A comparison of Likert and visual analogue scales for measuring change in function
Abstract
Many controlled trials rely on subjective measures of symptoms or quality of life as primary outcomes. The relative merits of different response options for these measures is an important, but largely unexplored, issue. Therefore, we compared the responsiveness of seven-point Likert vs visual analogue scales (VAS) in a questionnaire measuring quality of life in chronic lung disease. The VAS and seven-point scale versions of the questionnaire were administered to 28 patients before and after completing an inpatient respiratory rehabilitation program of known benefit. For all four dimensions of the questionnaire (dyspnea, fatigue, emotional function, and mastery) the VAS showed a larger improvement than the seven-point scale when both were standardized on a scale of 0-10. However, in each case the variability of the improvement was greater using the VAS. The difference in improvement between the two scales was not statistically significant. We conclude that the two methods of presenting response options show comparable responsiveness. The ease of administration and interpretation of the seven-point scale recommend its use in clinical trials.
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Since no external criterion can be used to verify the 72-hour fast, its validity can be verified only via long-term observation.
“Given that no external criterion can be used to verify the test, the validity of the test can be verified only via long-term observation [38].”
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Cites
The use of analogue scales in rating subjective feelings
BOND, A., & LADER, M. (1974) · British Journal of Medical Psychology · doi:10.1111/j.2044-8341.1974.tb02285.x · Cited by 1,972 · see citing works
Ohnhaus, E. E., & Adler, R. (1975) · Pain · doi:10.1016/0304-3959(75)90075-5 · Cited by 797 · see citing works
Comparison of fixed interval and visual analogue scales for rating chronic pain
Joyce, C. R. B., Zutshi, D. W., Hrubes, V., & Mason, R. M. (1975) · European Journal of Clinical Pharmacology · doi:10.1007/bf00562315 · Cited by 539 · see citing works
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Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., Hill, K., Holland, A. E., Lareau, S. C., Man, W. D.-C., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201309-1634st · Cited by 3,938 · see citing works
Pain: a review of three commonly used pain rating scales
Williamson, A., & Hoggart, B. (2005) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2005.01121.x · Cited by 3,083 · see citing works
Meaningful change and responsiveness in common physical performance measures in older adults.
Perera, S., Mody, S. H., Woodman, R. C., & Studenski, S. A. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00701.x · Cited by 2,513 · see citing works
Parshall, M. B., Schwartzstein, R. M., Adams, L., Banzett, R. B., Manning, H. L., Bourbeau, J., Calverley, P. M., Gift, A. G., Harver, A., Lareau, S. C., et al. (2012) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201111-2042st · Cited by 1,844 · see citing works
Evaluating patient-based outcome measures for use in clinical trials.
Fitzpatrick, Davey, Buxton, & Jones (1998) · Health Technology Assessment · doi:10.3310/hta2140 · Cited by 1,715 · see citing works
Outcome Measures for Low Back Pain Research: A Proposal for Standardized Use
Deyo, R. A., Battie, M., Beurskens, A. J. H. M., Bombardier, C., Croft, P., Koes, B., Malmivaara, A., Roland, M., Von Korff, M., & Waddell, G. (1998) · Spine · doi:10.1097/00007632-199809150-00018 · Cited by 1,229 · see citing works
Scoring Systems for the Functional Assessment of the Shoulder
Kirkley, A., Griffin, S., & Dainty, K. (2003) · Arthroscopy · doi:10.1016/j.arthro.2003.10.030 · Cited by 504 · see citing works
