Single-item Visual Analogue Scale Research Articles

Assessment of loneliness in patients with inflammatory arthritis.

This study aimed to explore loneliness and associated factors in Turkish patients with inflammatory arthritis. Adult patients with rheumatoid arthritis (RA) (n=58), ankylosing spondylitis (AS) (n=53), and psoriatic arthritis (PsA) (n=30), respectively, were included in the study. A single-item visual analog scale (VAS) for loneliness, UCLA Loneliness Scale-8 (ULS-8), Beck depression inventory (BDI), Beck anxiety inventory (BAI), revised multidimensional scale of perceived social support, Health Assessment Questionnaire-Disability Index (HAQ-DI) were used for the psychometric and functional assessments. Multiple regression models were generated for predicting the ULS-8 and HAQ-DI scores. There was no difference between disease groups in terms of the ULS-8 and HAQ-DI scores. Among demographic and clinical parameters, only the education status and number of drugs used had associations with the ULS-8 score. Single-item VAS score for loneliness did not predict the ULS-8 score well. There were significant correlations between the ULS-8 and HAQ-DI, depression, anxiety, social support, and physician global VAS scores. Only the education status significantly predicted (β=-0.208) the ULS-8 score in multiple regression analysis (adjusted R2 =0.15, P<.001). Beck depression, anxiety, and patient global VAS scores remained significant for predicting the HAQ-DI after multiple regression with the covariates ULS-8, depression, anxiety, social support, patient and physician global VAS scores, and the number of drugs used (adjusted R2 =0.53, P<.001). Disease activity and the ULS-8 scores were not found to be associated in any disease group. Loneliness is associated with depression, anxiety, lack of social support, disability, higher number of drugs used, and lower education but not with disease activity in Turkish patients with RA, AS, and PsA. Perception and expression of loneliness vary according to the cultural background. Single-item scales for loneliness may lack reliability compared to the more comprehensive ULS-8.

Meaning in life and quality of life: palliative care patients versus the general population.

Meaning in life (MIL) represent a key topic in palliative care. The aims of this study were to explore (1) the differences in perceived MIL and in the meaning-relevant life areas between a representative sample of the Swiss population and palliative care patients, and (2) to what extent MIL can be considered as a significant predictor of quality of life (QOL). A cross-sectional study was conducted separately for the patients (face-to-face interviews) and the general population (telephone survey). MIL was measured with the Schedule for Meaning in Life Evaluation (SMILE) and QOL with a single-item visual analogue scale (0-10). Sociodemographic variables were controlled for in the analyses. 206 patients and 1015 participants from the Swiss population completed the protocol. Results indicated high MIL scores in both populations even if the difference was significant (patients 81.9 vs general population 87, p<0.001). Patients were more likely to cite 'family' (OR=1.78), 'social relations' (OR=1.9), 'spirituality and religion' (OR=3.93), 'social commitment' (OR=1.94) and 'growth' (OR=2.07), and less likely to cite 'finances' (OR=0.15) and 'health' (OR=0.21) as MIL-relevant areas. The SMILE scores and MIL areas explained 21.8% of the QOL variance for the patients and 15.1% for the representative sample. Our data emphasise the importance of MIL as a contributor to QOL in both populations. It highlights the importance of the life areas contributing to MIL, especially social interactions for both populations, and spirituality and areas related to growth in palliative care patients.

P70 Evaluating the WASTEd: a new co-produced patient-reported measure of axial spondyloarthritis (axSpA) fatigue and energy

