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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Method
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“Scores are given by measuring the distance, usually in millimeters, from one end of the scale to the subject’s mark on a line (Wewers & Lowe, 1990).”
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BackgroundInfluential
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“VAS is also used in research, as well as clinical practice, especially where changes in symptoms are to be recorded [46].”
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“VASs have been found to be reliable, valid, and sensitive self-report measures of subjective experiences(29) and were used for their convenience, ease of completion, and low degree of participant burden.(30) Work performance was assessed by asking nurse participants to record any errors”
Method
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“At the top of this frame, the type The continuous version of the VAS typically uses a line that is 100 mm long and positioned horizontally, although occasionally a vertical orientation may be used (for reviews, see Ahearn, 1997; Wewers & Lowe, 1990).”
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“[30].”
Laser phototherapy as topical prophylaxis against head and neck cancer radiotherapy‐induced oral mucositis: Comparison between low and high/low power lasers
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Osteochondral Transplantation of the Talus
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“This technique is frequently used as a measure of patients’ perception of their abilities.(17,18) In this case series, subjects were presented with a 100-mm line anchored by the semantically opposite statements “no swallow ability” and “no swallow difficulty.”
Method
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Burn patients' pain and anxiety experiences.
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“l The VAS is a technique used to measure subjective phenomena (34).”
BackgroundMethod
PATIENT SATISFACTION AND DISABILITY AFTER BRACHIAL PLEXUS SURGERY
Kretschmer, T., Ihle, S., Antoniadis, G., Seidel, J. A., Heinen, C., Börm, W., Richter, H., & König, R. (2009) · Neurosurgery · doi:10.1227/01.neu.0000335646.31980.33 · Cited by 114
“We used 2 visual analog scales (VASs) (8, 31) ranging from 0 to 100 mm to obtain a subjective rating of the patients experienced pain and functional impairment.”
Method
From chronic pain patient to peer: benefits and risks of volunteering.
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Visual analog scale
長, 南. (1992) · doi:10.1007/978-3-540-29805-2_4813 · Cited by 113
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“bility both between individuals and between items that exist in visual analogue scales.(38,39) In these SDS data, with the exception of fatigue, only minor differences were found in mean scores for intensity.”
Background
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“The validity of VAS has been continuously assessed by researchers in different fields, such as for the evaluation of pain, mood, and craving [c.f. Wewers and Lowe (1990)].”
Background
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“Visual Analog Scale (VAS; Wewers & Lowe 1990).”
Method
Improvement in patient-reported outcomes in a rituximab trial in patients with severe rheumatoid arthritis refractory to anti-tumor necrosis factor therapy.
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“Pain was measured at baseline and weeks 4, 8, 12, 16, 20, and 24 using a VAS ranging from no pain to worst pain imaginable; a higher score indicated worse pain (34).”
Method
Intra-articular morphine and/or bupivacaine in the management of pain after total knee arthroplasty.
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“…characteristics were assessed requesting respondents to indicate the degree of agreement with each of a set of statements on a continue scale between zero “completely disagree” and ten “completely agree” (corresponding to the visual analogue scale (VAS), proposed by Wewers and Lowe, 1990).”
Background
A Randomized Controlled Trial Comparing 2 Types of Spinal Manipulation and Minimal Conservative Medical Care for Adults 55 Years and Older With Subacute or Chronic Low Back Pain
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Effect of cognitive load on speech prosody in aviation: evidence from military simulator flights.
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“During the first month, the participants and the 2 prosthodontist judges independently completed a survey instrument using a visual analog scale (VAS) to record baseline evaluations for various patient-centered and clinical outcomes (Table 2).(18,19) The VAS instrument was presented on a printed sheet of paper with a…”
Method
The Association Between symptoms of Discomfort and signs in Dry Eye
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First night efficacy of pramipexole in restless legs syndrome and periodic leg movements
Manconi, M., Ferri, R., Zucconi, M., Oldani, A., Fantini, M. L., Castronovo, V., & Ferini‐Strambi, L. (2007) · Sleep Medicine · doi:10.1016/j.sleep.2006.10.008 · Cited by 95
“In the morning, after each PSG recording, all patients evaluated the severity of their previous night symptoms by means of the Visual Analogical Scale (VAS) [12].”
Method
Age and cholinergic effects on hemodynamics and functional coherence of human hippocampus
Wink, A. M., Bernard, F., Salvador, R. M., Bullmore, E. T., & John Suckling, A. (2005) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2005.08.011 · Cited by 101
Psychometric evaluation and feasibility of the Greek Pittsburgh Sleep Quality Index (GR-PSQI) in patients with cancer receiving chemotherapy
Kotronoulas, G., Papadopoulou, C., Papapetrou, A., & Patiraki, E. I. (2010) · Supportive Care in Cancer · doi:10.1007/s00520-010-1025-4 · Cited by 103
“VAS has been extensively used for the assessment of various feelings or emotions in previous studies and qualified as reliable and valid [ 43 ].”
