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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Background
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Method
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MethodInfluential
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“It is a simple, efficient, and widely used measuring tool with established reliability and validity [12].”
BackgroundMethod
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Background
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MethodInfluential
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BackgroundMethodInfluential
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Background
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Method
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BackgroundMethod
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Method
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Method
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Monticone, M., Baiardi, P., Nido, N., Righini, C., Tomba, A., & Giovanazzi, E. (2008) · Spine · doi:10.1097/brs.0b013e318175c2b0 · Cited by 42
Comparison of assessment tools to score recovery of function after repair of traumatic lesions of the median nerve
Wong, K., Coert, J., Robinson, P., & Meek, M. (2006) · Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery · doi:10.1080/02844310600652878 · Cited by 42
“This test could also be used to measure pain, cold intolerance, and paraesthesia [12].”
Method
Short and long-term cosmesis of cervical thyroidectomy scars.
Dordea, M., & Aspinall, S. (2016) · Annals of the Royal College of Surgeons of England · doi:10.1308/rcsann.2016.0022 · Cited by 42
Effects of whole-body vibration exercise for non-specific chronic low back pain: an assessor-blind, randomized controlled trial
Wang, X., Gu, W., Chen, B., Wang, X., Hu, H., Zheng, Y., Zhang, J., Zhang, H., & Chen, P. (2019) · Clinical Rehabilitation · doi:10.1177/0269215519848076 · Cited by 47
Glucoregulatory and Cardiometabolic Profiles of Almond vs. Cracker Snacking for 8 Weeks in Young Adults: A Randomized Controlled Trial
Dhillon, J., Thorwald, M. A., Cruz, N. D. L., Vu, E., Asghar, S. A., Kuse, Q., Rios, L. K. D., & Ortiz, R. M. (2018) · Nutrients · doi:10.3390/nu10080960 · Cited by 45
Minimal important change and other measurement properties of the Oxford Elbow Score and the Quick Disabilities of the Arm, Shoulder, and Hand in patients with a simple elbow dislocation; validation study alongside the multicenter FuncSiE trial
Iordens, G. I. T., Hartog, D. D., Tuinebreijer, W. E., Eygendaal, D. E., Schep, N. W. L., Verhofstad, M. H. J., Lieshout, E. M. M. V., & on behalf of FuncSiE Trial Investigators (2017) · PLoS ONE · doi:10.1371/journal.pone.0182557 · Cited by 48
Music Listening Among Postoperative Patients in the Intensive Care Unit: A Randomized Controlled Trial with Mixed-Methods Analysis
Ames, N., Shuford, R., Yang, L., Moriyama, B., Frey, M., Wilson, F., Sundaramurthi, T., Gori, D., Mannes, A., Ranucci, A., et al. (2017) · Integrative Medicine Insights · doi:10.1177/1178633717716455 · Cited by 41
Effect of one year of a gluten-free diet on the clinical evolution of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis: a case-control study
Rodrigo, L., Blanco, I., Bobes, J., & de Serres, F. J. (2014) · Arthritis Research & Therapy · doi:10.1186/s13075-014-0421-4 · Cited by 46
“To evaluate the severity of digestive symptoms and the amount of pain and fatigue experienced by patients, three types of VAS were used [27–29].”
Method
Pain and anxiety during bone marrow biopsy.
Tanasale, B., Kits, J., Kluin, P., Trip, A., & Kluin-Nelemans, H. (2013) · Pain Management Nursing · doi:10.1016/j.pmn.2011.06.007 · Cited by 41
Effect of haemarthrosis on the rehabilitation of anterior cruciate ligament reconstruction- single bundle versus double bundle
Bahl, V., Goyal, A., Jain, V., Joshi, D., & Chaudhary, D. (2013) · Journal of Orthopaedic Surgery and Research · doi:10.1186/1749-799x-8-5 · Cited by 41
“Primary outcome measures included grade of haemarthrosis, according to the classification of Coupens and Yates [3] (graded subjectively from 0 to 4) (Table 1) and pain measured by VAS.”
Influential
The psychological effects of a videotape educational intervention on cardiac catheterization patients
Chair, S. Y., Mei, Y.-C., Sit, J. W. H., Wong, E. M. L., & Chan, A. W. K. (2012) · Contemporary Nurse: health care across the lifespan · doi:10.5172/conu.2012.40.2.225 · Cited by 41
Measurement of Symptom Distress in Women With Early‐Stage Breast Cancer
Boehmke, M. M. (2004) · Cancer Nursing · doi:10.1097/00002820-200403000-00008 · Cited by 41
Effectiveness of Kinesio Taping versus Cervical Traction on Mechanical Neck Dysfunction
Dawood, R., Kattabei, O., Nasef, S., Battarjee, K. A., & Abdelraouf, O. (2013) · doi:10.5455/ijtrr.00000019 · Cited by 41
“All participants completed the VAS by indicating the average pain level experienced during the past 2 week before intervention [15].”