Abstract Background Fatigue in axSpA is described as a complex, multidimensional symptom that involve disease-specific, cognitive/behavioural and personal factors. However, current assessment guidance in axSpA recommends using a single-item visual analogue scale on fatigue severity. This type of provides a limited assessment and may fail to adequately capture the multiplicity of fatigue experience. Despite the high prevalence and significant impact of fatigue, there is currently no axSpA-specific patient-derived multi-item questionnaire for fatigue. In our previous qualitative research, we identified energy as a related but distinct component of fatigue experience in axSpA. In response, and in collaboration with our patient and public involvement (PPI) group, we have co-produced a 30-item patient-reported outcome measure (PROM) specific to axSpA-fatigue and energy: the Warwick Axial Spondyloarthritis faTigue and Energy measure (WASTEd). The aim of this study was to evaluate the quality of the WASTEd and make statistically informed item refinement decisions following completion by a UK-wide patient cohort. Methods A UK-based postal survey of 580 axSpA patients provided necessary data supporting both classic (Classic Test Theory; CTT) and modern (Rasch Measurement Theory; RMT) psychometric evaluation. CTT analysis included evaluating structural validity using exploratory factor analysis (EFA), internal consistency using Cronbach’s alpha and assessing item-total correlations. RMT analysis included evaluating evidence of local dependency between items, item fit and category characteristic curves. Results The survey response rate was 64.13% (n = 372). EFA identified four factors: energy, fatigue, symptoms and control. Five items were removed due to narrow cross-loadings. Final item-total correlations ranged from 0.61 to 0.83. Cronbach’s alpha was estimated to be 0.97. Rasch analysis highlighted one item as under discriminating. Numerous items showed evidence of respondents opting for a middle-option answer following visual inspection of the category characteristic curves. Findings were discussed with the study PRP group and co-refinement (item removal, modification or introduction) decisions were made during the meeting. A further seven items were removed to produce a final 18-item short-form version of the WASTEd. Conclusion The WASTEd has good evidence of data quality, structural validity and content validity. Psychometric evidence supports qualitative findings that energy is a distinct but related component in fatigue experience. Following a final stage of testing, the WASTEd will be ready for incorporation into both research and clinical practice settings, providing an essential patient-derived assessment of fatigue and energy with which to inform shared decision-making. Disclosures N.A. Pearson None. H. Parsons None. E. Tutton None. J. Martindale Honoraria; JM has received speaker fees and/or honoraia from Abbvie Ltd, Novartis, Pfizer and UCB. Grants/research support; JM has received a research grant from Pfizer. G. Strickland None. J. Thompson None. J. Packham None. K.L. Haywood None.

Psychometric properties of a single-item visual analog scale measuring goals of care in patients with advanced cancer

The purpose of this study was to examine the psychometric properties of a single-item visual analog scale (VAS) to measure goals of care in patients with advanced cancer. Data were obtained from 378 patients with diagnoses of advanced lung, gastrointestinal, or pancreatic cancer. Goal of care was measured at baseline and every 3months until patient death or completion of the 15-month study period. A single-item VAS ranging from 0 (quality of life is all that matters) to 100 (length of life is all that matters) was used to measure patients' goals of care for all study subjects; a subsample of subjects also completed the Quality of Life-Length of Life scale which asked patients to select categories of preferences. Test-retest reliability (intra-class correlation) and construct validity (known-groups, convergent, divergent) were evaluated. At 9 and 12months, the test-retest reliability for patients with stable symptoms (n = 107) was established with the ICC(1,3) = 0.81, p < .001. Known-groups (r = 0.99, p < .001), convergent (r = 0.78, p < .001), and divergent (r = .06, p = 0.24) validity all demonstrated evidence of good construct validity. Preliminary psychometric testing for a single-item VAS that measures goals of care in a sample of patients with advanced cancer met standard requirements for reliability and validity. While further testing with a larger sample size is recommended, the tool's use in the clinical area to assess cancer patients' goals of care is appropriate. Such a tool could facilitate goals of care discussions in the clinical area.

A Single-Item Visual Analogue Scale (VAS) Measure for Assessing Depression Among College Students.

There is an increased need for efficient, low-cost methods to collect information on a range of widely prevalent mental health outcomes in the general population that can be administered outside of clinical settings. We evaluate the validity of a single-item Visual Analogue Scale (VAS) for assessing the presence and severity of depression and compare its performance with the Patient Health Questionnaire (PHQ-9) depression scale using a large non-clinical sample (N = 1816) of college students from Switzerland. The VAS scale is strongly correlated with the PHQ-9 total score (0.61) and its 9 individual items (ranging from 0.19 to 0.67). ROC analysis shows that the VAS scale has high accuracy for detecting the presence and different levels (mild to severe) of depression corresponding to PHQ-9 cutoffs. The VAS depression scale represents a simple, easily implementable instrument that is suitable for mental health research in common settings and larger population-based studies.