Method
Language-Specificity in the Perception of Paralinguistic Intonational Meaning
Chen, A., Gussenhoven, C., & Rietveld, T. (2004) · Language and Speech · doi:10.1177/00238309040470040101 · Cited by 104
Assessing undergraduate palliative care education: validity and reliability of two scales examining perceived efficacy and outcome expectancies in palliative care
Mason, S., & Ellershaw, J. (2004) · Medical Education · doi:10.1111/j.1365-2929.2004.01960.x · Cited by 104
Cochlear implantation as a long-term treatment for ipsilateral incapacitating tinnitus in subjects with unilateral hearing loss up to 10 years
Mertens, G., De Bodt, M., & Van de Heyning, P. (2016) · Hearing Research · doi:10.1016/j.heares.2015.09.016 · Cited by 103
Reducing Intra-articular Hemarthrosis After Arthroscopic Anterior Cruciate Ligament Reconstruction by the Administration of Intravenous Tranexamic Acid
Karaaslan, F., Karaoglu, S., & Yurdakul, E. (2015) · American Journal of Sports Medicine · doi:10.1177/0363546515599629 · Cited by 103
“85) Lysholm score, median (range) Postoperative week 2 75 (50-90) 70 (40-85) \.”
Motives for becoming a living kidney donor.
Lennerling, A., Forsberg, A., Meyer, K., & Nyberg, G. (2004) · Nephrology, Dialysis and Transplantation · doi:10.1093/ndt/gfh138 · Cited by 103
“The respondents were asked to mark the importance of each statement with a cross on a 10.0 cm visual analogue scale (VAS) [10, 11 ].”
BackgroundInfluential
Auricular acupuncture, education, and smoking cessation: a randomized, sham-controlled trial.
Bier, I. D., Wilson, J., Studt, P., & Shakleton, M. (2002) · American Journal of Public Health · doi:10.2105/ajph.92.10.1642 · Cited by 103
Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort
Haines, H. M., Pallant, J. F., Fenwick, J., Gamble, J., Creedy, D. K., Toohill, J., & Hildingsson, I. (2015) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2015.05.002 · Cited by 102
Making support work: The interplay between social support and social identity
Frisch, J. U., Häusser, J. A., van Dick, R., & Mojzisch, A. (2014) · Journal of Experimental Social Psychology · doi:10.1016/j.jesp.2014.06.009 · Cited by 102
Proof of Principle of a Brain-Computer Interface Approach to Support Poststroke Arm Rehabilitation in Hospitalized Patients: Design, Acceptability, and Usability
Morone, G., Pisotta, I., Pichiorri, F., Kleih, S. C., Paolucci, S., Molinari, M., Cincotti, F., Kübler, A., & Mattia, D. (2015) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2014.05.026 · Cited by 105
“Before starting each training session, patients’ mood and motivation were monitored by means of visual analog scales (VASs; 0, the lowest level, to 10, the highest level).(41,42) Mood was also assessed by means of the Center for Epidemiologic Studiese Depression Scale, ranging from 0 to 60 points, with a cutoff of 16…”
Method
Does Preoperative Psychologic Distress Influence Pain, Function, and Quality of Life After TKA?
Utrillas-Compaired, A., Torre-Escuredo, B. J. D. L., Tebar-Martínez, A. J., & Asúnsolo, Á. (2014) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-014-3570-5 · Cited by 105
“Sociodemographic details, height, weight, affected side, Sangha comorbidity scale [41], diagnosis, Folstein Mini Mental Test [16], Hospital Anxiety and Depression (HAD) Scale [49], The Knee Society Score (KSS ) [27], the WOMAC quality-of-life scale [4–6], and the VAS for pain [45] were collected for all patients in th…”
Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial
Sakuramoto, S., Yamashita, K., Kikuchi, S., Futawatari, N., Katada, N., Watanabe, M., Okutomi, T., Wang, G.-Q., & Bax, L. (2013) · Surgical Endoscopy · doi:10.1007/s00464-012-2658-9 · Cited by 100
The Effectiveness of Group Therapy for Students With Mild Voice Disorders: A Controlled Clinical Trial
Simberg, S., Sala, E., Tuomainen, J., Sellman, J., & Rönnemaa, A.-M. (2005) · Journal of Voice · doi:10.1016/j.jvoice.2005.01.002 · Cited by 119
Observational Visual Analog Scale in Pediatric Pain Assessment: Useful Tool or Good Riddance?
van Dijk, M., Koot, H., Saad, H., Tibboel, D., & Passchier, J. (2002) · The Clinical Journal of Pain · doi:10.1097/00002508-200209000-00006 · Cited by 99
Effects of music therapy and guided visual imagery on chemotherapy-induced anxiety and nausea-vomiting.
