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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Flanagan, S. D., Dupont, W., Caldwell, L. K., Hardesty, V. H., Barnhart, E. C., Beeler, M. K., Post, E. M., Volek, J., & Kraemer, W. (2017) · Journal of Medicinal Food · doi:10.1089/jmf.2017.0071 · Cited by 24
Diurnal preference, mood and the response to morning light in relation to polymorphisms in the human clock gene PER3
Turco, M., Biscontin, A., Corrias, M., Caccin, L., Bano, M., Chiaromanni, F., Salamanca, M., Mattei, D., Salvoro, C., Mazzotta, G. M., et al. (2017) · Scientific Reports · doi:10.1038/s41598-017-06769-w · Cited by 27
Management of Ankyloglossia and Breastfeeding Difficulties in the Newborn: Breastfeeding Sessions, Myofunctional Therapy, and Frenotomy
Ferrés-Amat, E., Pastor-Vera, T., Rodríguez-Alessi, P., Ferrés-Amat, E., Mareque-Bueno, J., & Ferrés-Padró, E. (2016) · Case Reports in Pediatrics · doi:10.1155/2016/3010594 · Cited by 24
“The Visual Analogue Scale (VAS) was used in the evaluation of the pain [18].”
The RESCueH Programme: Testing New Non-Pharmacologic Interventions for Alcohol Use Disorders: Rationale and Methods
Nielsen, A. S., Nielsen, B., Andersen, K., Roessler, K. K., Bühringer, G., Bogenschutz, M. P., Ekstrøm, C. T., & Søgaard, J. (2016) · European Addiction Research · doi:10.1159/000447398 · Cited by 21
Determinants of Well-being Among Legal and Illegal Immigrants: Evidence from South Italy
D’Isanto, F., Fouskas, P., & Verde, M. (2015) · Social Indicators Research · doi:10.1007/s11205-015-0924-7 · Cited by 22
Use of outcome measures improved after a tailored implementation in primary care physiotherapy: a prospective, controlled study.
K.All, I., Larsson, M., & Bernhardsson, S. (2016) · Journal of Evaluation In Clinical Practice · doi:10.1111/jep.12513 · Cited by 24
Patient Reported Outcomes in Adult Spinal Deformity Surgery: A Bibliometric Analysis
Cutler, H. S., Guzman, J., Maaieh, M. A. A., Connolly, J. G., Skovrlj, B., & Cho, S. K. (2015) · Spine Deformity · doi:10.1016/j.jspd.2014.12.004 · Cited by 24
Scottish, English, British?: Innovations in Attitude Measurement
Llamas, C., & Watt, D. J. L. (2014) · Language and Linguistics Compass · doi:10.1111/lnc3.12109 · Cited by 24
Do people with recurrent back pain constrain spinal motion during seated horizontal and downward reaching?
Crosbie, J., Nascimento, D. P., Negrão, R. D. F., & Ferreira, P. (2013) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2013.09.001 · Cited by 24
Colonoscopy using a small-caliber colonoscope with passive-bending after incomplete colonoscopy due to sharp angulation or pain
Sato, K., Shigiyama, F., Ito, S., Kitagawa, T., Tominaga, K., Suzuki, T., & Maetani, I. (2013) · Surgical Endoscopy · doi:10.1007/s00464-013-3016-2 · Cited by 24
Changes in electromyographic activity of trunk muscles within the sub-acute phase for individuals deemed recovered from a low back injury.
Butler, H. L., Hubley-Kozey, C., & Kozey, J. (2013) · Journal of Electromyography & Kinesiology · doi:10.1016/j.jelekin.2012.10.012 · Cited by 24
“Pain intensity before and after testing was assessed using a visual analog scale (VAS; 0 mm = no pain and 100 mm = extreme pain) (Wewers and Lowe, 1990).”
Method
Effectiveness of sensorimotor training in patients with rheumatoid arthritis: a randomized controlled trial
da Silva, K. N. G., Teixeira, L. D. P. D. P., Imoto, A., Atallah, Á., Peccin, M., & Trevisani, V. (2013) · Rheumatology International · doi:10.1007/s00296-013-2706-3 · Cited by 24
Effect of cognitive load on articulation rate and formant frequencies during simulator flights
Huttunen, K. H., Keränen, H. I., Pääkkönen, R. J., Eskelinen-Rönkä, R. P., & Leino, T. K. (2011) · The Journal of the Acoustical Society of America · doi:10.1121/1.3543948 · Cited by 21
Deep rectal and parametrial infiltrating endometriosis with monolateral pudendal nerve involvement: case report and laparoscopic nerve-sparing approach.