Quality and acceptability of patient-reported outcome measures used to assess fatigue in axial spondyloarthritis (axSpA): a systematic review (protocol)

BackgroundThe prevalence of axial spondyloarthritis (axSpA) is estimated between 0.15 and 1.2%, with many of those patients experiencing severe fatigue. Current axSpA assessment guidance recommends use of a single-item visual analogue scale for fatigue severity. However, concerns have been raised about the ability of such a limited assessment to identify patients with major fatigue, to detect important change in fatigue or to reflect the multi-dimensional nature of fatigue. The proposed systematic review will identify and evaluate the quality and acceptability of single- and multi-item patient-reported outcome measures (PROMs) used to assess fatigue in axSpA, seeking to make recommendations for the ‘best’ measures for research and/or clinical practice.Methods/designThe review will seek to include published studies which report evidence of the development and/or measurement and/or practical properties of clearly defined and reproducible measures of fatigue following completion by patients with axSpA. Five major databases will be searched from 1980 to August 2017: MEDLINE (OVID), EMBASE (OVID), PsycINFO (OVID), World of Science and CINAHL. Study methodological quality will be assessed against the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The measurement and/or practical properties of reviewed measures will be assessed against current international standards. A short list of the ‘best’-quality PROMs will be produced. The review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.DiscussionThis study will provide the first robust and transparent evaluation of patient-reported measures of fatigue used in the axSpA population, synthesising evidence of quality, relevance and acceptability. The review will benefit patients, clinicians, health professionals and researchers wishing to enhance axSpA-fatigue assessment in routine practice, service evaluation and research. The findings will impact future research which seeks to better understand the nature of axSpA fatigue and evaluate the relative benefit of fatigue-management strategies.Systematic review registrationPROSPERO CRD42016042271

Brief treatment for nighttime fears and co-sleeping problems: A randomized clinical trial

Sixty-eight 4–6 year old children who co-slept with their parents and who avoided sleeping alone due to intense nighttime fears were randomized to a brief combined parent-based intervention (CBT-based bibliotherapy plus doll) or a wait list control group. After the waiting period, the wait list participants were offered treatment. Co-sleeping patterns, sleep records, anxiety, general fears, and behavior problems were assessed with parent-report measures. Nighttime fears were assessed with parent-report measures and a single item visual analogue scale for the young children. Assessments were completed pre-treatment, post-treatment, and at 3 months following treatment. Results showed that the combined intervention was superior to the wait list control condition and that treatment effects were maintained at 3-month follow-up. This study provides initial support for use of CBT-based bibliotherapy plus doll in the treatment of nighttime fears. Such a treatment might be used to supplement standard CBT approaches in routine clinical practice or in a stepped care approach to treatment.

A Comparative Study between Transcutaneous Electrical Nerve Stimulation and Fentanyl to Relieve Shoulder Pain during Laparoscopic Gynecologic Surgery under Spinal Anesthesia: A Randomized Clinical Trail.

Background Traditionally, laparoscopic procedures have been performed under general anesthesia. Spinal anesthesia is an effective alternative to general anesthesia. However, one of the intraoperative complications of performing laparoscopic surgery under spinal anesthesia is shoulder pain. This study aimed to compare the effect of transcutaneous electrical nerve stimulation (TENS) with fentanyl on pain relief in patients who underwent gynecologic laparoscopy under spinal anesthesia. Methods We conducted a prospective randomized clinical trial from May 2016 to March 2017. A sample of patients who underwent gynecological laparoscopy under spinal anesthesia was recruited. If they had shoulder pain, they randomly received either transcutaneous electrical nerve stimulation (TENS) or 50 mg of fentanyl. Pain intensity was measured using the single item visual analogue scale (VAS-10 cm) immediately before and 5, 10, 20, and 30 minutes after treatment. Also, the effect of higher doses of analgesia on pain relief was analyzed. Results In all, 80 patients (40 patients in each group) were entered into the study. The mean pain intensity score was 9.02 ± 1.32 in the TENS group and 8.95 ± 1.33 in the fentanyl group at baseline (P = 0.80). Repeated measures analysis of variance indicated that there was no significant difference on overall pain scores between the two treatment groups adjusted for age, BMI, total analgesia used, and baseline pain score (F (1, 74) = 1.44, P = 0.23). The use of analgesic drugs in the TENS group was significantly higher than the fentanyl group (P = 0.01). In addition, we found that nine patients (22.5%) complained of nausea/vomiting in the TENS group compared to thirteen patients (32.5%) in the fentanyl group (P = 0.31). Conclusions The findings indicated that TENS was not superior to fentanyl for pain relief in laparoscopic surgery. It seems that the correct use of TENS parameters might merit further investigation. This trial is registered with: IRCT2016031216765N3.

