The use of Visual Analog Scale in urogynecologic research: A psychometric evaluation Emily S. Lukacz, MD, a Jean M. Lawrence, ScD, MPH, b Raoul J. Burchette, MS, b Karl M. Luber, MD, c Charles W. Nager, MD, a J. Galen Buckwalter, PhD b Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, San Diego, Calif a ; Department of Research and Evaluation, Kaiser Permanente, Pasadena, Calif b ; Department of Obstetrics and Gynecology, Kaiser Permanente, San Diego, Calif c Received for publication December 3, 2003; revised January 20, 2004; accepted April 19, 2004 KEY WORDS Psychometric Quality of life Urogynecologic research Visual Analog Scale Objective: The purpose of this study was to assess the validity of Visual Analog Scales in urogynecologic research. Study design: In phase I, 35 women completed short forms of the urogenital distress inventory, incontinence impact questionnaire, and Beck depression inventory fast screen using the Likert- type scale and Visual Analog Scale formats. Reliability was estimated with Spearman’s correlations and Cronbach’s alpha; construct validity was assessed with the use of factor analyses. In phase II, 101 women were recruited for the test-retest reliability assessment of the Visual Analog Scale formats of the urogenital distress inventory and incontinence impact questionnaire short forms. Reproducibility was analyzed with intraclass correlations. Results: In phase I, correlations between the Likert-type scale and the Visual Analog Scale were good: urogenital distress inventory (0.748), incontinence impact questionnaire (0.787), and Beck depression inventory fast screen (0.852; P ! .05). In phase II, intraclass correlations were 0.898 and 0.938 for the urogenital distress inventory and incontinence impact questionnaire scores, respectively (P ! .001). Conclusion: The Visual Analog Scale is a simple, reliable, and reproducible method for the assessment of quality of life in urogynecologic research. Ó 2004 Elsevier Inc. All rights reserved. The impact of pelvic floor disorders (PFD) on quality of life (QOL) has been studied extensively. Several instruments have been developed to measure objectively QOL in women with urinary incontinence, fecal incon- tinence, pelvic organ prolapse, and sexual dysfunction. 1-4 These instruments were developed with a 4- or 5-point Likert-type scale to assess the degree of bother that is related to a particular symptom. Debate exists regarding whether Likert-type scales represent ordinal data versus a continuous scale, depending on the modifiers that are used. 5 If one considers Likert-type scaled items to be ordinal measures, they may have some disadvantages. ‘‘Bother,’’ like pain, is a subjective assessment and is difficult to categorize into discrete variables. With Likert- Supported by the National Institutes of Health (1RO1HD041113- 01A1). Presented at the Twenty-fourth Annual Meeting of the American Urogynecologic Society, Hollywood, Fla, September 11-13, 2003. Reprint requests: Reprints will not be available from the authors. 0002-9378/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.ajog.2004.04.047 American Journal of Obstetrics and Gynecology (2004) 191, 165e70 www.elsevier.com/locate/ajog