Ceccaroni, M., Clarizia, R., Roviglione, G., Bruni, F., Ruffo, G., Peters, I., Placido, G. D., & Minelli, L. (2010) · European Journal of Obstetrics, Gynecology, and Reproductive Biology · doi:10.1016/j.ejogrb.2010.07.032 · Cited by 24
Marital Status and Quality of Life in Patients with Esophageal Cancer or Barrett's Esophagus: The Mayo Clinic Esophageal Adenocarcinoma and Barrett’s Esophagus Registry Study
Miller, R. C., Atherton, P., Kabat, B., Fredericksen, M., Geno, D., Deschamps, C., Jatoi, A., Sloan, J., & Romero, Y. (2010) · Digestive Diseases and Sciences · doi:10.1007/s10620-009-1100-1 · Cited by 24
A Linguistic Possibility-Probability Aggregation Model for decision analysis with imperfect knowledge
Yuen, K. K. F., & Lau, H. (2009) · Applied Soft Computing · doi:10.1016/j.asoc.2008.08.003 · Cited by 24
“Others, which can be regarded as minor variations of Likertlike scales, include numerical scales, graphic rating scales, visual analogue scales [41], semantic differential scales [33], and recently phrase completion scales [17], which are visual analogue-like scales”
Background
Development of the Competency Based Fieldwork Evaluation (CBFE)
Miller, L., Bossers, A., Polatajko, H., & Hartley, M. (2001) · doi:10.1002/oti.149 · Cited by 24
Catastrophizing, locus of control, pain, and disability in chinese chronic low back pain patients
Cheng, S. K. W., & Leung, F. Y. K. (2000) · Psychology and Health · doi:10.1080/08870440008405482 · Cited by 22
“The VAS were commonly used to measure subjective affect (Wewers and Lowe, 1990), and shown to have acceptable reliability and validity in measuring psychological distress (Price, McGrath, Rafii and Buckingham, 1983).”
Method
Gender differences in fears related to coronary arteriography.
Heikkilä, J., Paunonen, M., Virtanen, V., & Laippala, P. (1999) · Heart & lung : the journal of critical care · doi:10.1016/s0147-9563(99)70040-3 · Cited by 24
Current Practices for Mental Fatigue Quantification and Induction in Movement Science: Introducing the SPeCIFY Guidelines
Schampheleer, E., Habay, J., Proost, M., Arauz, Y. L. A., Russell, S., Roose, M., Bian, C., MEEUSEN, R. R., Pauw, K. D., & Roelands, B. (2025) · Sports Medicine · doi:10.1007/s40279-025-02286-3 · Cited by 28
“Examples include a motivation VAS [221] (task-specific motivation), the Matthews Success Motivation and Intrinsic Motivation scales [222] (intrinsic motivation before the task), and the Situational Motivation Scale (situational motivation after task completion) [223].”
Effect of Hypnobirthing Training on Fear, Pain, Satisfaction Related to Birth, and Birth Outcomes: A Randomized Controlled Trial
Buran, G., & Aksu, H. (2022) · Clinical Nursing Research · doi:10.1177/10547738211073394 · Cited by 23
“The Cronbach’s alpha value of the scale was reported to be .92 (Wewers & Lowe, 1990).”
Method
The Effect of Cochlear Implantation on Tinnitus and Quality of Life: A Systematic Review and Meta-analysis
Yuen, E., Ma, C., Nguyen, S. A., Meyer, T. A., & Lambert, P. R. (2021) · Otology & Neurotology · doi:10.1097/mao.0000000000003172 · Cited by 36
“Consistent with findings from previous meta-analyses, the present study demonstrated a positive impact of CI on tinnitus severity and distress, as determined by significant reductions in THI (42), TQ, and VAS (42,44) scores post-implantation.”
MethodInfluential
Development and feasibility study of an addiction focused phenotyping assessment battery
Keyser-Marcus, L., Ramey, T., Bjork, J., Adams, A. S., & Moeller, F. (2021) · American Journal on Addictions · doi:10.1111/ajad.13170 · Cited by 23
Post-traumatic ankle osteoarthritis: quality of life, frequency and associated factors
D'Ambrosi, R., Silvestri, C. D. D., Manzi, L., Indino, C., Maccario, C., & Usuelli, F. (2019) · Muscle Ligaments and Tendons Journal · doi:10.32098/mltj.03.2019.10 · Cited by 23
Revision Surgery after Percutaneous Endoscopic Transforaminal Discectomy Compared with Primary Open Surgery for Symptomatic Lumbar Degenerative Disease
Liang, J.-Q., Chen, C., & Zhao, H. (2019) · Orthopaedic Surgery · doi:10.1111/os.12507 · Cited by 23
Effects of Group-Based CBT on Post-Event Processing in Children with Social Anxiety Disorder Following an Experimental Social Stressor
Asbrand, J., Schmitz, J., Krämer, M., Nitschke, K., Heinrichs, N., & Tuschen‐Caffier, B. (2019) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-019-00558-x · Cited by 24
Effects of dexmedetomidine as an adjunct in transversus abdominis plane block during gynecological laparoscopy
Xue, Y.-R., Yuan, H., & Chen, Y.-Q. (2018) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2018.6295 · Cited by 23
“The Steward score system is used to evaluate recovery of patients following general anesthesia by assessing respiration, consciousness and motor coordination (12).”