Insomnia and Autonomic Function Predict Well-Being in Patients Receiving Palliative Care.

The improvement of health-related quality of life (HRQOL) is one of the main treatment goals in end-of-life care. Although definitions and conceptualizations remain heterogeneous, many researchers proposed HRQOL to be considered as subjective patient well-being. However, research on its determinants in palliative care is rare, and little is known about the interplay between psychological and biological variables. The aim of this study was to explain differences in terminally ill patients' acute well-being (AWB) by use of a multimethod approach, examining both self-ratings and physiological predictors. The study was conducted on a palliative care unit in Heidelberg, Germany. A total of 69 adult patients receiving palliative care were included in the analysis. Patients filled out the EORTC QLQ-C15-PAL questionnaire and an additional single-item visual analogue scale on AWB. In addition, we recorded a five-minute segment of beat-to-beat fluctuations of heart rate (i.e., heart rate variability, HRV) and calculated three indices of cardiac autonomic function: mean heart rate, the root mean square of successive differences, and the standard deviation of normal-to-normal (SDNN) intervals. Exploratory, multiple regression analyses were used to identify significant predictors among the QLQ subscales and HRV parameters. Insomnia (p < 0.001) and SDNN (p < 0.001) were significantly associated with AWB and together explained 26.3% of the variance. All other predictors including pain, fatigue, and physical functioning failed to reach significance (all p > 0.05). Both autonomic dysfunction and sleep disturbances independently explained differences in patient's AWB among terminally ill patients. Their role within the concept of quality of life needs to be further addressed in future studies.

Relationship Between Spirituality, Meaning in Life, Psychological Distress, Wish for Hastened Death, and Their Influence on Quality of Life in Palliative Care Patients

ContextSpiritual, existential, and psychological issues represent central components of quality of life (QOL) in palliative care. A better understanding of the dynamic nature underlying these components is essential for the development of interventions tailored to the palliative context. ObjectivesThe aims were to explore 1) the relationship between spirituality, meaning in life, wishes for hastened death and psychological distress in palliative patients and 2) the extent to which these nonphysical determinants influence QOL. MethodsA cross-sectional study involving face-to-face interviews with Swiss palliative patients was performed, including the Schedule for Meaning in Life Evaluation (SMILE), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), the Idler Index of Religiosity (IIR), the Hospital Anxiety and Depression Scale (HADS), and the Schedule of Attitudes toward Hastened Death (SAHD). QOL was measured with a single-item visual analogue scale (0–10). ResultsTwo hundred and six patients completed the protocol (51.5% female; mean age = 67.5 years). The results indicated a significant negative relationship between FACIT-Sp/SMILE and HADS total scores (P = 0.000). The best model for QOL explained 32.8% of the variance (P = 0.000) and included the FACIT-Sp, SMILE, and SAHD total scores, the IIR “private religiosity” score, as well as the HADS “depression” score. ConclusionBoth spiritual well-being and meaning in life appear to be potential protective factors against psychological distress at the end of life. Since nonphysical determinants play a major role in shaping QOL at the end of life, there is a need for the development of meaning-oriented and spiritual care interventions tailored to the fragility of palliative patients.

Comparing the Single-item Visual Analog Scale with Multi-item Hospital Anxiety and Depression Scale, and Patient Health Questionnaire-9 to Diagnose Depression in Patients with Idiopathic Parkinson’s Disease