Background
Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: expert consensus and protocol (Guangzhou)
He, J.-X., Liang, H.-R., Wang, W., Akopov, A., Aiolfi, A., Ang, K., Bertolaccini, L., Cai, K., Cao, Q., Chen, B., et al. (2021) · Translational Lung Cancer Research · doi:10.21037/tlcr-21-663 · Cited by 40
“(I) The scoring criteria [Visual Analogue Scale (VAS) (0–10 points) (33-35)]: (i) 0 points, no pain; (ii) ≤3 points, slight pain that is endurable; (iii) 4–6 points, pain interferes with sleep but may still be endured; (iv) 7–10 points, increasingly severe pain that cannot be endured, interferes with appetite and slee…”
Background
Efficacy of a single intra-articular injection of ultra-high molecular weight hyaluronic acid for hip osteoarthritis: a randomized controlled study
Clementi, D., D'Ambrosi, R., Bertocco, P., Bucci, M., Cardile, C., Ragni, P., Giaffreda, G., & Ragone, V. (2018) · European Journal of Orthopaedic Surgery & Traumatology · doi:10.1007/s00590-017-2083-9 · Cited by 40
Microcurrent as an adjunct therapy to accelerate chronic wound healing and reduce patient pain
Nair, H. K. R. (2018) · Journal of Wound Care · doi:10.12968/jowc.2018.27.5.296 · Cited by 41
Graded increases in cognitive control exertion reveal a threshold effect on subsequent physical performance.
Brown, D. M. Y., & Bray, S. R. (2017) · Sport Exercise and Performance Psychology · doi:10.1037/spy0000091 · Cited by 39
“To assess task motivation prior to each handgrip trial, a Visual Analogue Scale (VAS; Wewers & Lowe, 1990) was used.”
Method
A Pilot Study
Running, A., & Hildreth, L. (2017) · Journal of Holistic Nursing · doi:10.1177/0898010116638739 · Cited by 40
Effectiveness of Spiritist "passe" (Spiritual healing) for anxiety levels, depression, pain, muscle tension, well-being, and physiological parameters in cardiovascular inpatients: A randomized controlled trial.
Carneiro, É. M., Barbosa, L., Marson, J. M., Terra, J., Martins, C. J. P., Modesto, D., de Resende, L. A. P. R., & Borges, M. D. F. (2017) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2016.11.008 · Cited by 40
Similar Effects of Thrust and Non-Thrust Spinal Manipulation Found in Adults With Subacute and Chronic Low Back Pain – A Controlled Trial with Adaptive Allocation
Xia, T., Long, C., Gudavalli, M., Wilder, D., Vining, R., Rowell, R., Reed, W., Devocht, J., Goertz, C., Owens, E., et al. (2016) · Spine · doi:10.1097/brs.0000000000001373 · Cited by 40
“The scale has excellent metric properties, is easy to administer and score, and is commonly used in LBP research.(45,46) The recommended MCID for the VAS is 15 mm.”
Method
The prediction of the palatability of orally disintegrating tablets by an electronic gustatory system.
Nakamura, H., Uchida, S., Sugiura, T., & Namiki, N. (2015) · International journal of pharmaceutics · doi:10.1016/j.ijpharm.2015.07.056 · Cited by 40
Patients' Evaluations of Complete Denture Therapy and Their Association with Related Variables: A Pilot Study.
Santos, B., dos Santos, M. B. F., Santos, J. F. F., & Marchini, L. (2015) · Journal of Prosthodontics · doi:10.1111/jopr.12286 · Cited by 40
Reliability of the radiographic union score for tibial fractures.
Çekiç, E., Alıcı, E., & Yeşil, M. (2014) · Acta Orthopaedica et Traumatologica Turcica · doi:10.3944/aott.2014.14.0026 · Cited by 40
“Patients were asked to score their pain at the fracture site during rest and activity.[5-7] Patients were also evaluated using the Medical Outcomes Study Short Form Health Survey (SF-36).”
Method
CO(2) insufflation for potentially difficult colonoscopies: efficacy when used by less experienced colonoscopists.
Uraoka, T., Kato, J., Kuriyama, M., Hori, K., Ishikawa, S., Harada, K., Takemoto, K., Hiraoka, S., Fujita, H., Horii, J., et al. (2009) · World Journal of Gastroenterology · doi:10.3748/wjg.15.5186 · Cited by 40
Osteoid osteoma of the upper extremity. A diagnostic challenge.
Themistocleous, G., Chloros, G., Benetos, I., Efstathopoulos, D., Gerostathopoulos, N., & Soucacos, P. (2006) · Chirurgie de la Main · doi:10.1016/j.main.2006.02.001 · Cited by 40
Symptom reporting in childhood asthma: a comparison of assessment methods
Halterman, J., Yoos, H., Kitzman, H., Anson, E., Sidora-Arcoleo, K., & Mcmullen, A. (2006) · Archives of Disease in Childhood · doi:10.1136/adc.2006.096123 · Cited by 40
Prevalence and clinical characteristics of white matter hyperintensities in Migraine: A meta-analysis
Zhang, W., Cheng, Z., Fu, F.-W., & Zhan, Z. (2023) · NeuroImage: Clinical · doi:10.1016/j.nicl.2023.103312 · Cited by 39
“Among the included relevant studies, pain severity was recorded using the Visual Analog Scale (VAS) (Wewers and Lowe, 1990), and the degree of disability was recorded using the Migraine Disability Assessment Scale (MIDAS) (Stewart et al.”
