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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Method
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Method
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Background
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Background
Comparison of three different brushing techniques to isolate and culture primary nasal epithelial cells from human subjects
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Method
An integrative review of literature examining psychometric properties of instruments measuring anxiety or fear in hospitalized children.
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Method
Impairments and activity limitations in subjects with chronic upper-limb complex regional pain syndrome type I.
Schasfoort, F., Bussmann, J., & Stam, H. (2004) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2003.06.026 · Cited by 52
Measuring fatigue in patients with cancer
Richardson, A. (1998) · Supportive Care in Cancer · doi:10.1007/s005200050141 · Cited by 48
The International Classification of Functioning (ICF) to evaluate deep brain stimulation neuromodulation in childhood dystonia-hyperkinesia informs future clinical & research priorities in a multidisciplinary model of care.
Gimeno, H., & Lin, J.-P. (2017) · European journal of paediatric neurology · doi:10.1016/j.ejpn.2016.08.016 · Cited by 52
Phase II clinical trial of CD34+ cell therapy to explore endpoint selection and timing in patients with critical limb ischemia.
Fujita, Y., Kinoshita, M., Furukawa, Y., Nagano, T., Hashimoto, H., Hirami, Y., Kurimoto, Y., Arakawa, K., Yamazaki, K., Okada, Y., et al. (2014) · Circulation Journal · doi:10.1253/circj.cj-13-0864 · Cited by 52
Flap Survival of Skin-Sparing Mastectomy Type IV: A Retrospective Cohort Study of 75 Consecutive Cases
Santanelli, F., Longo, B., Sorotos, M., Farcomeni, A., & Paolini, G. (2013) · Annals of Surgical Oncology · doi:10.1245/s10434-012-2672-0 · Cited by 51
Effect of rituximab on physical function and quality of life in patients with rheumatoid arthritis previously untreated with methotrexate
Rigby, W. F. C., Ferraccioli, G., Greenwald, M., Montiel, B. E. Z., Fleischmann, R., Wassenberg, S., Ogale, S. S., Armstrong, G., Jahreis, A., Burke, L. S., et al. (2010) · Arthritis Care & Research · doi:10.1002/acr.20419 · Cited by 54
Aquatic Versus Land‐based Exercises as Early Functional Rehabilitation for Elite Athletes with Acute Lower Extremity Ligament Injury: A Pilot Study
Kim, E., Kim, T.-G., Kang, H., Lee, J., & Childers, M. K. (2010) · PM&R · doi:10.1016/j.pmrj.2010.03.012 · Cited by 44
A Randomized Trial Investigating a Chiropractic Manual Placebo: A Novel Design Using Standardized Forces in the Delivery of Active and Control Treatments
Hawk, C., Long, C. R., Rowell, R. M., Gudavalli, M. R., & Jedlicka, J. (2005) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2005.11.109 · Cited by 62
“Previous use of chiropractic was ascertained at baseline, using photographs. ris Back Pain Questionnaire (RMQ) (Riddle et al., 1998; Stratford et al., 1996), VAS for Pain (Wewers and Lowe, 1990), Beck Depression Inventory (BDI; Beck et al., 1988), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36;…”
Visual analogue scales for detecting changes in symptoms of the sick building syndrome in an intervention study.
Kildesø, J., Wyon, D., Skov, T., & Schneider, T. (1999) · Scandinavian Journal of Work, Environment and Health · doi:10.5271/sjweh.446 · Cited by 51
“Wewers & Lowe (5) regard bipolar scales of this kind as more difficult for subjects to use, although subjects experience little difficulty in using bipolar scales to assess environmental dimensions such as hot and cold or dry and humid, which have a well-understood neutral point.”
Background
Intradermal normal saline solution, self-selected music, and insertion difficulty effects on intravenous insertion pain.
Jacobson, A. F. (1999) · Heart & lung : the journal of critical care · doi:10.1053/hl.1999.v28.a95256 · Cited by 51
Reliability, validity, responsiveness, and minimal important change of the Disabilities of the Arm, Shoulder and Hand and Constant-Murley scores in patients with a humeral shaft fracture
Mahabier, K. C., Hartog, D. D., Theyskens, N., Verhofstad, M. H. J., Lieshout, E. M. M. V., Bos, P. K., Bronkhorst, M. W. G. A., Bruijninckx, M. M. M., de Haan, J., den Hoed, P. T., et al. (2016) · Journal of Shoulder and Elbow Surgery · doi:10.1016/j.jse.2016.07.072 · Cited by 58
No ego-depletion effect without a good control task
Mangin, T., André, N., Benraïss, A., Pageaux, B., & Audiffren, M. F. (2021) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2021.102033 · Cited by 65
Randomised clinical trial: oral taurine supplementation versus placebo reduces muscle cramps in patients with chronic liver disease
Vidot, H., Cvejic, E., Carey, S., Strasser, S., Mccaughan, G., Allman-Farinelli, M., & Shackel, N. (2018) · Alimentary Pharmacology and Therapeutics · doi:10.1111/apt.14950 · Cited by 50
“Participants were asked to rate the intensity of their muscle cramps using a Likert scale (VAS) of 1–10.(27) Daytime was defined as 0700–2059 and night‐time was defined as 2100–0659.”