Background: Depression is one of the common non-motor symptoms in patients with Parkinson disease (PD), which can have a negative effect on the quality of life of the patients. Therefore, it is necessary to have suitable, accurate, cheap, and simple diagnostic tools to identify depression in patients with PD and apply a proper treatment. The current study aimed at comparing the single-item visual analog scale (VAS) with the multi-item hospital anxiety and depression scale (HADS) and patient health questionnaire-9 (PHQ-9) in respect to their sensitivity and specificity to diagnose depression in patients with idiopathic PD. Methods: The current cross sectional, comparative study employed the simple non-probability method and selected 79 patients with idiopathic PD, with the mean (SD) age of 59.10 (10.84) years and the average (SD) of disease progression level of 3.24 (1.13), based on Hoehn and Yahr scale. The single-item scale VAS and multi-item tests HADS and PHQ-9 were used as an index tests, and Beck depression inventory (BDI) was employed as the reference test to evaluate depression in 3 levels of lack of (or mild) depression, moderate depression, and severe depression using 90% sensitivity and 90% specificity. To determine the sensitivity, specificity, and the ability of each index test in order to diagnose depression, agreement percent of index tests with reference test and receiver operating characteristic (ROC) analysis were used. Results: The results of ROC analysis showed that VAS (AUC = 0.84) and HADS (AUC = 0.87) and PHQ-9 (AUC = 0.85) possessed similar abilities to discriminate depression in patients with PD. The sensitivity of VAS, HADS, and PHQ-9 tests in moderate or greater threshold were 92%, 96%, and 89%, respectively, and in severe threshold were 64%, 79%, and 49%, respectively. Specificity of these tests in moderate or greater threshold were 42%, 50%, and 62%, respectively, and in severe threshold were 88%, 77%, and 88%, respectively. The highest agreement level with BDI in mild/moderate and severe levels of depression were found in VAS and PHQ-9, respectively. Conclusions: The single-item scale VAS, similar to multi-item tests HADS and PHQ-9, had a low to high sensitivity and specificity to diagnose depression in moderate or greater and severe thresholds in patients with PD.

Olfactory Stimuli Increase Presence in Virtual Environments.

BackgroundExposure therapy (EXP) is the most empirically supported treatment for anxiety and trauma-related disorders. EXP consists of repeated exposure to a feared object or situation in the absence of the feared outcome in order to extinguish associated anxiety. Key to the success of EXP is the need to present the feared object/event/situation in as much detail and utilizing as many sensory modalities as possible, in order to augment the sense of presence during exposure sessions. Various technologies used to augment the exposure therapy process by presenting multi-sensory cues (e.g., sights, smells, sounds). Studies have shown that scents can elicit emotionally charged memories, but no prior research has examined the effect of olfactory stimuli upon the patient’s sense of presence during simulated exposure tasks.Methods60 adult participants navigated a mildly anxiety-producing virtual environment (VE) similar to those used in the treatment of anxiety disorders. Participants had no autobiographical memory associated with the VE. State anxiety, Presence ratings, and electrodermal (EDA) activity were collected throughout the experiment.ResultsUtilizing a Bonferroni corrected Linear Mixed Model, our results showed statistically significant relationships between olfactory stimuli and presence as assessed by both the Igroup Presence Questionnaire (IPQ: R2 = 0.85, (F(3,52) = 6.625, p = 0.0007) and a single item visual-analogue scale (R2 = 0.85, (F(3,52) = 5.382, p = 0.0027). State anxiety was unaffected by the presence or absence of olfactory cues. EDA was unaffected by experimental condition.ConclusionOlfactory stimuli increase presence in virtual environments that approximate those typical in exposure therapy, but did not increase EDA. Additionally, once administered, the removal of scents resulted in a disproportionate decrease in presence. Implications for incorporating the use of scents to increase the efficacy of exposure therapy is discussed.

Preliminary Validation of Subjective Anchor Scales for Worry and Rumination

This research is a preliminary validation of two single-item visual analogue scales. The worry visual analogue scale (WVAS) and the rumination visual analogue scale (RVAS) are self-report measures developed to track state changes in worry and rumination. Each of these scales uses an idiographic anchor sheet, enabling each participant to quantify their personal scale of worry or rumination. We compared ratings on the WVAS and RVAS with self-report measures of trait worry and rumination as well as other constructs administered concurrently in two separate studies. In study 1 we compared results within an unselected undergraduate sample. In study 2 we compared results within a community-based sample of individuals with generalized anxiety disorder (GAD), individuals with GAD comorbid with unipolar depressive disorders, and healthy controls. Results from both studies indicate the WVAS is a reliable state-level measure of worry with acceptable discriminant and convergent validity. Results for the RVAS showed similar reliability and convergent validity but lacked as much discriminant validity. This difference is possibly due to all experimental groups having comorbid anxiety, which is associated more with worry than rumination. Regression analyses indicate the WVAS predicts trait-level anxiety measures more strongly than measures of depression and beyond the predictive ability of the RVAS. The RVAS predicts measures of depression more strongly than it does measures of anxiety but is not consistently a stronger predictor of depression than the WVAS. These findings suggest worry and rumination are distinct regulatory constructs. In study 2, participants with GAD, and GAD comorbid with unipolar depressive disorders, scored significantly higher than healthy controls in worry and rumination. The internal reliability of the measures is reported.

