Using Concealed Public Accompaniments to Teach Individuals to Tact Intensity.

This chapter describes multiple baselines and multiple probe designs and their use by applied researchers investigating the effectiveness of a wide range of interventions in educational and clinical settings. It discusses how baseline logic applies to this class of designs, and how threats to internal validity are evaluated. The chapter presents guidelines for their use, discussing advantages and limitations of both designs. It provides an overview of the three types of multiple baseline and multiple probe designs: across behaviors, across conditions, and across participants. Multiple baseline designs have the research benefit of continuous measurement prior to and during intervention, thereby allowing day-to-day data analyses and decisions. Multiple baseline and multiple probe designs are better suited to many of the practical demands of applied settings than are A-B-A-B designs. When using a multiple baseline or multiple probe design across behaviors, identify a minimum of three similar yet functionally independent behaviors emitted by one individual.

This chapter describes two variations of the multiple baseline design: changing criterion design, and the delayed or multiple baseline design. The changing criterion design and non-concurrent multiple baseline design require the attention and caution before using. Though these two designs have some practical advantages, they have serious internal-validity limitations and may be best used in combination with an A-B-A-B design, multiple baseline design, or multiple probe design. The design requires initial baseline observations on a single target behavior. Unlike multiple baseline and multiple probe designs across behaviors, the changing criterion design has the advantage of requiring only one target behavior. The nonconcurrent multiple baseline design requires that the same independent variable be implemented across tiers, that the same dependent variable be repeatedly measured, and that each subsequent tier's baseline condition be longer than preceding tiers. The intervention condition was evaluated within the context of a multiple baseline design across behaviors and participants.

Pregabalin beneficial effects on sleep quality or health-related quality of life are poorly correlated with reduction on pain intensity

The Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and the Faces Pain Scale-Revised (FPS-R) are among the most commonly used measures of pain intensity in clinical and research settings. Although evidence supports their validity as measures of pain intensity, few studies have compared them with respect to the critical validity criteria of responsivity, and no experiment has directly compared all 4 measures in the same study. The current study compared the relative validity of VAS, NRS, VRS, and FPS-R for detecting differences in painful stimulus intensity and differences between men and women in response to experimentally induced pain. One hundred twenty-seven subjects underwent four 20-second cold pressor trials with temperature order counterbalanced across 1°C, 3°C, 5°C, and 7°C and rated pain intensity using all 4 scales. Results showed statistically significant differences in pain intensity between temperatures for each scale, with lower temperatures resulting in higher pain intensity. The order of responsivity was as follows: NRS, VAS, VRS, and FPS-R. However, there were relatively small differences in the responsivity between scales. A statistically significant sex main effect was also found for the NRS, VRS, and FPS-R. The findings are consistent with previous studies supporting the validity of each scale. The most support emerged for the NRS as being both (1) most responsive and (2) able to detect sex differences in pain intensity. The results also provide support for the validity of the scales for use in Portuguese samples.

IntroductionPain is a clinical complication to chronic obstructive pulmonary disease (COPD) that interferes negatively with physical activity level (PAL), quality of life (QOL) and pulmonary interventions. Yet, research in pain characteristics including prevalence, localization, and intensity in people with COPD are sparsely researched.AimTo investigate self-reported pain prevalence, localization and intensity of pain in people with and without COPD, and to investigate the association between pain intensity and PAL among participants with COPD.MethodsData were derived from the Danish Health and Morbidity Survey in 2017. The study population was restricted to individuals aged ≥35 years. Data included pain intensity assessed on the Numeric Rating Scale (NRS) and localization, PAL, QoL, sleep disturbance, comorbidities, sociodemographic and behavioral factors.ResultsIn all, 528 participants with COPD and 8184 participants without COPD (51% females, mean ±SD age 67.1±11.4 years) were analyzed. Pain prevalence within the past 14 days was significantly higher in participants with COPD vs nonCOPD (72.7% vs 57.7%, p<0.001) and mainly located in the limbs, thorax, and lower back. COPD was associated with the prevalence of chronic pain (≥6 months) (OR: 2.78, 95%CI: 2.32; 3.34, p<0.001). Participants with COPD reported a higher pain intensity compared to those with nonCOPD with a mean difference of 1.04 points (95%CI: 0.75; 1.32, p<0.001) on the NRS. In the adjusted multiple logistic regression analysis, pain intensity was negatively associated with odds of being physical active (OR: 0.72, 95%CI: 0.61; 0.85, p<0.001).ConclusionPain is more prevalent in people with self-reported COPD. After adjustment for age and gender, COPD was associated with an elevated pain intensity. Sleep disturbance and multimorbidity had the most pronounced impacts on pain intensity in the multiple linear regression model. In participants with COPD, increased pain intensity was negatively associated with being physically active.

