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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Chochinov, H., Kristjanson, L., Hack, T., Hassard, T., Mcclement, S., & Harlos, M. (2006) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2006.05.011 · Cited by 29
Quality of life before and after laparoscopic sleeve gastrectomy. A prospective cohort study.
Charalampakis, V., Bertsias, G., Lamprou, V., de Bree, E., Romanos, J., & Melissas, J. (2015) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2014.04.024 · Cited by 29
“VAS is a single-item measure, that is, an instrument measuring the whole construct at once, thus it is easy to use and therefore applicable to a variety of practice and research settings [15–17].”
Background
Subacute and chronic, non-specific back and neck pain: cognitive-behavioural rehabilitation versus primary care. A randomized controlled trial
Lindell, O., Johansson, S.-E., & Strender, L.-E. (2008) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-9-172 · Cited by 28
“Pain score (VAS, 0 – 100; median (IQR))[48]:”
The Association Between PLAYfun and Physical Activity: A Convergent Validation Study
Bremer, E., Graham, J., Bedard, C., Rodriguez, C., Kriellaars, D., & Cairney, J. (2020) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2019.1652723 · Cited by 28
“Overall, such a scoring system increases the range of possible scores to evaluate a participants’ performance (Wewers & Lowe, 1990).”
Background
Measuring the Frequency of Inner-Experience Characteristics by Self-Report: The Nevada Inner Experience Questionnaire
Heavey, C., Moynihan, S. A., Brouwers, V., Lapping-Carr, L., Krumm, A. E., Kelsey, J. M., Turner, D. K., & Hurlburt, R. T. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.02615 · Cited by 28
“…a specified list of situations or a specified list of characteristics); and (d) reduces the ambiguity of anchors by using visual-analog scales (Wewers and Lowe, 1990) with anchors Frontiers in Psychology | www.frontiersin.org 2 January 2019 | Volume 9 | Article 2615 from Never to Always (for…”
BackgroundMethod
Comparison of the Efficacy Between Two Micro‐Operative Therapies of Old Patients With Osteoporotic Vertebral Compression Fracture: A Network Meta‐Analysis
Zhang, Y.-L., Shi, L.-T., Tang, P., & Zhang, L. (2017) · Journal of Cellular Biochemistry · doi:10.1002/jcb.25966 · Cited by 28
“ODI is an index used to quantify the disability caused by low back pain, from 0 to 100 [Wewers and Lowe, 1990; Zigler and Delamarter, 2014].”
Method
Citric Acid Suppresses the Bitter Taste of Olopatadine Hydrochloride Orally Disintegrating Tablets
Sotoyama, M., Uchida, S., Tanaka, S., Hakamata, A., Odagiri, K., Inui, N., Watanabe, H., & Namiki, N. (2017) · Biological and Pharmaceutical Bulletin · doi:10.1248/bpb.b16-00828 · Cited by 46
Children’s Perioperative Multidimensional Anxiety Scale (CPMAS): Development and validation.
Chow, C. H. T., Lieshout, R. J. V., Buckley, N., & Schmidt, L. A. (2016) · Psychological Assessment · doi:10.1037/pas0000318 · Cited by 30
Hearing Performance in Single-Sided Deaf Cochlear Implant Users After Upgrade to a Single-Unit Speech Processor
Mertens, G., Hofkens, A., Punte, A., Bodt, M. D., & de Heyning, P. V. (2014) · Otology and Neurotology · doi:10.1097/mao.0000000000000653 · Cited by 28
“The VAS score is determined by measuring in millimeters from the left hand end of the line to the marked point (14).”
Clinical efficacy of a herbal dentifrice on dentinal hypersensitivity: a randomized controlled clinical trial.
Kumari, M., Naik, S., Rao, N. S., Martande, S., & Pradeep, A. (2013) · Australian dental journal · doi:10.1111/adj.12109 · Cited by 28
The relationship between the level of salivary alpha amylase activity and pain severity in patients with symptomatic irreversible pulpitis
Ahmadi-Motamayel, F., Shahriari, S., Goodarzi, M., Moghimbeigi, A., Jazaeri, M., & Babaei, P. (2013) · Restorative Dentistry & Endodontics · doi:10.5395/rde.2013.38.3.141 · Cited by 28
“Prior to anesthesia, pain severity was assessed using a visual analogue scale (VAS) and 5 mL of unstimulated saliva was taken from each patient in a sitting position while bending the neck forward via the spitting method.(3,11,12) Sialochemical analysis”
Method
Measurement and assessment of pain in children--a review.