The bother of anal incontinence and St. Mark's Incontinence Score.

Patient self-report is important in the assessment of the impact of anal incontinence (AI) on quality of life. This study aimed to (1) determine the correlation between total St. Mark's Incontinence Score (SMIS) and a single-item visual analogue scale (VAS) for bother from AI, and (2) determine the correlation between individual components of SMIS and VAS. This is a retrospective study conducted on a cohort of 516 women seen for symptoms of lower urinary tract and pelvic floor dysfunction between January 2013 and August 2014. If a woman responded "yes" to the question "Do you experience any leakage from the back passage/anus?" they were considered to have AI, and the SMIS was administered. They were also asked "How much are you bothered by these symptoms?" to assess bother from AI by VAS. Statistical analyses were performed using Spearman's correlation and Mann-Whitney U test. Eighty-four (16.3%) women reported AI with a mean SMIS of 11 (SD±5.11, range 2-24) and median bother of 5 (VAS 1-10). There was a fair correlation between VAS for the bother from AI and SMIS (Spearman's r=0.523, p<0.001). Fecal urgency, impact on lifestyle, and use of pad/plug were significantly associated with VAS (p=0.05, p=0.002 and p<0.001, respectively). There is a fair, positive correlation between VAS for bother from AI and SMIS. Patients' bother from AI is strongly associated with its impact on lifestyle as quantified by individual SMIS components.

Utility and validity of a single-item visual analog scale for measuring dental anxiety in clinical practice.

We evaluated whether a visual analog scale (VAS) was comparable to the multi-item Modified Dental Anxiety Scale (MDAS) in assessing dental anxiety in clinical practice. In total, 200 consecutive patients aged 20-70 years who presented at the dental outpatient department of SRM Dental College, Chennai were enrolled. The test-retest value for the VAS was 0.968. The Spearman rank correlations between the VAS and MDAS items and total score were significant (P < 0.001). The Spearman rank correlation between postponement of a dental visit and the VAS also showed a strong correlation (r = 0.473, P < 0.001). On linear regression analysis, the coefficient of determination showed a strong relationship between the two variables; the MDAS accounted for 74% of the variation. The regression coefficient was statistically significant (P < 0.001). On the basis of receiver-operating-characteristic curve analysis, a VAS cut-off value of ≥4.8 was selected to discriminate between patients who were and were not anxious, and a cut-off value of ≥7 was selected to identify patients with dental phobia. The weighted kappa was 69% for agreement between MDAS and the VAS in identifying patients with and without dental anxiety at cut-offs of 13 and 4.75, respectively. The VAS was found to be a valid measure and was comparable to the multi-item MDAS.

Testing a single-item visual analogue scale as a proxy for cohesiveness in group psychotherapy.

Group cohesion is one factor that is widely suggested to be important in producing clinically meaningful change in group psychotherapy. However, the construct has proved difficult to define, and in an effort to capture the construct's multidimensionality, contemporary measures have become long, cognitively demanding, and challenging for people with limited literacy. In response to this, we test a single-item visual analogue scale that provides a simple, intuitive, time-efficient, and user-friendly proxy for the cohesion construct. The Group Entitativity Measure–Group Psychotherapy (GEM-GP) was validated in a clinical sample of individuals who completed a group cognitive–behavioral therapy course for depression. GEM-GP scores correlated highly with a lengthier, traditional measure of group cohesion and were just as predictive of outcomes as a multi-item, traditional measure. The GEM-GP is a valid, user-friendly, and brief proxy for the cohesion construct in the group psychotherapy context.