Prevalence of temporomandibular disorders in patients with Hashimoto thyroiditis
Grozdinska, A., Hofmann, E., Schmid, M., & Hirschfelder, U. (2018) · Journal of Orofacial Orthopedics-fortschritte Der Kieferorthopadie · doi:10.1007/s00056-018-0140-6 · Cited by 23
Prevalence of carpal tunnel syndrome and its correlation with pain amongst female hairdressers.
Demiryurek, B. E., & Gündoğdu, A. A. (2017) · International Journal of Occupational Medicine and Environmental Health · doi:10.13075/ijomeh.1896.01068 · Cited by 23
The Effectiveness of Health Education on Maternal Anxiety, Circumcision Knowledge, and Nursing Hours: A Quasi-Experimental Study.
Chang, S.-F., Hung, C.-H., Hsu, Y.-Y., Liu, Y., & Wang, T.-N. (2016) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000177 · Cited by 23
“The VAS-A is a quick and easy method for respondents to report their subjective pain, nausea, fatigue, breathing difficulty, and anxiety (Cella & Perry, 1986; Wewers & Lowe, 1990).”
Method
Correlations of Japanese Orthopaedic Association Scoring Systems with Gait Parameters in Patients with Degenerative Spinal Diseases
Zheng, C.-F., Liu, Y.-C., Hu, Y.-C., Xia, Q., Miao, J., Zhang, J.-D., & Zhang, K. (2016) · Orthopaedic Surgery · doi:10.1111/os.12280 · Cited by 23
The accuracy of subjective measures for assessing fatigue related decrements in multi-stressor environments
Smith, B. P., Browne, M., Armstrong, T., & Ferguson, S. A. (2016) · Safety Science · doi:10.1016/j.ssci.2016.03.006 · Cited by 24
Complementary therapies for bladder pain syndrome: a systematic review
Verghese, T., Riordain, R. N., Champaneria, R., & Latthe, P. (2015) · International Urogynecology Journal · doi:10.1007/s00192-015-2886-3 · Cited by 23
Does the Use of a Brief Cryotherapy Intervention With Analgesic Administration Improve Pain Management After Total Knee Arthroplasty?
Wittig-Wells, D. R., Johnson, I., Samms-McPherson, J., Thankachan, S., Titus, B., Jacob, A., & Higgins, M. K. (2015) · Orthopaedic Nursing · doi:10.1097/nor.0000000000000143 · Cited by 28
“Validity and reliability are high with verbal numeric symptom rating scales ( Flaherty, 1996 ; Hjermstad et al., 2011 ; Wewers & Lowe, 1990 ; Williamson & Hoggart, 2003 ).”
Does it matter which effort task you use? A comparison of four effort tasks when agents compete for a prizePreprint
Lezzi, E., Fleming, P., & Zizzo, D. (2015) · SSRN Electronic Journal · doi:10.2139/ssrn.2594659 · Cited by 23
Parent-Child Agreement Using the Spence Children’s Anxiety Scale and a Thermometer in Children with Autism Spectrum Disorder
May, T., Cornish, K. M., & Rinehart, N. (2015) · Autism Research and Treatment · doi:10.1155/2015/315495 · Cited by 21
Pain control in patients with hepatocellular carcinoma treated by percutaneous radiofrequency ablation: comparison of the efficacy of one-shot and continuous intravenous fentanyl delivery
Yokoyama, K., Ikeda, O., Kawanaka, K., Nakasone, Y., Inoue, S., Tamura, Y., & Yamashita, Y. (2014) · Acta Radiologica · doi:10.1177/0284185113519623 · Cited by 23
“It measures characteristics or attitudes that range across a continuum of values that cannot be easily measured directly (14).”
Background
Outcomes of buttonhole and rope-ladder cannulation techniques in a tropical renal service.
Smyth, W., Hartig, V., & Manickam, V. (2013) · Journal of renal care · doi:10.1111/j.1755-6686.2013.12020.x · Cited by 23
Medium-Term Results of Oxford Phase-3 Medial Unicompartmental Knee Arthroplasty
Clement, N., Duckworth, A., Mackenzie, S., Nie, Y.-X., & Tiemessen, C. (2012) · Journal of Orthopaedic Surgery · doi:10.1177/230949901202000204 · Cited by 23
Arthroscopic side-to-side repair of massive and contracted rotator cuff tears using a single uninterrupted suture: the shoestring bridge technique.
van der Zwaal, P., Pool, L. D., Hacquebord, S., van Arkel, E. V., & van der List, M. V. D. (2012) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2011.11.006 · Cited by 23
Improvement of MR cholangiopancreatography (MRCP) images after black tea consumption
Ghanaati, H., Rokni-Yazdi, H., Jalali, A., Abahashemi, F., Shakiba, M., & Firouznia, K. (2011) · European Radiology · doi:10.1007/s00330-011-2217-0 · Cited by 23

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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