Spertus, J., Dorian, P., Bubien, R., Lewis, S., Godejohn, D., Reynolds, M. R., Lakkireddy, D. R., Wimmer, A. P., Bhandari, A., & Burk, C. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.110.958033 · Cited by 485 · see citing works
Responsiveness and validity in health status measurement: a clarification
Guyatt, G. H., Deyo, R. A., Charlson, M., Levine, M. N., & Mitchell, A. (1989) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(89)90128-5 · Cited by 480 · see citing works
Self-citationAnker, S. D., Agewall, S., Borggrefe, M., Calvert, M., Jaime Caro, J., Cowie, M. R., Ford, I., Paty, J. A., Riley, J. P., Swedberg, K., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu205 · Cited by 362 · see citing works
Psychometric evaluation of a visual analog scale for the assessment of anxiety
Williams, V. S., Morlock, R. J., & Feltner, D. (2010) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-8-57 · Cited by 287 · see citing works
The validation of the visual analogue scale for patient satisfaction after total hip arthroplasty
Brokelman, R. B. G., Haverkamp, D., van Loon, C., Hol, A., van Kampen, A., & Veth, R. (2012) · European Orthopaedics and Traumatology · doi:10.1007/s12570-012-0100-3 · Cited by 260 · see citing works
The Quebec Back Pain Disability Scale: Conceptualization and development
Kopec, J. A., Esdaile, J. M., Abrahamowicz, M., Abenhaim, L., Wood-Dauphinee, S., Lamping, D. L., & Williams, J. I. (1996) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(96)00526-4 · Cited by 242 · see citing works
Zannad, F., Garcia, A. A., Anker, S. D., Armstrong, P. W., Calvo, G., Cleland, J. G. F., Cohn, J. N., Dickstein, K., Domanski, M. J., Ekman, I., et al. (2013) · European Journal of Heart Failure · doi:10.1093/eurjhf/hft095 · Cited by 231 · see citing works
The Bull's-Eye Values Survey: A Psychometric Evaluation
Lundgren, T., Luoma, J. B., Dahl, J., Strosahl, K., & Melin, L. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.01.004 · Cited by 172 · see citing works
Seeking the Patient's Perspective: A Qualitative Assessment of EuroQol, COOP-WONCA Charts and MYMOP
Paterson, C. (2004) · Quality of Life Research · doi:10.1023/b:qure.0000025586.51955.78 · Cited by 107 · see citing works
DAM, T. V., DALGAARD, L. B., SEVDALIS, V., BIBBY, B. M., JANSE DE JONGE, X., GRAVHOLT, C. H., & HANSEN, M. (2022) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002961 · Cited by 66 · see citing works
Wilson, A. M., Duong, M., Crawford, L., & Denburg, J. (2005) · Clinical & Experimental Allergy · doi:10.1111/j.1365-2222.2004.02072.x · Cited by 21 · see citing works
Adelmeyer, J., Schauer, C. M., & Kann, P. H. (2024) · Hormones · doi:10.1007/s42000-024-00542-1 · Cited by 3 · see citing works
“Given that no external criterion can be used to verify the test, the validity of the test can be verified only via long-term observation [38 ].”
- Authors
- Guyatt, G. H., Townsend, M., Berman, L. B., & Keller, J. L.
- Affiliations
- McMaster University Medical Centre (CA)
- McMaster University (CA)
- ORCID
- Guyatt, Gordon H.
- Venue
- Journal of Chronic Diseases
- Publisher
- Elsevier BV
- Published
- 1987-01
- Volume
- 40
- Issue
- 12
- Pages
- 1129-1133
- ISSN
- 0021-9681 (ISSN-L)
- OpenAlex
- W2017489436
- Cited by
- 456
- References
- 3
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 11 · 2023: 11 · 2022: 11 · 2021: 13 · 2020: 7 · 2019: 11 · 2018: 15 · 2017: 14 · 2016: 14 · 2015: 15 · 2014: 22 · 2013: 9 · 2012: 28
- FWCI
- 13.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Chronic Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- Likert scale, visual analogue scale, responsiveness, quality of life, chronic lung disease, pulmonary rehabilitation, dyspnea, fatigue, emotional functioning, mastery, clinical trial outcome measures
- MeSH terms
- Clinical Trials as Topic, Humans, Lung Diseases, Pain Measurement, Quality of Life, Surveys and Questionnaires
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