by 17
Inducing driving anger with multi-stage road events in simulator environment
Wang, Y., Zheng, J., Zhang, W., Chen, X., & Wu, M. (2024) · Transportation Research Part F Traffic Psychology and Behaviour · doi:10.1016/j.trf.2024.02.001 · Cited by 18
The effect of virtual reality on women's perceived pain, fear, anxiety, and views about the procedure during hysterosalpingography: A randomized controlled trial.
Sezer, N. Y., Aker, M., Gönenç, I., Topuz, Ş., & Şükür, Y. (2023) · European Journal of Obstetrics, Gynecology, and Reproductive Biology · doi:10.22541/au.166118224.46838782/v1 · Cited by 17
Indications for and Outcomes of Three Unilateral Biportal Endoscopic Approaches for the Decompression of Degenerative Lumbar Spinal Stenosis: A Systematic Review
Bui, A. T., Trinh, G. M., Wu, M.-H., Hoang, T., Hu, M.-H., & Pao, J.-L. (2023) · Diagnostics · doi:10.3390/diagnostics13061092 · Cited by 17
“To evaluate postoperative clinical outcomes, we collected data on patients’ scores on the Visual Analog Scale (VAS; for back and leg pain) [10], Oswestry Disability Index (ODI) [11], and Macnab criteria [12] (the proportion of excellent and good results).”
Method
Impact of the awareness and fear of COVID-19 on menstrual symptoms in women: a cross-sectional study
Buran, G., & Öter, E. G. (2021) · Health Care for Women International · doi:10.1080/07399332.2021.2004149 · Cited by 17
“The scale is a simple method for measuring the severity of pain and it has a line between 0 and 10 indicating the intensity of pain, in which 0 indicates no pain and 10 the worst pain (Wewers & Lowe, 1990).”
Method
Fatigue Is Associated With Diminished Cardiovascular Response to Anticipatory Stress in Patients With Coronary Artery Disease
Gecaite-Stonciene, J., Hughes, B. M., Burkauskas, J., Bunevičius, A., Kažukauskienė, N., van Houtum, L. V., Brozaitiene, J., Neverauskas, J., & Mickuviene, N. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.692098 · Cited by 17
“The method of VAS is considered a valid and applicable tool to evaluate subjective experience in various experimental clinical settings (Wewers and Lowe, 1990).”
Method
Severity and Its Contributing Factors in Patients With Vestibular Migraine: A Cohort Study
Liu, W., Dong, H., Yang, L., Zhao, H., Dong, W., & Yang, Y. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.595328 · Cited by 22
“The exclusion criteria were as follows: (1) <18 years old; (2) during the followup period, no attack or loss of follow-up was reported; (3) inability to complete questionnaires within 72 h after attack; (4) headache or vestibular symptoms attributed to secondary causes; (5) long-term users (more than 2 weeks) of migra…”
BackgroundMethod
Patient-reported outcome after patient-specific unicondylar knee arthroplasty for unicompartmental knee osteoarthritis
Freigang, V., Rupp, M., Pfeifer, C., Worlicek, M., Radke, S., Deckelmann, S., Alt, V., & Baumann, F. (2020) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-020-03776-3 · Cited by 17
Validity and reliability of the Body Awareness Questionnaire in patients with non-specific chronic low back pain
Unal, A., Altuğ, F., Erden, A., Cavlak, U., & Şenol, H. (2020) · Acta Neurologica Belgica · doi:10.1007/s13760-020-01399-y · Cited by 17
Correlation between APACHE III score and sleep quality in ICU patients
Wang, C.-Y., Shang, M., Feng, L.-Z., Zhou, C.-L., Zhou, Q.-S., & Hu, K. (2019) · Journal of International Medical Research · doi:10.1177/0300060519856745 · Cited by 17
“Pain scores were obtained using the NRS, which was completed by patients indicating the severity of their pain on a scale with markings from 0 to 10 mm.(20) Noise and light levels next to the patient’s ear and pillow were measured at three time-points (at 20:00 h on the first day, at 00:00 h and at 04:00 h on the seco…”
An open/pilot trial of cognitive behavioral therapy in Turkish patients with refractory chronic migraine
Onur, Ö. Ş., Ertem, D. H., Karşıdağ, Ç., Uludüz, D., Özge, A., Sıva, A., & Gürü, M. (2019) · Cognitive Neurodynamics · doi:10.1007/s11571-019-09519-y · Cited by 20
Medicolegal Considerations Involving Iatrogenic Lingual Nerve Damage.