Comparison of a Visual Analogue Scale and Lake Louise Symptom Scores for Acute Mountain Sickness

Assessment of the presence and severity of acute mountain sickness (AMS) is based on subjective reporting of the sensation of symptoms. The Lake Louise symptom scoring system (LLS) uses categorical variables to rate the intensity of AMS-related symptoms (headache, gastrointestinal distress, dizziness, fatigue, sleep quality) on 4-point ordinal scales; the sum of the answers is the LLS self-score (range 0-15). Recent publications indicate a potential for a visual analogue scale (VAS) to quantify AMS. We tested the hypothesis that overall and single-item VAS and LLS scores scale linearly. We asked 14 unacclimatized male subjects [age 41 (14), mean (SD) yr; height 176 (3) cm; weight 75 (9) kg] who spent 2 days at 3647 m and 4 days at 4560 m to fill out LLS questionnaires, with a VAS for each item (i) and a VAS for the overall (o) sensation of AMS, twice a day (n = 172). Even though correlated (r = 0.84), the relationship between LLS(o) and VAS(o) was distorted, showing a threshold effect for LLS(o) scores below 5, with most VAS(o) scores on one side of the identity line. Similar threshold effects were seen for the LLS(i) and VAS(i) scores. These findings indicate nonlinear scaling characteristics that render difficult a direct comparison of studies done with either VAS or LLS alone.

A Systematic Review of Measures Used to Assess Chronic Musculoskeletal Pain in Clinical and Randomized Controlled Clinical Trials

There are many types of pain assessments available to researchers conducting clinical trials, ranging from simple, single-item Visual Analog Scale (VAS) questions through extensive, multidimensional inventories. The primary question addressed in this survey of top-tier medical journals was: Which pain assessments are most commonly used in trials? Articles addressing chronic musculoskeletal pain in clinical trials were identified in 7 major medical journals for the year 2003. A total of 50 studies (1476 total original research articles reviewed) met selection criteria, and from these we identified 28 types of pain assessments. Selected studies were classified according to the dimensions of pain assessed, the type of scale and descriptors/anchors used, and the reporting period specified. The most frequently used assessments were the single-item VAS and the Numeric Rating Scale; multidimensional inventories were used infrequently. There was considerable variability in the instructions patients received about the period to consider when evaluating their pain, and many studies provided only cursory information about their assessments in the methods. Overall, it appears that clinical trials use simple measures of pain and that there is no widely accepted standard for clinical pain assessment that would facilitate comparison of outcomes across trials. This review highlights the heterogeneity of pain outcome measures used and the abundance of single-item measures in clinical trials. Although there are many pain outcome measures available to clinical researchers, more consistency in the field should be encouraged so that results between studies can be compared.

Correspondence Between Daily and Weekly Fatigue Reports in Breast Cancer Survivors

Fatigue is a contributor to decreased quality of life and one of the most common symptoms reported by cancer survivors. Most assessment of fatigue has been retrospective and/or unidimensional. Single-item visual analogue scale ratings are commonly used, despite arguments that fatigue is better conceptualized as multidimensional. The relationships of daily to weekly ratings of fatigue, or of unidimensional to multidimensional assessments, have not been explored. Twenty-five breast cancer survivors provided daily ratings of fatigue and completed the Multidimensional Fatigue Symptom Inventory-Short Form weekly for one month. Using hierarchical linear modeling, stronger relationships of weekly ratings to average and peak rather than most recent daily ratings were found. Visual analogue scale ratings shared more variance with the General Fatigue subscale than with the other four fatigue dimensions measured. Findings suggest that different information is captured by daily versus weekly reports, and that although visual analogue scale ratings can provide a quick assessment of general fatigue, they do not capture other important dimensions.

Evaluating Instruments for Quality

Having reliable and valid instruments is a necessity for nurses and others measuring concepts such as patient satisfaction. The purpose of this article is to describe the use of convergence to test the construct validity of the Davis Consumer Emergency Care Satisfaction Scale (CECSS). Results indicate convergence of the CECSS with the Risser Patient Satisfaction Scale and 2 single-item visual analogue scales, therefore supporting construct validity. Persons measuring patient satisfaction with nurse behaviors in the emergency department can confidently use the CECSS.