Visual Analog Scale Satisfaction Research Articles

Determination of the minimal clinically significant difference on a patient visual analog satisfaction scale.

To determine the minimal clinically significant difference (MCSD) on a visual analog patient satisfaction scale. The authors prospectively collected patient satisfaction evaluations during a clinical trial assessing the effect of introducing personal television sets on overall patient satisfaction from their ED encounters. Patient satisfaction was assessed with 2 scales: a 100-mm visual analog scale (VAS) (0 = least satisfied, 100 = most satisfied) and a 7-point categorical scale ("terrible," "mostly dissatisfied," "mixed," "partially satisfied," "mostly satisfied," "pleased," and "delighted"). The differences between the mean VAS scores of "delighted" and "pleased" patients, and between "pleased" and "mostly satisfied" patients were used to determine the MCSD on the VAS. Reliability of each of the scales was determined. 181 patients were evaluated. Mean age was 41 years; 59% were female. On a subset of 19 patients, the VAS yielded an interobserver correlation of 0.93. The kappa measurement of agreement on the categorical scale was 0.77. The mean difference between "delighted" and "pleased" patient VAS satisfaction scores was 6.8 mm (95% CI, 1.3-12.3 mm). The mean difference between "pleased" and "mostly satisfied" patient VAS satisfaction scores was 10.7 mm (95% CI, 5.5-15.8 mm). The MCSD in patient satisfaction scores measured with a 100-mm VAS was approximately 7-11 mm. Future studies evaluating differences in patient satisfaction should be designed to detect this difference.

MHC5 The EuroQol in Parkinson's Disease Research: Rated Current Health vs. Population-Derived Health State Preferences

Policy analysts summarize health-related quality of life (HRQL) with a single value representing the “worth of life” arising from the many dimensions of HRQL. OBJECTIVES: To (1) examine construct validity of two summary HRQL measures, a visual analogue scale (VAS) and EuroQol preference weights (PW), in Parkinson's disease (PD) patients and (2) predict PW and VAS scores from a HRQL profile measure. METHODS: A cross-sectional survey of 193 neurology questionnaires contained the Medical Outcomes Study 36-item short form (SF-36), PD stage and symptoms, VAS, EuroQol, and health satisfaction. A priori hypotheses for testing construct validity predicted varying strengths of relationships between the summary HRQL scores and the SF-36, clinical, and health satisfaction scores. RESULTS: The correlation between VAS and PW was moderate (Spearman correlation 0.415). The PW had more ceiling scores than the VAS (19% vs. 2%). The ranked order of correlation between the individual SF36 scale scores, the clinical scores, and the VAS was as hypothesized, but that for the PW was not. Specifically, the General Health scale ranked 1 for the VAS but 7 for the PW; Health Satisfaction ranked 4 for the VAS but 13 for the PW. The VAS distinguished mild from moderate stage subjects while the PW did not. Models predicting VAS and PW scores from SF-36 scores had adjusted model R-squares of 0.44 (VAS) and 0.52 (PW). CONCLUSION: The VAS, but not the PW, distinguished subjects with different disease severity. The two measures were only moderately correlated and had very different relationships with the domains of HRQL, particularly general health perceptions and health satisfaction.

Level of physical activity in elderly patients after hemiarthroplasty for three- and four-part fractures of the proximal humerus.

We report on 13 physically active patients who performed sports activities at a weekend or recreational level when they suffered a severe proximal humerus fracture or fracture dislocation. All patients were treated using the NEER II hemiarthroplasty, 9 patients within 4 weeks after trauma and 4 patients 2, 5, 10 and 15 months after trauma. At an average follow-up of 50 (range 6-98) months, all patients were evaluated, both by clinical review and radiographs. Patients obtained 69.0 points using the HSS score (Hospital for Special Surgery) for evaluation. Subjectively, 85% of the patients evaluated the result as 'good' or 'excellent' on a visual analogue scale for satisfaction. There was no radiographic evidence of implant loosening. At an average period of 33 (range 16-52) weeks 10 patients started with their physical activities again without a change in their participation level.

The Effects of Epidural Morphine and Epidural Butorphanol on Maternal Outcomes After Cesarean Delivery

To the Editor: Gambling et al. [1] compared postcesarean outcomes of epidural morphine 3 mg plus epidural butorphanol 3 mg versus epidural morphine 3 mg alone. Patients receiving butorphanol had less analgesia, an equivalent need for treatment of pruritus, and equivalent satisfaction compared with controls. In an earlier study [2], we had compared postcesarean outcomes of epidural morphine 4 mg plus epidural butorphanol 3 mg versus epidural morphine 4 mg alone. Patients receiving butorphanol in our study had significantly greater analgesia, a significantly lower incidence of treatment for pruritus, and significantly greater overall satisfaction compared with controls. We carefully reviewed both studies to determine why our results differed Table 1.Table 1: Epidural Morphine and Epidural Butorphanol: Comparison of Similar Studies with Contrasting ResultsWith 10-cm visual analog scales (VASs), numerical pain score values imply the following: 1) VAS > 3.0 represents inadequate analgesia; 2) VAS = 1-3 represents good analgesia; and 3) VAS < 1 represents extraordinary analgesia ("pain prevention") [3]. Over the expected range of adequate-to-superb VAS analgesia scores (0-3 cm), a difference of 0.5 cm is clinically important. Specifically, postoperative pain scores < 1 cm generally require continuous epidural administration of local anesthetics [3,4]. VAS sensitivity depends on administering an anchored scale in a standardized manner, evaluating patients on multiple occasions, and obtaining a uniform distribution of scores [5]. With respect to cumulative pain assessment, our study group was unique in achieving "pain prevention" (mean VAS = 0.7 cm) with an extremely narrow distribution of low scores (SD = 1.0 cm) that was both statistically and clinically significant. Statistical analysis of VAS scores involved pairwise comparisons of each study group with the control group using one-way analysis of variance. Furthermore, chi squared analysis of 265 evaluations among the two groups demonstrated that butorphanol significantly reduced the incidence of inadequate analgesia to a level (4%) threefold less than control (11%). Our post hoc power analysis demonstrated that 265 evaluations among two groups produced a statistically significant difference (P < 0.05) in mean VAS pain scores of less than 0.5 cm. In contrast, the study design of Gambling et al. [1] presumed that 102 evaluations among two groups produced a power of 0.8 to detect a difference (P < 0.005) in mean VAS scores of 2.0 cm. Nearly a third of their pain score evaluations claimed inadequate analgesia (VAS pain score > 3). The duration of analgesia after epidural morphine administration does not reliably extend to 24 h [2,6], so one third of their patient assessments occurred at a time (24 h) when epidural opioid analgesia was dissipating. Overall, the lack of statistically significant differences in the study by Gambling et al. [1] appears to be due to inadequate numbers of patient evaluations (no VAS satisfaction scores were presented), unusually high VAS pain scores [2,6], and statistical methods that were biased toward unreasonable limits of detection. Bernard Wittels, MD, PhD Alicia Toledano, ScD Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL 60637