Pippi, R., Spota, A., & Santoro, M. (2018) · Journal of oral and maxillofacial surgery · doi:10.1016/j.joms.2018.03.020 · Cited by 17
Long-Term Effect of Pulsed Nd:YAG Laser in the Treatment of Children with Juvenile Rheumatoid Arthritis: A Randomized Controlled Trial
El-Shamy, S., Alayat, M., Abdelgalil, A., & Alshehri, M. A. (2018) · Photomedicine and Laser Surgery · doi:10.1089/pho.2018.4444 · Cited by 17
Test of Responsiveness and Sensitivity of the Questionnaire “Lymphedema Quality of Life Inventory”
Klernäs, P., Johnsson, A., Boyages, J., Brorson, H., Munnoch, A., & Johansson, K. I. (2018) · Lymphatic Research and Biology · doi:10.1089/lrb.2017.0048 · Cited by 17
“22,23 Because VAS measurements were repeated, the initial scores were made available to the patient at the second test.”
Clinical and histological evaluation on application of platelet concentrates on depigmented gingival epithelium
Debnath, K., & Chatterjee, A. (2018) · Journal of Indian Society of Periodontology · doi:10.4103/jisp.jisp_342_17 · Cited by 17
Self‐reported periodontal conditions among Dutch women during pregnancy
Stelmakh, V., Slot, D., & van der Weijden, G. V. D. (2017) · International Journal of Dental Hygiene · doi:10.1111/idh.12210 · Cited by 17
Detection of Nausea-Like Response in Rats by Monitoring Facial Expression
Yamamoto, K., Tatsutani, S., & Ishida, T. (2017) · Frontiers in Pharmacology · doi:10.3389/fphar.2016.00534 · Cited by 17
“However, since this method is based on subjective evaluation (Wewers and Lowe, 1990), it is impossible to recognize and evaluate whether animals feel nausea with this method.”
Method
Measurement of Symptoms Pre- and Post-treatment of Dry Eye Syndromes.
McMonnies, C. (2016) · Optometry and Vision Science · doi:10.1097/opx.0000000000000965 · Cited by 17
“However, the ‘‘worst pain imaginable’’ or ‘‘pain as bad as it can be’’ have no absolute value and can be considered to be unmeasurable.(20) The visual analogue scale anchor ‘‘worst pain imaginable’’ was found to be more appropriate in the assessment of dental pain (compared to ‘‘unbearable’’ and ‘‘intense’’) because i…”
BackgroundMethodInfluential
Prevalence of alterations in the characteristics of smile symmetry in an adult population from southern Europe.
Jiménez-Castellanos, E., Orozco-Varo, A., Arroyo-Cruz, G., & Iglesias-Linares, A. (2016) · The Journal of prosthetic dentistry (Print) · doi:10.1016/j.prosdent.2015.08.031 · Cited by 17
“”(19) This agrees with other data from different populations obtained with measurements from frontal photographs.(15,16,20-24)”
Result
Development and validity of a very short form of the Eating Disorder Inventory.
Maïano, C., Morin, A., Monthuy-Blanc, J., Garbarino, J., & Ninot, G. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.11.004 · Cited by 17
“These instruments also generally rely on Likert-type response scales, which tend to be associated with insufficient variability at the item-level to provide precise repeated assessments providing sufficient sensitivity to short-term fluctuations [27, 28].”