Method
The effects of high intensity interval training in women with rheumatic disease: a pilot study
Sandstad, J., Stensvold, D., Hoff, M., Nes, B., Arbo, I., & Bye, A. (2015) · European Journal of Applied Physiology · doi:10.1007/s00421-015-3186-9 · Cited by 50
“…was calculated by the disease activity score (DAS28), based on the number of tender and swollen joints (out of 28), visual analog scale (VAS)-score for general health (indicated by marking a 10 cm line between very good and very bad), and CRP levels (Wewers and Lowe 1990; Crowson et al. 2009).”
Method
Nurses’ responses to suicide and suicidal patients: a critical interpretive synthesis*
Talseth, A., & Gilje, F. (2011) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2010.03490.x · Cited by 45
Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20
Melin, E. O., Thulesius, H. O., & Persson, B. A. (2010) · BioPsychoSocial Medicine · doi:10.1186/1751-0759-4-5 · Cited by 47
“Zero means there is no pain and 100 the "worst possible pain" [60].”
Background
Gender Differences in Adolescent Athletes’ Coping with Interpersonal Stressors in Sport: More Similarities than Differences?
Hoar, S., Crocker, P. R. E., Holt, N. L., & Tamminen, K. A. (2010) · Journal of Applied Sport Psychology · doi:10.1080/10413201003664640 · Cited by 54
“Visual analogue scales have high face validity, ease of completion, and adequate psychometric qualities (Francis & Stanley; Wewers & Lowe, 1990).”
Background
Is satisfaction with doctors' care related to health-related quality of life, anxiety and depression among patients with carcinoid tumours? A longitudinal report.
Fröjd, C., Lampic, C., Larsson, G., & von Essen, L. (2009) · Scandinavian Journal of Caring Sciences · doi:10.1111/j.1471-6712.2008.00596.x · Cited by 50
Focused evidence review: psychometric properties of patient-reported outcome measures for chronic musculoskeletal pain
Goldsmith, E. S., Taylor, B. C., Greer, N., Murdoch, M., MacDonald, R., McKenzie, L., Rosebush, C. E., & Wilt, T. J. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4327-8 · Cited by 49
Long-Term Outcome after Laparoscopic Bowel Resections for Deep Infiltrating Endometriosis: A Single-Center Experience after 900 Cases
Ruffo, G., Scopelliti, F., Manzoni, A., Sartori, A., Rossini, R., Ceccaroni, M., Minelli, L., Crippa, S., Partelli, S., & Falconi, M. (2014) · BioMed Research International · doi:10.1155/2014/463058 · Cited by 49
“Preoperative and postoperative scoring of symptoms was considered using a 10-point visual analogue scale (VAS; 10-point rating scale: 0 = absent, 10 = unbearable) [14].”
Method
Psychological Distress and Milk Volume in Lactating Mothers
Hill, P., Aldag, J., Chatterton, R., & Zinaman, M. (2005) · Western Journal of Nursing Research · doi:10.1177/0193945905277154 · Cited by 49
“Psychometric properties of visual analogue scales are well documented (Wewers & Lowe, 1990).”
Comparison of three instruments for measuring patient anxiety in a coronary care unit.
Elliott, D. (1993) · Intensive & Critical Care Nursing · doi:10.1016/0964-3397(93)90027-u · Cited by 49
Psychiatric patients' perception of physical restraint
Fugger, G., Gleiss, A., Baldinger, P., Strnad, A., Kasper, S., & Frey, R. (2016) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12501 · Cited by 48
“VAS are a suitable tool in social and behavioural research to measure subjective phenomena (31).”
Method
Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome
Siqueira, F., Monsignore, L., Rosa-e-Silva, J., Poli-Neto, O., de Castro-Afonso, L. H., Nakiri, G., Muglia, V., & Abud, D. (2016) · Clinics · doi:10.6061/clinics/2016(12)05 · Cited by 48
“This scale was chosen due to its wide use for the clinical evaluation of pain syndromes (19).”
