1550 The Journal of Rheumatology 2008; 35:8 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2008. All rights reserved. Visual Analog Scales in Formats Other than a 10 Centimeter Horizontal Line to Assess Pain and Other Clinical Data THEODORE PINCUS, MARTIN BERGMAN, TUULIKKI SOKKA, JILL ROTH, CHRISTOPHER SWEARINGEN, andYUSUFYAZICI ABSTRACT. Objective. To analyze visual analog scales (VAS) for pain and patient global estimate on a MultidimensionalHealthAssessmentQuestionnaire(MDHAQ)informatsotherthanatraditional10 cm horizontal line, designed to facilitate scoring on MDHAQ in usual clinical care. Methods. The MDHAQ withVAS for pain and global estimate was completed by each patient at eachvisit.VASformatsotherthanatraditional(unnumbered)10cmhorizontallinebasedon21cir- cles at 0.5 intervals were analyzed. Formats included unnumbered, symbol at the 11th circle, num- bers and/or squares (instead of circles) at selected intermittent scores, and numbers at each circle. Analyses were performed to study the time to score MDHAQ with differentVAS formats, possible “clustering” of responses in any format, particularly with intermittent numbers and/or symbols, and test-retest reliability of various formats. Results. ThemediantimetoscoreMDHAQwitha10cmlineVASwas15.6seconds,comparedto 7.4 seconds for the 21 numbered circle VAS. No other format was scored in fewer seconds. Clustering was seen for scores ofVAS formats with intermittent numbers or symbols, which ren- dered them unsuitable for use. No clustering was seen for the 21 numbered circleVAS format, for whichtest-retestagreementwassignificant,andsimilartothe10cmlineVASformat. Conclusion. A 21 numbered circleVAS may be a desirable alternative to a 10 cm horizontal line, yielding similar results and requiring less than half the time to score. (First Release June 15 2008; J Rheumatol 2008;35:1550–8) KeyIndexingTerms: VISUALANALOG SCALES PAIN PATIENTGLOBALSTATUS RHEUMATOIDARTHRITIS FromtheNYUHospitalforJointDiseases,NewYork,NewYork;Taylor Hospital,RidleyPark,Pennsylvania,USA;JyväskyläCentralHospital, Jyväskylä,andMedcareOy,Äänekoski,Finland;BaylorCollegeof Medicine,Houston,Texas;andMedicalUniversityofSouthCarolina, Charleston, South Carolina, USA. SupportedinpartbygrantsfromAmgen,Bristol-MyersSquibb,the ArthritisFoundation,andtheJackC.MasseyFoundation. T.Pincus,MD,NYUHospitalforJointDiseases;M.Bergman,MD, TaylorHospital;T.Sokka,MD,PhD,JyväskyläCentralHospitaland MedcareOy;J.Roth,BS,BaylorCollegeofMedicine;C.Swearingen, MS,MedicalUniversityofSouthCarolina;Y.Yazici,MD,NYUHospital for Joint Diseases. AddressreprintrequeststoDr.T.Pincus,NYU-HospitalforJoint Diseases,301East17Street,NewYork,NY10003,USA. E-mail: tedpincus@gmail.com Accepted for publication March 19, 2008. Measurement of pain on a visual analog scale (VAS) was established as a valuable quantitative clinical assessment in the 1970s by Huskisson and colleagues 1,2 .TheVASformat hasbeenextendedtoassesspatientglobalestimateofstatus, fatigue, functional status 3-5 , and other patient problems 6 ,as wellastoaphysician/assessorestimateofglobalstatus.Two VASscoresforpainandpatientestimateofglobalstatusare included in the American College of Rheumatology (ACR) Core Data Set 7,8 , and are found on the Health Assessment Questionnaire (HAQ) 3 and its multidimensional version (MDHAQ) 4,9 . PainandpatientglobalestimateVASscoresareincluded inallrheumatoidarthritis(RA)clinicaltrialsandmostclin- icalresearch.However,painandglobalstatusVAShavenot beenassessedquantitativelyatthemajorityofvisitsinusual care,aspatientquestionnairesarenotcompletedatmostvis- its to rheumatologists 10 . One potential reason involves the timerequiredtousearulertomeasurethedistancefromthe left border of a traditional 10 cm line VAS. Further, the lengthofa10cmVASmaybedistortedinprintingandpho- tocopying, and some patients have difficulty with a 10 cm lineVAS 11 .AVASof21squaresorcirclesin0.5unitincre- ments can be scored quickly without a ruler, overcoming these limitations. Earlyreportsindicatedthata10cmhorizontallinewith- out numbering provided an optimal format for a painVAS, comparedtovertical,numbered,andotherformatsdesigned tofacilitatescoring 1,2,12 .Therefore,formalstudiesappeared necessary to compare results using other formats to the tra- ditional10cmhorizontalline.Thisreportpresentscompar- isonsofthe10cmhorizontallineVAStootherVASformats, including 21 circles at 0.5 intervals, unnumbered or num- www.jrheum.org Downloaded on December 19, 2021 from