BackgroundMethod
Making the case for developing alternative lameness scoring systems for dairy goats
Vieira, A., Oliveira, M., Nunes, T., & Stilwell, G. (2015) · Applied Animal Behaviour Science · doi:10.1016/j.applanim.2015.08.015 · Cited by 17
Predictors of flexion using the rotating concave–convex total knee arthroplasty: preoperative range of motion is not the only determinant
Langlois, J., Charles-Nelson, A., Katsahian, S., Beldame, J., Lefebvre, B., & Bercovy, M. (2015) · Knee Surgery, Sports Traumatology, Arthroscopy · doi:10.1007/s00167-014-3479-2 · Cited by 17
Topical nepafenac 0.1% alone versus prednisolone acetate 1% as postoperative anti-inflammatory agents in small gauge vitrectomy
Nagpal, M., Lambat, S. P., Mehrotra, N. S., Paranjpe, G., Yadav, H., & Bhardwaj, S. S. (2014) · Indian Journal of Ophthalmology · doi:10.4103/0301-4738.129781 · Cited by 17
“[17,18] The VAS consisted of a 10-cm line, with 0 on one end representing no pain and 10 on the other representing the worst pain ever experienced.”
Development and initial validation of the Impression Motivation in Sport Questionnaire-Team.
Payne, S., Hudson, J., Akehurst, S., & Ntoumanis, N. (2013) · Journal of Sport & Exercise Psychology (JSEP) · doi:10.1123/jsep.35.3.281 · Cited by 17
The Effects of Foot Reflexology on Peripheral Neuropathy, Symptom Distress, Anxiety and Depression in Cancer Patients Treated with Oxaliplatin
Lee, S., Ham, Y., Ok, O.-N., Kim, E.-J., Kwon, I., Hwang, M., & Cho, M. (2012) · doi:10.5388/aon.2012.12.4.305 · Cited by 17
The impact of phonation mode and vocal technique on vocal fold closure in young females with normal voice quality.
Bodt, M. D., Clement, G., Wuyts, F., Borghs, C., & Lierde, K. V. (2012) · Journal of Voice · doi:10.1016/j.jvoice.2012.05.003 · Cited by 17
Hearing Aid Users Benefit from Induction Loop When Using Digital Cellular Phones
Sorri, M., Piiparinen, P. J., Huttunen, K., Haho, M. J., Tobey, E., Thibodeau, L. M., & Buckley, K. A. (2003) · Ear and Hearing · doi:10.1097/01.aud.0000058111.61435.53 · Cited by 17
“At this listening level, the subjects were asked to assess the amount of possible interference, the clarity of the message and the quality of the sound using a horizontal visual analog scale (VAS) (e.g., Gift, 1989; Wewers & Lowe, 1990).”
Method
Electroencephalogram based quantitative estimation of pain for balanced anaesthesia
Kumar, S., Kumar, A., Trikha, A., & Anand, S. (2015) · doi:10.1016/j.measurement.2014.09.021 · Cited by 17
Introducing Flowometer
Reese, D. D. (2010) · IGI Global eBooks · doi:10.4018/978-1-61520-717-6.ch011 · Cited by 13
The Role of Driver Sleepiness in Car Crashes: A Review of the Epidemiological Evidence
Connor, J. (2009) · Birkhäuser Basel eBooks · doi:10.1007/978-3-7643-9923-8_12 · Cited by 17
The efficacy of honey or olive oil on the severity of oral mucositis and pain compared to placebo (standard care) in children with leukemia receiving intensive chemotherapy: A randomized controlled trial (RCT).