Jain, A., Yeluri, R., & Munshi, A. (2012) · Journal of Clinical Pediatric Dentistry · doi:10.17796/jcpd.37.2.k84341490806t770 · Cited by 28
Effects of voice training in normal-speaking women: Videostroboscopic, perceptual, and acoustic characteristics
Södersten, M., & Hammarberg, B. (1993) · doi:10.3109/14015439309101347 · Cited by 28
Circulating uridine dynamically and adaptively regulates food intake in humans
Hanßen, R., Rigoux, L., Albus, K., Kretschmer, A. C., Thanarajah, S. E., Chen, W., Hinze, Y., Giavalisco, P., Steculorum, S. M., Cornely, O. A., et al. (2023) · Cell Reports Medicine · doi:10.1016/j.xcrm.2022.100897 · Cited by 27
Evaluation of the efficiency of different treatment modalities in individuals with painful temporomandibular joint disc displacement with reduction: a randomised controlled clinical trial.
Ekici, Ö., Dundar, U., Gökay, G. D., & Büyükbosna, M. (2021) · British Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.bjoms.2021.08.001 · Cited by 27
The Influence of Breastfeeding Educational Interventions on Breast Engorgement and Exclusive Breastfeeding: A Systematic Review and Meta-Analysis
Huda, M. H., Chipojola, R., Lin, Y.-M., Lee, G. T., Shyu, M.-L., & Kuo, S.-Y. (2021) · Journal of Human Lactation · doi:10.1177/08903344211029279 · Cited by 27
“A visual analog scale (VAS) with a score range of 0–10 was used to measure breast pain after delivery, with a test–retest reliability of 0.95 (Wewers & Lowe, 1990).”
MethodInfluential
Sleep quality and nocturnal pain in patients with hip osteoarthritis
Martinez, R., Reddy, N., Mulligan, E. P., Hynan, L., & Wells, J. (2019) · Medicine · doi:10.1097/md.0000000000017464 · Cited by 27
Self-rated health after stroke: a systematic review of the literature
Araújo, É. D. F., Viana, R. T., Teixeira-Salmela, L., Lima, L., & Faria, C. D. C. D. M. (2019) · BMC Neurology · doi:10.1186/s12883-019-1448-6 · Cited by 27
Patient-reported outcomes measures (PROMs) following a piezocision-assisted versus conventional orthodontic treatments: a randomized controlled trial in adults
Charavet, C., Lecloux, G., Jackers, N., Maes, N., & Lambert, F. (2019) · Clinical Oral Investigations · doi:10.1007/s00784-019-02887-z · Cited by 27
Prompting medical students to self–assess their learning needs during the ageing and health module: a mixed methods study
Kennedy, G., Rea, J. N. M., & Rea, I. M. (2019) · Medical Education Online · doi:10.1080/10872981.2019.1579558 · Cited by 35
“In the present study, the VAS tool was used to produce interval data between the pre-and post-estimations of student-perceived-learning needs for the Student Year or Student class-group, which according to these authors is more likely of greater value and reliability [31].”
BackgroundMethod
No association between MRI changes in the lumbar spine and intensity of pain, quality of life, depressive and anxiety symptoms in patients with low back pain.
Babińska, A., Wawrzynek, W., Czech, E. M., Skupiński, J., Szczygieł, J., & Łabuz-Roszak, B. (2018) · Neurologia i Neurochirurgia Polska · doi:10.5603/pjnns.a2018.0006 · Cited by 27
“This scale determines pain intensity from 0 to 10 with the use of a 10 cm ruler where 0 means no pain, and 10 the worst pain imaginable [14].”
Method
Efficacy of pulsed high-intensity laser therapy on pain, functional capacity, and gait in children with haemophilic arthropathy
El-Shamy, S., & Abdelaal, A. (2018) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1261416 · Cited by 27
“Assessment of knee joint pain was done using visual analogue scale (VAS).[22, 23] VAS is an ordinal scale, using a 100-mm line which ranged from no pain to worst (from no pain 1⁄40 to unbearable pain 1⁄410).”
Method
Pethidine hydrochloride is a better sedation method for pharyngeal observation by transoral endoscopy compared with no sedation and midazolam
Yamasaki, Y., Ishihara, R., Hanaoka, N., Matsuura, N., Kanesaka, T., Akasaka, T., Kato, M., Hamada, K., Tonai, Y., Yamamoto, S., et al. (2017) · Digestive Endoscopy · doi:10.1111/den.12746 · Cited by 27
Shared Decision Making at the Limit of Viability: A Blueprint for Physician Action
Daboval, T., Shidler, S., & Thomas, D. (2016) · PLoS ONE · doi:10.1371/journal.pone.0166151 · Cited by 27
Clinical and Histologic Evaluation of Platelet-Rich Fibrin Accelerated Epithelization of Gingival Wound
Bansal, M., Kumar, A., Puri, K., Khatri, M., Gupta, G., & Vij, H. (2016) · Journal of Cutaneous and Aesthetic Surgery · doi:10.4103/0974-2077.191647 · Cited by 27
“,[9] visual analogue scale scores,[10] epithelization test with toluidine blue and histological evaluation by punch biopsy on 5th post‐operative day at mid of 11 and 21 region in both the quadrants.”