Karagozoglu, S., Tekyasar, F., & Yılmaz, F. A. (2013) · Journal of Clinical Nursing · doi:10.1111/jocn.12030 · Cited by 97
Clinical efficacy of new aloe vera- and myrrh-based oral mucoadhesive gels in the management of minor recurrent aphthous stomatitis: a randomized, double-blind, vehicle-controlled study.
Mansour, G. A., Ouda, S., Shaker, A., & Abdallah, H. M. (2014) · Journal of Oral Pathology & Medicine · doi:10.1111/jop.12130 · Cited by 96
The Effects of Providing Preoperative Statistical Anaesthetic-Risk Information
Inglis, S., & Farnill, D. (1993) · Anaesthesia and Intensive Care · doi:10.1177/0310057x9302100609 · Cited by 96
The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study
Fathollahnejad, K., Letafatkar, A., & Hadadnezhad, M. (2019) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-019-2438-y · Cited by 95
“This scale is widely used in clinical settings and is known as a valuable tool for assessing pain [18, 19] with ICC = 0.”
Method
Postpartum fatigue, baby-care activities, and maternal-infant attachment of vaginal and cesarean births following rooming-in.
Lai, Y., Hung, C.-H., Stocker, J., Chan, T., & Liu, Y. (2015) · Applied Nursing Research · doi:10.1016/j.apnr.2014.08.002 · Cited by 95
Comparison of a Paraspinal Approach with a Percutaneous Approach in the Treatment of Thoracolumbar Burst Fractures with Posterior Ligamentous Complex Injury: A Prospective Randomized Controlled Trial
Jiang, X., Tian, W., Liu, B., Li, Q., Zhang, G.-L., Hu, L., Li, Z.-Y., & He, D. (2012) · Journal of International Medical Research · doi:10.1177/147323001204000413 · Cited by 95
Clinical performance of direct composite restorations for treatment of severe tooth wear.
Hamburger, J. T., Opdam, N., Bronkhorst, E., Kreulen, C., Roeters, J., & Huysmans, M. (2011) · Journal of Adhesive Dentistry · doi:10.3290/j.jad.a22094 · Cited by 95
Use of intranasal fentanyl for the relief of pediatric orthopedic trauma pain.
Saunders, M., Adelgais, K., & Nelson, D. (2010) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2010.00905.x · Cited by 95
Are Mood and Anxiety Disorders and Alexithymia Associated with Endometriosis? A Preliminary Study
Cavaggioni, G., Lia, C., Resta, S., Antonielli, T., Panici, P. B., Megiorni, F., & Porpora, M. G. (2014) · BioMed Research International · doi:10.1155/2014/786830 · Cited by 108
“Pain intensity was assessed by a 10-point visual analogue scale (VAS) with 0 representing no pain and 10 representing the worst pain [18].”
Method
Analgesic action of gabapentin on chronic pain in the masticatory muscles: A randomized controlled trial
Kimos, P., Biggs, C., Mah, J., Heo, G., Rashiq, S., Thie, N., & Major, P. (2007) · Pain · doi:10.1016/j.pain.2006.08.028 · Cited by 94
“The validity and reliability of these methods for determining pain intensity have been confirmed (Scott and Huskisson, 1976; Chapman and Syrjala, 1990; Wewers and Lowe, 1990; Jensen and Karoly, 1992).”
Background
The Effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomized Controlled Trial
Chi, L.-M., Lin, L.-M., Chen, C.-L., Wang, S.-F., Lai, H., & Peng, T.-C. (2016) · Evidence-Based Complementary and Alternative Medicine · doi:10.1155/2016/7358918 · Cited by 93
“Pain was scored using VAS; a Likert scale was used for evaluating the subjective experience of pain intensity [25, 26].”