Pain assessment is challenging given its subjective nature, and existing assessment tools have limitations, especially for patients having problems with verbal communication. A prior study evaluated the Grasp, a handheld device for assessing pain intensity through squeezing, showing a moderate association with the numeric rating scale (NRS). This study examined an improved version of the Grasp with instant visual feedback through color-coded categories and compared it to NRS. Healthy adults underwent two consecutive cold pressor tests (CPTs), reporting pain intensity via NRS or Grasp with colour-coded feedback. Two additional CPTs assessed the association of repeated measurements with both instruments. The Grasp was calibrated to individual strength before CPTs. Forty-six subjects completed all tests. Pain intensity association between Grasp and NRS was moderate with a mean Kendall's τ-b coefficient (τ-b) of 0.45, 95% confidence interval (CI) 0.35-0.56. Repeated Grasp measurements showed a moderate association (τ-b = 0.37, 95% CI 0.27-0.48), while repeated NRS measurements had a stronger association (τ-b = 0.71, 95% CI 0.64-0.78). After adjusting Grasp to individual squeeze strength (resulting in a 0.0-1.0 scale), a simple equation relating NRS value and mean Grasp value was identified: Grasp = 0.091 × NRS. Grouping reports into mild, moderate, and severe pain resulted in agreement proportions across two CPTs of 69% for Grasp and 79% for NRS. The moderately high agreement proportions for pain intensity categories suggest that the Grasp method with colour-coded feedback may be useful for categorical pain intensity assessment, especially in settings where conventional tools (i.e., NRS) are inconvenient or not feasible.

The numerical rating scale and visual analogue scale are used to quantify pain intensity. However, it has not yet been explored whether these scores are interchangeable in adults with chronic pain. Data from the prospective multicentre cross-sectional INTERVAL study were used to evaluate the one-dimensionality and agreement between numerical rating scale scores and visual analogue scale scores in adults with chronic pain. Pain intensity scores using the numerical rating scale and visual analogue scale were provided by 366 patients with chronic pain for current, average, minimal and maximal pain. To evaluate whether pain intensity scales are completed in accordance with each other, the proportion of patients who satisfied the following condition was calculated: minimal pain intensity ≤ maximal pain intensity. A factor analysis confirmed the one-dimensionality of the pain measures. A significant difference was found between numerical rating scale and visual analogue scale scores for average, current, minimum and maximum pain. Intra-class correlation coefficient estimates ranged from 0.739 to 0.858 and all measures failed to show sufficient and acceptable agreement at the 95% level. The strength of agreement between pain severity categories was classified as 'moderate' for average and minimal pain and 'substantial' for current and maximal pain. The proportion of patients who scored minimal pain ≤ maximal pain was 97.5% for the numerical rating scale and 89.5% for the visual analogue scale. This study failed to show an acceptable agreement between the numerical rating scale and visual analogue scale when pain intensity was rated by adults with chronic pain, despite showing both scales measure the same information.

Numerical rating scale for self-report of pain intensity in children and adolescents: Recent progress and further questions

To evaluate the psychometric quality of two single-item pain-intensity measures: the Numeric Rating Scale (NRS) and the Verbal Rating Scale (VRS). Measuring pain intensity is a vital step in initiating symptom management and evaluating the effectiveness of interventions with cancer patients. Single-item pain-intensity measures of the NRS and VRS format have been evaluated to be acceptable for use in clinical practice and research; however, evidence to choose one over the other, as a standardised pain-assessment format, is insufficient. Descriptive correlational study. The study was guided and reported following the STROBE guideline. Data accrued at two time points during cancer treatment with a total of 249 patients treated in a Korean University Hospital. Two single-item measures were constructed to assess pain intensity over 1week. The Brief Pain Inventory (BPI; pain intensity subscale and interference subscale) and the functional assessment of chronic illness therapy-fatigue were the criterion. Convergent and concurrent validity were tested with Pearson's correlations. In the convergent-validity evaluation of the cross-sectional association with the BPI, the NRS showed a much higher level of association than the VRS (0.81 versus 0.61). In convergent validity with a longitudinal association with the BPI, the NRS score change had a much higher level of association (0.61 versus 0.37). In concurrent-validity evaluation, the NRS and VRS showed similar levels of associations with fatigue (-0.48 versus -0.49). Yet, the NRS showed statistically higher levels of correlation with functional limitations than the VRS (0.55 versus 0.42), comparable to the concurrent validity of the BPI. The NRS showed higher validity than VRS when assessing overall pain intensity over the past week. Pain assessment is a vital role of nurses in caring for patients with cancer. Current study findings support the use of the single-item NRS pain measure to assess global pain intensity over the past week.