Badr, L., Asmar, R. E., Hakim, S., Saad, R., Merhi, R., Zahreddine, A., & Muwakkit, S. (2023) · Journal of pediatric nursing · doi:10.1016/j.pedn.2022.12.003 · Cited by 16
Improving emotion regulation in breast cancer patients in the early survivorship period: Efficacy of a brief ecologically boosted group intervention
Merckaert, I., Waroquier, P., Caillier, M., Verkaeren, O., Righes, S., Liénard, A., Libert, Y., Kristanto, P., & Razavi, D. (2023) · Psycho-Oncology · doi:10.1002/pon.6105 · Cited by 22
“, anxiety, sadness, FCR, and emotional fatigue) was assessed just after exposure to both cancer‐related triggers and relaxation exercises using four 100‐mm visual analog scales (VAS; with the extreme left defined as “not at all” and the extreme right defined as “extremely”).(25,26) The negative emotion intensity score…”
Method
The effectiveness of psychoeducation and problem-solving on depression and treatment adherence in adolescents living with HIV in Botswana: an exploratory clinical trial
Olashore, A., Paruk, S., Ogunwale, A., Ita, M., Tomita, A., & Chiliza, B. (2023) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-022-00541-3 · Cited by 16
“Third, the reliability of the VAS in assessing adherence may be low and subjective compared to other methods, such as electronic pill caps (MEMS, AARDEX) [26], which suggests a further cautious interpretation of the study’s findings.”
MethodResult
Cortisol response to psychosocial stress, mental distress, fatigue and quality of life in coronary artery disease patients
Gecaite-Stonciene, J., Hughes, B. M., Kažukauskienė, N., Bunevičius, A., Burkauskas, J., Neverauskas, J., Bellani, M., & Mickuviene, N. (2022) · Scientific Reports · doi:10.1038/s41598-022-23712-w · Cited by 16
Quadriceps muscle strength recovery with the use of high tone power therapy after anterior cruciate ligament reconstruction: a randomized controlled trial
Ogrodzka-Ciechanowicz, K., Glab, G., Ślusarski, J., & Gądek, A. (2021) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-021-04862-w · Cited by 16
Cross-sectional assessment of sleep and fatigue in middle-aged Japanese women with primary Sjogren syndrome or rheumatoid arthritis using self-reports and wrist actigraphy
Kiyoko, M., Fujimoto, K., Abe, T., Takei, M., & Ogawa, K. (2021) · Medicine · doi:10.1097/md.0000000000027233 · Cited by 15
“Both were scored using a 10-cm visual analog scale (VAS),([26]) with 0cm indicating “not refreshed” and 10cm indicating “very refreshed”.”
Method
Clinical and Economic Evaluation of Acupuncture for Opioid-Dependent Patients Receiving Methadone Maintenance Treatment: The Integrative Clinical Trial and Evidence-Based Data
Wen, H., Wei, X., Ge, S.-Q., Zeng, J.-C., Luo, W., Chen, R., Dong, Y., Xiao, S., Lai, Y., & Lu, L.-M. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.689753 · Cited by 16
“The opioid craving VAS score was determined by measuring in millimeters from the left-hand end of the line to the point that the participant marked (27).”
Method
Comparison of clinical outcomes between open and modified endoscopic release for carpal tunnel syndrome
Chen, Z., Liu, J., Yuan, T., Cai, D., Wang, X., & Qin, J. (2021) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2021.10293 · Cited by 16
“0: No pain; 1‐3 points: Mild pain, normal life, no sleep disturbance; 4‐6 points: Obvious pain, unbearable, analgesic drugs required, sleep disturbed; 7‐10 points: Severe pain, intolerable, need analgesic, sleep by serious interfer‐ ence, can be accompanied by autonomic nervous disorder or passive position (20).”
Background
How Experiences Affect Psychological Responses During Supervised Fasting: A Preliminary Study
Ma, Q.-Y., Yang, C., Wu, R.-L., Wu, M., Liu, W., Dai, Z., & Li, Y.-H. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.651760 · Cited by 16
The relationships between prenatal attachment, maternal anxiety, and postpartum depression: A longitudinal study.
Kaydırak, M., Yılmaz, B., Demir, A., & Oskay, Ü. (2021) · Perspectives in psychiatric care · doi:10.1111/ppc.12841 · Cited by 16
The role of stress reactivity and pre-injury psychosocial vulnerability to psychological and physical health immediately after traumatic injury
Pozzato, I., Tran, Y., Gopinath, B., Thuraisingham, R. A., Cameron, I. D., & Craig, A. R. (2021) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2021.105190 · Cited by 22

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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