Method
Tolerability and efficacy of erythropoietin (EPO) treatment in traumatic spinal cord injury: a preliminary randomized comparative trial vs. methylprednisolone (MP)
Costa, D., Beghi, E., Carignano, P., Pagliacci, C., Faccioli, F., Pupillo, E., Messina, P., Gorio, A., & Redaelli, T. (2015) · Neurological Sciences · doi:10.1007/s10072-015-2182-5 · Cited by 48
Patient Anxiety and Satisfaction in a Magnetic Resonance Imaging Department: Initial Results from an Action Research Study.
Munn, Z., Pearson, A., Jordan, Z., Murphy, F., Pilkington, D., & Anderson, A. (2015) · Journal of Medical Imaging and Radiation Sciences · doi:10.1016/j.jmir.2014.07.006 · Cited by 48
“When testing hypotheses, although parametric tests have been used for VAS data [20], nonparametric tests were deemed more appropriate in this case for the following”
Method
Anxiety and its time courses during radiotherapy for non-metastatic breast cancer: a longitudinal study.
Lewis, F., Merckaert, I., Liénard, A., Libert, Y., Etienne, A., Reynaert, C., Slachmuylder, J.-L., Scalliet, P., Paul, V. H., Coucke, P., et al. (2014) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2014.03.016 · Cited by 48
“’’ The VAS was used because such scales have been shown to be appropriate and adequate for the assessment of state anxiety [20–22] and is easy to complete.”
Method
The comparison of single incision laparoscopic cholecystectomy and three port laparoscopic cholecystectomy: prospective randomized study
Deveci, U., Barbaros, U., Kapakli, M., Manukyan, M., Şimşek, S., Kebudi, A., & Mercan, S. (2013) · Journal of the Korean Surgical Society · doi:10.4174/jkss.2013.85.6.275 · Cited by 48
“POFD-VAS was higher in group 1 than in group 2 (2.32 vs. 3.32, P 0,001).”
MethodInfluential
Comparison of efficacy of three commercially available dentifrices [corrected] on dentinal hypersensitivity: a randomized clinical trial.
Pradeep, A., Agarwal, E., Naik, S., Bajaj, P., & Kalra, N. (2012) · Australian dental journal · doi:10.1111/j.1834-7819.2012.01726.x · Cited by 48
Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour.
Chang, S., Chou, M. M., Lin, K., Lin, L.-C., Lin, Y.-L., & Kuo, S.-C. (2011) · Midwifery · doi:10.1016/j.midw.2010.08.009 · Cited by 48
“Visual Analogue Scale for Pain The Visual Analogue Scale (VAS) is a single, 100-mm line (Wewers and Lowe, 1990).”
Method
Evaluating the effects of ginger extract on knee pain, stiffness and difficulty in patients with knee osteoarthritis
Zakeri, Z., Izadi, S., Bari, Z., Soltani, F., Narouie, B., & Ghasemi-rad, M. (2011) · doi:10.5897/jmpr.9000605 · Cited by 48
“There were also no significant differences between the remaining patients of the two groups in VAS and WOMAC indexes at the beginning of the study (Table 1).”
MethodInfluential
Perception of Paralinguistic Intonational Meaning in a Second Language.
Chen, A. (2009) · doi:10.1111/j.1467-9922.2009.00510.x · Cited by 48
Alcohol delamination of the corneal epithelium for recalcitrant recurrent corneal erosion syndrome: a prospective study of efficacy and safety
Singh, R. P., Raj, D., Pherwani, A., Lagnado, R., Abedin, A., Eatamadi, H., Mathew, M., & Dua, H. (2007) · British Journal of Ophthalmology · doi:10.1136/bjo.2006.112912 · Cited by 48
Enhanced recovery after surgery (ERAS) protocol reduces LOS without additional adverse events in spine surgery
d’Astorg, H., Fière, V., Dupasquier, M., Vieira, T. D., & Szadkowski, M. (2020) · Orthopaedics & Traumatology Surgery & Research · doi:10.1016/j.otsr.2020.01.017 · Cited by 51
Influences of the biofeedback content on robotic post-stroke gait rehabilitation: electromyographic vs joint torque biofeedback
Tamburella, F., Moreno, J. C., Valenzuela, D. S. H., Pisotta, I., Iosa, M., Cincotti, F., Mattia, D., Pons, J. L., & Molinari, M. (2019) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-019-0558-0 · Cited by 59
Effects of Listening to Live Singing in Patients Undergoing Hemodialysis: A Randomized Controlled Crossover Study
Burrai, F., Lupi, R., Luppi, M., Micheluzzi, V., Donati, G., Lamanna, G., & Raghavan, R. (2018) · Biological Research for Nursing · doi:10.1177/1099800418802638 · Cited by 47

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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