Method
Exertion Fatigue and Chronic Fatigue Are Two Distinct Constructs in People Post-Stroke
Tseng, B. Y., Billinger, S. A., Gajewski, B. J., & Kluding, P. M. (2010) · Stroke · doi:10.1161/strokeaha.110.596064 · Cited by 89
Extracorporeal Shockwave Therapy
Chung, B., & Wiley, J. (2002) · Sports Medicine · doi:10.2165/00007256-200232130-00004 · Cited by 93
Assessing the Impact of a Novel Smartphone Application Compared With Standard Follow-Up on Mobility of Patients With Knee Osteoarthritis Following Treatment With Hylan G-F 20: A Randomized Controlled Trial
Skrepnik, N., Spitzer, A., Altman, R., Hoekstra, J., Stewart, J., & Toselli, R. (2017) · JMIR mHealth and uHealth · doi:10.2196/mhealth.7179 · Cited by 88
“In contrast, visual analog scales [37] and the Western Ontario and McMaster Universities Osteoarthritis Index (used to assess pain, stiffness, and physical function over a specific time frame [ie, the last 48 hours] in XSL • FO RenderX clinical trials [38]) are both subjective measures that rely on…”
Management of pain in multiple sclerosis: a pharmacological approach
Solaro, C. M., & Uccelli, M. M. (2011) · Nature Reviews Neurology · doi:10.1038/nrneurol.2011.120 · Cited by 97
Oxford Phase 3 unicompartmental knee arthroplasty: medium-term results of a minimally invasive surgical procedure
Lisowski, L., van den Bekerom, M. V. D., Pilot, P., van Dijk, C. V., & Lisowski, A. (2010) · Knee Surgery, Sports Traumatology, Arthroscopy · doi:10.1007/s00167-010-1213-2 · Cited by 92
“The WOMAC Questionnaire [3], the Knee Society Score (KSS) [17], Oxford Knee Score (OKS) [9] and postoperative visual analogue scale (VAS) for pain and satisfaction were used [ 54 ].”
Method
Initial patterns of clinical care and recovery from whiplash injuries: a population-based cohort study.
Côté, P., Hogg-Johnson, S., Cassidy, J., Carroll, L., Frank, J., & Bombardier, C. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.19.2257 · Cited by 92
Evaluation of shark cartilage in patients with advanced cancer
Loprinzi, C. L., Levitt, R., Barton, D. L., Sloan, J. A., Atherton, P., Smith, D. J., Dakhil, S. R., Moore, D. F., Krook, J. E., Rowland, K. M., et al. (2005) · Cancer · doi:10.1002/cncr.21107 · Cited by 97
“02) as well as clinically significant, as the score showed 10 points difference on a scale from 0 to 100.(26) In the shark cartilage arm, for each time point up to and including 1 month, patients reported a decrease in QOL from their baseline scores for the 5 LASA questions and the total SDS score.”
Background
Health-Related Quality of Life Following Operative Treatment of Unstable Ankle Fractures: A Prospective Observational Study
Bhandari, M., Sprague, S., Hanson, B., Busse, J., Dawe, D., Moro, J., & Guyatt, G. (2004) · Journal of Orthopaedics and Trauma · doi:10.1097/00005131-200407000-00002 · Cited by 92
“In addition to the SF-36, at each visit, we administered a 10-point visual analogue scale (VAS) addressing patients’ degree of ankle pain at discharge, 3 months, 6 months, 12 months, and 24 months postoperation.(27) We also recorded readmissions to hospital for ankle-related problems as well as infections, nonunions,…”
Method
Evidence-Based Survey Design: The Use of Continuous Rating Scales in Surveys
Chyung, S. Y., Swanson, I., Roberts, K., & Hankinson, A. (2018) · Performance Improvement Journal · doi:10.1002/pfi.21763 · Cited by 113
Visual analogue scale (VAS) measurement of antiretroviral adherence in people living with HIV (PLWH): a meta-analysis
Finitsis, D. J., Pellowski, J. A., Huedo-Medina, T. B., Fox, M., & Kalichman, S. (2016) · Journal of behavioral medicine · doi:10.1007/s10865-016-9770-6 · Cited by 91
Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy: surgical outcomes and learning curve analysis.
Escobar, P., Starks, D., Fader, A., Barber, M., & Rojas-Espalliat, L. (2010) · Gynecologic Oncology · doi:10.1016/j.ygyno.2010.05.026 · Cited by 91
“It could be argued that a VAS is trying to produce interval/ratio data out of subjective values that are at best ordinal [14].”
Background
Motor function measure: validation of a short form for young children with neuromuscular diseases.
de Lattre, C., Payan, C., Vuillerot, C., Rippert, P., de Castro, D. D., Bérard, C., & Poirot, I. (2013) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2013.04.001 · Cited by 90
An Economic Perspective on Urinary Tract Infection: The “Costs of Resignation”
Ciani, O., Grassi, D., & Tarricone, R. (2013) · Clinical drug investigation · doi:10.1007/s40261-013-0069-x · Cited by 90
“sponding to descriptors at each end (0 for no impact, 10 for maximum impact)—the impact on QoL due to discomfort or pain caused by LUTS, vulvodynia and dyspareunia [12].”
Background
Conservative surgical management for diffuse uterine adenomyosis.
Nishida, M., Takano, K., Arai, Y., Ozone, H., & Ichikawa, R. (2010) · Fertility and Sterility · doi:10.1016/j.fertnstert.2009.03.046 · Cited by 90

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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