Effects of an exercise therapy protocol on inflammatory markers, perception of pain, and physical performance in individuals with knee osteoarthritis
Aguiar, G. C., Nascimento, M. R. D., de Miranda, A. D., Rocha, N., Teixeira, A., & Scalzo, P. (2015) · Rheumatology International · doi:10.1007/s00296-014-3148-2 · Cited by 27
Integrating cancer patients' perspectives into treatment decisions and treatment evaluation using patient-reported outcomes--a concept paper.
Huebner, J., Rose, C., Geissler, J., Gleiter, C., Prott, F., Muenstedt, K., Micke, O., Muecke, R., Buentzel, J., Bottomley, A., et al. (2014) · European Journal of Cancer Care · doi:10.1111/ecc.12095 · Cited by 27
Long term results in late implanted adolescent and adult CI recipients
Bosco, E., Nicastri, M., Ballantyne, D., Viccaro, M., Ruoppolo, G., Maddalena, A. I., & Mancini, P. (2013) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-012-2264-4 · Cited by 27
Comparison of budesonide and dexamethasone for local treatment of oral chronic graft-versus-host disease.
Park, A.-R., La, H., Cho, B. S., Kim, S., Lee, B., Rhie, J., & Gwak, H. (2013) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp120567 · Cited by 27
“The severity of pain associated with oral cGVHD was evaluated using a visual analog scale ranging from 0 (no pain) to 10 (the most severe pain).(35) This prospective open-label study was approved by the Catholic Medical Center’s institutional review board.”
Method
Arthroscopic radial head excision in managing elbow trauma
Wijeratna, M., Bailey, K., Pace, A., Tytherleigh-Strong, G., van Rensburg, L., & Kent, M. (2012) · International Orthopaedics · doi:10.1007/s00264-012-1667-6 · Cited by 27
Determination of a comfortable volume of mouthwash for rinsing.
Keukenmeester, R., Slot, D., Rosema, N., & van der Weijden, G. V. D. (2012) · International Journal of Dental Hygiene · doi:10.1111/j.1601-5037.2012.00565.x · Cited by 27
Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development.
Nowier, A., Esmat, M., & Hamza, R. T. (2012) · International Brazilian Journal of Urology · doi:10.1590/s1677-55382012000300011 · Cited by 27
“The grade of satisfaction of the surgical outcome was estimated by a subjective satisfaction score (range from 0 = very disappointed to 10 = satisfied) (8).”
Method
A comparison of low-molecular-weight heparin and combined therapy of low-molecular-weight heparin with an anti-inflammatory agent in the treatment of superficial vein thrombosis
Uncu, H. (2009) · Phlebology · doi:10.1258/phleb.2008.008025 · Cited by 27
Effects on fluid balance, digestion and exercise response in Standardbred horses fed silage, haylage and hay
Muhonen, S., Lindberg, J., Bertilsson, J., & Jansson, A. (2008) · doi:10.1017/s1478061509342334 · Cited by 27
Ameliorating adults' acute pain during phlebotomy with a distraction intervention.
Cason, C., & Grissom, N. L. (1997) · Applied Nursing Research · doi:10.1016/s0897-1897(97)80536-8 · Cited by 27
Comprehensive Review on Personalized Pain Assessment and Multimodal Interventions for Postoperative Recovery Optimization
Xu, J., Liu, X., Zhao, J., Zhao, J., Li, H., Ye, H., & Ai, S. (2025) · Journal of Pain Research · doi:10.2147/jpr.s516249 · Cited by 39
“11,12 Similarly, conventional single-drug analgesic approaches are limited by their focus on biological mechanisms alone, neglecting the substantial impact of psychological states and social contexts on pain perception and recovery.”
The effect of acupressure on pain level and hemodynamic parameters after coronary angiography: a randomized controlled study
Düzel, B., Yanik, T. Ç., Kanat, C., & Uğraş, G. A. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1173363 · Cited by 26
“A score of 0 obtained from the VAS indicates no pain, 1–3 points indicate mild pain, 3–6 points indicate moderate pain, 7–9 points indicate severe pain, and 9–10 points indicate the maximum possible pain level (15, 19).”
BackgroundMethod

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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