Method
Systematic review of arts and culture-based interventions for people living with dementia and their caregivers
Letrondo, P. A., Ashley, S. A., Flinn, A., Burton, A., Kador, T., & Mukadam, N. (2022) · Ageing Research Reviews · doi:10.1016/j.arr.2022.101793 · Cited by 44
“Seven studies used mixed measures such as qualitative interviews, Visual Analogue Scales (VAS)(Wewers and Lowe, 1990) and the Addenbrooke’s Cognitive Examination (ACE)(Moisander and Huovinen, 2018) (Camic et al., 2019; D’Cunha et al., 2019; Johnson et al., 2017; Kirk et al., 2018; Loizeau et al., 2015; MacPherson et a…”
Method
Defining pleasant touch stimuli: a systematic review and meta-analysis
Taneja, P., Olausson, H., Trulsson, M., Svensson, P. J., & Baad‐Hansen, L. (2019) · Psychological Research · doi:10.1007/s00426-019-01253-8 · Cited by 46
Association of lumbar spine stiffness and flexion-relaxation phenomenon with patient-reported outcomes in adults with chronic low back pain – a single-arm clinical trial investigating the effects of thrust spinal manipulation
Xia, T., Long, C. R., Vining, R. D., Gudavalli, M. R., DeVocht, J. W., Kawchuk, G. N., Wilder, D. G., & Goertz, C. (2017) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-017-1821-1 · Cited by 49
Electronic visual analogue scales for pain, fatigue, anxiety and quality of life in people with multiple sclerosis using smartphone and tablet: a reliability and feasibility study
Kos, D., Raeymaekers, J., Remoortel, A. V., D'hooghe, M. B., Nagels, G., D’haeseleer, M., Peeters, E., Dams, T., & Peeters, T. (2017) · Clinical Rehabilitation · doi:10.1177/0269215517692641 · Cited by 42
The Effects of Extracorporeal Shock Wave Therapy in Patients with Coccydynia: A Randomized Controlled Trial
Lin, S.-F., Chen, Y., Tu, H., Lee, C.-L., Hsieh, C., Wu, W., & Chen, C. (2015) · PLoS ONE · doi:10.1371/journal.pone.0142475 · Cited by 43
“Before treatment, all of the patients reported the pain intensity, using a visual analog scale (VAS), on a scale from 0 through 100 mm (0 for no pain and 100 mm for the worst pain) [28].”
Effect of duration and type of anesthetic on tear production in dogs.
Shepard, M., Accola, P., López, L. A., Shaughnessy, M. R., & Hofmeister, E. (2011) · American Journal of Veterinary Research · doi:10.2460/ajvr.72.5.608 · Cited by 39
The effect of spinal manipulation on the efficacy of a rehabilitation protocol for patients with chronic neck pain: a pilot study.
Murphy, B., Taylor, H., & Marshall, P. (2010) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2010.01.014 · Cited by 39
“The VAS score is determined by measuring in millimeters from the left hand end of the line to the point that the patient marks.(21)”
Method
Testing the interval-level measurement property of multi-item visual analogue scales
Krabbe, P., Stalmeier, P., Lamers, L., & Busschbach, J. (2006) · Quality of Life Research · doi:10.1007/s11136-006-0027-7 · Cited by 39
“Formally called rating scales, these are often referred to as VAS [9, 10].”
Background
The development and testing of the PATCOA to assess pain in confused older adults.
Decker, S., & Perry, A. (2003) · Pain Management Nursing · doi:10.1016/s1524-9042(02)54209-0 · Cited by 39
Selection for inpatient rehabilitation after severe stroke: what factors influence rehabilitation assessor decision-making?
Hakkennes, S., Hill, K., Brock, K., Bernhardt, J., & Churilov, L. (2013) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-1065 · Cited by 39
Gender and Age Differences in Nurses' Triage Decisions Using Vignette Patients
Arslanian‐Engoren, C. (2001) · Nursing Research · doi:10.1097/00006199-200101000-00009 · Cited by 39
Classroom Movement Breaks Reduce Sedentary Behavior and Increase Concentration, Alertness and Enjoyment during University Classes: A Mixed-Methods Feasibility Study
Peiris, C. L., O’Donoghue, G., Rippon, L., Meyers, D., Hahne, A., De Noronha, M., Lynch, J., & Hanson, L. C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18115589 · Cited by 38
“Visual analogue scales are considered valid and reliable, especially when the time between repeat measurements is small [27].”
BackgroundMethod
Aromas Influencing the GABAergic System
Hartley, N., & Mclachlan, C. (2022) · Molecules · doi:10.3390/molecules27082414 · Cited by 38
“The anxiety-VAS is a self-evaluation scale that is simple and rapid, consisting of a horizontal line 10cm long labelled “no anxiety” to the left and “worst possible anxiety” to the right [33] scored, by measuring the distance from one end of the scale to the subject’s mark on the line [34].”
Background

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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