In clinical practice, children are often asked to rate their pain intensity on a simple 0 to 10 numerical rating scale (NRS). Although the NRS is a well-established measure for adults, no study has yet evaluated its validity for children with chronic pain. To examine the convergent and discriminant validity of the NRS as it is used within regular clinical practice to document pain intensity for children with chronic pain. Interchangeability between the NRS and an analogue pain measure was also assessed. A cohort of 143 children (mean [± SD] age 14.1±2.4 years; 72% female) rated their pain intensity (current, usual, lowest and strongest levels) on a verbally administered 0 to 10 NRS during their first appointment at a specialized pain clinic. In a separate session that occurred either immediately before or after their appointment, children also rated their pain using the validated 0 to 10 coloured analogue scale (CAS). NRS ratings met a priori criteria for convergent validity (r>0.3 to 0.5), correlating with CAS ratings at all four pain levels (r=0.58 to 0.68; all P<0.001). NRS for usual pain intensity differed significantly from an affective pain rating, as hypothesized (Z=2.84; P=0.005), demonstrating discriminant validity. The absolute differences between NRS and CAS pain scores were small (range 0.98±1.4 to 1.75±1.9); however, the two scales were not interchangeable. The present study provides preliminary evidence that the NRS is a valid measure for assessing pain intensity in children with chronic pain.

The effects of a conversation prompt procedure on independent play

Comparison of education, home exercise and supervised exercise in patients with knee and hip osteoarthritis: data from the BOA registry

The Numerical Rating Scale (NRS), Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), and Faces Pain Scale-Revised (FPS-R) are valid measures of pain intensity. However, ratings on these measures may be influenced by factors other than pain intensity. The purpose of this study was to evaluate the influence of non-pain intensity factors on the pain intensity scales. We administered measures of pain intensity (NRS, VAS, VRS, FPS-R), pain unpleasantness, catastrophizing, depressive symptoms, and pain interference to 101 individuals with chronic lower back or knee pain. Correlation analyses examined the associations among the pain intensity scales, and regression analyses evaluated the contributions of the non-pain intensity factors (depressive symptoms, and pain unpleasantness, catastrophizing, and interference) to the VAS, VRS, and FPS-R ratings, while controlling for NRS, age, and gender. Although the NRS, VAS, VRS, FPR-S, scales were strongly associated with one another, supporting their validity as measures of pain intensity, regression analyses showed that the VRS also reflected pain interference, the FPS-R also reflected pain unpleasantness, and the VAS was not associated with any of the additional non-pain intensity factors when controlling for NRS, age, and gender. The VAS appears to be most similar to the NRS and less influenced by non-pain intensity factors than the VRS or FPS-R. Although the VRS and FPS-R ratings both reflect pain intensity, they also contain additional information about pain interference and pain unpleasantness, respectively. These findings should be kept in mind when selecting pain measures and interpreting the results of research studies using these scales. The influence of pain interference and pain unpleasantness on VRS and FPS-R, respectively should be kept in mind when selecting pain measures and interpreting the results of research studies using these scales.

Understanding the Multidimensional Nature of Illness Severity as Measured by Patient-Reported Outcome Measures in Irritable Bowel Syndrome

Objective: To compare three rating scales in assessment of postoperative pain intensity after laparoscopic cholecystectomy Methods: A total 102 patients who underwent elective laparoscopic cholecystectomy surgery were participated on a voluntary basis in this cross-sectional questionnaire survey. The questionnaire form elicited items on sociodemographic characteristics of patients, pain characteristics and the pain intensity assessment via three scales including Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Descriptor Scale (VDS). Results: Mean(SD) VAS, VDS and NRS scores were 4.7(1.3), 2.8(0.7) and 4.5(1.2), respectively. VDS (67.6%) was the most commonly preferred scale by patients, as followed by VAS (23.5%) and NRS (8.8%). Positive significant correlations were noted between each scale (r: ranged from 0.809 between VAS and VDS to 0.865 between VDS and NRS, p&lt;0.001 for each). There was a high level of inter-scale concordance overall (Cronbach's alpha: 0.910), including VAS x VDS (Cronbach's alpha: 0.820), VAS x NRS (Cronbach’s alpha=0.906) and VDS x NRS (Cronbach’s alpha=0.868). Conclusion: In conclusion, our findings demonstrate that all three scales (VAS, NRS, VDS) provide reliable and valid data with strong correlations and a high level of inter-scale concordance in assessing postoperative pain intensity in laparoscopic cholecystectomy patients. However, VDS appears to be the best scale in assessing pain intensity after laparoscopic cholecystectomy surgery with respect to patient preference rates as well as its strong correlation with other scales, particularly the NRS.